Inspection on 26/08/08 for Brendon House

This inspection was carried out on 26th August 2008.

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

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

Brendon House 10/02/09

Brendon House 25/10/07

Brendon House 14/11/06

Brendon House 27/02/06

Brendon House 20/10/05

Brendon House 08/02/05

Brendon House 18/10/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Brendon House Brendon Avenue Loundsley Green Chesterfield Derbyshire S40 4NL Lead Inspector Jill Wells Unannounced Inspection 26th August 2008 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.V370538.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.V370538.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brendon House Address Brendon Avenue Loundsley Green Chesterfield Derbyshire S40 4NL 01246 347610 01246 347612 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.V370538.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 25th October 2007 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 Autumn 2009. 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.V370538.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 0 star. This means the people who use the service experience poor quality outcomes. The inspection visit was unannounced and took place over 8 hours. There were 26 people living at the home on the day of the inspection. 12 residents, 4 staff, 2 visitors, and 2 managers were spoken with during the visit. We also looked at all the information that we have received, or asked for, since the last key inspection on the 25th October 2007. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • • • 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, relatives and professionals that visit. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. What the service does well: The service provides up-to-date information about the home to help people make a decision about whether to stay at the home. A good induction programme is provided for new staff. Complaints and any allegations made are taken seriously and investigated appropriately. Staff are caring, dedicated and committed, often doing things for people in their own time for example shopping and volunteering to help with outings. Several positive comments were received about staff including, I feel well looked after and, staff will bring me anything that I need. Peoples health care needs are met with doctors and other health professionals involved as required. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 6 There was a choice of food at each meal times and most people were happy with the food provided. Comments from people included, “the food is very nice and, I enjoyed the food, it is all very good and lovely gravy! Transport was provided for an outing on a monthly basis. People had recently gone to Bakewell and a trip to a safari park was planned. People live in a safe, maintained and comfortable environment. People living at the home were pleased with their bedrooms. One person said, my bed is comfortable and I have got a lot of my own things. People were also happy with the cleanliness of the home. What has improved since the last inspection? What they could do better: Not everyone admitted to the home had an up-to-date assessment to ensure that staff are aware of their needs. Care planning documentation could be improved by ensuring that the information recorded is accurate, person centred and regularly reviewed. There were unsafe medication procedures and practices, which may put people at risk. Hours designated for activities were being used to undertake care duties due to inadequate staffing levels at busy times. This meant that insufficient activities were provided to ensure that people were stimulated. One person spoken with said, they are always short staffed and, if theres only two staff on duty you often have to wait a while before staff come to you, especially if you ring the call bell. Several people said that they were often bored as there was not enough to do, and one person wanted more exercise. Not all fire safety checks were being done which may put people at risk. Although induction and mandatory training was provided for new staff, refresher training for staff was not always provided in a timely way. There was not clear evidence that people had been consulted regarding the food provided. Staff were not receiving formal supervision on a regular basis to ensure that they were undertaking their work correctly and have the opportunity to voice any concerns. There were not adequate systems in place so that staff and management practices are monitored to ensure that people receive a good, and safe service. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 7 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.V370538.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.V370538.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): 1,3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have the information that they need about the home to help them make a decision about whether to live there, however not everyone receives an upto-date assessment before being admitted. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that everyone living at the home is provided with an up-to-date statement of purpose and service user guide about the home. They also say that people come for a minimum of a days visit before moving into the home. A full needs assessment is completed before they are admitted to the home. During this inspection visit we looked at the homes statement of purpose and service user guide and found that they had been updated and provided all the Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 10 information that was necessary, including information concerning fees and items not covered by the fees. We also looked at the assessments that were completed for people before they were admitted to the home. One person was staying for short-term care and had stayed previously. The last assessment completed for this person was March 2007 and had not been reviewed or updated. The issue concerning lack of assessments for new people was highlighted at the last inspection visit. People spoken with said that they had come for a trial visit before deciding to stay at the home, although most people had come for short-term care before deciding to make this their home. Brendon House DS0000035785.V370538.