Inspection on 10/04/08 for Brentry

This inspection was carried out on 10th April 2008.

CSCI found this care home to be providing an Adequate 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

Brentry 16/04/09

Brentry 25/04/07

Brentry 01/09/06

Brentry 03/02/06

Brentry 14/07/05

Brentry 16/02/05

Brentry 12/08/04

Brentry 03/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brentry Knole Lane Brentry Bristol BS10 6GH Lead Inspector Sandra Garrett Key Unannounced Inspection 09:30 10 & 11th April 2008 th 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 Brentry DS0000035568.V361154.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. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brentry Address Knole Lane Brentry Bristol BS10 6GH 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) 0117 9038934 0117 9038936 Bristol City Council Mrs Jean Kathryn Blackmore Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 40. 25th April 2007 Date of last inspection Brief Description of the Service: Brentry House is a care home registered with the Commission for Social Care Inspection in the Older Persons category. Bristol City Council Adult Community Care runs the home and it can house 40 people. The home is arranged over two floors with a lift. All rooms are single but none have en-suite facilities. It has large patio areas to the front and rear of the home. The home is largely accessible for disabled older people and their relatives, and work to improve access further has been carried out. Recent additional funding from the Department of Health has been given to build a conservatory at the side of the dining room and work has recently started on this. The current fees payable are £460 per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are assessed by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk Brentry DS0000035568.V361154.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 this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was the first key inspection since April 2007. Before the visit, all information the Commission for Social Care Inspection (the Commission) has received about the service since the last inspection was looked at. These included: care records, complaints, staff rotas, training records and activities records. The last independent quality assurance survey report done in July 2007 was also looked at. We also visited the home just before this inspection to carry out our own survey and gained the views of 12 people living there. Comments from this are included throughout the report. What the service does well: What has improved since the last inspection? Eleven out of thirteen requirements made at both the last key inspection and a following pharmacy inspection were met at this visit. Much work had gone into making sure records such as contracts, staff photographs, some care records, medication, activities, staff training and fire safety records were in place, up to date and had the right information. This makes sure the home meets the needs of people living there and that they’re kept safe and protected. The home was exceptionally clean at this visit and smelled fresh and pleasant so that people have a comfortable place in which to live. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 6 Five out of six good practice recommendations had been adopted that included: - Keeping accurate care records during the assessment period, that showed the home is the right place for a person, - Re-doing of menus to include peoples suggestions for meals they would like, - More thorough checking of water temperatures to make sure they meet peoples needs and: - Improvements in medication record keeping that showed people are kept safe from risk. What they could do better: Two requirements from the last inspection were moved forward: One of these was about making sure a written care plan is put in place following an assessment period. One person had been in the home for several months yet still had no care plan in place. Therefore not all her/his needs may be picked up and met. Further, although the assessment highlighted a risk of falls no risk assessment was in place for this. Although staff hours have been increased there is still an issue about numbers of staff available at weekends. People living at the home have the same needs at weekends as during the week. Therefore the same number of staff must be available to meet those needs. Both these requirements are moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken and a warning letter has been issued to the registered provider. One new requirement was made about medication: One or two people look after and take their own medication. Nothing was seen on care plans about this or about any help they might need. A good practice recommendation was also made to make sure that new supplies of medication for people self-medicating are written on their medication administration sheets. They should then sign to say they have been given the supply. This will make sure staff can keep a record of medications given and people will be sure of getting the right medicines when they need them. Other good practice recommendations made at this visit were: Information displayed for people to see should be checked regularly so that it’s still current and doesn’t say different things. Information seen on notice boards and around the home at this visit was confusing and not clear, that could have an effect on people, particularly those with any degree of dementia. Staff should continue to have clear Equalities and Diversity training so that they are clear about not discriminating against people, particularly in writing of care records. Further, staff should have team building sessions to make sure they work together effectively as a team for the benefit of people they care for. