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Inspection on 10/02/09 for Brendon House

Also see our care home review for Brendon House for more information

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People continue to be satisfied with the level of cleanliness at the home. One resident said, "my bedroom is regularly cleaned and the bedding is changed". Peoples needs were assessed before being admitted to the home to ensure that staff could meet their needs. People were given choices, for example whether they wanted to be checked at night by staff and whether they wanted a key to their bedroom. Independence was also promoted for example supporting people to self administer their medication where they were able. A worker said, "we are good at promoting Independence". There was a choice at mealtimes and people spoken with were satisfied with the quality of the food provided. One person said "The food is very good". A relative wrote in our survey, "Mother always speaks well of the food". Any complaints from residents or relatives were taken seriously, and action was taken to resolve any issues as necessary. There was a safe system for recruiting new staff, although delays in recruiting could cause some staffing difficulties. People continued to speak highly of the staff working at the home. They clearly worked hard and in the best interests of residents. Comments included "carers will shop for me", "the care staff are always caring and helpful" and, "staff are very good with residents".

What has improved since the last inspection?

Personal service plans were individualised and clearly set out what each person needed in order to meet their needs. Care staff were writing monthly reviews as updates on each person. A care assistant said that they always read the plans of new people so that they knew what their needs were. Staff had completed or were due to complete all mandatory training courses. Additional training had been booked for staff, for example diabetes awareness and loss and bereavement. There had been an additional 36 care hours per week provided at the home. This meant that additional staff could be arranged at busy times. A new position of laundry worker for 20 hours per week was due to be advertised. This would give care staff additional time with residents. An administrative post was also due to the advertised. This would release managers from some administrative duties and allow them to spend more time with residents and staff. The recording of activities is now clearer and accurate. The additional care hours has meant that the activities organisers were called on less to work care shifts. Staff meetings and one-to-one supervision were now happening on a regular basis, giving staff the opportunity to raise issues or voice any concerns. Residents had been told that they could access their own individual records, and one person had chosen to do so.

What the care home could do better:

Not all new people admitted for respite care had a personal service plan or photograph in their file. Activities had sometimes been cancelled due to staff shortages, and activities, particularly for people with dementia could be improved. Residents spoken with were not aware of an increase in activities provided. There was not the opportunity for religious observance. One person spoken with said that they would like a service or hymn singing at the home. People being admitted for respite care that wished to self administer their medication were not always being given facilities to store their medication securely. There was a high number of male care staff and male deputy managers working at the home. People had not been consulted about whether they were happy to have a male worker assisting with intimate personal care. There had been times when there were only male staff working on a shift. Staff spoken with were aware of at least one person that did not like having male staff assisting them.

CARE HOMES FOR OLDER PEOPLE Brendon House Brendon Avenue Loundsley Green Chesterfield Derbyshire S40 4NL Lead Inspector Jill Wells Key Unannounced Inspection 10th February 2009 09:00 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 Brendon House DS0000035785.V374108.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. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brendon House Address Brendon Avenue Loundsley Green Chesterfield Derbyshire S40 4NL 01629 537610 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) www.derbyshire.gov.uk Derbyshire County Council Amanda Plumtree Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Brendon House care home is registered to provide accommodation and personal care for service users whose primary care needs fall within the following category: Old age, not falling within any other category (OP) The maximum number of persons to be accommodated at Brendon House is 31 26th August 2008 2. Date of last inspection Brief Description of the Service: Brendon House is situated in the Loundsley Green area of Chesterfield, close to local shops and public transport. The home provides accommodation on two floors and personal care for up to 31 older people. There is an extensive garden, part of which has been fenced to provide a secure area for residents to use. Derbyshire County Council owns Brendon House and the authority has plans to provide a replacement building in 2010. Residents and their families have been made aware of these plans. The home is not accepting anyone on a permanent basis until after the closure to minimise disruption. The authority has undertaken a programme of refurbishment that reflects the proposed lifetime of the building. The home provides both short-term respite and long term care provision. Fees charged are as follows: Short-term care - £102.90-£336.42 per week dependant on a person’s savings. Long term care - between £0.00-£392.18 per week. Dependant on income, savings and property they have. Additional charges are made for hairdressing, private chiropody, newspapers and toiletries. A copy of the home’s service guide is available for people in the main reception area. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. The inspection visit was unannounced and took place over 9.5 hours. There were 18 people living at the home on the day of the inspection. 