Inspection on 16/04/09 for Brentry

This inspection was carried out on 16th April 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brentry 10/04/08

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Brentry Knole Lane Brentry Bristol BS10 6GH Lead Inspector Sandra Garrett Key Unannounced Inspection 16th April 2009 10:00 DS0000035568.V374885.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Brentry DS0000035568.V374885.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 brentry.eph@bristol.gov.uk 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.V374885.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. 10th April 2008 Date of last inspection Brief Description of the Service: Brentry House is a care home registered with the Care Quality Commission 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 (from April 2009) are £488.16 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.V374885.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. Before the visit, all information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. Paperwork included: The Annual Quality Assurance Assessment (AQAA) filled in by the registered manager, sent to us together with notices of incidents affecting people living at the home. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. We also visited the home before the inspection to fill out our ‘Have Your Say’ surveys with people living there. This gives us an opportunity to find out what people think about the quality of care they get. Eight people filled in surveys and their comments are included throughout this report. During the visit itself we spoke with five people, the manager and assistant manager. Permanent staff were all at a team building session held elsewhere and agency staff were caring for people. What the service does well: The home is clean, well decorated and furnished and offers a good standard of accommodation. Mrs Jean Blackmore has been manager of the home for just over two years. In that time she has made improvements for people living there. Mrs Blackmore responds quickly to requirements and good practice recommendations and keeps us informed of any changes in good time. Satisfactory arrangements for people coming into the home make sure their needs are met. Staff that are suitably trained and experienced meets peoples’ specialist needs. They are looked after well in respect of health and personal care needs. Peoples needs for stimulating and enjoyable social and leisure pursuits are met. They have lots of choice with few restrictions and live in a relaxed atmosphere. The number of care staff trained to National Vocational Qualification at Level 2 or above, meets the recommended standard for giving good quality care to people in the home. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Complaints management must be improved following several complaints that weren’t dealt with satisfactorily by members of the management team. They should have training in how to manage complaints properly. People can therefore be more confident that any concern or complaint will be quickly dealt with and action taken to improve care. Management staff must deal with issues of poor care practice and staff behaviours in clear and systematic ways that show people are protected and are treated with dignity and respect. Where any incident that happens in the home is likely to have a negative effect on people living there, notices must be sent to the Commission in good time. Further, information must be given to the Commission about actions taken and outcomes of such incidents. People and their relatives/representatives will therefore be confident that they will be protected from risk of harm from staff that are aware of their responsibilities under regulation. Institutional ways of working need to be checked and stopped so that people are treated with dignity and respect. Some areas of the home need attention particularly one bedroom and communal areas. People should be able to enjoy living in a comfortable and well-kept home. Continuing work is needed to make sure the whole staff team is aware of responsibilities to people living at the home and to supporting the manager. Examples are included in the body of this report. In particular staff should Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 7 build on teamwork and caring for people in truly person-centred ways that puts them at the heart of everything that is done for them. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Brentry DS0000035568.V374885.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.V374885.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory arrangements for people coming into the home make sure their needs are met. People are looked after well in respect of their specialist needs by staff that are suitably trained and experienced. EVIDENCE: We case-tracked three peoples care. This means looking at all records associated with the person and tracking their care by talking with both them and staff caring for them. Records looked at included care assessments. These are done by social workers before a person comes into a care home. They include background information about the person’s life in the community, Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 10 cultural needs and a basic care plan. Any Equality and Diversity needs (this means finding out about peoples needs in relation to race, culture, religion, sexuality, disability and age and not discriminating against them in the meeting of those needs) are also picked up and actions recorded to help meet