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 7 The manager should have a clear action plan for picking up and dealing with all comments from the home’s own quality assurance survey report so that people can be confident their comments and concerns will be dealt with. 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. Brentry DS0000035568.V361154.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 Brentry DS0000035568.V361154.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): 1,2,3 &4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being given clear information about their rights, responsibilities and fees they have to pay, when they come into the home. Clear and detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. EVIDENCE: A requirement from a previous ‘thematic’ inspection (an inspection done to focus on one area of a service and looked at as part of a nationwide theme), was followed up at this visit. The requirement, that was about giving people information about their rights, responsibilities and the fees they have to pay, was met at this visit. The manager had put in place a file that held each person’s contract. All were looked at and included: Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 10 Rights and responsibilities, Room numbers Person responsible for paying the fees and: Each individual amount payable. All were signed either by the people themselves or their relatives. People also have a copy of the contract that they keep in their rooms, together with the service users guide and their care plans. However, six out of twelve people that took part in our own survey done just before this visit, said they had been given information about the home before they moved in and had signed a contract. The other six said they hadn’t. Comments about contracts included: ‘My daughter did all the paperwork’, ‘I don’t remember’ and: ‘I can’t remember that far back’. Comments about information given to them included: ‘When I came here to look around the atmosphere was lovely and it still is now’, ‘I was in hospital and was just dumped here’ and: ‘I came here after being discharged from hospital’. We looked in detail at three peoples care records. All had social work assessments or assessments done by people qualified or experienced to do them. Those that had social work assessments also had a basic care plan from which the home’s care plan is started. These covered needs that were known before people were admitted. From the assessments care plans had been developed for two out of the three people. One person had come into the home and her/his circumstances were such that the trial period had been extended. This person had a clear social work assessment and care plan but no care plan done by staff at the home. Please see Standards 7 –10 for more about this. We followed up a requirement about making sure that the ability to meet peoples needs is confirmed in writing. We saw that care plans drawn up at the end of the trial period were all signed by a staff member and the person themselves or their relative. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of care plans that identify assessed needs of people staying at the home for longer than four weeks, puts them at risk of not having those needs met. Further, lack of proper review during a longer stay may mean not all needs will be picked up. Failure to risk assess a likelihood of falls following care assessment information about this may mean people aren’t kept safe. People living at the home are looked after well in respect of their healthcare and medication needs. However peoples ability to manage their own medication isn’t always recorded that will make sure they are kept safe. Being treated with dignity and respect benefits people living at the home. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 12 EVIDENCE: We followed up a requirement from the last visit that had several parts to it. These were to do with making sure care plans properly record actions to help someone with eating difficulties, putting in place risk assessments for falls and making sure that care plans are looked at regularly. Two out of the three parts were met. One person had become unwell and had lost weight. Since s/he had come to the home weight records had been kept regularly. These showed that s/he had lost a little weight but that the GP had been called because of the person’s ill health. This was the reason for the weight loss and daily records showed the care being given during the period of illness. Another person had difficulties swallowing and needed a soft diet. This was recorded together with food supplement drinks given regularly to help keep weight up. The person was being weighed regularly and any losses reported to the GP. Staff were recording the person’s food intake and records were quite precise about what s/he had eaten and drank. The person had risk assessments for choking and malnutrition associated with her/his swallowing issues. Care plans showed that they were being looked at monthly and this was recorded on separate sheets. Monthly checks were seen for each person’s care plan we looked at. Where changes were needed these were properly recorded. From the home’s own quality assurance survey report people and their