Inspection on 16/04/08 for Bretby House

This inspection was carried out on 16th April 2008.

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

Bretby House 18/10/07

Bretby House 19/04/07

Bretby House 16/10/06

Bretby House 06/06/06

Bretby House 09/02/06

Bretby House 25/10/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bretby House 253 Boldmere Road Wylde Green Sutton Coldfield West Midlands B73 5LL Lead Inspector Brenda O’Neill Unannounced Inspection 16th April 2008 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 Bretby House DS0000064275.V362143.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. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bretby House Address 253 Boldmere Road Wylde Green Sutton Coldfield West Midlands B73 5LL 0121 373 6562 F/P 0121 373 6562 jd012g3610@blueyonder.co.uk 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) Care First Class (UK) Ltd vacant post Care Home 24 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (24) of places Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. The home is registered to accommodate to 24 older people that may include 6 people with dementia. Registration Category 24 (OP) 6(DE)(E). Provide assisted bathing/showering facilities on the first and second floors of the home within twelve months of registration. Provide additional dry goods storage space within eighteen months of registration. Provide a sluice facility within six months of registration. Provide guards of covers to all radiators within the home within six months of registration. Replace or relay the uneven garden path to improve safe access to the garden within six months of registration. In addition to the manager and ancillary staff a minimum of three care staff must be on duty during the waking day and two care staff on night duty. 18th October 2007 Date of last inspection Brief Description of the Service: Bretby House is a large, extended house with parking space available. It is close to public transport routes with Wylde Green station being a short walk away. The home is on a bus route. Boldmere shopping centre is also close to the home. The home provides care and accommodation for up to 24 older people. Accommodation for the people living in the home is spread over three floors with a mixture of single and double rooms, some of which have en-suite facilities. There are several toilets, one shower room and three bathrooms in the home, however not all of these are in use. Communal areas are located on the ground floor and comprise of one large lounge/diner and two further lounges. Also located on the ground floor are the kitchen, laundry, office and staff facilities. There is a large and well maintained garden to the rear of the home that is accessed via a ramp. The range of fees charged at the home was not available in the service user guide. Bretby House DS0000064275.V362143.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 home is 1 star. This means the people who use this service experience adequate outcomes. Two inspectors carried out this key inspection over one day in April 2008. During the course of this visit a partial tour of the premises was made, three staff and three files for the people living in the home were sampled as well as other care and health and safety records. The inspectors had lunch with the people living in the home and made observations of the care being offered to them throughout. We spoke with the manager, owner, three staff members and five of the people living in the home. The home had not received any complaints since the last inspection. We received some concerns about the home a little after the inspection. These were in relation to personal care, poor manual handling, pressure relieving equipment not being used, staff being rude and not speaking English. The concerns had been passed back to the provider to investigate at the time of writing this report. The providers responded to the concerns within five days. The concerns in relation to poor manual handling and pressure relieving equipment were upheld. There are no staff in the home that do not speak English although one does have quite a heavy foreign accent. Staff being rude could not be determined. As a result of the investigation staff disciplinaries were undertaken and a staff meeting was held to emphasise to staff that they must follow the care plans and risk assessments that are in place. There had been some adult protection issues raised about the home since the last inspection. The issues were in relation to two of the people that had been living in the home. The allegations made were quite serious and resulted in several adult protection meetings being held and all the people living in the home being reviewed by Social care and Health. The outcomes of the reviews indicated that for the majority of the people living in the home there were no concerns and relatives were satisfied with the service being offered. However there were some issues raised that needed to be addressed including, inconsistent recording by staff, people losing weight, food records not detailing soft diets, medication administration including someone hiding medication and medication being given for wandering, how to recognise when they can no longer care for the people living in the home and admitting people they could not care for. As a result of the adult protection meetings we had a meeting with the manager and the owners of the home. All the issues were discussed with them and they had already begun to address them, for example, better pre admission assessments. Due to the concerns we also decided to bring forward the key inspection date to enable us to assess the progress on the concerns that had been raised. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The pre admission assessment procedure had improved and ensured the home knew the needs of the people being admitted to the home prior to their admission. The care plans had been improved and were much more person centred they gave much more detail of the needs of the individuals, their abilities and where they needed assistance from staff. All the required risk assessments had been put in place and where necessary management plans had been drawn up for staff to follow to minimise any identified risks to the people living in the home. Individual activity records had been put in place that identified if the people living in the home had enjoyed the activity or not. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 7 Further improvements had been made to the environment, for example, exposed radiators had been covered, some new lighting had been installed and improvements to the garden were ongoing. The recruitment procedures for the home had improved ensuring the people there were safeguarded. What they could do better: The records kept in the home in relation to dietary intake needed to be accurate, clear and cross reference to all other relevant records to ensure the nutritional needs of the people living in the home were met. Separate food and fluid intake records needed to be kept for any of the people living in the home where they had been identified as being at risk in relation to their diet so that their intake could be easily monitored. Staff must ensure that appropriate assistance and encouragement is given at meal times, adequate amounts of vegetables are available for the people living in the home and that food records are a true reflection of the food that has been eaten. This will ensure the nutritional needs of the people living in the home are met. To ensure the people living in the home and the staff were safeguarded there needed to be management plans in place for any challenging behaviours. Staff needed to ensure they followed the handling instructions on the manual handling assessments to ensure the people living in the home were moved safely. The management plans for pressure care needed to be updated as the needs of the people living in the home changed. To ensure the people living in the home were fully safeguarded and received person centred care staff needed to follow the care plans and risk assessments that were in place. To ensure that the people living in the home are safe COSHH substances must be stored securely at all times and good infection control procedures followed. To ensure staff have the necessary skills and knowledge to care for the people living in the home the training matrix must be updated and any shortfalls that are identified must be addressed. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 8 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. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 9 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 Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 10 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 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was information available for people wanting to live in the home. This needed to be updated to ensure people had all the current information to enable them to make an informed choice about where they lived. The assessment procedures in the home had improved and ensured the needs of the people moving in were known to the staff prior to admission. EVIDENCE: There was a service users’ guide available at the home. This had been updated at the time of the last inspection. The conditions of registration had recently changed for the home and they were able to accommodate 10 people with dementia above the age of 55. This needed to be reflected in the service user guide. This would ensure that people considering moving into the home had all the current information to enable them to make an informed choice about where they lived. It was also recommended that the range of fees charged at Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 11 the home was included in the document to ensure the information was comprehensive. Issues had been raised at the recent adult protection meetings in relation to the home admitting people who they were unable to care for. At the time of the inspection the manager was being much more careful about who was admitted to the home and gave an example of where she had refused an admission due to the challenging behaviours of the individual. The files for two people admitted to the home since the last inspection were sampled. These showed that the pre admission assessment procedure had improved. The manager had undertaken assessments on both individuals prior to admission. The form used for the assessments was quite thorough and it was evident from these that the individuals had been spoken to and asked a number of questions about their lives and any difficulties they were having. At the end of the forms there was a summary of needs which gave details of the individual needs of the people being assessed. One of the files also included some information from the social worker involved in the admission. People were able to visit the home prior to admission if they wished and if it was appropriate. One of the assessments seen was undertaken at the home on the pre admission day. For the other individual it was thought a pre admission visit would have been too distressing however her son did visit the home. One of the people living in the home told us she could have visited the home but did not want to and left it to her son to go and have a look around. Both files sampled included signed copies of the terms and conditions at the home. These did include the fees for the service but not the room number that was to be occupied. It was recommended that this was included so that individuals knew what room they were paying for. There was no evidence one of the files sampled that the placement at the home had been reviewed after the 28 day trial period. The manager had pursued this for this person and been told the review would be conducted when a new social worker was allocated. As there had been some incidents of challenging behaviour with this individual the manager needed to follow this up and ensure a social worker was allocated. A review needed to take place to ensure the placement was appropriate and that staff were managing the behaviour appropriately. Bretby House DS0000064275.V362143.