their specialist needs. The assessments are then used to build a new care plan in the four-week trial period that each person is offered. We saw that assessments had been properly used to plan care for people and needs had been transferred into care plans done during the four-week trial period. One person had come to the home some months before but took time to settle. Regular assessment reviews had been held and the person’s comments and wishes noted. Staff are given induction when they first start their job, followed by essential and good practice training to help them meet peoples needs. Where people have specialist needs i.e. due to their mental health, behaviour or physical impairments, training is given to staff to help manage any issues. The home is accessible to older people with physical impairments and to disabled visitors. Standard six wasn’t inspected as the home doesn’t provide intermediate care for people. Brentry DS0000035568.V374885.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are looked after well in respect of health and personal care needs. The giving and signing of medication may not keep people living at the home safe. Continuing use of institutional practices doesn’t make sure people are treated with dignity or respect. EVIDENCE: We asked people if they get the care and support they need. People told us: ‘I’m looked after magnificently here and the staff are very efficient’, ‘Yes I’m looked after well. I’ve got no complaints with that. I get what I want’, ‘I have a good time here. We have a laugh and the staff look after me very well’, Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 12 ‘Yes I’m looked after very well. They’re all nice staff and I get on really well with my key worker, she does all sorts for me’, ‘More or less I do’, ‘I can’t fault the carers’, ‘Yes we get all our meals and everything here. They’re quite good’. However one person commented: ‘They dumped me in here after a stay in hospital and that was years ago. It was nice then it’s gone a bit down hill now’. We also asked if people feel they get the medical care and support they need. Comments included: ‘I get it if I need it and I have needed it recently as I haven’t been very well’, ‘The staff arrange all my appointments and transport because I have to go to the BRI regularly’, ‘I get all my tablets at meal times and I can have a doctor when I want one. I’m having treatment now’. ‘I do if I ask for it’ and: ‘I’m sure I would if I needed it but I haven’t had any yet as I’ve not been here long enough’. We looked at three peoples records in detail. Care plans are written in personcentred ways from the viewpoint of the person being cared for. Therefore statements such as ‘I have’ ‘I need’ and ‘I would like’ make the plans more personal and help to understand peoples needs and wishes. Care plans were detailed and included full information for staff to be able to care for people and meet their needs. Clear outcomes for people were recorded. Needs covered included personal care and hygiene, diet, health care needs such as chiropody and mouth/dental care, emotional needs and leisure interests, mobility and continence among others. Where possible people had signed their plans or commented on them at the review stage. We spoke to one person that had a very clear and detailed plan. While we were talking to her we noticed that she had very chipped nail polish. She told us she had no polish remover and had to keep chipping away at it. It’s our view that the person’s key worker or other care staff members should have noticed this and removed the polish, giving her a fresh manicure if she wished. We told the manager and later heard a staff member asking her if she wanted the polish removed. Monthly review sheets were seen together with six monthly reviews. Risk assessments for moving and handling and individual issues such as use of oxygen and smoking were also seen in peoples files. Records of healthcare visits by GP, district nurses, psychiatrist, community mental health nurses, chiropodists etc were all recorded. Following a letter from one doctor we saw that an intensive programme of support had been put in place for a person. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 13 Whilst we saw a clear risk assessment for a person who smokes heavily we noticed that actions to keep her/him safe in his room hadn’t happened. We advised the manager to get equipment that would make the bedroom safer and the assistant manager ordered it immediately. We observed medication being given out at lunchtime. We saw that this took some time and the person handling it signed for the medication before giving it to the person concerned. This isn’t good practice as people could decline to take it yet it has already been signed for. This practice should therefore stop. We advised the manager to check medication practice regularly. We saw and heard care staff helping people and interacting with them. Attitudes were respectful and staff clearly know peoples individual characters and needs well. However we noted some institutional practice i.e. putting plastic aprons commonly used by staff when doing care tasks, on people when having their lunch. Further, we saw racks with boxes of disposable latex gloves situated outside the toilets. This gives an institutional look and feel to the home. We suggest tabard style aprons be bought for people that need them and the removal of the racks and sited in more discreet places. This will make sure people are treated with dignity and respect. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs for stimulating and enjoyable social and leisure pursuits are met. However doing regular activities that people have asked for and enjoy would give them a better quality of life. Few restrictions placed on people living at the home gives them lots of choice in a relaxed atmosphere. Failure to display menus regularly may stop people from seeing what meals are available to them. Further, over use of high fat ingredients and meal choices may not keep people fit and healthy. EVIDENCE: We looked at copies of five residents meeting minutes. The meetings had been held between April 2008 and April 2009. Activities had been regularly discussed and people had been able to say what they would like. We noticed however that in November people had said they wanted a return of Bingo. A Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 15 feedback sheet had been given to people after that meeting that said this would happen. However in April ’09 it was recorded again that people would like Bingo to re-start. Where people request activities these should happen as soon as possible so that they get stimulation and enjoyment from them. We also saw photographs on notice boards of activities such as baking that people had taken part in. They told us they had enjoyed this as an activity but it hadn’t happened ‘for months’. We also saw that: ‘a new activity timetable is being put in place – this will be up and running by the end of April’. In our view people at Brentry are asked regularly and are very clear what they would like – in all sorts of areas, but there is a delay in following up their wishes. This could deny them real choice and enjoyment. Comments about activities were very mixed. They included: ‘If I want to there is plenty to do’ ‘They used to do a lot of trips out but not any more they haven’t got the staff’, ‘I’m never bored I’ve got loads to do. I enjoy my drawing and painting and I enjoy some of what they put on here’, ‘They put music on and that sort of thing and they get entertainers in regularly as well’, ‘I have loads to do they provide entertainment here and I have a really good social life’. However others commented: ‘No there is nothing to do’, ‘No there isn’t anything to do’ and: ‘No there is nothing here to do’. We did see staff playing ball with people in the lounge and wartime songs were played after lunch for people to sing along to. On one of the days of our visit we also heard a local community group singing hymns with people in the main lounge. They then went along to one person’s room, as s/he wasn’t well enough to come to the lounge and sang to her/him there. S/he later told the group leader s/he had been delighted with this and ‘would remember it for the rest of my life’. We asked people about the quality of meals at the home. Comments were mixed: ‘It depends on the cook really because some are better than others but there is always plenty of choice’. ‘Some of it’s all right but most of the vegetables are hard and when we have stew the meat is tough, the cooks don’t seem to care’, ‘I don’t grumble. I enjoy all my meals and I’ve got a pretty good appetite’, ‘Yes the food is very nice’, ‘The food is really nice since the menu has been changed and the food is now a lot hotter since a few of us complained about it’, ‘The food is reasonable’, Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 16 ‘It’s not bad although I wish we could have some onions in or meals as we never have any’ and: ‘I’m not a lover of the food because I’m not one for cooked dinners and that is what there is a lot of here’. We saw from residents meeting minutes that they are asked about meal choices regularly and their wishes are followed up. The range of four weekly menus used to be displayed near the dining room so that people could see what was on offer each week. This has now stopped and the daily meal is put up on a whiteboard in the dining room. This is high up on the wall and may not be accessible to everyone particularly those with sight difficulties. We discussed this with the manager. The cook also told us however that staff go round to people and ask them what they want for the next day. She said this was working well. We saw the sheets and that people had asked for rice pudding even though this wasn’t one of the menu choices for the day! Menus showed a wide variety of meal choices particularly at lunchtime. The menus included a vegetarian option as well as a soft diet one on each day. This is good practice. However, in common with other Bristol City Council homes the menus – of traditional English meals – show a high level of red meat or higher fat meats such as pork and lamb. Further, looking across each day, people get a high fat diet by having a cooked breakfast if they want it, a high fat lunch, a cooked tea followed by a second dessert of the day and sandwiches, crisps, biscuits and cakes at suppertime. As older people are less active and likely to be more at risk of heart disease or strokes we recommend that menus should be looked at to offer lower fat, healthier meal choices alongside peoples own choices. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of proper attention to handling complaints in a timely manner fails to meet peoples needs for action to be taken over them. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. EVIDENCE: From our survey people had commented about feeling able to raise issues of concern or make formal complaints. All eight people that filled in our survey said they knew how to complain. Comments about who to speak to if people are unhappy included: ‘I’d go down to the office and they would sort anything out for me if I asked them to’, ‘I know I could speak to Jean or someone down there’, ‘Yes but I’m certainly not unhappy though’, ‘I would speak to anyone here they are all friendly and approachable’ (two similar comments). However one person said: ‘I’d talk to my family; I wouldn’t talk to the staff unless I really needed to’. About knowing how to make complaints people told us: I’ve never made one but if it was something serious and I felt it necessary I would of course’, Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 18 ‘If anyone makes a complaint it would usually be looked at and resolved if possible’, ‘Yes but I have nothing to complain about’, ‘Yes I made a complaint about the food not being hot enough and it got dealt with straight away’, Yes I do and I would’, ‘Yes I would if I needed to’ and: ‘Yes I would if I needed to. Whether something would be done or not I don’t know’. We saw that concerns and complaints had been discussed at a residents meeting in April ’08 with a reassurance from the manager that ‘all complaints and concerns will be responded to however small or big’. Five complaints had been recorded since the last inspection Complaints had been made between April ’08 and February ‘09. All were about poor care practice. Of the five, management team members had recorded three of them but hadn’t followed them up by investigating or taking clear action. Instead the manager had taken up the investigation and recorded her findings. This meant for two of the more serious complaints a delay of two months passed before letters were written to the person complaining. Of the complaints recorded one was about staff attitude. One had no details as the person complaining was reluctant to do so, but this didn’t make it clear what the poor care practice was. (However we did see that the issue of poor care practice was discussed at a care staff meeting shortly after one of the complaints had been made). We followed complaints up with the manager but again records failed to clearly deal with staff attitudes particularly around Equality and Diversity issues. Again Equality and Diversity issues were discussed at team meetings but actions taken didn’t go far enough to stop them from happening again. We discussed the above with the manager who couldn’t explain why management staff had failed to deal with complaints quickly. The manager had previously done training in complaints management and has a clear track record in dealing with them in a proper manner. We suggest that any member of the management team receiving complaints should be able to deal with them and not wait for the manager to do so. This could delay actions being taken and people complaining being given prompt information about them. Further, records must show that complaints about poor care practice are dealt with swiftly and properly by staff training and proper supervision. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 19 We also saw from staff meetings that safeguarding adults from abuse issues had been discussed. The manager had discussed what the term ‘vulnerable adult’ means and pointed staff to a folder in the office that had information about definitions and case studies that staff were encouraged to read. We saw a list of training done by the whole staff group. This showed that all had done safeguarding adults from abuse training within the last year or two years. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well maintained home that is accessible to them and meet their needs. However not all parts of the home are fresh smelling and pleasant to live in. Failure to change the décor in peoples rooms when it’s needed doesn’t give them a comfortable or good quality of accommodation. EVIDENCE: A lot of refurbishment was going on at the time of our visit. Carpeting throughout the upstairs corridors was being replaced and some redecoration had been done. From the AQAA that the manager had filled in before the visit, we saw that a lot of refurbishment had been done or was planned. These Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 21 included redecoration of individual bedrooms, removal of unsuitable seating in both the dining room and a ground floor lounge and starting to build a new conservatory at the front of the home. However this has been stopped, as it will be too small. The AQAA also listed what could be done better. The manager had written: ‘further audit of communal areas/bedrooms with more updated furniture. Work to continue to upgrade the environment for the benefit of the client group’. We saw from residents meeting minutes that people had been consulted about the environment and had asked for plastic flower arrangements to be thrown out as they were old and gathered dust. This had been done. People had also asked for a trolley shop – e.g. items to be taken around to them as the permanent shop was inaccessible to them. They had also asked for a cat as pet for the home. It wasn’t clear from the minutes if this was being followed up and both issues had been raised more than once. We did however notice that despite refurbishment of several areas, some rooms still need attention. In particular one bedroom was in a poor state with dull brown wallpaper and lots of torn areas where pictures had been stuck on then removed. We recommended this room be redecorated to the choice of the person now using it. Further, the bar area looked ‘tired’ and the kitchen units to one side of it in need of repair. We followed up a good practice recommendation made at the last visit