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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individuals care records did not give guidance to staff on how to meet peoples health and personal care needs. There was not a safe system for receipt, recording and administering medication, which may put people at risk. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they uphold all aspects of each persons health and personal care and support service users to visit their own GP, dentist etc when possible. They also said that Medication Codes of Practice are received by all managers and implemented. During this inspection visit we looked at three peoples care plans and related health care records. We found that they were of a mixed quality. For example one persons file had a personal service plan that was signed by the resident, Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 12 and this had been reviewed on a monthly basis. However another resident that had been admitted for short-term care had no up-to-date assessment, care plan or risk assessments. Key workers were expected to write monthly reports and some were completed regularly, however one person had not had a monthly report since April 08, and another since January 08. The document entitled preferred routine had no date, therefore it was unclear how up to date this information was. Although risk assessments were being completed concerning moving and handling, nutrition, tissue viability, oral health care and medication, they were not reviewed as regularly as necessary for example one persons score on the tissue viability risk trigger tool stated that they needed a weekly review, however it had been at last reviewed January 08. One persons nutritional assessment stated that the person had diabetes but there were no details regarding this. Where the form asked if there was any food that the person cannot eat or does not like, this was left blank. Another person had a recently completed nutritional and tissue viability assessments stating that there had been no change in their weight, although this person had lost 7 kg in 8 months. Records of bathing showed several gaps with no date of bathing. Staff said that this was when people had refused a bath, although this had not always been recorded on the document. Personal service plans that were seen were not person centred and did not promote independence. For example one persons plan said that they needed a lot of help with personal care. This did not indicate their preferences or their abilities concerning personal care. The manager was spoken with about this. She said that managers and staff had not received training in person centred planning and care. People spoken with said that they had access to health care services and could request a doctor when they felt they needed one. District nurses were involved with peoples health care and the district nurse visited on the day of the inspection visit. People spoken with felt that they were treated with respect and their right to privacy was upheld. One person said, staff dont stop you doing what you want to do. Another person said, all staff without exception are very kind. However one person said, “most people treat you with respect here but one or 2 staff don’t always”. They did not wish to give further details. A visitor spoken with said, staff seem to treat people very well. They are pleasant and helpful when we visit. Staff supervision records showed that there had been recent incidents where some staff members had not treated people respectfully and discussions concerning their practice had taken place between them and the manager. Brendon House DS0000035785.V370538.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The amount and type of activities did not always meet people’s social needs. A varied and appetising menu was provided to meet the needs of people living at the home. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that there are regular meetings with service users and relatives to discuss routines of the home and activities that they would like. Activities planned for a week are on display. They also said that people are provided with a choice at mealtimes. During this inspection visit we talked to people about activities provided. Some people said that there were insufficient activities available. One person said I would like more exercises we dont do it often enough. Another person said I enjoyed the drinks night on a Saturday. Two people said that they were often very bored. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 14 We spoke with an activities co-ordinator. Although there were two staff members to provide activities for 35 hours per week it was explained that the majority of these hours were taken up by care duties or escorting people to hospital appointments. They also said that if the home was short staffed due to holidays and sickness and they were due to do an activities shift, they would be asked to cover care instead. The manager said that out of the 35 hours per week there was on average two hours per day x five days per week dedicated to activities which totalled 10 hours per week. The activities worker said that if they did not have time for activities they would put the music on in the lounge area and try to encourage a sing song. Activities that were arranged included manicure and hand massage, bingo, coffee morning, chair based exercises and dominos. There was also a monthly trip out. The last outing was to Bakewell and there was a trip planned to a safari park. One resident spoken with said, anybody who wants to go on the trips can do. There was a new reminiscence room and sensory room that people could use. There were few activities for people with memory loss who may have difficulty with the usual planned activities. There was