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans and risk assessments for the people living in the home had improved. Staff needed to follow the care plans and risk assessments to ensure the needs of the people living in the home were met and any risks were minimised. The medication system was generally well managed and the people living in the home received their medication as prescribed. EVIDENCE: There had been further improvements to the care plans, entitled Individual Service Statements (ISS), in place at the home since the last inspection. The files for three people admitted to the home since the last key inspection were sampled. One of the individuals had only been in the home for two weeks and there was no ISS on her file. The manager stated that the ISS was drawn up after the 28 day trial period when staff had had the opportunity to get to know the person. She had written up a general over view of the individual on Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 13 the day of admission and the pre admission assessment did give a summary of the person’s needs. All relevant risk assessments had also been undertaken. The ISSs for the other two people living in the home were quite comprehensive and covered numerous areas of their lives. They included, all aspects of personal care, communication, mobility, dietary needs, behaviour and motivation and activities. The ISSs included some good detail of what the individuals could do for themselves and what assistance they needed from staff, for example, ‘is able to dress, staff to hand clothes to her or will put them on in the wrong order’ and ‘forgets she has eaten’ then described how staff were to offer toast half a slice at a time in the morning so that she could have many servings. Improvements had been made to the care plans in relation to the people living in the home where there were concerns over dietary intake. The care plans clearly detailed what staff were to do, for example, ‘staff to ensure food is mashed and there are no peas or sweet corn as she does not like it’ and ‘staff to offer more puddings and give fortisips and log this’. The observations made at lunchtime and the food records did not fully evidence this was happening. The individual did have some soft foods but was also recorded as having such things as cheese on toast, chips and burgers. She was not offered extra pudding on the day of the inspection despite not eating her lunch. The daily records stated ‘ate reasonable amount today plenty of fluids. No concerns.’ The Food records stated she had eaten a quarter of her meal which can not be termed as a reasonable amount and the food records generally indicated this person was not eating full meals. There was a similar situation for another of the people living in the home whose care plan stated she was to be encouraged to eat by staff. No encouragement was given at lunchtime and she only ate a very small amount. The daily records stated ‘eaten and drank well’, food records indicated she had eaten a quarter of her meal. From the observations made this was not the case. These issues were discussed with the manager and she was advised she must ensure staff follow the care plans that are in place and that recordings made by staff must be checked for accuracy so that it can be assured peoples’ dietary needs are being met. Where there were concerns about anyone’s food intake there needed to be separate food records that detailed exactly what they had ate and drank throughout the day so that this could be closely monitored. Issues over diet and staff recording had been raised at the recent adult protection meetings and although the manager had tried to address these clearly further work was required. Personal risk assessments were available on all the files sampled for such things as, falls, smoking, wandering and confusion. These were generally comprehensive and detailed how staff were to minimise the risks. One of the people living in the home had a very detailed management plan in place for challenging behaviour. This indicated how the behaviour presented and how Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 14 staff were to manage it. Speaking to staff they had some understanding of the management plan but were not fully conversant with it. The daily records for another of the people living in the home indicated they could be aggressive when staff were trying to assist with personal care. There was no management plan in place for this. Manual handling risk assessments had been undertaken and where necessary there was guidance for staff to follow on how to move people and what equipment was to be used. Staff spoken with were able to tell us who they used equipment for and what this equipment was. This corresponded with the risk assessments that were seen. A little after the inspection some concerns were raised with us about how one of the people in the home was being moved. This indicated that not all staff were following the manual handling risk assessments. The concerns have been passed to the manager and the provider to investigate. The issue was discussed with the manager and she was advised staff must follow manual handling guidelines for the safety of the people living in the home and themselves. Tissue viability assessments had improved and indicated who was at risk. Where a risk had been identified for one of the people living in the home there was a management plan in place however it was not clear from this if the individual had broken skin or not but then elsewhere it did state the nurse was visiting every 3 days to do a dressing. The daily records indicated that the nurses had said the individual was to lie on her side and be assisted to stand at regular intervals to aid pressure care. This had not been updated in the management plan. Concerns raised with us after the inspection indicated that a pressure mattress had been delivered to the home and had not been put on the bed three days later. This is not acceptable. This issue was also discussed with the manager who stated she was not on duty when the mattress was delivered or the next day. The mattress was now in place and she would investigate why it had not been utilised straight away. The manager needed to ensure that all care plans, risk assessments and management plans cross referenced to each other, were kept up to date and indicated to the reader if there was further information elsewhere. There also needed to be system in place ensuring that staff read, understood and agreed to follow the care plans and risks assessments. The people living in the home were receiving medical attention when required from G.Ps and district nurses. Staff were able to identify health care needs and these were followed up. Records also showed that the people living in the home had access to opticians, chiropodists and so on. The home had recently had an outbreak of sickness and diarrhoea and all the correct procedures had been followed. Where possible the people living in the home were being weighed on a regular basis. Where this was not possible staff were measuring the upper arm of the individuals however it was not clear what this indicated. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 15 The manager was advised to ask the district nurses for help with this to ensure it was being done correctly and what the changes in measurements indicated. Medication continued to be generally well managed. All staff that were administering medication had received training. It was recommended at the last inspection that there was a sample staff signature sheet with the MAR charts so that it could be determined who had administered the medication at any time. This had been addressed. There was a slight discrepancy in the amount of tablets left in the home for one of the medicines audited and one lot of medication had not been booked in. It was also noted that there were eye drops in the medication fridge that had not been dated on opening. Controlled medication was being recorded and administered appropriately. No specific issues were raised in relation to privacy and dignity at the time of the inspection. The people living in the home were spoken to appropriately and by the name of their choice. People were able to lock their bedroom doors for privacy if they wished and there was screening in double bedrooms. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 16 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There did not appear to be any rigid rules or routines in the home and the people living there could spend their time as they chose. The suitability of the activities being offered needed to be discussed with the people living in the home or their representatives to ensure they met with their expectations and abilities. There were no restrictions on visitors to the home within reasonable hours. People living in the home were satisfied with the food being served to them. Food records needed to be improved to ensure they were a true reflection of what people were actually eating. EVIDENCE: There were no rigid rules or routines in the home and the atmosphere was quite relaxed. People were seen to wander freely around the home and could clearly get up when they wished. Care plans were in place for social care needs however it was not clear that these were being followed. For example, one stated ‘enjoys singing and dancing’ but there was no evidence that this had actually happened. Individual activity records had been introduced which allowed for staff to comment if the activity was enjoyed or not. Activities on these included such things as, drafts, making pompoms, skittles and target Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 17 games. Some of the activity records indicated some of the people living in the home had not been involved in any activities for a considerable amount of time. The abilities of the people living in the home varied considerably, for example, some had dementia and some poor eyesight. The activities available needed to reflect this. There were no records of people having one to one staff time where they could not or did not want to join in with activities. The suitability of the activities being offered needed to be discussed with the people living in the home or their representatives to ensure they met with their expectations and abilities. The daily records indicated that the people living in the home could have visitors at all reasonable times and could go out with their relatives if they wished. The menus in the home were quite varied and choices were available at all meals. The meals being served generally reflected the menus. The manager had attempted to improve the food records however as mentioned previously in the report these did not always reflect what people were eating. On the day of the inspection we ate with the people living in the home the meal was well cooked and presented. The manager needed to ensure that the people living in the home had adequate amounts of vegetables with their meals. On the day of the inspection the only vegetables were a small amount of mixed vegetables which were in the chicken pie. One of the people living in the home told us she had very poor eye sight and did not know what she was eating until she put it in her mouth. This individual’s care plan stated ‘needs staff to cut up her food and tell her what is on her plate and where it is’ staff did cut up her food but did not tell her what was on her plate or where it was. She also told us she had told staff she wanted mashed potatoes but she was given sauté potatoes. Staff needed to ensure they followed the care plans for the people living in the home and that they were served what they asked for. The food records for this person indicated she had had mashed potatoes and chips. It was also noted that none of the people living in the home were asked if they wanted any more food or offered anything different if they did not eat their meal. The manager was advised she should observe meal times on a regular basis to ensure these issues were addressed with staff. The people living in the home that were spoken with were satisfied with the food being served in the home. Bretby House DS0000064275.V362143.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was an appropriate complaints procedure on site and it appeared that any complaints were listened to. To ensure the people living in the home were fully safeguarded staff needed to follow the care plans and risk assessments that were in place. EVIDENCE: There was a complaints procedure for the home and the people living there received a copy of this in the service user guide. The home had not received any complaints since the last inspection. The home has demonstrated in the past that they do take complaints seriously and investigate them fully. It was recommended that staff record any minor complaints or ‘niggles’ that the people living in the home make to evidence they listen to them and take action. We received some concerns about the home a little after the inspection. These were in relation to personal care, poor manual handling and pressure relieving equipment not being used. The concerns had been passed back to the provider to investigate at the time of