CARE HOMES FOR OLDER PEOPLE
Brentry Knole Lane Brentry Bristol BS10 6QH Lead Inspector
Sandra Garrett Unannounced Inspection 3rd February 2006 09:30 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.V280798.R01.S.doc Version 5.1 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.V280798.R01.S.doc Version 5.1 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 Mr Paul David Fuller Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th July 2005 Brief Description of the Service: Brentry House is a care home registered with the Commission in the Older Persons category. It is operated by Bristol City Council Social Services & Health (SS&H) and has 40 beds. The home is arranged over two floors with lift access and has large patio areas to the front and rear of the home. Brentry is largely accessible for disabled older people and their relatives, and continuing work to improve access has been carried out. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out to follow up requirements and recommendations made at the last visit in July ’05. Thirty-six residents were living at the home at the time of this visit and three care staff were on duty. A range of care and administrative records were examined. Ten residents were spoken with at the visit. Brentry House has been selected for possible closure over the next two years. Residents commented on their concerns about this. One resident said: ‘I love it here and would be sorry to go. It hurts to know this is happening. It’s like taking something away from us’. What the service does well: What has improved since the last inspection?
A requirement in respect of complaints management and availability of complaints records was met. Complaints were properly documented in the complaints record that was available for inspection. Evidence of investigation within clear timescales was seen. Residents were aware of their right to complain and said they were confident any concerns would be taken seriously. A suitable impermeable floor covering that made the room smell more pleasant and fresh, had replaced carpeting in one of two rooms identified at the last visit. One that had not been done had been because of the resident’s choice. A good practice recommendation in respect of painting toilet doors a suitable colour for people with dementia to recognise had been implemented. All doors throughout the communal areas of the home had been painted. Residents are confident of being able to identify and access toilet facilities. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Satisfactory admission arrangements ensure residents’ needs are identified and can be met. Trial visits ensure that residents are able to be clear that the home is right for them. Residents with dementia or their representatives may not be confident that their specialist needs will be fully met. EVIDENCE: From care records examined pre-admission assessments were seen that form the basis of individual care plans. One resident had been admitted from a hospital ward and the assessment contained clear information about all identified needs. Further a Social Services and Health enhanced level care plan was seen that gave a lot of information about the resident’s needs. It was disappointing to note however that no corresponding care plan had been developed by the home despite the resident having lived there for several months. Please see standard 7 below. Day visits and four-week trial periods are offered to ensure residents and their relatives can be confident the home is able to meet their needs. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 9 It was disappointing to note that a good practice recommendation in respect of seeking advice from dementia care organisations in respect of daily living routines and activities had not been implemented. The home has a number of residents who have some degree of dementia and may be unable to join in with social activities or be fully aware of their surroundings and daily routines. The manager said he had consulted the Mental Health In-Reach team that works with several care homes but no evidence was available to show what advice had been given. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 Attention is needed to ensure each resident has a relevant and up to date care plan that identifies assessed social care needs and health care needs with clear actions documented to meet them and is reviewed regularly. EVIDENCE: Care plans were seen for each resident. Evidence of monthly review was seen recorded at the front of each plan. Residents or their relatives had signed some care plans and their comments included. However a number were seen that were unsigned with no comments. Four care files were examined in depth at this visit. A resident who had come to the home in November ‘05 had detailed pre-admission assessment and care plan although the information hadn’t been transferred into a care plan done since admission to the home. A care plan was seen that was minimal in content and a manual handling risk assessment was undated and incomplete. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 11 Another care plan had been updated following the resident spending a long period in hospital. However assessed needs in respect of pressure area care that had been identified since her/his return were not recorded on the plan or a risk assessment. Manual handling risk assessments were in place for each resident. However some had not been updated following changes and gave minimal information e.g. a resident had been noted to have a number of frequent falls. No actions to reduce the risk of falls were seen recorded on the manual handling risk assessment to reflect how the situation was to be managed to prevent further falls. Requirements in respect of all the above made at the July’05 visit are therefore continued with a short timescale. Failure to meet the requirement could lead to enforcement action. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents benefit from a varied and healthy diet that is developed from their choices. EVIDENCE: The inspector took lunch with residents. Residents were offered fish and chips or a choice of another dish. The meal was hot and tasty. Residents said they enjoyed the food and had no complaints about it. Four weekly menus were seen pinned up on the wall outside the dining room so that residents could see what was on offer each day. Food is discussed at residents meetings and they are able to say if they want particular dishes put on the menu. Menus seen were varied and offered a good mix of healthy options. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Satisfactory complaints management and recording ensures residents can feel confident in raising concerns about any aspect of their care. Satisfactory management of incidents that affect vulnerable residents ensure they are protected from harm or abuse. EVIDENCE: A requirement in respect of complaints recording and management was met at this visit. The complaints file was available for inspection. It was noted that one complaint in respect of missing money had been received and dealt with by a manager from the local authority Elderly Peoples Homes team. A copy of the report had been sent to the Commission and recommendations made and implemented. No complaints were seen recorded in the home’s communication book. However it was noted that the complaints form in use was out of date and refers to the situation for reporting before Commission for Social Care Inspection was established. The manager was advised to replace this with a more suitable form that gives details of dates and timescales. Following the incident in respect of the missing money a full investigation had been carried out under the safeguarding adults guidance. The inspector had been kept updated about the investigation and outcome that ensures residents are protected from possible financial abuse. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Residents’ benefit from living in an accessible environment that meets their physical needs. Attention must be given to making sure all parts of the home are kept clean and hygienic at all times to ensure residents live in a fresh smelling and pleasant environment. EVIDENCE: The ground floor areas of the home were clean and hygienic. It was pleasing to note a good practice recommendation in respect of painting toilet doors a primary colour that residents with dementia can recognise, had been implemented. Toilet doors were painted a bright red whilst bathroom doors had been painted blue. The paintwork brightened up the communal areas that had looked darker when the doors were all varnished black. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 15 Other access works had been completed to ensure the home meets requirements of the Disability Discrimination Act e.g. a fully accessible disabled person’s toilet, automated self-opening front door and wheelchair ramp to the front door were all seen. This is good practice. Domestic staff were seen working around the home cleaning bedrooms and shampooing carpets. A requirement made at the last visit in respect of replacing unhygienic carpeting in two rooms was partly met. One room had new impermeable flooring laid in the room. The other had not been replaced that staff said was the resident’s choice. It was noted that the carpet was frequently shampooed although this had not removed the odour entirely. However the upper floor of the home was observed to be dirty in some areas and didn’t smell fresh or pleasant. The hairdressing room was seen to be dirty and in need of a deep clean. Chairs outside this room were also seen to be dirty and shabby. Strong odours of urine and cigarette smoke were present throughout the corridors and it was noted that in several rooms commodes and urinals had not been emptied. Please see standard 27 in respect of staffing levels that could affect the environment. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Attention is needed to ensure an adequate number of staff is available meet residents’ needs and match their dependency levels. Attention is needed to ensure care staff receive training appropriate to their jobs to ensure that residents are cared for by competent trained staff. EVIDENCE: Three care staff were on duty at this visit to care for thirty-six residents with varying levels of dependency. Whilst staffing may be calculated to meet residents’ needs, it was noted that care staff have other duties including emptying and cleaning commodes and urinals. It was observed that this was delayed until late morning on the first floor. One staff member said that s/he thinks there are enough staff on duty in the mornings but a resident had fallen and needed help that delayed staff from completing other tasks. In the inspectors opinion staffing levels should be calculated and managed to ensure all care tasks can be carried out in a suitable timescale. Staff were observed helping residents in the dining room at lunchtime. A requirement made at the last visit in respect of providing dementia awareness training was partly met. It was noted that a staff member from another local authority care home is delivering such training. At this visit six care staff had attended one session and others are being planned. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 17 Whilst it is clear that staff are offered regular training sessions in different subjects, from examining staff records it was noted that these were not up to date. Several records showed training carried out until 2004 only and nothing recorded since. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35,36, 37 & 38 Improvement in managing residents’ finances ensures that they are protected from risk of financial abuse. Attention is needed to ensure all parts of the home are kept secure. Attention is needed to ensure staff get full opportunity through regular supervision to reflect on their working practices. EVIDENCE: A sample check of residents’ cash was carried out. Following the incidents of missing money a new system has been put in place to ensure all actions are taken to prevent this happening. This includes two signatures when issuing cash to residents and on balance checks. The sample check revealed all balances to be correct and cash sheets were clear and appropriately signed. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 19 Staff supervision records were examined. From this it wasn’t clear if care staff get regular opportunities to reflect upon their work. Some records seen showed only one session plus a yearly performance review although the majority showed evidence of four sessions including the yearly review. A good practice recommendation is made to make sure ways of recording each session are found that demonstrates supervision is carried out at least six times a year. A number of daily, progress and key time records were seen. Some key time records reflected regular one to one social contact with residents that are good practice. However some progress records were written in style that could be interpreted as the resident refusing to comply with care provided. Progress reports suggested that at times some staff may use the records to express their feelings, rather than writing from a person-centred or simply factual approach. Therefore the content may not always be respectful and does not take into account residents’ past histories, age and mental health impairments. It was noted that the office door was left open and unlocked while no staff member or manager on duty was in the vicinity. A good practice recommendation was made to ensure residents’ confidentiality and security is maintained at all times. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 2 2 2 Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 21 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. OP7 Regulation 15(2)(b)(c) Timescale for action Care plans must be put in place 30/04/06 for each resident at the end of a trial period. Care plans must be completely reviewed and amended when residents situations change. Progress records in respect of care given must be kept regularly particularly where situations change and focus on abilities not deficits. Records of meeting assessed needs, particularly in respect of dementia, must be maintained, documented and regularly reviewed. (Timescale not met
from July ’05 inspection) Requirement 2. OP8 13(4)(c) Risk assessments in respect of 30/04/06 pressure areas and frequent falls must be done where these are identified. Actions taken in respect of pressure area care must be recorded on individual care plans. (Timescale not met from
DS0000035568.V280798.R01.S.doc Version 5.1 Page 22 July ’05 inspection)
Brentry 3. OP19 16(2)(J), 23(2)(d) The hairdressing room, including 30/04/06 furniture used must be thoroughly cleaned. The first floor must be kept clean and hygienic Officers and all care staff must 01/05/06 attend training on dementia awareness and care by a recognised provider (Timescale
from July ’05 4. OP30 18 (1)(c)(i) not met inspection) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP30 OP36 OP38 Good Practice Recommendations All staff training records should be regularly and fully updated to reflect training sessions undertaken. A method of identifying regular supervision sessions carried out for care staff should be found and maintained. The office door should be kept locked at all times when no staff member is in the vicinity in order to protect residents’ confidentiality and keep records secure. Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brentry DS0000035568.V280798.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