a six-week plan of activities on the notice board. This did not inform people about the activities for the day as no one knew which week they were on. There was also a weekly activities notice board, however there was only the three regular events written on the board which included the hairdresser visiting. The activities person said that they told people each morning what was happening. The activities records showed significant gaps where no activities had been recorded. The activities co-ordinator said that activities might have been organised but not recorded. Several people had no records of activities done with them. The activities co-ordinator said that one to one time was spent with these people although this was often not recorded. The issue concerning activities was highlighted at the previous inspection visit. People spoken with said that they could sit where there wanted and do what they wanted within reason. One person said, the office keep my money safe and I just ask for money when I need it. No one spoken with was aware that they could access their personal records if they wished to do so. The menu showed a varied and nutritious diet. Meals were taken in the dining room. There was the day’s menu displayed on a notice board. The cook was heard asking people during the morning whether they were happy with the main lunch or whether they would prefer an alternative. The mealtimes were observed. Vegetables were served in a tureen to encourage independence. People were given assistance if this was required. Some staff were asking which dessert people wanted, however one staff member was placing the main option in front of people without asking. An individual asked the staff member if they could have the alternative dessert. The staff members response was to show non-verbal signs of frustration at this request. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 15 The cook was spoken with. They said that there was a hot breakfast option every morning and a choice available at every mealtime. The menu was changed on a seasonal basis. They said that consultation concerning the menu took place on a one-to-one basis and during residents meetings. The last two minutes of residents meetings were seen, however there was no discussion regarding meals at these meetings. The Cook said that she would provide different food for individuals, for example kippers and said that we aim to please whenever we can. Most people spoken with were happy with the food and confirmed that alternatives were available. However two people spoken with were not happy with the food saying that it was not often to their liking. One person made a comment, my grumble is the food and explained that there was a lot of things that they could not eat. They were unhappy that they were often providing their own food. Several people made positive comments for example, the food is very nice and, I enjoyed the food, it is all very good and lovely gravy! One person said, when I am poorly I dont come down for my meals and staff bring my meals into my bedroom. Brendon House DS0000035785.V370538.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 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and systems are in place to help protect people from abuse. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they implement an “informal” complaints approach by listening to service users and responding and giving feedback as quickly as possible. They also ensure that service users are safeguarded from abuse and discrimination by implementing the Safeguarding Adults Policy. They ensure that staff attend training and refresher training in safeguarding adults and it is discussed in supervision and staff meetings. At this inspection visit we looked at complaints records and talked to people living at the home about whether they felt comfortable making a complaint if they needed to. There had been one complaint made to CSCI about the service since the last inspection visit. This triggered a ‘safeguarding adults’ investigation by Derbyshire County Council. The outcome of the investigation was that there was insufficient evidence found to uphold the allegation. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 17 A second ‘safeguarding adults’ investigation had been undertaken as a result of an allegation made. The police had been involved, however there was insufficient evidence to uphold the allegation. There had been a total of three complaints received by the home since the last inspection visit. These had been dealt with appropriately and a formal response given to the complainant where appropriate. People spoken with say 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 record showed that most people had undertaken this training although some people were due refresher training. Staff signed that they had received a copy of the General Social Care Council Code of Conduct. There had been several incidents where staff had provided below standard of care and the manager had used the appropriate disciplinary procedures regarding these matters. Brendon House DS0000035785.V370538.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 and 26. 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, maintained and comfortable environment, which encourages independence. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they have continued with the programme of redecoration, purchased new armchairs, commodes and clocks for peoples bedrooms, and have only six bedrooms left to re-decorate. A detailed inspection of the environment was not completed, as the home is due to close approximately Autumn 2009 and be replaced by a new home. However some of the environment was seen in the process of the inspection Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 19 visit. Since the last inspection visit they have changed one upstairs bedroom into a relaxation room and made another room into a reminiscence room. The home was comfortable and generally well maintained. There were no unpleasant smells and people spoken with said that they were very happy with their bedrooms and the cleanliness of the home generally. One person spoken with said, my bed is comfortable and I have got a lot of my own things. Several people spoken with had a key to their bedroom and confirmed that they could spend as much or as little time as they wished to in their room. General maintenance and repairs are being undertaken, however the manager is trying to balance not spending excessive money on the home due to the planned closure, with the comfort of residents. The action plan completed by the home said that the recommendation made at the last inspection visit concerning re-varnishing the staircase had not been done due to the cost and planned closure. This was accepted as reasonable. Recommendations concerning cleaning of lights and sky lights in corridors had been done. Brendon House DS0000035785.V370538.