Inspection on 24/04/07 for Brenan House

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Brenan House 10/07/06

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 24th April 2007 09:30 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.V337821.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.V337821.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 Post Vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The registered manager: has at least 2 years` experience in a senior management capacity in the managing of a relevant care setting within the past five years; and [by 2005], has a qualification, at level 4 NVQ, in management and care or equivalent; or where nursing care is provided by the home (ie nursing home), is a first level registered nurse and has a relevant management qualification [by 2005]. Service users DE(E) are restricted to one (1) whose DOB is 26/04/1909. 20th February 2007 2. Date of last inspection 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. The Registered Providers have installed en-suite 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: £309.00 - £434.43 per week Brenan House DS0000044013.V337821.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 key inspection visit to the home on 24th April 2007 by one inspector. The inspection takes account of information received from a variety of sources including written information from the registered provider, service users and staff. The previously made requirements and recommendation from other inspections were inspected and all key standards. The inspector spent time talking to service users and the 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? The care plan format has been revised and is much easier to follow. The service users care plans now contain skin integrity assessments and nutritional assessments. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 6 The care staff have recently attend a basic adult protection training course. All of the staff are now enrolled on the NVQ training course and those staff who already have this qualification have been enrolled on the next level of training. The staff duty rotas show that there has been an increase of the numbers of staff on duty throughout the day. Recruitment procedures have improved, with the required security checks being conducted prior to them starting work. The owner has complied with the requirements made by the Home Office regarding the employment of overseas staff. All new staff complete induction training and the home also provides an in house health & safety induction session. Work has started on the homes quality assurance programme, with internal audits being conducted and surveys of relatives and service users planned. The registered provider is currently studying for a dementia care qualification. The overall management of the home has improved, the registered provider is now proactive in her approach, resulting in her identifying what needs to be done, herself. This has resulted in a positive change in the day to day running of the home. Staff feel they are able to put forward their views and opinions and that these are acknowledged and sometimes put into practice. What they could do better: The care plans need to include information about care needs that have been identified through the variety of assessments the home conducts, such as skin condition. Staff who are responsible for carrying out the pre-admission assessment need to have the appropriate training. The records of the night time care need to clearly and accurately record the events, care provided and night time routines for each service user. The homes business plan for 2007/08 needs to be formerly produced and implemented. The registered provider needs to formerly appoint a manager or apply to become the registered manager themselves. Six good practice recommendations have been made. These are; • To include specific sections in the care plan for skin integrity, sleep and nutrition. • That even small concerns that are raised are recorded. • That the senior care staff attend advanced adult protection training. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 7 • • • That staffs interview records are kept in their individual files. That a mental capacity policy is written and implemented. That the monthly visual inspections of fire equipment if recorded in the log book. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 8 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.V337821.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1236 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Service Users are assessed prior to admission and provided with appropriate information to make an informed decision. The home does not provide intermediate care; therefore standard 6 is not applicable. EVIDENCE: The statement of purpose and the service users contract has been up dated and revised. These documents are also produced in large print. Prospective service users are visited and pre-admission assessments are conducted. The registered provider has done the assessments previously and these had obtained sufficient information. A new service users file was case tracked, this included a pre-admission assessment, which was conducted by the head of care with the registered provider present. The information recorded was brief and lacked detail. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 10 Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users have written care plans. The quality of care provided is of a good standard, with prompt and appropriate action is taken to access medical care. The homes paperwork continues to improve but is not sufficiently detailed. EVIDENCE: The care plan format has been revised and is much easier to follow, however, further work is required to ensure they identify all of the service users care needs. The approach to care is now more holistic but has not included all of the persons needs. The service users records now contain skin integrity assessments and nutritional assessments. These have now been completed correctly, however, the outcome/ findings of the assessment has not been included in the care plan. One person’s file did include some details of needs relating to both skin condition and nutrition but how to meet these needs was Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 12 not included. When speaking with service users they stated they are happy and well cared for, none raised issues about the quality of the care provided. Another service user has a pressure sore, on case tracking it was not clearly recorded in the daily records or recorded on a body map chart or written in the care plan. However, the District Nurse was visiting the service user at the time of the inspection visit. She explained the home had called in the District Nurses as soon as the staff had noted the pressure sore and therefore the service user had received treatment promptly and prevented it from deteriorating. She also expressed that they have a good working relationship with the home and that they are not required to visit as frequently as they were in the past. Service users files contain records that show they are supported to attend hospital appointments, the doctors and other health care professionals appointments. A medication audit was conducted with the senior carer on duty. The home conducts its own medication audits on a regular basis, the findings are recorded and appropriate action taken. One member of staff is being taken through the disciplinary process due to the findings of these checks. The inspection audit, found no unidentified errors and over all the practices were satisfactory. The registered provider stated that she has identified that they need to develop a policy and paperwork for service users/relatives taking medication out of the home for days out. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 13 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. 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, support to continue with hobbies/clubs outside of the home 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 trained complimentary therapist was working in the home, the cost is subsidised by the home. Service users were enjoying head massages, aromatherapy treatments etc. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 14 Two service users like to use the first floor lounge and explained how a new television and DVD player has been bought by the home and that they love to watch the films 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 home benefits from a voluntary gardener. Service users stated they enjoy the food. The cook gave a tour of the kitchen and stores, which were well stocked with brand name foods. Fresh fruit and vegetables are purchased twice a week and the cook users predominately fresh produce. Homemade cakes are served everyday. There were three options available for the main meal of the day and a diabetic diet and soft diets. Cook had a list of what service users had chosen to eat that day. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure to follow and service users are aware of how to make a complaint. Staff have been provided with a basic knowledge and understanding of adult protection. The home access advocacy services for the benefit of the service users. EVIDENCE: The registered provider stated the home has not received any complaints since the last inspection visit. She confirmed that there has been minor issues raised that they have been able to resolve quickly however, these have not been documented. The CSCI has not received any complaints. Five service users were spoken with throughout the day, all of these said that they felt they could approach the registered provider with their concerns and that action would be taken to resolve them. All staff have attended a 2 hour training session regarding adult protection. The new mental capacity act was discussed and the relevance for the home to produce it’s own policy relating to this. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 16 The registered provider spoke of private circumstances, that was causing a service user some concern. The home accessed CROP (citizens rights for older persons) advocacy service with the consent of service user, for help and advice. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 17 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. 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 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. Several of the bedrooms have en-suite toilets. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 18 One service user stated that they would like a bigger bed, the registered provider made a verbal commitment to follow this up. The home has recently purchased a standing hoist. It also accesses some of its specialist equipment from the local community NHS Trust. 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. One service user is visually impaired and uses a Braille machine. The home has enable them to use this to produce labels in Braille to enable them to use the lift independently. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff are provided in sufficient numbers to meet the needs of the service users. Recruitment procedures are thorough. Staff are attending appropriate training courses. EVIDENCE: There has been an increase in the numbers of care staff on duty. The staffing rotas show that between 3-4 care staff are on duty at a time, plus an additional part time apprentice carer. At night there is 1 waking and 1 sleep-in carer, the registered provider stated that she is in the process of reviewing the staffing at night and that it is most likely this will be changed to 2 waking staff. At the random inspection it was found that recruitment procedures had improved. New staff were employed with a minimum of a POVA first check and are appointed a supervisor, which is identified on the duty rota. Their files provide evidence of a thorough procedure being followed. During this inspection visit a prospective carers file was assessed, this supported the findings of the previous inspection. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 20 Some of the staff are from overseas and it was previously recommended that the registered provider contact the Home Office. The registered provider has done this and has adhered to the adhered to the requirements the Home Office made. The induction training is a one-day course conducted by a training company, the subjects include those specified by “skills for care”. The home also provides an in house health & safety induction session. A variety of training course have been attended and further courses are booked for the future. Some of these are basic introductions to subjects such as dementia and adult protection. The registered provider stated that all staff are enrolled on NVQ level 2 and those with level 2 are working towards level 3. The newly appointed Head of care is to study for the NVQ level 4 later in the year. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 37 38 Quality in this outcome area is good, adequate. This judgement has been made using available evidence including a visit to this service. The management style of the home has improved, with a more proactive approach being adopted. Quality assurance systems are being introduced. EVIDENCE: At the random inspection there had been significant progress and improvement in the management of the home, partly evidenced through the work carried out, to meet 13 of the 16 previously made requirements. The findings of this inspection visit showed that progress is continuing to be made, with the registered provider adopting a proactive approach to the management of the home. This was demonstrated through some of the discussions that took place Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 22 and the registered provider was stating areas of work she had identified they needed to change and policies she felt the home needed. The registered provider has introduced internal audits, such as medication. The registered provider confirmed that she is planning surveys of the service users and relatives. There are now regular staff meeting, which are documented and staff confirmed that these meetings occur. One member of staff stated that the management listen to their ideas (the care staff) and have put into practice some of these. The member of staff felt very positive about working at the home and although there were areas they could improve, they changes that have been made were good and done through discussions with the staff. An example they gave was the new daily record pages. All of the information gathered through these processes, will need to be collated into a quality assurance final report and plan. The overall quality of the homes documentation and daily records are improving but some staff still needs to include more information about the care they provide. This was most evident in the night records. The registered provider has the registered managers award qualification. The registered provider is currently studying for the VRQ in dementia and is planning for the senior staff to attend this course in the future. Since the last inspection the CSCI registration department has confirmed that the registered provider will need to make an application to become the registered manager or appoint a manager. 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. The fire risk assessment has been reviewed and updated to include changes made to a doorway. A keypad has been put on a doorway where a service user fell down a flight of stairs during the night. Door sensors have been fitted to other doors that have been identified as a potential risk. The registered provider confirmed that the home currently has full bed occupancy and is financially viable. The business plan has not been produced for 2007/08. Through discussions with the registered provider it is apparent that the areas that need to be included in the business plan have been identified but not formerly written down. Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 23 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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 2 3 X 2 3 Brenan House DS0000044013.V337821.R01.S.doc Version 5.2 Page 24 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. 1. Standard OP3 Regulation 14 15 Requirement The person appointed to conduct the pre-admission assessment must be appropriately trained. The head of care must complete relevant training to perform the assessment. The care plans must include all of the service users needs. Specific needs identified through assessments such as skin integrity and nutrition must be included in the care plan, with clear instructions on how to meet these needs. The registered provider must apply to become the registered manager or appoint a manager. The Registered Provider is required to collate the information gathered and to produce a written report that includes any actions required. A copy must be sent to the CSCI. For the 2007/08 business plan to produced and implemented. DS0000044013.V337821.R01.S.doc Timescale for action 30/09/07 2. OP7 12,13,15 30/09/07 3. 3. OP31 OP33 7 9 10 12 10,12,15, 24 30/10/07 30/11/07 4 OP34 17,25 sch 4 30/06/07 Brenan House Version 5.2 Page 25 5 OP37 15 17 Records of care provided and service users night time routines must be fully documented and recorded. 30/06/07 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 OP7 OP16 OP18 OP29 OP37 OP38 Good Practice Recommendations To include sections in the care plans that relate to: sleep; skin integrity and nutrition. That small/minor concerns that are raised are recorded. For senior care staff to attend an advanced safe guarding adults (adult protection) training course. Prospective staffs interview records to be in their individual files and not in a communal record book. For the registered provider to produce and implement a mental capacity policy. That the monthly visual inspection of fire equipment is recorded in the log book. Brenan House DS0000044013.V337821.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V337821.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. 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