about making sure notices on boards were not out of date or gave conflicting information. We saw that all information was current. Photographs, details of activities and outings, copies of residents meeting minutes in accessible formats were seen pinned up on boards. The most recent inspection report was also displayed together with information about the new Care Quality Commission and its values. We saw lots of cleaning going on during our visit. Bedrooms were clean and smelled fresh. However, we noticed that the area in the entrance hall near the front door didn’t smell fresh at all and could give a negative impression on people coming in to the home or visiting. We asked people if the home is clean and hygienic for them. Comments included: ‘Sometimes the toilets are a bit of a mess but I only have to say and it’s sorted straight away’, ‘It’s kept as clean as possible’, ‘They clean my room every morning’, ‘Yes it’s very clean. They’re cleaning all the time’, ‘Yes it’s reasonable’, ‘Yes it’s very clean’ and: ‘Yes it’s kept clean’. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care staff that don’t work as a team, don’t take instruction from or support the management team and give poor standards of care, fail to meet peoples needs. Care staff trained to National Vocational Level 2 meets the recommended standard for giving good quality care to people in the home. Improvements in staff training and team building could help make sure people will be cared for properly and kept safe. EVIDENCE: We followed up a requirement made at the last visit about staffing levels particularly at weekends. The manager showed us the new rotas that will make sure weekend cover is the same as during the week. Unfortunately the rotas for the week we were visiting still showed lower numbers of staff on one of the weekend days. However the manager assured us this will not happen when the new rotas start. We saw that rotas and changes had been discussed at a full staff meeting in September 2008. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 23 We asked people in our survey if the staff were available to meet their needs. Comments were mixed about this: ‘I think there are times when they can be a bit short but they always come promptly when I use my buzzer’, ‘When I press my buzzer they come eventually but there is definitely not enough staff’, ‘Yes and they are all good workers here’ ‘I know it can be a bit short at times but we all understand’, ‘Sometimes but I don’t think that there are enough staff here’, ‘Yes there are but it makes me mad really that there are new staff in here every day because they use quite a lot of agency staff and not the same ones very often’ and: ‘I’m not sure really but I think they do want a few more staff but can’t get them’. From the home’s own quality assurance survey done in June 2008 staffing only scored 68 out of 100. Comments were largely good about permanent staff but less so about use of agency staff. Low staffing levels were commented on. We asked people if staff listen and act on what they say. Comments about this were mixed and included: ‘Yes they certainly do. They brought me up a hot lemon the other night when I was feeling a bit unwell’ and: ‘They listen but they don’t always act though. They use agency staff here that don’t give a damn although most of the permanent staff do. There are a couple of night staff that don’t give a damn either’. From our discussions with the manager, reading complaints, supervision records and minutes of staff meetings, we remain concerned that the whole staff team still don’t work well together to meet peoples needs or support the manager in her attempts to improve peoples quality of life. Complaints about poor care practice, failure to follow these up properly in supervision (together with discussions in team meetings about staff not responding well to instruction) and continuing issues about peoples clothing going missing, show that staff need to take more responsibility for their actions. From staff meeting minutes we noted constant reminders for staff to do things or refrain from doing them e.g. lack of recording of activities and reminders of roles and responsibilities. We saw from one particular staff meeting held in September ‘08 that the manager had written: ‘I am disappointed that our previous meeting did not appear to get the message across. The team seem to lack the ability to take responsibility for the role they have’. From our findings at this visit we would agree with the last sentence. From the AQAA we saw that of twenty-one staff, fourteen already have National Vocational Qualification in care at level 2 or above. Two staff are currently working towards getting it. This meets the National Minimum Standards recommended minimum of 50 of staff with the qualification in any care service. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 24 We followed up a good practice recommendation about training in Equality and Diversity and team building. We saw from training records that staff had done or been booked to do the general equalities foundation course. This is more of a distance-learning course using workbooks that staff do in their own time. However, we picked up a particular equalities issue around race and culture that came out of the complaints records. The staff member involved hadn’t done training in the specific issue but had simply done the general training that everyone else had. This doesn’t stop the issue from happening again and doesn’t give the staff member an opportunity to gain greater awareness of the issue. Following the good practice recommendation made at the last visit, it was good to find that staff were having team building sessions with a trainer from the Council’s training department during this one. The sessions were being held elsewhere and all staff were attending over three days. One of the management team gave us feedback about the session that she felt was ‘brilliant’. She said that she felt it had brought all the staff together in solving things. The manager also told us that she feels the team building has ‘shifted staff attitudes and got them on board, more motivated and organised’. This is positive and if staff all adopt the learning from the sessions they will have the ability to improve the quality of life for people living at the home and for themselves. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 36, 37 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the manager is trained and experienced, the management team and staff failure to support her doesn’t make sure people’s dignity, choices rights or property are respected. Whilst there are proper ways of checking quality of care for people keep them safe and protected in place, staff haven’t yet learned to take responsibility for their actions that will improve quality of care. Satisfactory management of peoples money makes sure they are protected from financial risk. Insufficient recording of supervision and failure to follow up unsatisfactory practice could lead to poorer quality of care given to people. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 26 Whilst care records include facts about people’s care, attention is needed to make sure they’re written regularly and reflect the overall quality of peoples lives. Failure to report events that could negatively affect people doesn’t make sure that action is taken to protect them from harm. Peoples health and safety is promoted by clear policies, procedures and records that show they’re kept safe. EVIDENCE: The manager Mrs Jean Blackmore is trained to National Vocational Qualification Level 4 and has the Registered Managers Award. She has recently done Leadership courses with the City Council and is welcoming and open to the inspection process. Mrs Blackmore keeps us informed of any changes and improvements in the home by way of regular letters to us. She has also developed a newsletter for people living at the home following comments made at residents meetings about wanting more information. We saw the first edition of the newsletter that included peoples birthdays, retirement of a staff member, the new administrator and a poem written by several people living at the home. From records we were able to see how Mrs Blackmore positively raises issues with staff about all areas of the work, but in particular quality of care, work routines and how she deals with complaints. However it’s our view that the management team could support her better. In particular, the deputy and assistant managers could do better at handling complaints, supervising staff, notifying us of events that could affect people and keeping records. Further, as written elsewhere in the report the whole staff team could do better at working together and supporting the manager in delivering good quality care to people. We followed up a good practice recommendation about the manager developing a clear action plan to follow up comments made in the home’s own quality assurance survey report. We looked at the survey that was done in June 2008. We also saw the development plan drawn up in September ’08. We saw from records and talking to people that the manager had taken up many of the issues raised from the survey. However we weren’t sure whether action was being taken on some of the others e.g. not having enough baths and missing laundry. We recommend that the manager follow up issues as soon as the report is received and clearly records her actions on all of them. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 27 Overall the quality assurance report showed that people have between 68 – 75 satisfaction with living at the home. The highest level was for management and administration (75 ) and the lowest was for staffing (68 ). It’s clear that work still needs to be done to improve the ratings for 2009, even though people and their relatives/representatives gave lots of good comments. We did a check of peoples cash looked after by the management team. All cash sheet balances were right and showed evidence of regular checking. A new system of making sure staff look after peoples money when they go shopping for them was in place. Receipts were attached that made it easy to see that the money was spent properly. We looked at staff supervision records. These generally happened regularly but there were some long gaps between sessions. the manager had dealt with staffing issues following complaints and properly recorded these. However they hadn’t been followed up. One person living at the home had raised an issue about staff with us that s/he wasn’t happy about. The manager knew of the issue and it was mentioned briefly in records we saw but clear actions weren’t recorded. We looked at a wide range of records as described above. In general records are properly kept, secure and available for inspection. However when we looked at peoples progress of care records, there were long gaps between entries. For one person records we saw gaps of between nine and fourteen days. Only one good ‘social’ record of the person enjoying entertainment was seen. The rest were brief and fact based. Where the person had been ill