relatives had commented on care plans i.e. ‘I have a care plan’ and: ‘my relative has a care plan that’s monitored regularly in full consultation with the family’. However, the person that had become ill had been admitted three to four months previously yet had no care plan. S/he had an assessment that gave lots of information about care needs, health and risks. The basic social work care plan covered personal care only and was brief. There was no care plan done by staff at the home at all. Further, the social work plan was found tucked away in the file and not easily available to staff. This meant it wasn’t clear if staff had picked up the person’s needs from the plan, nor any new ones since admission. Luckily, daily records gave clear information about the person’s health and continuing needs around this. We spoke to the person at the visit but s/he was too unwell to be able to say much about her/his needs. The social work assessment stated that the person was ‘susceptible to falls’. No risk assessment for this was seen, although one was in place for leaving the building that referred to ‘slips, trips and falls’. However this was while away from the home and not in it. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 13 Other peoples risk assessments were looked at and all were properly done including for use of oxygen and pressure areas. To the question in our survey ‘Do you receive the care and support you need?’ Eleven people said ‘always’ although one person said ‘sometimes’. Comments included: ‘Yes they really do look after me’, ‘I can’t grumble’, ‘They’re all lovely,’ ‘They always try but they are up against the council all the time’, ‘Yes I’m fine. They’re very good’, ‘They certainly look after me here’, ‘I get all what I need and more’ and: ‘Oh I think so, there’s no doubt about that. This is a good home, one of the best’. Healthcare records were good and well documented. A ‘medical information monitoring sheet’ was seen in each person’s records. This gave information about GP, district nurse and chiropody visits plus other healthcare issues. We asked people if they got the medical support they need. Eleven out of twelve people said ‘always’. Comments included: ‘Yes if I want it’, ‘I’m quite happy with my medical support, he’s not the best doctor but I get support from Southmead and Frenchay hospital’, ‘I take about 9 different tablets and painkillers but they don’t seem to do anything and I think it’s a bit much’ ‘Yes it’s very good’ and: ‘I’ve just got over a bug that left me having to stay in bed and the staff looked after me really well’. Two GP’s that visit the home filled in comment cards before our visit. These showed that GP’s feel staff have clear understanding of peoples care needs and their advice is incorporated into care plans. From the home’s own quality assurance survey healthcare scored 83 . Comments included: ‘I cannot speak too highly of the health care provided for my relative’, ‘immediate attention is given to any medical need my relative has’ and: ’Health care is good at Brentry House – my relative is visited by his GP of choice (two similar comments)’ We followed up requirements and good practice recommendations from an inspection done by the Commission’s pharmacy inspector in May ’07. We did a check of medication and found all four requirements had been met. Risk assessments for people that look after and take their own medicines were seen. Medication was stored properly in locked metal cabinets that are fit for the purpose. Medication administration sheets were all signed properly with no gaps. All medicines given to people were recorded and signed for and records kept that showed medicines received into the home were also signed for. Medicines controlled by legislation were kept properly locked within the main cupboard. The home had got a proper controlled drugs book in which to record Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 14 giving of these types of medicines. All were checked and found to be correctly recorded with the right number of tablets left and signed by two staff. However one person had died and controlled medication wasn’t in the cupboard, although her/his other medication was. The assistant manager said that the district nurse had taken the medication to destroy it but no record was seen of this. As this medicine is a Class ‘A’ drug a record must be kept if it leaves the home. The manager was able to get a record of receipt from the district nurse by the following day and the nurse also signed the home’s controlled medication book. Comments about medication practice from the home’s quality assurance survey report included: ‘Staff watch to make sure I take my medication when required (five similar comments)’ and from a relative: ‘It’s clear that there are strict controls over the dispensing of medication and I have no concerns in this area’. For people looking after and using their own medicines (that included creams, lotions, inhalers and angina relieving sprays), nothing was seen recorded in their care plans about this. Further, new supplies of medicines given to them weren’t recorded or signed for. Therefore it wasn’t clear if the people had their medicines or even if they were taking them. A new requirement and good practice recommendation about these issues were made. Staff were observed talking to people and answering call bells quickly. They were very patient with one person who was clear about wanting her/his needs met promptly and wasn’t happy to wait. Staff showed understanding of the person and treated her/him with dignity and respect. From the home’s quality assurance survey report a person had commented: ’staff knock before coming in’. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to activities recordkeeping show that peoples needs for stimulating and enjoyable social and leisure pursuits are met. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Meals at the home are well managed and provide daily variation, good nutrition and social contact for people. EVIDENCE: A requirement about finishing a survey on activities that had been started before the last visit in 2007, was met. We saw results of the survey that showed what people liked to do, their individual hobbies, what they would like in the future and included trips and outings. Some people are able to do individual activities i.e. one person likes to go out dancing, another to a day Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 16 centre and yet another gets their own prescriptions from the local GP surgery. A list of activities and outings was seen on a notice board. These included: Trips to: a garden centre, Bristol zoo, supermarket shopping (at Cribbs Causeway retail centre) and a local wildlife centre, Singalongs, Poetry readings (the manager said they really enjoy this) and: Bingo. Further, a rummage box for people with dementia to use as an aid for memory and reminiscence was in place. Unfortunately this, although full of items, was in the ‘pamper room’ upstairs that no one was using. We recommended it be brought down and put in the lounge and staff could use it with people every so often. The pamper room is a new idea and is used for manicures, massage and reflexology. There’s also a hairdressing salon on the same floor. People said they liked the shopping trip and the home has use of a community bus that they can use to take smaller numbers of people on short trips. From the home’s record of activities we saw other activities including a coffee morning, quiz afternoon, ‘keep fit’, Valentine’s day entertainment, making easter bonnets and a board games day including Ludo. Comments were recorded that showed how many people took part and how they enjoyed the sessions. From our survey ten people said there were ‘always’ activities arranged by the home although one person said ‘usually’ and one said ‘never’. Comments included: ‘You make your own activity at this time of the year. Come the summer there will be plenty of trips and outings. I don’t really enjoy the bingo it’s not really my style’, ‘There are but I don’t do any by choice,’ ‘I know there are activities and things to do but I can’t take part at the moment because I get too breathless’, ‘I went to Asda last week and there’s a trip to Cadbury garden centre next week. Indoor activities are things like bingo and exercises But not that many turn up’, ‘I don’t take part in any activities at all’, ‘There are activities if you want and there are regular trips out. I needed to go to the bank yesterday and a staff member took me in her car after getting permission’, ‘I’m quite happy with my puzzles and my TV. I don’t really join in with the indoor activities but I enjoy the outings’, ‘I like doing my puzzles and watching TV. We went to Asda last week and we had a laugh. It was a fun day’ and: ‘You can do almost anything you want but I’m fairly active and I like doing my own thing’. One person told us she likes to fold napkins for the dining room. However from the home’s own quality assurance survey report daily living and activities only scored 75 . A number of positive comments were received from people and their relatives but equally a number of negative ones were seen. However the survey was done in July ‘2007 and from the comments at this Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 17 visit it was clear things had improved. An activity room has been set up that has equipment for making raffia items and painting. It was disappointing to note that a good practice recommendation about finding a safe way to help people to be able to do cooking for themselves as a meaningful activity, hadn’t been adopted. Several people had said they wanted to do this and the manager said she was still considering how to achieve it. We recommended that she speak to a colleague in another local authority home that had started very successful baking sessions that people enjoyed. The manager said she would do this and possibly take a group of people to the other home for a joint session. This would be good practice. Contact with the local community is a work in progress. The manager said that a local church group comes to hold a service each month and priests and vicars visit on request. The local library runs a mobile service at the home and a local school orchestra visits to play for people. A new conservatory is being built at the side of the dining room that will give people more of an outlook when it’s finished and more space for activities to happen. The activities survey also showed that some people don’t want to take part and that’s well accepted. People choose to stay in their rooms if they want and were seen listening to the radio or their CD’s, pottering about, doing jigsaws or watching TV. Staff said most people like to get up at the same time but can stay in bed as long as they want. One person told us that s/he is able to get up when s/he wants to and have breakfast later. People can choose where to sit and there are plenty of lounges and spaces on both floors for them. A good practice recommendation about re-doing menus to show that peoples