Inspection on 25/04/07 for Brentry

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 10/04/08

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 6QH Lead Inspector Sandra Garrett Unannounced Inspection 09:30 25 & 26th April 2007 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.V337837.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.V337837.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brentry Address Knole Lane Brentry Bristol BS10 6QH 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 9507567 0117 9507575 Bristol City Council To be appointed Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2006 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. It has large patio areas to the front and rear of the home. Brentry is largely accessible for disabled older people and their relatives, and work to improve access further has been carried out. 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.V337837.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key or main inspection carried out over two days. The visit was to follow up requirements and recommendations made at both the last key inspection in September 2006 and a ‘themed’ inspection in January ’07. The themed inspection was done to focus particularly on information given to people who use the service, including fees and complaints. A number of people using the service and staff were spoken with at this visit. The former manager had just left to take up a new appointment elsewhere. Therefore an experienced manager from another local authority home is acting as manager until a new one is appointed. A range of records was looked at that included: care records, complaints, staff rotas, training records and activities records. The last independent quality assurance survey report done in September ‘06 was also looked at. We also visited the home just before this inspection to carry out our own survey. Comments from this are included throughout the report. What the service does well: What has improved since the last inspection? The home was very clean and hygienic at this visit. It smelled fresh in all areas. In particular the ground floor lounge carpet had been deep cleaned. That had been a requirement from the September ’06 inspection. People were seen using the lounge throughout the visit. From the themed inspection done in January this year two requirements and a good practice recommendation were met: the home has a clear complaints procedure based on the wider local authority one. Each person has a copy of Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 6 the complaints leaflet and other copies were seen about the home. From records seen complaints had been dealt with quickly, recording was good and showed clear evidence of investigation and outcomes for people who use the service. Each person has a file of information that they keep in their rooms. The files hold the complaints leaflet, a copy of the home’s Statement of Purpose and service users guide. Further, copies of residents meeting minutes are kept in the file so that each person is kept up to date with services available and any discussions and consultation. This is good practice. What they could do better: A number of requirements made at the September ’06 key inspection and also one from the themed inspection in January ’07 hadn’t been met. Further, new requirements and good practice recommendations were made. Work needs to be done on reviewing the service users guide to include details of the total fee payable and the arrangements for paying it. The current guide doesn’t have clear information about fees; neither does the statement of terms and conditions (the contract) that each person is given after their four-week trial period. This requirement is therefore continued with a short timescale. Further, signed copies of peoples contracts weren’t seen at this visit and some people couldn’t remember ever having been given one. People who use the service therefore can’t be sure of what they’re paying for or what their contribution is. Care plans and records need to be improved particularly where health conditions or behavioural issues are picked up during the four-week trial period. Further, people’s health and welfare must be managed properly particularly where they may be at risk i.e. from weight loss or frequent falls. The requirement is therefore continued with a short timescale. Care plans must also show evidence of regular review to make sure changing healthcare needs are picked up and properly met. A number of issues about medication were or incorrect recording particularly about labelling on short life medication such as fridge temperatures. The requirement is timescale. found. These included: insufficient controlled medication, a lack of antibiotic creams and medication therefore continued with a short Whilst some action had been taken to find out what peoples wishes were about activities, the survey hadn’t been finished nor the results looked at. Several residents said they would like to go out more. The requirement is therefore continued with a short timescale. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 7 Carpeting in one bedroom that was empty at this visit had not been replaced. It was heavily stained and with a faint odour. This must be replaced to make sure that anyone using the bedroom has a fresh and clean room to sleep in. The requirement is continued with a short timescale. Failure to meet previous requirements raises concern about the management of the home and the failure of line managers to follow this up. However the registered manager has left and the manager of another home is managing temporarily. It has been decided therefore to give the new manager the chance to address outstanding requirements before taking enforcement action. However failure to comply within the new timescales will lead to enforcement. New requirements made at this visit included: From looking at rotas and speaking with staff it was clear that fewer staff are on duty at weekends even though the number of people using the service doesn’t change. The reason given