there was no follow up record to show that s/he was treated for it or improving. On the person’s key time sheet there was only one record and that was of her/him joining in with a group activity not one to one key time. We did a kitchen inspection. The kitchen was very clean and tidy. All foodstuffs were stored properly. Records of food, fridge and freezer temperatures were properly done with no gaps. Fridges and freezers were at the right temperatures. We saw a large box full of old records in the kitchen, yet very few in the file. The cook told us the box was for archiving. We had to find recent records from the box and advised the cook to keep at least one month of them in the file. The deputy manager later removed the box and archived it with others. Food temperatures were all satisfactory. The cook told us and we saw from residents’ meeting minutes, that there had been a problem with keeping food hot before it was served. We found this to be the case when we sampled lunch. The manager took immediate action to make sure the warming cupboard was checked so that food kept in it arrives on tables hot enough for people. Records of events that happen in the home either to individuals or because of something happening had been sent to the Commission as required under regulation. However we came across an incident that could have had a Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 28 negative or unsafe effect on people that hadn’t been reported at all. Neither had we been given follow up information about what was happening about the incident. We discussed the issue with the manager and the deputy manager who was on duty at the time of the incident. He said he had been busy on the day in question and had forgotten to do it. We also took the matter up with the service manager in charge of all Bristol City Council care homes. She very quickly gave us information and sent us correspondence confirming her actions. We checked health and safety records including fire safety. We saw records of fire training for staff held in August ’08. The fire safety risk assessment was full and detailed. The acting director of health and social care had signed it off. A record of only one fire drill held in April ‘08 was seen. However, a notice in the office said that further drills were planned for October ’08 and April ’09. One had been cancelled but the other had been held. We asked about this and the deputy manager wrote up the results of the drill while we were there. All other health and safety records were satisfactory. The fire alarm was tested while we were at the home and people were all told it was going to happen. Brentry DS0000035568.V374885.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 X X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X X 3 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 2 Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP16 Regulation 22 (4) Requirement Concerns and complaints must be investigated and resolved in a timely manner and investigation and actions properly recorded by the person receiving and dealing with the complaint. This will make sure people and their relatives/representatives are confident their concerns will be taken seriously. Notices of any incidents that negatively affect people living at the home, any investigation or action taken to stop them happening, must be sent to the Commission in a timely manner. This will make sure people are kept safe from risk of harm. Timescale for action 10/07/09 2. OP38 37 31/05/09 Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 31 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 OP10 Good Practice Recommendations Institutional ways of working should be checked regularly and action taken to stop them. Further, a clear system for dealing with missing articles of clothing should be put in place to stop it happening. This will make sure people are treated with dignity and respect. Where people enjoy group activities every effort should be made to continue them. This will make sure people get a good quality of life at the home by doing things they enjoy. Menus should be looked at to include lower fat or healthier choices across each day. This will make sure peoples wellbeing is maintained by a healthier diet. Management staff should all have training in how to deal with concerns and complaints. This will make sure that people will be confident that concerns or complaints will be dealt with quickly and properly. Room 19 should be redecorated in the choice and style of the person using it. This will make sure people live in comfortable, homely surroundings of their own choosing. Action should be taken to find the source of the unpleasant smell in the entrance hall and for deep cleaning or recarpeting of the area to be done. This will make sure that people have a clean and fresh home in which to live. Members of the management team should have training in developing supervision skills and proper recording. This will make sure that records show properly supervised staff care for people safely. Progress records about peoples care should be written at least weekly and include information about their quality of life at the home, not just meeting of care needs. This will make sure people get good quality of care that is DS0000035568.V374885.R01.S.doc Version 5.2 Page 32 2. OP12 3. OP15 4. OP16 5. OP24 6. OP26 7. OP36 8. OP37 Brentry regularly recorded. Brentry DS0000035568.V374885.R01.S.doc Version 5.2 Page 33 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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