writing this report. The providers responded to the concerns within five days. The concerns in relation to poor manual handling and pressure relieving equipment were upheld. There are no staff in the home that do not speak English although one does have quite a heavy foreign Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 19 accent. Staff being rude could not be determined. As a result of the investigation staff disciplinaries were undertaken and a staff meeting was held to emphasise to staff that they must follow the care plans and risk assessments that are in place. There had been some adult protection issues raised about the home since the last inspection. The issues were in relation to two of the people that had been living in the home. The allegations made were quite serious and resulted in several adult protection meetings being held and all the people living in the home being reviewed by Social Care and Health. The outcomes of the reviews indicated that for the majority of the people living in the home there were no concerns and relatives were satisfied with the service being offered. However there were some issues raised that needed to be addressed including, inconsistent recording by staff, people losing weight, food records not detailing soft diets, medication administration including someone hiding medication and medication being given for wandering, how to recognise when they can no longer care for the people living in the home and admitting people they could not care for. As a result of the adult protection meetings we had a meeting with the manager and the owners of the home. All the issues were discussed with them and they had already begun to address them, for example, better pre admission assessments. At the time of this inspection the manager had improved the systems in the home further to try and address the issues raised including, much better care plans that included details of medication administration, much more robust risk assessments, clear details of how nutritional needs were to be met and improved food records. Clearly from the evidence at the time of this inspection further improvements were still needed, for example, all staff following care plans and risk assessments at all times. The manager was very receptive to the findings of the inspection and very determined to ensure the issues were addressed. The manager has shown in the past that she is clearly aware of her responsibilities to report any allegations of abuse. Some of the staff at the home had had training in adult protection issues but as the training matrix was not up to date it was not possible to identify how many had not. Bretby House DS0000064275.V362143.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, 20, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been further improvements to the environment enhancing the comfort and facilities available to the people living there. Some issues needed to be addressed to ensure the people living in the home were entirely safe. EVIDENCE: The home was suitable for its stated purpose, was generally well maintained and safe. There had been some further improvements made at the home since the last inspection, for example, some redecoration, new lighting on the stairs and upper floors, some new bed bases had been purchased and improvements were underway in the garden area. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 21 There was ample communal space with one combined lounge/diner and two further lounges. All communal areas were comfortable and adequately furnished and decorated. Two large screen televisions had been purchased for the lounges. The other lounge was seen more as a quiet lounge. There were some aids and adaptations throughout the home to assist those people with mobility difficulties including shaft lift, mobile hoist, assisted bathing facilities and a ramp for going into the garden. The home also had an emergency call system. It was strongly recommended that hand rails are fitted in the corridors throughout the home. At the time of the last inspection due to the relocation of some of the furnishings in the home some of the radiators had become accessible to the people living in the home and these were not guarded. This had been addressed at the time of this inspection. Some bedrooms were seen on the day of the inspection. They varied in size and the majority of the required furnishings and fittings were evident. The previous manager had audited the rooms for furnishings and fittings against the National Minimum Standards (NMS) but any shortfalls had not been rectified. If individuals choose not to have all of the furnishings and fittings required by the NMS this should be documented in their files. All rooms had a lockable facility and the people living in the home were able to have keys to their bedroom doors if they wished. Rooms seen were appropriately personalised and double rooms had adequate screening. Some new bed bases had been purchased however there were still some that needed to be replaced. The home was generally clean and odour free, with the exception of one bedroom. The manager was trying to address this issue. The laundry was appropriately located, albeit very small. The proprietor has had planning permission to build a new laundry. There was a sluice washing machine and two tumble driers installed. It was noted that COSHH substances were accessible to the people living in the home in the laundry and in the staff toilet as the key had been left in the door. This issue was raised at the last inspection, in a different area of the home, staff needed to be more vigilant and ensure COSHH substances were locked away when not in use. Numerous commodes were being used in the home and effective cleaning of the pots can be problematic therefore the home should at their earliest opportunity install a commode pot washer/disinfector. The kitchen was clean and tidy with all the appropriate checks in place. It was noted that staff wander in and out of the kitchen without putting on any protective clothing which is not conducive to good infection control. The environmental officer had raised this issue on the last visit to the home. Bretby House DS0000064275.V362143.