suggestions have been included, was met. New menus were seen that were taken from suggestions at residents’ meetings. The cook had also talked to people about things they would like on the menu and was clear about describing peoples likes and dislikes. Menus were on good sized yellow laminated paper and included pictures of food that are easier for people with sight difficulties to see or those with dementia to understand. In one person’s records we looked at nothing about the person’s cultural needs was recorded. The person was described to us as not having any desire for cultural food and we were told liked an English diet. This was also recorded in the care plan. However no information was available to know if this was the case or not. The person concerned didn’t comment on whether s/he wanted cultural food but said s/he he was happy and content. Staff were observed helping people at lunchtimes and discreetly assisting people to eat. Two choices of meal were shown to people so that they could choose what they wanted. The plates were hot and the meals were hot and tasty. We asked people what they thought of food at the home. Comments were mixed however and included: Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 18 ‘I enjoy the food very much and there is a good selection’, ‘They’re all right’, ‘The food needs sorting out’, ‘Most times they are pretty good but other times they are not very nice,’ ‘Some like it and some don’t. I don’t like it very much. I don’t like chicken and fowl and things like that’, ‘Sometimes they’re not too bad’, ‘Goodness me they give you plenty of food’, ‘I get on OK with the food, there are certain things that I don’t like but they will always do me something different’, ‘I like the food’, ‘The food is lovely here’ and: ‘It’s good most days. There isn’t anything to complain about really’. These comments echoed those in the home’s own quality assurance survey report although food and drink scored highly at 83 . One person had commented: ‘cook seems to take command of everything – ‘never upset the cook’. She does sort out seating squabbles though’. We discussed the findings with the manager who spoke about a period of low morale and confidence among kitchen staff. This had improved following the kitchen reaching a two star health and safety inspection rating by the local authority health and safety officers. We were given copies of residents meetings over the past year that showed menus and meal choices are regularly discussed. From the notes of meetings people hadn’t complained about the meals and in fact comments were mainly positive. We spoke with the cook on duty. She told us that people do give her feedback on the meals and she would soon know if they didn’t enjoy their meal. She said she has a list of peoples likes and dislikes and is aware of individual portion sizes. We recommend that the manager continues to discuss quality of meals at residents meetings so that she can monitor whether their dissatisfaction with them increases or decreases. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good complaints management and recording makes sure people living at the home are confident in raising concerns about any aspect of their care. Arrangements for protecting people living at the home makes sure that they are protected from risk or harm as far as possible. EVIDENCE: The Statement of Purpose is available in the entrance hall for people to look at. This includes the complaints procedure that had recently been amended with our updated address details. We saw that people are reminded about their right to complain, at each residents meeting. Further, each person has a copy of the procedure in the files kept in their rooms. From our survey eleven out of twelve people said they know who to speak to if they’re not happy and all 12 said they know how to make a complaint. Comments included: ‘I don’t know (who to speak to) because it’s never been an issue’, ‘I’d talk to someone down in the office’ (three similar comments), ‘I have a good relationship with my key worker she’s lovely and I would talk to her about anything I needed to’ ‘I’d talk to the officer and she’s really easy to talk to’, ‘Yes there is the head lady and plenty of other staff to turn to’, ‘I could always ask but I’ve never needed to,’ ‘If I’ve got a complaint I’ll go straight away and Jean knows that’, Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 20 ‘Oh I do!’ ‘Oh yes I’d soon make a complaint if I needed to’ and: ‘I would but I don’t think that there will be a problem there’. We looked at the home’s complaints record. A number of compliments and letters of thanks were at the front of the file and showed relatives gratitude at the care people had received at the home. Since the last visit, five complaints had been made. Two of these were about poor care practice (one about an agency staff member that following an apology was withdrawn), two about poor meal experience and one about an odour from a sink and pipework that was later replaced. All had been dealt with quickly e.g. either by the same day or within seven days. All had details of whether the complaints had been upheld or not. One of the complaints about meals centred around running out of fish for a salad that resulted in one person not getting a proper meal. The manager had put in place a system whereby menus are taken around the day before and people asked what they want to eat. This makes sure cooks get the right quantity of food for each person, so that no one goes without. This is good practice. We followed up a requirement about making sure all staff have training in safeguarding adults from abuse. From the learning development training needs sheet and the quick guide to who has done the training, thirteen staff had been identified as needing to do it. We saw confirmation that staff had been booked on courses and nearly all had done it including new staff and night staff, who had done the training in 2007. We spoke to a group of staff who all confirmed that they would feel confident in recognising if someone was being abused and were able to say how they would recognise it and what they would do about it. This is good practice. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 21 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, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated and looked after, physically accessible and meets their needs. EVIDENCE: The home was very clean at this visit and free from odours that had been noticeable the last time we inspected. The first floor was much cleaner and staff were seen cleaning toilets and other areas. Rooms were properly decorated and none of them looked worn or shabby. Peoples bedrooms were all differently decorated and furnished according to how the person likes to live. Photographs of families and pets added to the homeliness of individual rooms. People were seen in their rooms or in the lounges. Some people enjoy being in their rooms doing hobbies such as Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 22 jigsaws, listening to the radio or CD or just pottering about. People talked to us about this and it was clear that they regard their rooms as ‘home’. As we toured the home we noted in a number of bedrooms that curtains had come away from their tracks. Some were broken although others just needed re-hanging. This gives rooms a feeling of being uncared for that could be felt by people living there. The manager said she’s setting up a ‘curtain programme’ e.g. giving a staff member the responsibility of going around to make sure curtains are all clean, hung properly and repaired if necessary. Notice boards around the home give lots of information about what’s going on, the programme of planned activities and other items of interest. However, some of the notice boards could do with being brightened up e.g. with photographs of activities or events that people have enjoyed. To the question in our survey ‘is the home fresh and clean?’ ten people said ‘always’, one person said ‘usually’ and one person said ‘never’. Comments about cleanliness were mixed: ‘They have the cleaners here everyday so it’s pretty good’, ‘Some of the girls do well but these agencies aren’t keen on pushing themselves. We’ve got two or three of our own and they’re quite reasonable’, ‘I have a men’s and ladies toilet right outside my room and they’re filthy. I can smell them from my room’, ‘They come round daily and I’d soon have something to say if they didn’t anyway’ and: ‘I like to do my own bit as well, being as it’s my home’. One person commented on not being able to open the window wide enough. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate numbers of staff aren’t available at weekends to meet peoples’ care and social needs or match their dependency levels. However, progress with training in National Vocational Qualification in Care and other care issues makes sure people are looked after properly. Improvements in keeping of staff records makes sure people are protected. A continuing commitment to training staff in Equalities and Diversity issues is needed to make sure people living at the home aren’t discriminated against and staff work as a team. EVIDENCE: To the question in our survey: ‘Are the staff available when you need them?’ comments were mixed: ‘Yes I think so although they’re pretty busy all the time’ (two similar comments), ‘There are enough staff for what I want anyway’, ‘Yes there’s always staff about’, Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 24 ‘Not really but I can’t do much about it’, ‘There are in the office sometimes’, ‘Yes I think there are. I ring my bell if I need to and they always get to me quite quickly’, ‘It gets a bit hectic at certain times of the day and there seems to be less staff at weekends’ and: ‘There’s no doubt about it. All I have to do is ring my bell. I don’t think you would do any better if you were staying in the grand hotel’. We followed up a requirement made at the last visit about weekend staffing. Following this inspection the team manager for the home told us that extra hours had been agreed. However,from our survey, looking at the rotas and talking with staff it was clear the requirement hadn’t been fully met. We discussed this with the manager who said she had found there was a problem with the rota that every few weeks allows for less staff at weekends. However, staff told us that there are less staff on in the evenings at any weekend and that they always feel they’re ‘working against the clock’. In general staff said they also feel there’s not enough of them, particularly if people need more help because of greater levels of dependency. They went on to say that because there aren’t enough staff they don’t have time to spend with people that are ill or just to spend quality time with someone. They also spoke about key time (spending one to one social time with individual people) yet they always find that they’re saying ‘I’ll be back in a minute’. Because of all the above the requirement is therefore moved on with a short timescale. Failure to meet the requirement