for this was the increasing cost of meeting staffing levels. Numbers of staff must be increased so that peoples needs are properly met every day of the week. Staff records didn’t include clear, recent photographs of each staff member. These must be done to make sure people who use the service are protected from risk of harm. Staff training records were poorly kept and didn’t show all training done by each member of staff over the last three years. Also records showed that some staff hadn’t done safeguarding adults training at all. This could result in people who use the service not being fully protected from risk of abuse happening to them. The last proper fire drill recorded was in January 2006. Issues arising from this had been recorded but it wasn’t clear if any action had been taken. No further drills were recorded to make sure people who use the service are kept protected from risk of harm. Further, water temperature records showed that they weren’t being checked throughout the home and may be too low to meet peoples needs. Proper health and safety checks must be carried out regularly to keep people safe. 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.V337837.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.V337837.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 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home isn’t clearly available for everyone to see and hasn’t been updated to include information about fees payable. Inadequate recording during the four-week trial period may mean the home isn’t suitable for or able to meet an individual’s needs. EVIDENCE: Each person has a file of information that they keep in their rooms and several were seen during the course of this inspection. The file holds: A copy of the Statement of Purpose and service users guide A copy of the complaints leaflet Copies of residents’ meeting minutes A copy of the individual terms and conditions (the contract) and A copy of the person’s individual care plan. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 10 No other copies of the service users guide were seen around the home, although lots of other information was available in leaflet form or pinned up on notice boards. The service users guide together with the Statement of Purpose gives a lot of information about the home. However it hasn’t been updated recently and doesn’t give enough information about fees payable. The Care Homes Regulations were amended in September 2006. The new regulation gives more detail about what information about fees must be included in the service users guide. This wasn’t there and neither were contracts for three of the four people whose records were looked at in detail. Only one was signed. It contained the person’s room number and that s/he would be responsible for her/his own fees. Copies of other peoples contracts also didn’t include signatures or information about fees payable. Social work assessments were seen for each person whose records were looked at. The assessments gave clear information about peoples needs and what actions would need to be taken to meet those needs. However not all issues shown on the plan had been followed up and transferred into the home’s care plan e.g. one person needed encouragement to drink more but nothing about this was seen on the home’s plan. A letter from a dietician gave clear information about helping another person to gain weight but nothing about this was seen either (Please see standard 7 for more about this). An Adult Community Care (formerly social services) care plan was attached to each assessment and for one person who was still in the four-week trial period this care plan was being used. The assessment/care plan gave lots of information about the person’s mental state, specialist needs and behaviour that could challenge staff. The person was now coming to the end of the trial period and a review meeting was to be held shortly. However on looking at the daily records these weren’t clear enough to show whether the home could meet the person’s needs, or what action staff were taking to meet them. Further they hadn’t been recorded regularly throughout the four weeks of her/his stay. No care plan had been drawn up by home staff to show how needs would be met at the home. A requirement made at the September ’06 inspection was followed up. Key workers sign care plans that are drawn up after the four-week trial period. However it isn’t clear whether this is to confirm that peoples needs can be met. No other documents were in place to confirm that the home is suitable for the person concerned or that their needs can be met. The requirement is therefore continued with a short timescale. We did a survey of people who use the service just before this inspection. People were asked if they had received a contract but most couldn’t remember as they had been at the home a long time. They were also asked about Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 11 information they were given when they came to the home and most said that they had been able to come for a day’s visit. During this they had been given enough information to enable them to make a decision. Some however had been admitted as an emergency due to home circumstances. People said: ‘I came here for a day and from that day here I am. It’s the best home I’ve ever had and would recommend anyone to come here’, ‘I’ve been here before’, ‘I had all the info’ and: ‘I’ve been here before. I like it and its always my choice to come here’. Intermediate care is not given at this home although people can come in for respite care if they need to. Therefore standard six doesn’t apply. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 12 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. Infrequently reviewed care plans and records don’t always show the proper actions taken to meet peoples needs so that they are kept safe. Inadequate management of medication doesn’t keep people who use the service protected from risk. People who use the service are treated with dignity and respect and their other healthcare needs are met. EVIDENCE: People who use the service responded well to the question from our survey about whether they get enough care and support. Comments included: ‘They’re very good’ (2), ‘They look after me well’ and: ‘they look after people really well here’. The home’s own quality assurance survey report showed that people were more concerned about their key workers and the time they could spend with them. However one resident had commented that s/he felt s/he needed more help than s/he received with washing, dressing and medication. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 13 Four peoples care was tracked and their care plans closely looked at. Care plans were patchy in the level of detail, actions and outcomes recorded. One person’s plan was very clear and good actions and outcomes were seen. Another person had lots of different sheets with a range of issues and actions that looked unfinished and didn’t follow a logical course. The person had a history of falls but didn’t have a falls risk assessment (although the moving and handling risk assessment mentioned falling). This person had come to live at the home recently but no copy of the four-week review was seen to show if it had been confirmed that staff could meet her/his needs. Another person using oxygen had no risk assessment about it although again it was mentioned on the moving and handling one. This person had signed the care plan. All the others looked at had been signed only by the key worker and not by the person using the service. No evidence of regular care plan reviews was seen for any of the four people whose care records were looked at. A previous requirement about weight monitoring had been met. A person identified as having a weight problem had now gained weight and was being weighed regularly. A new and detailed bath record had been put in place that included among other things, care of dentures and regular weight checks. This was checked for all residents and showed that where necessary people were being weighed at frequent intervals. In one person’s records a detailed letter from a dietician was seen that gave clear information about the need to encourage the person to eat and how to do this. On looking at care records since admission however it was clear that the person had continued to lose weight and was now considerably underweight. The care plan gave no indication about how to help the person gain weight but simply listed likes and dislikes. Staff said that the person was eating without difficulty, ate most things and was seen doing so at lunchtime. However a clear plan is needed to help the person gain her/his proper weight. From an action plan drawn up after a complaint about care practice, a number of recommendations had been made about dietary needs. One of these was to use food or fluid charts for people with concerns about weight loss or reluctance to drink. However no charts were seen for people with these issues. Regular visits from GP’s, district nurses and chiropodists were recorded and the GP and district nurse both visited during this inspection. Copies of optical prescriptions were seen in peoples care records. Comments about medical support from the home’s own quality assurance survey scored 85 out of 100 and our survey showed that needs were being met: ‘Always pretty good in here with all that’, ‘They take me to the clinic often because I have a heart problem’, ‘I get my tablets and things like that’ and: ‘They give me my meds downstairs and always offer me painkillers’. A requirement about medication from the September ’06 inspection was followed up but not met. A check of medication showed the following: Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 14 The amount of medication received into the home when a new person arrives wasn’t recorded. The temperature of the medicines fridge was high at 12°c (the temperature should be between 3°c and 5°c) and the fridge needed de-frosting (this was done by the second day of inspection). Perishable or short-life items such as antibiotic and anti-fungal creams weren’t labelled when opened and it wasn’t clear if they were still being used. The labelling process for eye drops was unclear and an opened bottle of drops wasn’t being stored in the fridge as directed. Some items in the fridge were out of date. Records of controlled medication didn’t match with the number of tablets dispensed. This, together with mistakes in recording the number of tablets left after each one was given, made it impossible to know how many tablets there should have been. Records were therefore all incorrect for one person. No records of medication given to those who can self-administer were kept. It wasn’t clear therefore if people were still using medication or not. Medication wasn’t always being signed for after each time it was given and gaps were seen over a pattern of days. Although a code can be used on the administration record to show why a medication isn’t given this wasn’t used so it wasn’t clear if there was a reason for not signing the sheet. People who use the service spoke highly of their relationships with staff and vice versa. The staff group when spoken with showed a good knowledge of the people they care for. Comments from our survey about staff listening and acting on what people say were positive: ‘It’s surprising what interest they take in you really when they have such a busy job’, ‘I wouldn’t know what I’d do without them’, ‘Definitely they listen and act on what I say’ and: ‘they’re pretty good’. People were seen being treated with dignity and respect and call bells were answered quickly. Brentry DS0000035568.V337837.