7 residents, 4 staff, 2 deputy managers, and the manager were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 26 August 2008. This included: What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection report. Completed surveys from people living at the home, staff and relatives that visit. Case tracking was used during the inspection visit to look at the quality of care received by people living at the home. Three people were selected and the quality of the care they received was assessed by speaking to them, observation, reading their records, and talking to staff. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Personal service plans were individualised and clearly set out what each person needed in order to meet their needs. Care staff were writing monthly reviews as updates on each person. A care assistant said that they always read the plans of new people so that they knew what their needs were. Staff had completed or were due to complete all mandatory training courses. Additional training had been booked for staff, for example diabetes awareness and loss and bereavement. There had been an additional 36 care hours per week provided at the home. This meant that additional staff could be arranged at busy times. A new position of laundry worker for 20 hours per week was due to be advertised. This would give care staff additional time with residents. An administrative post was also due to the advertised. This would release managers from some administrative duties and allow them to spend more time with residents and staff. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 7 The recording of activities is now clearer and accurate. The additional care hours has meant that the activities organisers were called on less to work care shifts. Staff meetings and one-to-one supervision were now happening on a regular basis, giving staff the opportunity to raise issues or voice any concerns. Residents had been told that they could access their own individual records, and one person had chosen to do so. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brendon House DS0000035785.V374108.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 Brendon House DS0000035785.V374108.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples needs are assessed before coming to the home to ensure that their needs can be met. EVIDENCE: Three peoples records were seen during the inspection visit. Each person had a full needs assessment completed by a care manager from Social Services. These had been completed before the individual had been admitted to the home. A resident spoken with who was staying for respite care said that someone had visited her before she came to the home to talk about what her needs were. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 10 The statement of purpose and service user guide were not inspected on this occasion as the previous inspection on 26 August 2008 saw that these documents had been updated and provided all the information people might need about the home. The home is planned to close in 2010 and existing residents will be moving to a purpose-built home in Staveley. Therefore the service is not accepting anyone on a permanent basis, to minimise disruption. However people are still being admitted for respite care. The people living at the home and their relatives have been involved and consulted concerning the closure and new build. Brendon House DS0000035785.V374108.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 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs were generally well met however the lack of consultation concerning male staff providing personal care means that some peoples dignity and individual choice may be compromised. EVIDENCE: During the inspection visit three peoples records were seen. There had been an improvement in the way that peoples plans of care were completed. Personal service plans and other records were more person centred and individualised. For example one persons records highlighted that they had, started to stay in bed later and it was better that they were left until they woke up themselves. One person spoken with had been at the home for two weeks for respite care and was due to return home that day. A personal service plan had not been completed for this person and there was no photograph of them in their file. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 12 After the inspection visit the manager informed us that she had set up a check list to minimise the risk of records not being in place. Care staff were completing monthly reports that were detailed and reflected any significant issues, events or changes in peoples needs. However personal service plans were not always updated to reflect the changes. For example one persons monthly report said that they now needed two staff for personal care and toileting, however the personal service plan had not being amended to reflect this change. There was however no indication that this was having a negative affect on the persons care. There were relevant risk assessments in place that had been reviewed. There were records of when people had received assistance with bathing and any occasions when they had been offered a bath and refused. Peoples weight was regularly checked. However one persons records showed that they had lost 5 kg within 2 months. There was no evidence that any action had been taken to look into the cause of this and their nutritional assessment had not been reviewed. A relief care assistant spoken with said that they would always read new peoples personal service plans and other peoples daily records when they started on shift so that they knew of any changes. There was evidence to show that people were asked if they wanted to be checked by care staff at night, wanted their bedroom door locked and if they wanted a key to their room or personal drawer. This showed that people were offered choices. One person spoken with said, I have a key to my room, it gives me peace of mind. There were a number of male care staff and deputy managers working at the home. The manager confirmed that people were not consulted as to whether they were happy with a male worker supporting them with their personal care needs. She said that there were occasions when there were only male staff on duty, although this was avoided where possible. A staff member spoken with said that there was at least one resident who did not like male staff providing support with their personal care. A specialist pharmacist inspector looked at the use of medicines in the home. There was evidence of much improvement in the handling and recording of medicines since the last inspection. All medicine charts for the past month were examined and we found that the necessary details about medication were recorded. We noted one occasion on which medicines appeared to have been given but the administration record was not signed. The receipt of medicines was recorded on each person’s medicine chart; two instances where receipt of a medicine had not been recorded were seen. The disposal of unwanted medicines was recorded. We audited a sample of medicines and found that the quantity of medicine remaining corresponded with the records of receipt and administration. We watched medicines being given to people at lunchtime. The administration record was signed immediately after each person had taken their medicine. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 13 We found that controlled drugs were stored and recorded correctly. Staff had signed to say that they had read and understood the home’s procedures for handling controlled drugs. We talked to three people who looked after their own medicines. Two people understood the need to keep their medicines safely locked away. However one person, who had held their own medication whilst staying for respite care had not been given a key to their lockable drawer to ensure that their medication was stored safely, although they had signed a declaration that they would keep their medication locked away in their room. This declaration had not been explained to the person and staff had not checked that the medication was being stored safely. We saw that medicines requiring cold storage were kept in a locked medicine fridge. However, records showed that the fridge temperature had been too low at times. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities and stimulation was provided, however lack of staff training in this area meant that this did not always meet peoples needs. A varied and appetising menu was provided to meet the needs of people living at the home. EVIDENCE: Since the last inspection visit we were informed that there were now 35 hours per week for activities and escorting people, for example to hospital or out in the community. We were told that these hours were now protected due to an increase in care hours. This was discussed with one of the activities workers during the inspection visit. They explained that 3-4 hours of the activity persons shift was used assisting people out of bed and assisting at breakfast and lunchtime. If escorting duties were required, the days activities were often cancelled. The activities records showed an increase in activities. However there were several days where activities were planned but did not take place. Staff said that this was due to staff shortages. The majority of the activities Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 15 organised were bingo, which was regular and popular with some residents, a social drink, coffee morning and a PAT dog brought into the home. Records showed and staff confirmed that there were several occasions when craft sessions, movement to music, reminiscence and one to one time with residents was planned but not done. Records of one to one time showed that this was done with each person at least fortnightly. An outside entertainer was organised every 3-4 months. Outings were also organised although the bad weather inevitably limits this. A recent outing had been cancelled due to lack of staff able to volunteer to assist. Residents spoken with were unable to confirm an increase in activities provided. One person said, there are not a lot of activities, but when there is, not many people take part. There were few activities provided for people with dementia. Staff had not received training in providing activities. The manager thought that the home was a member of NAPA (The National Association for Providers of Activities For Older People) but were not actively using this resource. Staff said that they were having difficulty getting people interested in being involved with very much. There was a notice board displaying activities planned for the week. However this was not completely accurate due to changes and cancellations. Staff confirmed that there were no opportunities for people to exercise religious observance. A staff member said that they had contacted the local vicar, but had received a poor response. A resident said that they would welcome a service or hymn singing at the home. A resident spoken with confirmed that visitors could come to the home at any time. Surveys completed by relatives confirmed that they felt welcomed and felt that communication was good. There was written information displayed at the home for visitors. A newsletter had been created and was displayed in reception. However this was September 2008 and out of date. People spoken with were happy with the meals provided. One person said, The food is very good. A relative wrote in our survey, Mother always speaks well of the food. The cook spoke with people in advance to ask them their preferred choice at mealtimes. A mealtime was observed. Staff were seen assisting and supporting people as required. Tables were pleasantly set out with use of gravy boats and vegetable tureens. Time had been spent with one person who had been unhappy with the food provided, to see if alternatives could be arranged. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 16 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 and 18Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were systems in place to support people who wished to voice a concern or complaint, and these were taken seriously. EVIDENCE: There was a complaints procedure displayed in the entrance hall. There had been 2 complaints received by the home since the last inspection visit on 26th August 2008. These had been dealt with appropriately and a formal response given to the complainant where relevant. One complaint was partially upheld and the second was not upheld. People spoken with said that they knew what to do if they wanted to make a complaint. There was also a suggestions box that was used by people living at the home. Staff spoken with had attended training in safeguarding adults and training records confirmed that this training had been done or planned. The Commission for Social Care Inspection had received an anonymous complaint since the last inspection visit. This triggered a ‘safeguarding adults’ investigation by an independent service manager from Derbyshire County Council Social Services. The outcome of the investigation was that there was no evidence to show that any abuse had occurred at the home, however there were some evidence of poor practice that may have led to the complaint. The service manager responsible for the service has confirmed that action has been Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 17 taken to ensure that the poor practice does not continue with the use of training, supervision and improved record keeping. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 18 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 and 24 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, comfortable environment that promotes their independence. EVIDENCE: A full tour of the environment did not take place, as the provider plans were to close the home by 2010 and move people to a new building. However a significant part of the service was seen during the inspection visit including the lounge, dining room, one bathroom and the bedrooms of the people spoken with. The lounge and dining room areas were clean, bright and looked comfortable. There was a large damp patch in a toilet area. This was shown to the manager who had not been made aware of it and agreed to deal with this as a matter of urgency. People spoken with were happy with their room. One person described their room as, an average room for a hotel. People spoken with were satisfied with the level of cleanliness. One resident said, my bedroom is regularly cleaned and the bedding is changed. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 19 Records showed that only one assisted bath was in operation as the second assisted bath was awaiting a lap strap. There had been a delay of several months in obtaining the strap. Staff explained that one resident had refused to use the only bath in use throughout this time. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are knowledgeable about residents and well trained, which ensures that peoples needs are met in a safe way. EVIDENCE: Since the last inspection visit we had been told that there had been an increase of 36 care staff hours per week. Staff rotas were seen during the inspection visit. The manager explained that these additional hours were being used at busy times, unless sickness and holidays prevented this. Most days on the rota showed some additional hours at busy times. An additional 20 hours per week for laundry had been agreed and this job was due to be advertised. This would give care staff additional time to spend with the residents. 17.5 hours office administrative hours had also been agreed, which would release managers from some office duties. Several residents were spoken with about staffing levels. No one was able to comment on the increase in staff hours and any impact that this has had. Several staff confirmed that there had been some sickness recently and this had meant working occasionally short staffed. One worker felt that there were insufficient relief carers to cover shifts. One resident said, we have been very short of staff recently. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 21 Training records showed that most staff had now completed all relevant mandatory training. Additional training including diabetes awareness, end of life and bereavement and developing as a worker had all been requested for staff. This was a significant improvement since the last inspection visit. Staff had signed that they had received a copy of the General Social Care Council code of conduct and were aware of their responsibilities under this code. A domestic assistant was spoken with who had worked at the home for two weeks. Although they had some experience of working in a care service, they had received no training in health and safety and working safely. They said that they had been shown the risk assessments concerning the chemicals used, but they had not read these. Two staff files were seen. There were copies of all relevant documents in these files, which showed that there was a safe recruitment procedure. The manager was concerned that there had not been an improvement in the time it takes to recruit new staff. She explained that it was taking an average of 3-4 months from advertising to starting a new worker. Residents were spoken with about the care that they received. One person said, staff come quite quickly when I ring the bell, and another person said, carers will shop for me. Comments received in relatives surveys included, the care staff are always caring and helpful and, staff are very good with residents. Comments in staff surveys in response to the question what does the service do well? Included, good staff, good meals service users are given security and they feel safe, and Brendan house is a happy home with the majority of staff very caring. We do our best to meet residents needs. We are always striving to improve the service and the way we work. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 22 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, 35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the service has improved, with supervision, regular staff meetings and improvements in health and safety checks. However the management team do not always work together to ensure an open, positive management approach for the benefit of people living at the home as well as staff. EVIDENCE: The registered manager has completed the registered managers award and has undertaken regular training to update her knowledge and skills. The deputy managers also had relevant management qualifications. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 23 The last inspection visit highlighted some poor practice issues and the service manager responsible for the service has taken appropriate action to ensure that this does not continue. In addition to this an experienced manager from another home has spent time with the manager to improve systems and practice. Some positive changes have taken place including more regular staff meetings, supervision and general improvement in records. The investigation into the anonymous complaint received as discussed previously, highlighted some difficulties amongst the staff team. Staff confirmed that morale had been low. Work was being done to improve this. Staff meetings were now held regularly and minutes of the meetings showed that staff felt able to voice concerns. However there was some evidence to show that appropriate action was not always taken. For example staff had brought up during three separate staff meetings that they were not happy when managers changed or gave them additional shifts without telephoning them. Minutes of these meetings did not reflect what action was to be taken as a result of this issue. A record in the minutes of one staff meeting stated that, staff feel not listened