Inspection on 19/04/07 for Bretby House

This inspection was carried out on 19th 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

Bretby House 16/04/08

Bretby House 18/10/07

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 Key Unannounced Inspection 19th April 2007 08:45 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.V334294.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.V334294.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.V334294.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. 16th October 2006 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 residents 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 allow for full assistance. Communal areas are located on the ground floor and comprise of one large and one smaller lounge and a dining room. 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 fees at the home ranged from £314.00 to £365.00 per week. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over one day in April 2007. During the course of this visit a tour of the premises was made, three resident and three staff files were sampled as well as other care and health and safety records. The inspectors had lunch with the residents and made observations of the care being offered to the residents throughout. The inspectors spoke with the proprietor, three staff members, two visitors and six of the residents. The home had not logged any complaints since the last key inspection. One anonymous complaint had been lodged with the Commission which was looked into at this visit. Issues raised were lack of food in the home, running out of milk with no money available to buy more, staff being employed from overseas who could not communicate appropriately with the residents, staffing levels and the management of the home. These issues were looked into and are detailed under the corresponding outcome areas. No regulations were found to have been breached when looking into these issues. A random inspection was carried out at the home in January 2007 by the pharmacist inspector as serious concerns were raised in relation to the medication management at the home at the last key inspection. At the random inspection the medication management at the home was assessed. At the time of this visit there had been a vast improvement. What the service does well: Despite being a very busy time of day when the inspection commenced the home was calm and the atmosphere very relaxed. No rigid routines were seen during the course of the inspection. Some of the staff had worked at the home for a considerable amount of time which was good for the continuity of care of the residents. Residents spoken with were very positive in their comments about the staff team and friendly relationships were evident. There had been little staff turnover since the last inspection and appropriate staffing levels were being maintained. Visitors were seen to come and go during the inspection and were made welcome by staff. Friendly relationships between staff and visitors were evident. The two visitors spoken with at the time of the visit were happy with the service being offered and confirmed they were always made welcome by staff. There were no restrictions on visitors to the home within reasonable hours. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 6 The menus were varied and nutritious and offered choices at each meal. The meals for the day were put on a menu board in the dining room. Residents spoken with were satisfied with the food being served to them. There was an appropriate complaints procedure on site and it appeared that any complaints were listened to. Recruitment procedures in the home were robust and safeguarded the residents. What has improved since the last inspection? What they could do better: All residents needed to have care plans in place that they had been consulted about and detailed all their needs and how they were to be met by staff to ensure they were cared for appropriately. Risk assessments needed to be developed further and in place for all residents to ensure any identified risks were documented and systems were in place to minimise them. Any issues in the home that could be deemed as adult protection must be referred to the appropriate social work team to ensure the residents are protected. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 7 There must be records of how any identified health care needs are being met and monitored on an ongoing basis. This will ensure residents health care needs are being met. Staff must ensure that the portions of food being served to the residents are adequate and that meals are served at the residents pace. All new staff needed to have training in line with the specifications laid down by Skills for Care to ensure they were equipped with the necessary skills and knowledge to care for the residents. All staff must have appropriate training in safe working practices to ensure they work safely with the residents. The quality monitoring system needed to be further improved to ensure it was based on seeking the views of the residents with a view to continuous improvement. The home was in need of a stable management team to ensure the systems that were in place for ensuring the safety of the residents and good service delivery were applied consistently and that new systems were put in place where the home was failing. There were some areas of the management of health and safety that needed to be improved to ensure the home was safe for the residents and staff. These included, checks on the fire alarm and emergency lighting and fire drills. 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.V334294.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 Bretby House DS0000064275.V334294.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 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents did not have the necessary information available to them to enable them to make an informed choice about where they lived. The assessment procedures in the home were comprehensive ensuring the needs of the residents were known to the staff prior to admission. EVIDENCE: The proprietor informed the inspectors that the statement of purpose and service user guide had been completed and were at the printers. Copies were e-mailed to the inspector after the inspection. Some further amendments were required to the document. Residents needed to be issued with a copy of the service user guide as soon as it was available. The assessments for two residents recently admitted to the home were sampled. Assessments had improved since the last inspection. The staff at the home had undertaken their own pre admission assessments which were quite Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 10 well detailed. 