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, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were being maintained to ensure the needs of the people living in the home could be met. It was not evidenced that employees were undertaking all the appropriate training to enable them to care for the people living in the home. Recruitment procedures had improved and ensured the people living in the home were safeguarded. EVIDENCE: Staff turnover at the home had been relatively low since the last inspection. This meant better continuity of care for the people living in the home. Relationships between staff and the people living in the home were generally good. The people living in the home described staff as ‘good’ and ‘caring’. The concerns recently raised with us alleged some staff had been rude to people visiting the home and that one could not speak English. The provider was looking into these issues however the manager had stated that there were no staff employed at the home who could not speak English. Several issues were raised during the course of the inspection in relation to staff not following the care plans and risk assessments for the people living in the home. The manager needed to address this so that it could be assured people were fully safeguarded and received person centred care. Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 23 Rotas indicated that staffing levels were appropriate for the needs of the people living in the home at the time of the inspection. The manager’s hours were supernumery to the care rota and the home also employed catering and domestic staff. There were seventeen care staff employed at the home and we were informed ten of these had NVQ level 2 or the equivalent. All the other care staff had been registered to undertake either NVQ level 2 or 3. The training matrix for the home was on a white board in the office. This indicated that since the last inspection staff had undertaken training in infection control, adult protection, fire procedures, tissue viability and a short course in dementia care. The training matrix was not up to date, for example, it indicated only very few staff had had food hygiene training and not all staff names were on it. The manager needed to ensure this was kept up to date so that she could easily identify what training staff had had and what shortfalls there were. Staff at the home were to undertake a distance learning course for dementia care which was much more in depth and facilitated by a local college. This had not commenced at the time of this inspection. The induction training for new staff was in line with the specifications laid down by Skills for Care. However where the manager believed this had already been done by new employees she needed to get evidence of completion from the employee so that she could be assured they were appropriately trained for their roles. There also needed to be evidence that an induction into the home has been undertaken. Recruitment had improved since the last inspection and all the required checks were being undertaken prior to new staff commencing at the home including POVA first checks, CRBs and two written references. It was recommended that the manager keep records of any discussions with staff about any offences that appear on CRBS. Risk assessments should be undertaken by the manager to ensure that staff with offences are suitable to work in the home. Bretby House DS0000064275.V362143.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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home had improved. Further improvements were required to ensure the home was run in the best interests of the people living there. Further improvements were required to the system in place for monitoring the quality of the service offered. The health and safety of the people living in the home and the staff were generally well managed. EVIDENCE: The manager of the home had been in post less than a year at the time of this inspection. Clearly her appointment had brought some stability to the home and many improvements had been made. There had been a vast improvement in the systems in place for care planning, risk assessments and the general running of the home. Staff spoken with were very positive about the Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 25 management of the home. They told us the manager was fair and approachable and if they needed to be told about something it was done in an acceptable way. The manager had a very good knowledge of the needs of the people living in the home. She showed a commitment to improving the home and was very receptive to the suggestions made during the inspection. The main issue for the manager at the time of this inspection was to ensure that staff followed the care plans and risk assessments that were in place for the people living in the home at all times. There were some systems in place for monitoring the quality of the service offered, for example, surveys being sent out to relatives and given to the people living in the home, meetings with staff and the people living in the home and in house audits on the medication system. The home has had a formal quality assurance system in the home in the past where the responsible individual for the home had undertaken a quality audit of the home. There was no evidence seen that any more of these audits had been undertaken. Clearly improvements had been made in the home and a quality audit should be undertaken with the involvement of the people living in the home to identify where further improvements are required and how they will be addressed. Some of the people living in the home continued to manage their own personal allowance and paid for things themselves such as hairdressing. The manager was satisfied that all the people living in the home had access to money when needed. The home continued to manage some of the finances on behalf of the people living there. Some records were sampled. Family members brought the money for these individuals into the home. The written records were appropriate and recorded all income and expenditure and all balances of cash held were correct. One minor issue was raised that one person did not have a receipt for the most recent chiropody treatment. The health and safety of the people living in the home and the staff were generally well managed. Staff had received training in safe working practices in most cases. There was evidence on site that the equipment being used was regularly serviced. The issue raised at the last inspection in relation to the emergency call system being serviced had been addressed. The in house checks on the fire system were up to date and a fire drill had been undertaken as part of the recent fire training. Issues raised at this inspection were the storage of COSHH substances and staff not always following risk assessments. We were being notified appropriately of any accidents or incidents in the home. Bretby House DS0000064275.V362143.