to, when they bring things up, they do not get feedback and do not see changes. The manager said that she did not hold this meeting and had not been made aware of this comment. Supervision was taking place, although this was not on a two monthly basis as expected by the provider. Some supervision records also showed that staff had brought up issues and concerns, but the record did not show what action was to be taken by the relevant manager about these concerns. The deputy managers were keeping supervision records locked away, but these were not accessible by the manager when the deputy was not on duty. This meant that the manager was unable to monitor the supervision provided. One care assistant said that communication has improved between managers and staff. One staff member wrote in our survey that, communication could be better, certain managers keep you updated, but others dont as much. Fire records showed that all checks were now being done including checks on emergency lighting, fire detection, fire equipment and fire escapes. The service manager visited the home regularly, supported the manager and completed monthly reports. The reports highlighted that the service manager had spoken with staff, residents and the managers. Notifications were being reported to CSCI. At the last inspection visit it was highlighted that on the Derbyshire County Councils electronic system there was not a way of showing residents clear Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 24 information about their money, particularly a history of debits and credits. The manager had set up a paper system, although this was not being kept up-todate. Since the last inspection visit on auditor had visited as a result of concerns around the petty cash recording system. This had improved using petty cash receipts, which highlighted who had taken money out of petty cash and brought back a receipt. Most but not everyone was completing these. Residents have been told at a residents meeting that they could have access to their records held about them. One resident had requested this as a result of the information they received. Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 25 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 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 2 2 3 3 Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 13 (1) (b) Requirement When monitoring of a persons weight shows significant unexplained increase or decrease, action must be taken, including advice from relevant health professionals where relevant and review of the persons nutritional assessment. This is to ensure that the persons health is being monitored. People must be consulted about their preference to same or different gender care staff providing intimate personal care for them. Any preferences must be recorded and taken into account when planning the staff rota. This is to ensure that peoples dignity and choice is respected. People who self administer their medication and have been assessed as safe to do so, must be provided with the means to store their medication safely so that medication is secure. Timescale for action 01/03/09 2. OP7 12(2) 01/03/09 3. OP9 13(2) 01/03/09 Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 27 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 Personal service plans should be in place for everyone staying at the home. These should be amended when changes occur to ensure that staff have accurate information about the person in order to meet their needs. There should be a photograph in place of everyone staying at the home in case of emergencies and to assist with safe medication administration. The registered provider should ensure that prompt action is taken if the medicine fridge is found to be operating outside the correct temperature range, so that medicines in the fridge are not adversely affected (e.g. by freezing). There should be adequate and appropriate activities provided for people with memory loss. This may require additional training for staff providing activities to ensure that everyone living at the home receives equality of opportunity for stimulation. Information displayed about activities that are planned should be accurate so that people can be aware of planned activities. There should be accurate information provided to CSCI and on the staff rota of staff hours provided for activities to assist in assessing whether adequate activities are being provided. Further attempts should be made to provide the opportunity for religious observance so that people have this opportunity to exercise their choice. Continued attempts should be made to ensure that the correct equipment for the assisted bath is in place (a lap strap) so that this can be quickly in use again for the benefit of residents that prefer this bath. Domestic staff should be given relevant training to assist them to do their job safely including knowledge of the control of substances hazardous to health (COSHH) before they start work, to ensure everyones safety. Any concerns voiced by staff and recorded in staff DS0000035785.V374108.R01.S.doc Version 5.2 Page 28 2. 3. OP8 OP9 4. OP12 5. OP12 6. OP12 7. 8. OP12 OP21 9. OP30 10. OP32 Brendon House 11. 12. OP36 OP35 meetings, supervision or other settings should have a record of the action that will be taken to address these concerns. The action should be monitored and reviewed to ensure that staff concerns are listened to and dealt with as appropriate. Written records of all staff supervision should be accessible to the registered manager so that they can monitor the supervision provided. Any individuals that wish to should have records made available to them of debits and credits into their account held by Derbyshire County Council so that people have information about their own money. The new petty cash recording system including completion of petty cash receipts should be followed by all staff to ensure protection of peoples money. Staff should receive formal supervision at least 6 times a year to ensure that they are appropriately supervised and have the opportunity to voice any issues, concerns or ideas. 13. OP35 14. OP36 Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 29 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Textphone: 03000 616171 Email: enquiries.eastmidlands@cqc.gov.uk Web: www.cqc.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 Brendon House DS0000035785.V374108.R01.S.doc Version 5.2 Page 30 - 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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