CARE HOMES FOR OLDER PEOPLE
Brendoncare Alton Adams Way Alton Hampshire GU34 2UU Lead Inspector
Anita Tengnah Unannounced 16/5/05 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brendoncare Alton Address Adams Way, Alton, Hampshire, GU34 2UU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01420 549797 01420 549989 The Brendoncare Foundation Patrick Carr CRH 75 Category(ies) of DE- Dementia registration, with number DE(E)- Dementia over the age of 65 years of places MD(E)- Mental Disorder over the age of 65 years OP- Old Age Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1- Service Users in the DE category should not be admitted below the age of 55 years. 2- Only one service user in the OP category (DOB-26/04/1946) can be admitted under 65 years of age. 3- The Mental Health wing must have an RMN or suitably qualified nurse on duty at all times. 4- The nursing wing must only be used to accomodate the 45 service users in the OP category 5- The mental health wing must only be used to accommodate the 30 service users in the DE(E), DE, MD & MD(E) categories for which the home is registered. 6- The overall manager of the overall service must be suitably qualified for the range of services offered. Date of last inspection 2/8/2004 Brief Description of the Service: Brendoncare Alton is a registered care home providing nursing and personal care for 45 service users in the older person category and 30 service users with mental health disorder. The home is owned by the Brendoncare Trust and has another home in the Hampshire area. Accommodation is provided on two floors with passenger lifts that allows access to all floors. All bedrooms are single and have ensuite facilities. There is a variety of aids and assisted baths to meet the needs of service users. The home also benefits from large well maintained gardens that are enclosed and accessible to wheelchair users. The service is situated in Alton with some local amenities close by. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection took place over one day on the 16th of May 2005 as part of the continuing monitoring process. A tour of some part of the building was undertaken and the inspector spoke to 14 service users, I visitor, 13 staff and the 2 team leaders that were managing the service at the time. The inspection process included examining 7 care records and 4 staff records, discussions with service users and staff. What the service does well: What has improved since the last inspection?
The home has an ongoing programme of refurbishment and a number of rooms have been decorated. This included new carpet in the corridor, lounge and office in the mental health unit. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 6 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. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,6 The lack of pre-assessment records may be detrimental to service users as vital information were not accessible to staff. EVIDENCE: The nurse in charge reported that all service users are assessed prior to admission. Prospective service users are offered the opportunity to visit the home however staff reported that this rarely happens due to their frailty and mental health conditions. Family do visit and information as per the statement of purpose is made available. All service users have a trial period on admission. The care record of a recently admitted service user was seen and there was no pre-assessment documentation available. The manager must ensure that these assessments are available and form part of care plan formulation while the long- term assessments are undertaken. Evidence of family/ carers’ involvement in the assessments process should also be maintained. The home does not provide intermediate care.
Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Some care plans were good however this was not consistent and lack of risk assessments, in particular, with regards to falls, wound assessment along with the lack of reviews could be detrimental to service users and fail to meet their needs. Service users access to external agency and GP are well managed at the service. The medication at the home is well managed promoting the safety and welfare of the residents. EVIDENCE: Care plans were formulated and in some instances these were detailed and included risk assessments. The care plans of all long stay service users in the mental health unit were all updated and reviewed monthly to reflect the changing needs of service users. This unit also has two respite beds that provide valuable support for carers.
Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 10 Care plan of a service user on respite care showed that she attended the home on a 6 weekly basis. However her care plans were not updated on admission and may not reflect her current needs. Her long- term needs assessments were incomplete and did not contain her medical needs, sleeping routine, personal history or sexuality and last reviewed in December 2004. Care plans for some service users were not reviewed and updated on a monthly basis. There was one service user with a lap strap on her waist that was in use all the time. There was no evidence of risk assessment or consultation and consent to demonstrate the need for the lap strap, its continuous use or how this decision was reached. The use of lap strap is constituted as restraint and there should be clear risk assessments and guidance to protect the service user. Another service user’s record showed that she did not wish to be nursed by male carers. There was no care plans to denote how her wishes would be respected, although the nurse in charge reported that all efforts are made to ensure that female staff administered personal care. Records of fluid intake were also poor with gaps in the recording of up to 14 hours for a service user that was frail and not taking any diet. The GP attends the home on a weekly basis and service users are reviewed as required. There were very good and up to date records of GP visits and any changes in treatment were clearly documented. Wound care plans for two service users were seen. Reviews of plans were discussed with the nurse in charge, as they did not contain current information of treatment and wound evaluation. This has the potential of putting service users at risks as treatment of wound may not be consistent and inform practice. A sample of Medication Administration Record (MAR) sheet showed that all medication received and administered were recorded accurately. Medication was stored safely and controlled drug was administered according to guidelines. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,15 Social activities are well managed and provide daily variation and interest for people living there. Meals are well presented and choices are available, the process of breakfast management needs to be reviewed to empower service users autonomy and choices. EVIDENCE: The home has an open visiting policy. Service users spoken to reported that they were able to receive their visitors in the privacy of their rooms as they chose. All service users spoken to said that they liked living at the home. One service user showed the inspector a variety of her needle -work that she continues to do despite her disability and staff stated that she also attends the stoke club in the community. The home employs activity coordinators and a variety of activities are organised on a daily basis. Service user said they have the choice of joining in activities or to remain in their rooms. Two lots of activities were observed at the time of the visit that was interactive. Meals were observed at lunch time and appeared nourishing and well balanced
Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 12 and choices were available. Staff were observed to be available to offer support in a sensitive way at meal times. Eight service users spoken to stated that they were not consulted regarding choice of meals and were not aware of cooked breakfast being available. Two of them said that a cooked breakfast would be nice change. The inspector saw a menu list that was available at lunchtime that staff were using to serve meals and a choice was available. Staff stated that some service users do have cooked breakfast. Staff should ensure that all service users are aware of the choices and availability of cooked breakfast as required. All service users spoken to stated that meals were nice and hot and cold drinks were available at all times. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaint and adult protection procedure in place for the safety and welfare of service users. EVIDENCE: The home has a complaint procedure and the manager or senior team leader investigate all complaints. A log of all complaints was available. The home must ensure that a copy of all correspondence entered with the complainant are maintained. Service users and a relative spoken to stated that they would report all concerns to the nurse in charge or the team leader. The home has in place information with regards to the Hampshire Adult Protection procedure. There has been no allegation of abuse at the home since the last inspection. Training in adult protection for all staff should be accessed as one staff member spoken to was unsure of what constitutes abuse. There should be clear guidance and adopted within a risk assessment framework regarding the use of restraint such as lap strap and records should be maintained in care plans to ensure the welfare of service users. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,22,24 The home presents a warm and homely atmosphere. Further refurbishment of some bedrooms will create a pleasing and environment to live in. Equipment and aids are in place hence promoting and maintaining service users mobility and independence. EVIDENCE: A tour of the premises was undertaken as part of the inspection. The home was clean and warm and there was no odour noted. Staff reported that there is an ongoing programme of redecoration and that some rooms have been decorated. Furnishing were of good quality, clean and appropriate to service users needs. The home had an external agency that was cleaning carpets and upholstery on the day of the visit. Locks were available in all service users rooms and communal bathrooms/ toilets. Most of the service users bedrooms were personalised. Taking into account that some service users are unable to advocate for themselves due to their mental incapacity, the home should involve family/ friends of service users in
Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 15 ensuring that their bedrooms are personalised and meet their needs. These should include access to bedside lighting as appropriate. Some improvements to decor in the mental health unit were required. One bedroom had about twenty scorch marks from cigarette burns. The team leader reported that this service user no longer smokes. A refurbishment of this bedroom was discussed and some other rooms where the walls needed painting as there was exposed plaster following repair to damage of the walls. The home has adequate bathrooms/ toilets that were equipped with assisted baths and grab rails to promote service users independence and passenger lifts were available to allow access to all the floors. The home benefits from well-maintained gardens that were secure and accessible to wheelchair users. Service users spoke proudly of the nice garden and seating was available. One service user stated that he preferred to spend most of his time in his room and “admired “ the view from his window. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 The staff have good understanding of service users’ support needs and have developed positive relationship with service users. The systems of recruitment are poor and does not protect the welfare and safety of service users in ensuring staff fitness. EVIDENCE: The home has a staff team that have worked at the home for a long time. The numbers and skill mix ensures that there were adequately trained -staff on duty to meet the needs of service users. Staff spoken to state that they enjoyed working at the home, and it was evident from interaction observed that staff have developed good rapport with service users. Four staff records were seen at the time of the inspection. Records were maintained securely in the administration office. It was noted that all four staff that have started work recently did not have a current CRB disclosure in place. Staff reported that these have been applied for. Staff reported that it was difficult to guarantee that these staff were supervised at all times. The manager must ensure that all checks are completed prior to commencement of employment in order to ensure the safety and welfare of service users. Some staff records did not contain 2 references as required. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 17 Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 The process of recording and reporting of incidences that are detrimental to service users need to improve in order to safeguard the welfare of service users. The lack of new staff induction in fire safety and the wedging of fire door pose risks to service users welfare and safety. . EVIDENCE: The home had an incidence of diarrhoea and vomiting recently and reports of that affected a number of service users and staff. It was noted that staff could not confirm how many service users and staff were affected as this was not recorded. Report as required regarding Regulation 37 notice was not submitted to the Commission. Staff reported that advice was sought from infection control and recommended measures were put in action. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 19 On a tour of the building, the fire alarm was tested. It was observed that a fire door in the kitchen on the unit was wedged open and did not close when the alarm was tested. A staff member stated that the small kitchen has a very noisy fan and the confine space is restrictive. The wedging of doors may have a detrimental effect of service users in the event of a fire. The manager must ensure that as part of the induction all staff including casual workers must have instruction on fire safety in order to safeguard the welfare of service users. One staff member that started work recently was unsure of the fire safety procedures on the unit. Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 3 3 x x 2 x x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x 2 2 Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 21 NO Are there any outstanding requirements from the last inspection? Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 22 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 7 Regulation 15, 17(1) (a) Requirement The manager is required to ensure that care plans and risk assessments are riviewed and updated on a monthly basis or sooner to reflect changing needs of service users. Wound care plans must contain details of treatment, assessments to inform practice and promote consistent approach to care. Staff must facilitate and ensure that service users are aware of meals choices. A programme of refurbishment of all areas identified at the time of inspection must be put in place. A robust recruitment policy and procedure must be in place to ensure that all checks are undertaken for the safety and welfare of service users. Timescale for action 30/06/05 2. 3. 15 19 13 23(2) 30/06/05 30/06/05 4. 29 19 30/06/05 5. 37 6. 38 Brendoncare Alton Staff records must be maintained as per schedule 2 17(1) The manager is required to 30/06/05 record and report to the Commission all incidences that are detrimental to service users health as required by Regulation 37 23(4) Fire safety training must form 30/06/05 part of the induction of all new staff for the safety of service users. Measures to eliminate the H54 S12203 Brendoncare Alton V226549 Version 1.30 Page 23 wedging of fire doors must be 160505.doc taken for the safety of service users. 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 Good Practice Recommendations Brendoncare Alton H54 S12203 Brendoncare Alton V226549 160505.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor- Overline House Blechynden Terrace Southampton Hampshire National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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