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 adequate. This judgement has been made using available evidence including a visit to this service. Whilst activities doesn’t ensure Although meals proper nutrition planning. EVIDENCE: A requirement was made at the September ’06 visit about planning activities to meet peoples needs. This was followed up at this inspection. Comments from our survey were almost all positive e.g. ‘I enjoy what they do here’, ‘If anything’s going on I join in if I have the time’, ‘They do provide entertainment and its pretty good’ and: ‘Bingo, we have a bar and history talks (reminiscence). I think the activities are great. There is a notice board with them all listed’. This was seen and activities/entertainment were seen going on during the visit. Some other people acknowledged that there are activities but they choose not to attend. Two people said that they didn’t think there were any. The home’s Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 16 happen, insufficient consultation with people using the service they’re happy with the range of social contacts offered. at the home are well managed and provide daily variation, and social contact, peoples choices aren’t respected in menu quality assurance survey report was looked at. Activities had scored lowest out of all the subjects covered, with a 79 satisfaction rate. One person had said s/he would like exercise sessions and records seen at this visit showed this was now being offered. From looking at records it was clear that a core of about twelve people join in with all activities. However it wasn’t clear what was being done to offer some type of meaningful activity to those who may be unable or didn’t want to join in group sessions. People who use the service spoken with at this visit said that they would like to go out more. One person said s/he would like to go out for afternoon tea somewhere. The desire to go out was also shown in the home’s own questionnaire on outings and activities that had been started but not finished. This asked people to tick what they like doing and the time of day they wanted to do it. The survey also asked if people would be willing to pay towards the cost of activities and lots said they would. From the finished questionnaires seen it was clear that going out on trips was most popular. The acting manager agreed that trips could be arranged. Staff spoken with said that they give individual key time of two hours per week to each resident but struggle to be able to take them out during this time. They also said that some people had expressed a desire to do some cooking as an activity. This was also seen in the minutes of a residents meeting held in October ’06. However staff also said there are no facilities in the home apart from the main kitchens that could pose risks, to enable them to do this. Visitors were seen in the home during this inspection. One visitor spoken with said that although satisfied with the care given to her relative she was disappointed that there was little stimulation for the person and few trips out. Although progress was clearly being made with activities and entertainment, the survey that had been started must be finished. Further, a plan must be put in place from the results, to make sure people are able to go out into the local community and further afield. From the home’s quality assurance survey a jumble sale had been held at the home last year. Old friends and neighbours from the local community had attended this that people using the service had enjoyed seeing. It wasn’t clear however how much contact with the local community people have on a regular basis. People were seen in various places during the visit. Most people choose to stay in their rooms although a lot were seen sitting in the ground floor lounge. One person liked knitting and was able to do this. One person doesn’t leave her/his bedroom because of a health condition and all meals are taken up to the room. This person said however that s/he was very happy with arrangements and care given. People can choose when to get up or go to bed and whether they want meals in their room. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 17 Menus were looked at together with information about meals from the residents meeting in October ’06. People had given ideas for food they would like including ‘spaghetti Bolognese with spaghetti not pasta twists’, ‘battered sausages for a change’ ‘bubble and squeak for tea with cold meat’ and ‘more suet puddings’. The minutes further showed that ‘apple pies were a big favourite to add to the menu’. The four weekly menus were closely looked at. Although these showed a good range of nutritious meals including a hot meal choice at teatime, the only dish from the above list was spaghetti Bolognese. This appeared once in the four-week period. Neither apple pies nor any of the other suggestions were included. The person who has all meals in her/his room said that the meals are always hot and tasty when brought up from the kitchen. However one person had complained about meals being cold and did so on the first day of the visit. S/he had been offered an alternative choice of meal. This was a lamb chop that looked tough and fatty and s/he declined to eat it. The manager offered something else but the person declined. Lots of comments about the food were made when we did our survey: ‘Can’t grumble about the food at all’ ‘Food is always lovely but wish we could have less beans they’re too heavy’ ‘Very good food and I get plenty’ ‘Suits me’ ‘Very good’ ‘I enjoy the food’ ‘The meals are pretty good’ ‘The food’s not that bad at all. I’m not a big eater but what I have is nice’ Only one negative comment was made: ‘Breakfast is nice but dinner is awful and tea is ok’. From the home’s own survey meals had scored a total of 86 out of 100. However, one person had said that s/he ‘appreciated the odd cups of tea throughout the day but wasn’t sure her dietary preferences had been passed on to the kitchen staff’. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 18 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. Satisfactory complaints use the service can feel care. Prompt referral of kept safe from abuse or EVIDENCE: Two requirements made at the themed inspection in January ’07 were met. The home follows the Adult Community Care complaints process and leaflets about it were seen in the front hall of the home. Each person using the service has a copy of the leaflet in the files kept in their rooms. These were seen and the Commission’s address details were also included. The leaflet was seen in the usual printed format only and it wasn’t clear if different formats could be made available for visually impaired people. From our survey people using the service gave a range of answers to the question about being able to make a complaint: ‘I probably wouldn’t ever make one’ ‘Complaints leaflet is in the bottom of my cabinet’ ‘I have the leaflet here’ ‘I know how to complain but wouldn’t. I would never want to get anyone in trouble’ ‘I’ve got nothing to complain about’ Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 19 management and recording makes sure people who confident in raising concerns about any aspect of their safeguarding adults issues also makes sure people are risk of it. ‘The complaints leaflet is kept in my drawer’ and: ‘If I wasn’t happy believe me I would say’. Only two people said they had never seen the leaflet. A third who was a person having a short stay respite care at the home said: ‘Have never been shown a complaints leaflet. Complaints are not featured as part of the home’s independent quality assurance survey although several people had said they would speak to their key worker or go to the office if there was a problem. This was echoed from our survey question that asked if they knew who to speak to if they are not happy. Comments included: ‘Whoever’s in charge’ and: ‘there’s a few people I could talk to’. The complaints log was closely looked at. A letter of thanks dated February ’07 was seen at the front of the file. This praised the staff for the care of a person who was no longer at the home. Two complaints had been received since the September ’06 inspection. One had been about a room that was unpleasant and dark. The other was about care practice. Both complaints had been dealt with quickly. The complaint about the room had been resolved by offering another bedroom and had been fully completed within four days. The other led to strategy meetings that we had been fully involved in and an action plan for improving practice had been drawn up. Both complaints had been written up satisfactorily giving clear information about actions and timescales and whether upheld or not. The complaint about care practice had been dealt with as a safeguarding adults situation and the local authority’s safeguarding adults co-ordinator involved. The local authority has a policy about abuse based on the Department of Health guidance ‘No Secrets’ plus a ‘Whistle blowing’ policy. Staff spoken with said they were aware of abuse issues and would be able to recognise if it were happening. All said they would report any concerns to the manager. Staff also said they had all done safeguarding adults training (but see standard 30 for more about this). Brentry DS0000035568.V337837.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. 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 who use the service benefit from living in a comfortable, clean, safe standard of accommodation that is well decorated and maintained, physically accessible and meets their needs. EVIDENCE: The home was extremely clean and smelled fresh at this visit. All areas were clean and hygienic. Two requirements made at the September visit were followed up. One about making sure the ground floor lounge carpet was either cleaned or replaced was met. The carpet looked very clean and no staining was seen on it. The lounge itself smelled fresh and pleasant. A number of people however were having to sit on hard chairs because there were not enough armchairs to go round. The acting manager immediately arranged for armchairs from other lounges to be brought in that were more comfortable for older people to sit in for long periods. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 21 The second requirement about replacing the flooring in one bedroom had not been fully met. Despite frequent cleaning the carpet was heavily stained and there was a faint odour on entering the room even though the window was open. The room was empty and the acting manager said it was being used for emergency admissions. Because of this the flooring must be replaced so that someone coming into the home has a clean, fresh bedroom to sleep in. All bathrooms and toilets were clean and hygienic. Toilet doors are painted red to help people with memory problems or a degree of dementia to find them easily. The home’s communication book was looked at and showed that a number of rooms had been redecorated. Some of these were seen that looked fresh and bright. Where necessary individual windows had been repaired and paintwork renewed. Comments from our survey showed that people appreciate the cleanliness of the home and seven people said that it always smells fresh: ‘It always smells fresh and my bed is changed daily more or less’ ‘No complaints about cleanliness and it smells fine’ It’s kept lovely and clean here yes’ and: ‘They employ a lot of people to do the cleaning and it always smells fresh’. Brentry DS0000035568.V337837.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 & 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’ needs. Staff records don’t make sure people using the service are fully protected. Not all staff have had essential training that keeps people safe and records don’t show clearly enough what training has been done. EVIDENCE: People were asked about staff availability in our survey. Comments were largely positive and included: ‘I don’t really know. Sometimes I have to wait for a bit, but you get that anywhere. The main thing is that they’re all friendly and not stuck up’, ‘there was a time a little while ago when they were really short staffed but ok again at the moment’, and: ‘They seem to do their job well anyway’. One person using the service and staff spoken with however said that there are fewer staff on duty at weekends, even though the number of people don’t change. The rotas for the past two weeks before inspection were closely looked at. This showed that overall there was one person less on duty on each shift. This applied to both care staff and domestic workers. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 23 The communication book looked at also showed the high level of staff sickness recorded and the frequent use of agency staff to cover this. The team manager who was visiting the home during this inspection gave information about a recruitment drive being done within the next few weeks to help ease the situation. However staffing levels must remain the same at weekends as they are in the week to meet peoples needs. A visit had been made before this inspection to the City Council’s personnel department to look at staff records. These were all found to be satisfactory. However, although the personnel department keeps individual’s proof of identity in its records, it doesn’t keep photographs of each staff member. The records kept at the home were looked at. This showed that some staff had poor photocopies of photographs e.g. from passports, or Polaroid photos that were clearer, or none at all. Some of the photos were old and bore no relation to the way staff looked at the visit. Training records were also looked at. Although staff spoken with had all said they had done safeguarding adults training there were at least eight staff who had no recording of ever having done it. The remainder of the staff had done it in 2004. Training records in general were poorly recorded. Some records ended at 2004 and it wasn’t clear if any training had been done since. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 24 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): 31,33,35 & 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 acting manager who understands peoples needs, gives clear management. A formal arrangement of making sure people who use services can comment about life in the home makes sure their views and opinions will be noted. Proper management of peoples money makes sure they are protected from financial risk although health and safety procedures may not always keep them safe. EVIDENCE: The previous registered manager had left his post at the end of March. The team manager said the job was about to be advertised but it could take some weeks before a new person is appointed. In the meantime a trained and experienced manager from another local authority home, Jean Blackmore, had Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 25 taken over. Mrs Blackmore was on duty for both days of inspection although she had only been working at the home for a couple of weeks. She was welcoming and open to the inspection process and quick to follow up requests and suggestions. Mrs Blackmore is trained to National Vocational Qualification in Care Level 4 and also holds the registered managers award. The existing management team was also on duty during the two days of the visit. As mentioned elsewhere in the report the home has an annual quality assurance survey done each year. The last survey report done in August ’06 was available and closely looked at. People who use the service, relatives and other interested parties such as social workers and healthcare professionals were consulted. The overall report was largely positive with few negative comments. From this, as mentioned above, a survey on activities is being done so that peoples views can be gained and put into action. Residents meetings are held regularly and minutes from meetings held in January, May, July and October 2006 were looked at. The manager said she would be holding another meeting shortly so that she could get to know residents and their opinions. A random sample of peoples cash looked after by staff was done. All balances were correct and cash sheets filled in correctly. Receipts for items bought were attached to individual sheets and a member of management staff does regular balance checks. Where possible two signatures were seen on sheets. Health and safety records were looked at. Fire safety matters are checked weekly including the fire alarm, fire safety equipment and door closers. A fire safety risk assessment was in place although this was dated 2004. The record of fire drills was looked at and the last one recorded was in June 2006. Five staff had attended. A brief comment written about the drill showed that there had been confusion and mistakes made. However no formal drill had been recorded since. Staff spoken with however said there had been fire drills and they had done fire safety training (some of which was seen in their training records). It was noted that there had been a problem with the water supply although this had been corrected quickly. However on checking water temperature records, the temperature at which water is delivered into individual rooms’ washbasins was low at 38°c instead of the recommended 43°c. Further only one washbasin was being checked each week so it wasn’t clear if the temperature remained the same throughout the building. Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 26 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 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X X STAFFING Standard No Score 27 1 28 X 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 27 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. Standard 1. OP2 Regulation 5(1) (bb) Requirement The registered person shall produce a written guide to the care home (in these regulations referred to as the service users guide) that shall include details of the total fee payable in respect of the services referred to and the arrangements for payment of such a fee. (Each person must be issued with a statement of terms and conditions by the end of the four-week trial period and a signed copy kept on file for easy access. This will make sure that people who use the service will be clear about their rights and responsibilities when they stay permanently at the home). (The service users guide given to people who use the service must be reviewed to include details of the total fee payable and the arrangements for payment of the fee. This will make sure that people know what they are to pay and how it will be paid). Timescale not met Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 28 Timescale for