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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 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 3 17 X 18 2 2 3 X 2 X 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Bretby House DS0000064275.V362143.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. 1. Standard OP8 Regulation 12(1)(a) Requirement The records kept in the home in relation to dietary intake must be accurate, clear and cross reference to all other relevant records. Separate food and fluid intake records must be kept for any of the people living in the home where they have been identified as being at risk in relation to diet. This will ensure the nutritional needs of the people living in the home are met. There must be specific management plans in place for staff to follow where there are any identified challenging behaviours. This will ensure that the people living in the home and the staff are not put at risk. Staff must follow the handling instructions on manual handling risk assessments. This will ensure the people living Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 28 Timescale for action 31/05/08 2. OP8 12(1)(a) 13(4)(c) 31/05/08 3. OP8 13(5) 31/05/08 4. OP8 12(1)(a) in the home are moved safely. The management plans for pressure care must be updated as the needs of the people living in the home change. 31/05/08 5. OP15 12(1)(a) 16(2)(i) This will ensure the people living in the home are not put at unnecessary risk. Appropriate assistance must be 31/05/08 offered to the people living in the home at meal times. (Previous time scale of 18/11/07 not met.) The records of food being served to the people in the home must be true reflection of what they have actually eaten. Adequate amounts of vegetables must be available at meal times for the people living in the home. This will ensure people have their nutritional needs met. Staff must follow the instructions given in the care plans and risk assessments of the people living in the home. This will ensure the people living in the home are fully safeguarded. All COSHH substances must be stored securely. (Previous time scale of 18/11/07 not met.) Good infection control procedures must be followed at all times. (Previous time scale of 18/11/07 not met.) This will ensure the people living in the home are not exposed to any unnecessary risks. 6. OP18 13(6) 31/05/08 7. OP26 13(4)(c) 31/05/08 Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 29 8. OP30 18(1)(c) The training matrix for the home must be updated. Any shortfalls identified must be addressed. This will ensure staff have the necessary skills and knowledge to care for the people living in the home. 31/05/08 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 OP1 Good Practice Recommendations The service user guide for the home should be reviewed and updated to include the changes to the service and the range of fees charged at the home. This would ensure that people considering moving into the home had all the current information to enable them to make an informed choice about where they lived. It is strongly recommended that the contract issued to the people living in the home includes the number of the room to be occupied. This will ensure individuals are aware of what room they are paying for. It is strongly recommended the manager seeks advice about measuring people’s arms where they cannot be weighed to ensure it is being done correctly and what the changes in measurements indicate. The minor issues raised in relation to the administration of medication should be addressed to ensure the people living in the home receive their medication safely. The suitability of the activities being offered in the home need to be discussed with the people living there or their representatives to ensure they meet with their expectations and abilities. Staff must ensure that the people living in the home are served the foods they have chosen to eat. It is recommended that all minor concerns and complaints raised by the people living in the home are recorded to show that they are listened to and that concerns are acted on. To promote good infection control the flooring in the toilets DS0000064275.V362143.R01.S.doc Version 5.2 Page 30 2. OP2 3. OP8 4. 5. OP9 OP12 6. 7. OP15 OP16 8. OP21 Bretby House on the first and second floors of the home should be replaced. (Not assessed at this visit). 9. OP22 It is recommended that handrails are fitted along all the corridors in the home to aid the mobility of the people living there. Not all the bedrooms had all the furniture and fittings detailed in the National Minimum Standards. This should be discussed with the people living in the home to ensure the furnishings meet with their needs. Numerous commodes were being used in the home and effective cleaning of the pots can be problematic therefore the home should at their earliest opportunity install a commode pot washer/disinfector. It is recommended that the manager keep records of any discussions with staff about any offences that appear on CRBS. Risk assessments should be undertaken by the manager to ensure that staff with offences are suitable to work in the home. Staff at the home should undertake more in depth training in dementia care to ensure they could care appropriately for all the people living in the home. The manager should obtain evidence of staff’s previous training so that she could be assured they were appropriately trained for their roles. The home should have a system in place for monitoring and improving the quality of the service offered based on seeking the views of the people living in the home. This will ensure that standards within the home are acceptable to the people living there. 10. OP24 11. OP26 12. OP29 13. 14. 15. OP30 OP30 OP33 Bretby House DS0000064275.V362143.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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