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 adequate. This judgement has been made using available evidence including a visit to this service. The number of care staff on duty may not always meet people’s needs. People were protected by the homes recruitment practices and staff received training to do their job. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they have a good skill mix of staff and qualifications and training have increased for all grades of staff. They have a good induction programme and staff then have the opportunity to undertake other relevant training and after being employed for 6 months, staff can be put forward to complete NVQ 2 Care. During this inspection visit we looked at staff rotas, and talked to staff and people living at the home about staffing levels. We also talked to the manager about dependency levels of people living at the home. Staff rotas showed that there was a minimum of two care staff on duty on all shifts. As previously mentioned there was 35 hours per week for activities, however many of these hours were being used for care hours. On the day of Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 21 the inspection visit there were 2 care staff on duty and an activities coordinator who spent some time holding a coffee morning with residents, and the rest of their shifts providing care. With three staff providing care there were adequate staff numbers to meet peoples needs. However when there was no activities co-ordinator shift at weekends and due to holidays and sickness there was likely to be significant pressure on staff and everyones needs may not be met at busy times. People living at the home were spoken with about this. One person said, they are always short staffed and, if theres only two staff on duty you often have to wait a while before staff come to you, especially if you ring the call bell. Another resident said, staff dont have time to talk to you, they are too busy. A visitor spoken with also said that the home often seemed short staffed. Several staff members spoken with mentioned the pressure on staff at times when there were only two people on duty. One person said, there is often not enough staff to do all you need to do. We get the essentials done but havent got time to spend five minutes with somebody. Staff explained that their additional duties were residents washing and ironing, the changing and making of beds, making drinks and washing breakfast pots. This took time away from providing care for residents. On the day of the inspection visit there was the manager and deputy manager at the home. The deputy manager administered medication but neither undertook care duties. They confirmed that they would only do care duties if there was an emergency situation. However the statement of purpose for the home stated that there were 99 hours per week management care hours, which was not the case. At the time of the inspection visit there were 26 people at the home, which included 6 people for short-term care. Due to the planned home closure the home was not taking any other residents on a permanent basis but were taking additional people for short-term care. Staff confirmed that people being admitted for short-term care often needed more time as staff settled them in and spent time to get to know them. The manager was recording dependency levels. She had assessed that there were 4 people with high, 15 people with medium and 7 people with low dependency needs. She explained that although she was recording this, she had no control over increasing or decreasing staff hours accordingly as staffing numbers were controlled by head office. The issue concerning staffing levels was highlighted at the previous inspection visit. Several positive comments were made by people living at the home about staff. These included we are looked after here and, I feel well looked after. Another person said, any little thing that I want like toothpaste they bring it for me. Staff confirmed that shopping for individuals was done in staff’s own time. Staff also volunteered on their days off to help with outings. This showed caring and commitment from staff. There were five male staff working at the home. Residents spoken with said that they did not mind being attended to by a male. A manager explained that Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 22 whenever possible there would not be an all male staff group on duty to ensure that people could choose to have assistance from a female if they wished to do so. Information provided was that 86 of care staff had undertaken NVQ Care level 2, which is above the minimum ratio of 50 and should be commended. One staff file was seen. Although not all information was available in the file, the manager confirmed that this information was at the head office. On this occasion this information was not requested. There was confirmation in files that relevant checks including criminal record bureau check had been completed. Training records were seen. These showed that there was a good induction programme for new staff. Most staff had undertaken initial mandatory training although some staff did not have up-to-date refresher training. Night staff were not receiving six monthly fire training as required. Staff spoken with said that training provided was very good although some staff were waiting for additional training to be made available for example loss and bereavement. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a lack of monitoring of running of the home, care practices and recording to ensure that the home is run and managed in the best interest of people living there. EVIDENCE: In the annual quality assurance questionnaire completed by the home they say that they implement all of the Derbyshire County Council policies and procedures as well as government legislation to ensure safe working practices. They have an annual business plan. Risk assessments are in place concerning the building and people within the building. They say that they complete Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 24 regular audits to meet standards:- Financial Audit, Case record audit, health and Safety and fire audits. There is better communication between managers and staff and the management team are working together to be efficient and effective. During this inspection visit we spoke with the managers on duty, staff and people living at the home about the management approach of the home. We also looked at staff supervision, record keeping and safe working practices. The manager has the registered managers award (RMA) and the deputy managers also have relevant management qualifications, which should be commended. One manager is undertaking BA Honours in Social Work. Staff spoken with said that the management team were approachable. A visitor spoken with said that they were kept informed if there were any issues concerning their relative. A resident spoken with said, the managers are very nice. The manager had implemented audit systems for deputy managers to follow to ensure that a manager regularly checked care records. These were not always been done. The manager was surprised and disappointed by this. Questionnaires had been sent out to people living at the home and the outcomes of these surveys were available. They showed that 100 of people living at the home were very satisfied with the cleanliness, visiting arrangements, food quality and the cheerfulness and trustworthiness of staff. 25 of people were not satisfied with the variety and choice of activities and 31 felt that improvements could be made in how they were treated as individuals for example the choice and frequency of bath times and feeling listened to. Someone made a suggestion that more one-to-one time should be made available for people living at the home. An action plan had been written in response to this outcome highlighting ways that the home will respond to any concerns. The system for recording and retaining residents’ personal finances were kept through Derbyshire County Council’s electronic system. The records were accessible using the computer system. During the inspection visit one resident told a manager that they wanted some money as they had not been given any since they had been at the home. The manager later told the inspector that this was not the case, residents can access their money when they wished to do so. On checking the computer system there was not a way of showing residents their history of debits and credits, which would have re assured this person and possibly others, and the manager said that they were not provided with a statement. The petty cash recording system was checked. Some records were shabby and unreadable. There was not a simple way of calculating the amount of petty cash that should be at the home as receipts were stored up one month at a time rather than recorded at the time of the transaction. This meant that there was no clear record of who had taken money out of petty cash, which Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 25 was not safe practice. Records were not signed by the person making the transaction, or countersigned. Some staff supervision records were seen. These showed that supervision of staff was taking place, although not always frequently. For example one deputy manager had not received formal one-to-one supervision since September 2007. The manager said that regular management meetings took place and communication was good between managers. The registration certificate was displayed. There was an insurance cover certificate in place. Records were kept securely. Information provided by the manager was that all servicing had taken place. Samples of these were seen, including gas installations safety certificate and lift and hoist servicing and were found to be in order. A fire risk assessment had been completed and reviewed. All the general risk assessments were in place and had been reviewed including use of electrical items and service user assisting in the kitchen. Fire safety records were checked. Although the daily and the weekly checks were being undertaken, the monthly checks were not always been done. For example the emergency lighting, automatic fire detection and fire fighting equipment were checked February 08 and July 08. The guidance provided was that monthly checks were required. Accidents were recorded and reported to relevant people as required. The service manager responsible for the home had been completing monthly reports, and recorded that she had spoken with the manager, staff and some residents during each visit and highlighted any issues that needed to be dealt with. However the service manager had recently left and the registered manager was waiting the name of a replacement. From discussions with the manager it was evident that she understood person centred planning and thinking but was having difficulty translating theory into practice to make a difference to the staff team or outcomes for people using the service. No one at the home had not received training in this area. The review dated 25/8/08 of the action plan to the previous inspection was not accurate for example it said, ‘managers use an admission check list form so that work can start on service user’s file as soon as they are admitted’. This was not happening. It also said, ‘staff skill mix and numbers is appropriate for the health and welfare of residents’ which was not always the case and was at times compromising activities provided for people. It also said,’ managers will ensure with the assessment team that assessments are up to date. If the paperwork is not completed the service user cannot be admitted’ and ‘managers review regularly the care plan and other assessments to ensure that they are current and relevant to the service user’ however managers were Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 26 admitting people without up to date assessments and care records were not regularly reviewed. This showed that there was not adequate monitoring of staff and management practices. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 27 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 x 1 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 2 1 2 2 Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) & (2) Requirement Timescale for action 26/09/08 2. OP7 15 Up to date assessments must be in place for everyone admitted to the home, including people admitted for short-term care to ensure that the home can meet individuals’ needs. (A similar requirement was made at the last inspection visit concerning written assessments) 26/10/08 Care planning documentation including personal service plans, risk assessments and health related documentation must be in place, accurate, reviewed as required, and discussed with the individual to ensure that health care is monitored and staff have up to date information on each person to assist them to meet their needs. (A similar requirement was made at the last inspection visit concerning care planning documentation) Safe medication procedures and practices must be followed in relation to ordering, receipt, administration, recording and security of medication to protect people using the service. (A DS0000035785.V370538.R01.S.doc 3. OP9 13(2) 26/09/08 Brendon House Version 5.2 Page 29 4. OP27 18(1) (a) similar requirement was made at the last inspection visit concerning safe medication systems) There must be sufficient staff on duty at all times to ensure that people’s health and social care needs are met. (A similar requirement was made at the last inspection visit concerning staffing numbers) 26/10/08 5. OP30 6. OP38 13 (6) All staff must receive regular 13 (4) refreshers for all mandatory 18 (1) (c ) training to ensure that they are appropriately trained and receive regular updates on good practice. 17(2) There must be records of fire schedule safety checks as required to 4 ensure that everyone at the home is safe. 26/12/08 26/10/08 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 Care planning documentation should be written in sufficient detail to give staff full information on people’s social, emotional and care needs, and be written in a person centred way to ensure individuals preferences and choices are met. The document being used entitled preferred routines must be dated to ensure that the information included is up to date. Records of supporting people living at the home with bathing should include occasions when a person has been offered a bath and refused to ensure that there are accurate records of staff offering and providing assistance with bathing. DS0000035785.V370538.R01.S.doc Version 5.2 Page 30 2. 3. OP7 OP7 Brendon House 4. 5. 6. OP7 OP10 OP12 Managers and staff should be provided with training in person centred planning and care so that they are more able to meet peoples needs in an individualised way. Staff should treat residents with dignity and respect at all times. People’s interest should be recorded and they should be given the opportunity for adequate stimulation through leisure and recreational activities that suit their needs, preferences and capacities. Adequate numbers of staff should be available to ensure that this occurs. 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. Records of activities provided for individuals should be accurate and in sufficient detail to assess whether each person is receiving adequate opportunity for stimulation. This includes group activities and one to one time spent with an individual that may not want to join in with group activities. Up-to-date information about activities planned should be available for everyone in formats suited to their capacities so that people can be aware of planned activities. People living at the home should be made aware, supported, encouraged and reminded of their right to access their personal records. All staff must offer everyone the opportunity for choice at mealtimes to ensure that everyone receives an equal opportunity to have the choice available. The agenda for residents meetings should include regular consultation with people concerning the meals provided to ensure that people have the opportunity to make comment about the food. Any person that regularly does not like the food provided should have time spent with them and information recorded in their files regarding their food preferences, likes and dislikes so that the home can try to accommodate their needs and wishes if possible. All staff should receive regular refresher training on safeguarding adults procedures to ensure residents safety. Additional training should be promptly provided for staff where their personal development plan highlights that they would benefit from this training in order to improve the quality of care provided for example loss and DS0000035785.V370538.R01.S.doc Version 5.2 Page 31 7. OP12 8. OP12 9. 10. 11 12 OP12 OP14 OP15 OP15 13 OP15 14 15 OP18 OP30 Brendon House 16 OP35 17 18 OP35 OP36 19 OP38 bereavement. 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 petty cash recording system should be more robust 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. There should be adequate systems in place so that staff and management practices are monitored to ensure that people receive a good and safe service. Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Brendon House DS0000035785.V370538.R01.S.doc Version 5.2 Page 33 - 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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