CARE HOMES FOR OLDER PEOPLE
Brentry House Knole Lane Brentry Bristol BS10 6QH Lead Inspector
Sandra Garrett Unannounced 14 July 2005 09:30 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. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Brentry Address Knole Lane, Brentry, Bristol, BS10 6QH 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) 0117 9507567 Bristol City Council TBA Care Home 40 Category(ies) of Old age not falling within any other category registration, with number (40) of places Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 16/18 February 2005 Brief Description of the Service: Brentry House is a care home registered with the Commission in the Older Persons category. It is operated by Bristol City Council Social Services & Health (SS&H) and has 40 beds. The home is arranged over two floors with lift access and has large patio areas to the front and rear of the home. Brentry is largely accessible for disabled older people and their relatives and continuing work to improve access is being carried out. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection focussed on the varying degrees of dementia. At the time of residents all of whom have either a diagnosis because of symptoms of dementia. A range of were examined. Six residents and two visiting visit. care of older people who have this visit the home has seven of or behaviours that challenge care and administrative records relatives were spoken to at the What the service does well: What has improved since the last inspection?
Information for residents was seen in accessible formats on noticeboards. This had been a requirement at the last inspection. This has now made it easier for residents with visual impairments to be kept informed of events in the home. Whilst the requirement made at the last inspection in respect of repairing, replacing and making safe windows to residents’ rooms had not been met, progress towards it is being made TO IMPROVE SAFETY. The windows had been surveyed and a plan is in place to repair and re-decorate them. Window restrictors had been checked and where necessary, will be repaired or replaced. ALTHOUGH SUFFICIENT STAFFING HAS BEEN AN ISSUE IN THE PAST The home works to make sure staffing levels are appropriate to meet RESIDENTS needs. APPROPRIATE NUMBERS OF STAFF WERE ON DUTY AT THE TIME OF THE INSPECTION AND RESIDENTS WERE CLEARLY WELL CARED FOR. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 6 Residents spoken to didn’t complain about staff shortages that could affect their care. 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. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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 Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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) None of the standards covering admission were inspected at this visit. EVIDENCE: Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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 Limited progress has been made on improving arrangements to ensure personal care needs of residents are identified and met. Residents’ needs to have healthcare professionals involvement are promptly met. Care plans that are relevant to the needs of people with dementia need attention to ensure their needs are met appropriately. EVIDENCE: The home has seven residents all of whom have either a diagnosis of or behaviours that challenge because of symptoms of dementia. The home has in the past accommodated other residents with dementia who have later transferred to specialist homes that were better equipped to meet their needs. It was noted that a resident had recently been admitted from another local authority home for people with dementia as it was felt her/his needs were better able to be met at Brentry. However there was little evidence of clear or consistent advice and support from specialist services to meet the needs of residents with dementia. It was clear that residents with dementia are cared for appropriately at the home on a daily basis. Basic personal care needs are met according to
Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 10 individual care plans. However information about the meeting of more specialist needs in respect of memory, behaviour, routines of daily living and appropriate activities (by getting advice and support from dementia care organisations), was not clearly available. Three care plans of residents with varying degrees of dementia were examined. Care plans in general were holistic and detailed. Residents or their relative had signed the plans and their comments were included. Some progress had been made to updating and amending care plans when situations change. However one care plan though reviewed and amended was not clear enough in detailing how assessed needs in respect of mobility and memory were to be met. The resident’s relative also raised specific issues in respect of her mother’s health and mobility that she felt were not being met and no evidence in respect of this was seen on the updated care plan. This resident had also expressed a wish to smoke in the bedroom but there was no clear evidence of how the resident would be enabled to do so and how any risks would be managed. One resident’s daily records identified a potential for pressure sores on parts of her/his body. The resident required full care and it was clear this was being given supportively. No evidence was recorded of how pressure area care would be given apart from applying cream. It was noted that the resident had an appropriate pressure-relieving mattress and attention was being given to ensuring s/he wasn’t left sitting or lying on red/sore areas. However no record of the potential for pressure sores was seen on either the manual handling risk assessment, neither was a specific risk assessment for this in place. Another resident with dementia had identified continence needs on her/his care plan. The care plan gave insufficient detail as to how this need would be managed effectively. However a staff member gave a good explanation of how successful toileting is achieved for residents’ benefit. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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) 12 & 13 Regular contact with relatives and friends is welcomed and the home open to visits at any time. The home needs to pay attention to concerns raised by relatives to ensure they are acted upon. Activities are provided although advice should be sought on appropriate activities for people with dementia. EVIDENCE: Notices about activities and entertainments were seen around the home. Key worker records demonstrated that entertainments are provided. However one resident said that there is ‘not much entertainment’ and that no trips out had been organised since Christmas. There was little information or evidence to show that activities suitable for people with varying degrees of dementia are provided. Two relatives were visiting residents at the home. Both relatives were positive about the care of the residents they were visiting. Relatives and other visitors are free to visit the home at any time and take residents out. However relatives spoke of concerns about issues they said they had raised in respect of healthcare needs and room fittings for the respective residents involved. Relatives asked for clarification of what was happening about the
Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 12 issues but it wasn’t clear what outcome they could expect. Please see Standard 16 below for more information on this. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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 The system of recording and dealing with complaints needs improvement as there was no evidence that complaints are taken seriously. Relatives and friends are not confident their concerns will be listened to, taken seriously or acted upon. EVIDENCE: It took some time for the complaints record file to be found. On inspection concerns raised by relatives (see above) hadn’t been recorded as complaints. Further, complaints seen written in the home’s communication book hadn’t been recorded as such. Clear information in respect of any of the issues raised hadn’t been given to residents or their relatives. In the inspectors opinion complaints recording is not given a high priority in the home and it isn’t clear if residents’ or their relatives’ complaints are given serious consideration. A requirement in respect of this made at the last inspection is therefore continued. Failure to meet the requirement could lead to enforcement action being taken. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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, 21, 22, 24 & 26 Limited improvements to the fabric and accessibility of the building are continuing and necessary to ensure residents safety and comfort. Cleanliness and hygiene must be improved on the upper floor of the home in order to give residents a pleasant and odour free environment to live in. EVIDENCE: The manager gave information about the requirement made to repair, replace or make safe all bedroom windows. No written plan had been drawn up and no information from property services in respect of the situation was seen. However the manager said that the windows had been surveyed a month prior to inspection and a plan is in place to: - Check all safety locks on windows and repair or replace where necessary - Window restrictors were checked regularly (done the day before inspection), - All windows together with fascia boards, are to be decorated and made good. The manager said there was no time frame allotted for the works to begin.
Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 15 A tour of the premises revealed the upstairs floor of the home to be dirty and untidy, with a strong odour of urine in one wing. This was identified in a room with carpeting that staff said was cleaned very regularly. However the repeated cleaning had not rid the room or surrounding area of the smell. Another room on the ground floor also had a similar problem with odour despite regular carpet cleaning. It was noted that all the toilet and bathroom doors are painted black. However toilets were not labelled and it was unclear how people with dementia or memory impairment would be able to find them. A good practice recommendation is made in respect of finding a way of identifying each toilet by an appropriate sign. An access officer from the City Council visited the home during the inspection to discuss the siting of an accessible parking space for disabled visitors. This is part of the Council’s ongoing commitment to improving disabled people’s access to care homes locally. The tour of the upper part of the premises occurred at mid morning and the manager said that staff had not yet had time to clean the area concerned. However following this inspection the inspector received a comment from a visitor to the home who said that s/he had found the upper floor to be in a similar state when s/he visited. A requirement was made at the last inspection in respect of the washbasin temperature in the upper floor Parker bathroom. It was disappointing to note that the temperature remained unchanged at this visit and very hot to the touch. However following a telephone call to property services department an engineer visited that same day, identified the problem and ordered a part that he said would be fitted the following day. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 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 & 30 Monitoring of staffing levels is sufficient to ensure that residents’ basic needs are met. However specific identified areas of need such as dementia care are not fully addressed EVIDENCE: Duty rotas seen showed the difficulty of maintaining a full complement of staff due to sickness and annual leave. The home relies on regular agency staff cover although the manager said that four domestic staff were scheduled for duty that day but one agency staff member was unable to work due to illness. The deputy manager gave information about the monitoring of staff levels i.e. by reduced numbers of residents, monitoring of residents’ assessed needs, monitoring the rota daily and covering of shifts by permanent staff. She also said that there are three care staff on each morning, afternoon and evening that in her opinion was sufficient to meet residents’ needs although if the need for extra staff was identified these would be provided by agency cover. Training records showed that some staff had done training in managing behaviour that challenges and some have had mental health training. However it was clear that no staff had done training in dementia awareness or care despite the percentage of residents in the home with dementia or confusion. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 17 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) 32, 37 & 38 The home is managed appropriately and ensures residents receive consistent quality of care. Care records have improved but need further attention to ensure regularity of recording takes place. Health and safety procedures and checks ensure safety and protection of residents. EVIDENCE: Both the manager and deputy manager were on duty during the inspection. Both gave clear information on subjects as required and demonstrated knowledge of the resident group and their care needs. Daily care records looked at in conjunction with care plans showed improvements in the way they were recorded that clearly showed the care given. However some long gaps were noted e.g. no record was made between 27 May and 3 July ’05 for one resident and between 21 February and 24 March ’05 for another. This made it difficult to know whether assessed needs had
Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 18 been met appropriately or how the residents had lived and enjoyed their lives during these periods. Health and safety checks including fire safety and water temperatures are carried out regularly and appropriately recorded. Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 19 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x 2 x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 3 x x x x 2 3 Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 Requirement Timescale for action 1 September 05 2. OP8 3. OP16 4. 5. OP24 OP30 15(2)(b)(c Care plans must be completely ) reviewed and amended when residents’ situations change. Records of meeting assessed needs, particularly in respect of dementia, must be maintained, documented and regularly reviewed 13(4)(c) Risk assessments in respect of pressure areas must be done where this need is identified and actions taken in respect of pressure area care must be recorded on individual care plans 22(3)(4) Any complaint received must be recorded using an appropriate method with evidence of investigation, timescales and outcomes for residents. The complaints records must be available for inspection at any time (not met from January 05 inspection 23(2)(d) Carpeting in rooms 2 and 25 must be replaced with a suitable and impermeable floor covering 18 Officers and care staff must (1)(c)(i) attend training on dementia awareness and care by a recognised provider 1 September 05 1 September 05 1 September 05 31 December 05 Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP4 OP22 OP37 Good Practice Recommendations Advice should be sought from specialists in dementia care to ensure the routines of daily living and activities needs of residents with dementia are able to be met Toilet doors should be repainted in a colour accessible for people with dementia and have an appropriate symbol on the doors to enable all residents to recognise them Daily records for each resident should be written at least weekly and be holistic and person-centred Brentry House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 22 Commission for Social Care Inspection 300 Aztec West Almondsbury Bristol BS32 4RG National Enquiry Line: 0845 015 0120 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 House D56_D05_S35568_Brentry_V238129_140705_Stage4.doc Version 1.40 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