action 30/06/07 from the Thematic inspection done in January ’07) 2. OP4 14(1)(d) The registered person shall not 30/06/07 provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of her/his health and welfare (Confirm in writing that the home is suitable for and can meet the needs of people using the service. This will make sure the home is the right place for people and they can be sure their needs will be met). Timescale not met from the September ’06 inspection 3. OP7 15(1)(2)(b) Unless it is impracticable to carry 01/06/07 out such consultation the registered person shall, after consultation with the service user or a representative, prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met. The registered person shall keep the service user’s plan under review. (Where eating difficulties and loss of weight is identified, a clear plan about how to manage this and help the person gain weight must be put in place and records kept. This will make sure a person’s health and welfare is properly maintained). (Where care assessments clearly show that falls are likely, a falls risk assessment must be put in Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 29 place and regularly reviewed. Further where a person needs to use oxygen a risk assessment must also be put in place. This will make sure people will be kept safe). (Each person’s care plan must be reviewed at regular intervals. This will make sure peoples changing needs will be picked up and met). The registered person shall make 30/05/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (The registered person must ensure that staff adhere to the medication policy and procedures when administering medication with particular regard to labelling, recording, counting of controlled medication and storage of perishable items. All the above will make sure that people who use the service are protected from medication errors). Timescale not met from the September ’06 inspection 4. OP9 13(2) 5. OP12 16(2)(m) The registered person shall, having regard to the size of the care home and the number and needs of service users – consult service users about their social interests and make arrangements to enable them to engage in local, social and community activities. (The survey on activities must be finished. Responses from the survey must be collated and results discussed with people who use the service. An action plan must be put in place to 30/06/07 Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 30 from the September ’06 inspection enable people’s wishes about trips outside the home to be carried out. This will make sure people get regular opportunities to have a stimulating and enjoyable life) Timescale not met 6. OP19 23(2)(d) The registered person shall 30/06/07 having regard to the number and needs of service users ensure that – all parts of the home are kept clean and reasonably decorated. (The carpet in room 27 must be replaced with suitable floor covering. This will make sure people have a clean, hygienic and comfortable standard of accommodation) The registered person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users – ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. 7. OP27 18(1)(a) 30/05/07 8. OP29 Schedule 2.1 (Staffing levels must be available in sufficient numbers at weekends as well as during the week. This will make sure peoples needs can continue to be met). The registered person shall not 30/06/07 employ a person to work at the care home unless he has obtained in respect of the person the information and documents specified in paragraphs 1-9 of Schedule 2. (Each permanent staff member Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 31 9. OP30 18(1)(c)(i) Sch 2.5 must have a clear, recent photograph kept at the home. This will make sure people who use the service are fully protected from risk of harm). The registered person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users, ensure that the person employed to work at the care home receive training appropriate to the work they are to perform. 30/05/07 10. OP38 13(4)(c) (- All staff must have training in safeguarding adults at regular intervals. - Any training done by individual members of staff must be recorded and records kept up to date. This will make sure people who use the service are protected from risk of abuse and are cared for by trained and experienced staff). The registered person shall after 30/06/07 consultation with the fire and rescue authority – ensure by means of fire drills and practices at suitable intervals, that the persons working at the care home and so far as practicable, service users, are aware of the procedure to be followed in case of fire including the procedure for saving life. (Written advice from the fire safety authority about frequency of fire drills must be sought. This will make sure people who use the service are protected from risk). Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 32 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 OP4 Good Practice Recommendations Accurate records should be kept during the four-week assessment period to show that the home is the most suitable place and can meet a person’s needs. This will make sure the home is the right place for the person. A safe way should be found to enable people who use the service to be able to do cooking for themselves as a meaningful activity. This will decrease boredom and help improve their self-esteem and confidence. Menus should be re-done to show that all suggestions made by people using the service have been included. This will make sure that people will get the choice of meals they want. Checking of water temperatures should be done in more than one bedroom and people should be consulted about the water temperature. This will make sure it meets peoples needs. 2. OP12 3. OP15 4. OP38 Brentry DS0000035568.V337837.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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.V337837.R01.S.doc Version 5.2 Page 34 - 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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