could lead to enforcement action being taken. Staff said that they have regular staff meetings. They said that they can speak freely to the manager about any issue and she encourages them to voice their opinions. They also said they do work as a team but there is a lot of ‘bickering’ between them that also has an effect on their work. This was also raised in comments we got back from staff surveys that we sent out before this visit. We saw an entry in the home’s communication book that a meeting with some staff was held because of issues of ‘not pulling their weight’. We recommend therefore that thought is given to having a team building session that has been successful in another home. This will help raise staff morale, reduce the bickering and improve team performance. Progress with National Vocational Qualification in Care training continues. From the Annual Quality Assurance Assessment (AQAA) sent in before the visit fourteen out of twenty-three staff have NVQ at Level 2 or above. One person is working towards it. This means that the home has reached the minimum recommended number of NVQ trained staff and is good practice. A requirement made at the last visit about making sure staff members had clear and up to date photographs in their files was met. Each file looked at had Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 25 a photograph except for one who is on extended leave. The manager said a new one would be taken when the staff member returns to work. A requirement had been made at the last visit about recording training done by each staff member. We looked at training records. These showed improvement in recording of sessions attended by staff. The learning development needs sheet is a checklist of what individual staff need and the numbers to be booked on to training sessions. Training needs included: medication training for management staff, moving and handling for ten staff and Equalities and Diversity foundation training for all staff. We had noted from the staff survey and reading peoples daily records, that there are issues of staff not being fully aware of disability or race discrimination. Only one staff member said she had done the training that she said she found useful and thought provoking. Other staff hadn’t done it at all. The manager discussed an issue of possible discrimination between staff members that she is taking action to resolve. The range of training staff had done was wide. Some of it was essential e.g. First Aid, safeguarding adults and moving and handling. However other more specialist training had been done including: Activity provision from a person-centred approach (meaning activities that help people with dementia to take part in those that are meaningful to them), Working with specific types of dementia, Working with people with speech difficulties and: Alcohol and the older person. Staff said they found these sessions enjoyable and domestic staff had been included in some of them, as all staff need to know how different types of dementia affect people and people with dementia may not be able to distinguish care staff from others. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 26 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): 31,32,33,37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A trained and experienced manager, who understands peoples needs and the inspection process, makes sure they are well cared for. Failure to use an action plan following quality assurance surveys, means peoples views of life in the home aren’t used to help change things, that will benefit them. Peoples health and safety is promoted by clear policies and procedures that keep them safe. EVIDENCE: Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 27 The manager of the home, Mrs Jean Blackmore, transferred to Brentry from another local authority home a year ago. Mrs Blackmore is trained to NVQ Level 4 and also holds the Registered Managers Award. She is experienced and has a consultative, open and approachable style. Staff confirmed this saying that they like and get on with her and that she ‘does a thorough job’. Evidence we saw showed that Mrs Blackmore has systematically improved records held in the home, particularly those that requirements were made about at the last visit. A comment from the home’s own quality assurance survey report sums up the management of the home: ‘I feel Brentry is run very professionally with a very approachable management team – they are never to busy to speak to you (two similar comments)’. People living at the home also commented on the manager: ‘Yes Jean is the one,’ and: ‘Jean is the head lady here and she’s very nice’. We used the home’s own quality assurance survey report to gain more evidence of how people enjoy life at the home. From our discussions with the manager it was clear that she had taken action on issues raised from it e.g. around activities and meals. However there were other comments that needed to be followed up, particularly about care practice, environment and money. The manager didn’t have an action or development plan to deal with these issues and it could mean peoples concerns won’t get resolved. We therefore recommend that the manager develops this for the next survey. Records generally were good. Care records were largely written in a respectful way and gave information about the person themselves and how they live in the home. Several staff had done effective recording skills training and this showed in the daily records. However when touring the home we found a lot of confusing or contradictory information that could make people with some degree of dementia or cognitive impairment (meaning their ability to think and reason for themselves) even more confused. Examples included: - Two copies of the Statement of Purpose were on display. One was the ‘old’ copy and one had been re-done with newer, up to date information. For anyone reading the Statement it wasn’t clear which was which or which was the right one, - Two notices about Bingo were seen on the same noticeboard. One said a day and time but the other one said the same day, different time. Therefore people wouldn’t know the right time for the game to start, - Menus for the week were displayed outside the dining room. However on looking at the menus and by being told what was for lunch, we found the information contradictory. In fact we found that the wrong week of menus was displayed so for every day people thought they were getting one meal choice but were actually getting another! By the second day all were put in order. However we recommend that the manager makes sure that all notices are checked around the home regularly. This will make sure they’re right so that people don’t become more confused if they’re not. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 28 We looked at health and safety records and followed up one requirement about frequency of fire drills and a good practice recommendation about random checking of water temperatures. The manager had done a new fire safety risk assessment in line with the new Regulatory Reform (Fire Safety) Order 2005. The Order stated that fire drills should be done at six monthly intervals. We looked at the home’s logbook of fire safety procedures. This showed that three drills had been held in the past year, two of which were planned. The records showed the number of staff attending and the length of the drill. The records also showed that fire safety officers had carried out an inspection that was satisfactory. Fire evacuations were also discussed in a residents meeting held in September ’07 with apologies for any disruption. The good practice recommendation was about checking of water temperatures in more than one bedroom and that people should be consulted about the water temperature. We saw that temperatures are being tested in a variety of places randomly so that a more accurate record of temperatures are recorded. However, we couldn’t see any evidence that people had been asked about the water temperature. We saw from the records that some in peoples individual washbasins were low at 35-37°c instead of 43°c as recommended. The manager said that there were problems with the heating system which is old and shared with a respite care service next door. Contractors were regularly visiting to try and resolve the problem. We also saw from the communication book that the water temperature was recorded above 50°c in one area in February‘08. The contractors were again called in to remedy this. The manager also called the contractors in at this visit to try and raise the temperature in peoples rooms. Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X X 2 3 Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1)(2) Requirement For every person that stays at the home for longer than a four week trial period, a written plan as to how the service user’s needs in respect of health and welfare are to be met must be put in place and kept under review. This will make sure that all care needs will be picked up and properly met. Where care assessments clearly show that falls are likely, a falls risk assessment must be put in place and regularly reviewed. This will make sure people are kept safe from risk of harm. 2. OP9 13(2) Timescale for action 31/05/08 (Timescale not met from April 2007 inspection) 3. OP27 18(1)(a) People that manage their own medication must have this clearly recorded in their care plans, with actions staff need to take to assist them with it. Staffing levels must be available in sufficient numbers at weekends as well as during the week. Rotas must be amended to show this is happening. This will make sure peoples needs DS0000035568.V361154.R01.S.doc 31/05/08 31/05/08 Brentry Version 5.2 Page 31 can continue to be met. (Requirement partly met but Timescale not met from the previous inspection in April 2007) 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 OP30 Good Practice Recommendations All Staff should have training in Equalities and Diversity particularly focussing on disability discrimination. This will make sure people aren’t discriminated against in care records on the grounds of their mental health or physical abilities. Further, staff should have team building sessions to make sure they are committed to caring for people from a united approach. The manager should develop a clear action plan to follow up any comments from the home’s own quality assurance survey report. This will make sure peoples comments will be taken seriously and action taken to resolve any issues for them. Information displayed around the home should be checked regularly to make sure it’s still current and not giving contradictory messages. This will make sure people are clear about what they read and won’t get more confused about what’s happening in the home. 2. OP33 3. OP37 Brentry DS0000035568.V361154.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Brentry DS0000035568.V361154.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. 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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