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. Copies of the social workers’ assessments had also been obtained by the home and these were very well detailed. Information included residents’ life styles, reasons for needing residential care, past medical history and their abilities. One of the files also included information from the hospital where the individual had been prior to admission. Contracts were evident on both files and residents visited the home before admission wherever possible. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans do not adequately detail all the needs of the residents and how these are to be met by staff. Risk assessments for residents did not detail how all risks were to be managed or minimised. The management of the medication system had improved and safe guarded the residents. EVIDENCE: Three residents care plans were sampled as part of case tracking. Two were for relatively new residents and one for a resident who had lived at the home for some time. Care plans were entitled Individual service Statements. (ISS) Although the pre admission assessments for new residents were thorough the needs identified had not been carried forward to the ISS that had been drawn up for the residents e.g. one assessment stated the individual wandered, was doubly incontinent and used bedsides none of this information had been included on the ISS. For the other new resident some aggression both verbal Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 12 and physical, poor diet and an ongoing health concern were identified none of this information was included on the ISS. For the resident who had lived at the home for some time there was a very detailed ISS but this had been rewritten as her physical condition had deteriorated and the current ISS did not include as much detail. The ISSs were very vague stating in most areas ‘assistance with’ but the type of assistance was not detailed. The ISSs did not include any of the preferred daily routines or activities of the residents’. Likes dislikes or abilities were not detailed. There was no evidence that the ISSs were being reviewed on a monthly basis and little evidence that they were updated as needs changed, for example, one of the residents was no longer using a walking aid this was still detailed in the ISS. All files included manual handling risk assessments. Two were adequate. The other assessment had been updated because the individual was not weight bearing but the handling methods to be used by staff for transferring were not detailed. It also appeared from the daily records that at some point this individual was being turned at night but the method to be used for this was not detailed. Nutritional risk assessments were not always completed properly, for example, one stated normal build and weight but this individual was only 5.5 stone and clearly very thin. Inspectors also observed other residents who were very thin and checked their nutritional assessments and care plans. There were no plans in place to ensure staff were aware of the issues and how they were to monitor and try and help the residents increase or maintain their weights. Pressure sore assessments were also in place but there was no grid to identify what the scores indicated. One resident had clearly had a pressure sore earlier in the year. The district nurse had been visiting but no management plan had been put in place for her pressure areas. There was no evidence of any personal risk assessments for two of the residents. The other resident did have personal risk assessments for smoking and hitting out at other residents. The one for hitting out was not adequate stating only for staff to observe. It was evident from the individual’s daily records that staff were finding her behaviours very challenging. Two of the residents also mentioned the individual’s behaviour and how distressing they found it. There was no management plan for staff to follow in the event of any challenging behaviour. The doctor had been consulted about the behaviour however there was no evidence of any contact being made with the appropriate social worker to inform them of the issues. The proprietor was informed if a resident is hitting another resident it must be reported as an AP issue and they will determine if it is to be pursued. Only one of the files sampled included a professional visit sheet. This detailed visits made by the G.P. and district nurse however the last visit for the district nurse stated a dressing had been changed and then there was nothing Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 13 following this to indicate the nurse had discharged the resident. One of the new residents had been registered with the G.P. according to her daily records but had not had any visits. Details of contact with the G.P. for the other new resident were included in her daily notes and will be lost as the daily records are removed from the file. Also the individual had attended hospital appointments however the reason for or the outcomes of the visits were not detailed. There was no indication that the ongoing health concern raised on the pre admission assessment had been followed up by the home. Serious concerns were raised in relation to the medication management at the home at the last key inspection. The pharmacist inspector has since undertaken a random inspection at the home to assess the medication management at the home. At the time of this visit there had been a vast improvement. At this inspection the medication system was audited for the residents being case tracked and in addition some of the boxed medication was also audited. Further improvements had been made and the system was well managed. Two requirements were made, one resident could have a variable dose of one medicine however there was no guidance for staff as to when they should give the larger dose. The medication system was being audited but staff competence was not and this is required to ensure staff are competent to administer medication. No specific issues were raised in relation to privacy and dignity. Residents were spoken to with respect and could lock their doors if they wished. To ensure the resident’s privacy was maintained the broken lock on the ground floor toilet door needed to be repaired. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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 residents could spend their time as they chose. There were activities available for residents but these did not meet with the expectations of all of them. There were no restrictions on visitors to the home within reasonable hours. Residents were satisfied with the food being served to them the food records evidenced that their nutritional needs were being met. EVIDENCE: When the inspector arrived some residents were having breakfast, others had finished and other residents were still getting up. Despite being a very busy time of day the home was calm and the atmosphere very relaxed. No rigid routines were observed during the course of the inspection. Residents were seen to wander freely around the home, meet and go out with visitors, spend time in their bedrooms, watch television and chatting to each other. At the time of the last inspection the recording of activities had lapsed. Staff had started to complete these records again. Activities recorded included bingo, listening to war CD, floor games and having nails done. There was also evidence on daily notes that residents had been asked to go swimming Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 15 however only one wanted to go when the time came. Residents spoken with said they did nothing during the day just sat. Another stated she got bored staff did not take her out although she went out regularly with family. It is strongly recommended that activities are discussed with the residents, collectively and individually, to ensure they are meeting the expectations of the residents. Visitors were seen to come and go throughout the course of the inspection and were made welcome by staff. Friendly relationships between staff and visitors were evident. The two visitors spoken with at the time of the visit were happy with the service being offered and confirmed they were always made welcome by staff. There were no restrictions on visitors to the home within reasonable hours. Residents were able to make choices on a daily basis, for example, when to get up and go to bed, what to wear and what to eat and how to spend their time. It was recommended that care plans include more detail of the preferred daily routines of the residents, their likes and dislikes and if they are able to make choices particularly where residents had dementia so that staff were aware of these preferences. Residents were encouraged to personalise their rooms to their liking and personal possessions were observed in the rooms seen. There were menus in place at the home and from the evidence on the food records these were generally followed. The menus were varied and nutritious and offered choices at each meal. The meals for the day were put on a menu board in the dining room. Residents spoken with were satisfied with the food being served to them. The inspectors had lunch with the residents and had different meals. Both meals were well presented and enjoyable. All the residents had the same (roast lamb and vegetables) and the majority appeared to enjoy it. It was noted that all the residents’ meals were served on small tea plates. This may be an adequate portion for some but others may need more. No one was asked if they wanted any more despite clearing their plates of both their lunch and their pudding. Staff were on hand to give assistance where required. It was observed that some dinners were on the table before the residents sat down and one resident was given her pudding before she had finished her dinner. She left her dinner and started to eat her pudding with her knife and fork. Staff needed to be mindful that they serve meals at the residents’ pace and do not leave plated meals to go cold. There had been a recent complaint lodged with the commission which included an issue about the lack of food in the home and the home running out of milk and there being no money to purchase anymore. Food stocks at the time of the visit were adequate. The proprietor stated that they have on occasions run out of milk but that there was always petty cash in the home to purchase extra supplies. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 16 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 residents are safe guarded staff at the home must ensure they report any issues that can be deemed as adult protection. EVIDENCE: The complaints and adult protection procedures have been viewed on several occasions and found to be appropriate. The home had not logged any complaints since the last inspection. One of the visitors spoken with at the time of the inspection stated they had raised some concerns with the staff at the home and they had been addressed appropriately. One anonymous complaint had been lodged with the Commission which was looked into at this visit. Issues raised were lack of food in the home, running out of milk with no money available to buy more, staff being employed from overseas who could not communicate appropriately with the residents, staffing levels and the management of the home. These issues were looked into and are detailed under the corresponding outcome areas. No regulations were found to have been breached when looking into these issues. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 17 No adult protection issues had been raised at the home prior to the inspection. During the process of case tracking it was evident that staff were having difficulties managing the behaviour of one of the residents. Daily records evidenced that the individual could be both physically and verbally aggressive to staff and residents. Two of the residents spoken with expressed their concern about this resident and described what had happened the previous night in the home. There was no evidence that the staff at the home had discussed the issues with the appropriate social workers. The inspectors were of the opinion that the issues detailed in the individual’s daily records were adult protection and should have been referred as such. Staff had received training in adult protection issues. The proprietor informed the inspectors that staff had also undertaken challenging behaviour training but the certificates had not arrived at the time of the inspection. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 18 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, 21, 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. The home was generally well maintained and comfortable. Further improvements were needed to enhance the comfort and safety of the residents. EVIDENCE: There had been no changes to the layout of the home which was suitable for its stated purpose. There was adequate communal space at the home with two lounges and a dining room. It was noted that the vinyl covering two of the armchairs and one foot stool in the large lounge was splitting and could be hazardous for any residents with frail skin. These needed to be recovered or replaced. There were some tripping hazards observed in the garden that needed to be addressed, for example, pieces of wood lying on the path and uneven paving. The bottom Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 19 of the garden was badly overgrown and could have been hazardous to any resident wandering in that area, it was recommended this area was fenced off. There were adequate numbers of toilets throughout the home and some were large enough for staff to offer assistance. The flooring in the toilets needed to be replaced as it was too small and left gaps at the wall and was ingrained with dirt, which is not conducive to good infection control. There were assisted bathing facilities on the first and second floors of the home. At the time of the last inspection the inspectors were informed that appropriate chairs were on order for the bathrooms however these were not seen on the day of the inspection and what appeared to be garden chairs were still in use. The home also had a shower but this had a large step up shower tray and was not used by the residents. The medic bathroom on the ground floor had been closed off since the last inspection as it was hazardous. Therefore there was no bathing or showering facility on the ground floor. The proprietor stated that plans for alterations to the ground floor had been passed and when this work was completed there would be a walk in shower on the ground floor. The built in cupboard in the ground floor bathroom was still being used to store food, which was not appropriate. The relocation of this had been incorporated in the planned works for the home. The environmental health officer had raised the issue of food storage and the registered person needed to consult with them about an appropriate time scale for completion. There were some aids and adaptations throughout the home to assist those residents 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. Bedrooms varied in size and the majority of the required furnishings and fittings were evident. The previous manager had begun to audit the rooms for furnishings and fittings against the National Minimum Standards (NMS) but any shortfalls had not been rectified. If residents 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 residents were able to have keys to their bedroom doors if they wished. Some bedrooms had had new carpets and new beds however there still remained some bed bases that were worn and needed to be replaced. The home was generally clean and odour free. Some minor issues were raised in relation to infection control e.g. fresh foods must be dated when frozen, one rusting commode was seen in a bedroom, a badly stained commode pot in the bathroom and some tablets of soap in one bathroom. 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 a tumble drier installed. Numerous commodes were being used in the home and Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 20 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 generally clean and tidy. A new fridge and freezer had been purchased since the last inspection. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 21 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 residents’ needs could be met. It was not evidenced that employees were undertaking suitable induction and ongoing training to enable them to care for the residents. Recruitment procedures were robust and safeguarded the residents. EVIDENCE: On the morning of the inspection there were three care staff on duty, a cook, laundry and domestic staff. The senior staff member was off sick but a manager from another home owned by the same proprietor was on her way to the home to give out medication. The proprietor also arrived at the home shortly afterwards and stayed for the duration of the inspector. Staff were managing well in the absence of a senior staff member and the home was relaxed despite it being a very busy time of day. Residents spoken with were positive in their comments about the staff team and friendly relationships were evident. There had been little staff turnover since the last inspection which was good for the continuity of care of the residents. An issue raised in the recent complaint was in relation to staffing levels particularly in the afternoons. The rotas for February, March and April were sampled. There was the odd occasion when the staffing levels dropped to two Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 22 instead of three care staff but this was due to sickness and was addressed by the next day. Another issue raised was in relation to staff from overseas who could not communicate with the residents. This was discussed with the proprietor and she stated they only employed two staff from overseas. One was a care assistant who spoke excellent English and the other a domestic assistant who could speak some English which was enough for the post she held. The home employed sixteen care staff five of these had NVQ level 2. All other staff were undertaking this training. Two staff had also commenced NVQ level 3. The Training records for seven staff were sampled. Manual handling, adult protection and dementia care training had been undertaken by all, two had food hygiene and medication training, one had tissue viability training and another infection control. Some staff did not have training records in place. The proprietor stated that the records were not up to date and staff had also had recent fire training, required at the last inspection, challenging behaviour and sight awareness training. There needed to be evidence that staff had undertaken all their regulatory training in topics such as food hygiene, health and safety and infection control. It was strongly recommended that a training matrix for the whole home be drawn up so that it could be easily determined what training staff needed to undertake. Any shortfalls in training needed to be addressed. As at the last inspection there was some evidence that staff undertook some induction training in the home but this needed to be cross referenced to the standards and specifications laid down by Skills for Care to ensure it complied with the requirements and was completed within the timescales given. The recruitment records for three staff were sampled. All the required documentation was in place. There had been no new care staff appointed since the last inspection. The only evidence of supervision sessions was for one staff member. The difficulties with retaining a competent manager at the home are reflecting on this. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is in need of a stable management team to ensure the service offered to the residents is entirely safe and continuously improved. Further improvements were required to the System in place for monitoring the quality of the service offered to ensure it was based on seeking the views of the residents with a view to continuous improvement. EVIDENCE: There was no manager in post at the time of the inspection. Day to day management was being undertaken by senior care staff, the proprietor and input from the manager of another home owned by the proprietor. The proprietor was in the process of trying recruit another manager via an agency. Despite the lack of a manager some improvements were noted in the home, for example, medication management was much safer. However other areas Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 24 needed to be vastly improved, for example, residents’ risk assessments. The home was urgently in need of a stable management team to ensure the systems that were in place for ensuring the safety of the residents and good service delivery were applied consistently and that new systems were put in place where the home was failing. The registered individual for the home had undertaken a quality assurance audit. Several areas audited had been identified as being met or exceeded however the evidence gained throughout the course of the inspection did not support this, for example, staff supervisions, residents meetings and environment. The audit did identify that induction training standards were poorly met. Questionnaires were sent out in December 2006 but there was only one on file. There was evidence of only two residents meetings having taken place where meals, Christmas and days out were discussed. There was no other evidence that residents had been consulted during or about the quality audit. There was no evidence of any improvement plan being drawn up after the quality audit had taken place. The home continued to manage some of the finances on behalf of the residents. Some records were sampled the written records were appropriate and recorded all income and expenditure and all balances of cash held were correct. It was noted that receipts were not available for all expenditure. Receipts needed to be obtained for all expenditure made on behalf of residents. Some issues were raised in relation to health and safety. Records on site detailed that the weekly fire alarm checks had not been carried out since 30/03/07 and the emergency lighting had not been checked since 08/03/07. No evidence could be found on site of an up to date fire drill. There was evidence of the regular servicing of the lift, portable electrical appliances, the fire alarm and extinguishers. The electrical wiring certificate was up to date and the water system had been checked for the prevention of legionella. The Commission was being notified of any accidents in the home as required but incidents of challenging behaviour were not being notified. Any incidents that affect the well being of the residents must be notified to the Commission so that it can be assured the home is being managed well and any incidents are addressed appropriately. Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 25 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 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 2 2 3 X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 2 Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4(1)Sch 1, 5(1) Timescale for action When completed the service user 18/06/07 guide for the home must be issued to all existing residents. This will ensure they have all the necessary information about the home. All residents must have care 18/06/07 plans that detail all their current needs in respect of health and welfare and how these are to be met by care staff. This will ensure that they receive person centred care that meets their needs. (Previous time scales of 01/01/06, 01/04/06, 14/09/06 and 31/12/06 not met.) 3. OP7 13(4)(c) All residents must have personal risk assessments undertaken to minimise any identified risks. This will ensure that residents are not exposed to any unnecessary risks. (Previous time scales of 01/12/05, 01/03/06, 31/07/06, 14/09/06 and 01/12/06 not met.) Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 27 Requirement 2. OP7 15(1) 18/06/07 4. OP7 13(5) Manual handling risk 18/06/07 assessments must be in place for all residents and detail all handling methods and the actions to be taken by staff in the event of a fall. Where a hoist is indicated the sling size must be detailed. This will ensure the safety of the residents. (Previous time scales of 31/07/06, 14/09/07 and 01/12/06 met.) There must be management plans in place for staff to follow for identified challenging behaviours. Any issues that can be deemed as adult protection must be referred to the appropriate social worker. This will ensure staff work consistently and residents are safeguarded. Nutritional assessments must be completed correctly and where any issues arise a corresponding care plan must be in place detailing the actions to be taken by staff. This will ensure that the residents’ nutritional needs are met. There must be care /management plans in place detailing how any needs residents may have in relation to pressure care are to be managed. This will ensure residents have their needs met. There must be records of how any identified health care needs are being met and monitored on an ongoing basis. This will ensure residents health care needs are being met. (Previous time scale of DS0000064275.V334294.R01.S.doc 5. OP8 OP18 13(4)(c) 13(6) 01/06/07 6. OP8 12(1)(a) 18/06/07 7. OP8 12(1)(a) 01/06/07 8. OP8 12(1)(a) 01/06/07 Bretby House Version 5.2 Page 28 9. OP9 13(2) 01/12/06 not met.) Regular staff drug audits must take place to assess staff competence in medicine management. Appropriate action must be taken when discrepancies are found. This will ensure staff have the skills to administer medication safely. (Previous time scale of 15/02/07 not met.) Where residents are able to have variable doses of medication there must be guidance for staff as to the amount to be administered. This will ensure that residents receive the correct levels of medication. The lock on the ground floor toilet must be repaired. This will ensure residents’ privacy is maintained. Staff must ensure that the portions of food being served to the residents are adequate. This will ensure residents’ nutritional needs are being met. Any tripping hazards in the garden must be addressed. This will ensure that residents are safe when using the garden area. Any chairs or footstools with split vinyl must be removed from the lounge. This will ensure residents are not at risk of injury. The registered person must consult with the environmental health officer to agree a time scale for the dry goods store to be relocated. This will ensure the home complies with food regulations. (Previous time scale of 14/11/06 not met.) Any worn bed bases must be DS0000064275.V334294.R01.S.doc 01/06/07 10. OP9 13(2) 01/06/07 11. OP10 12(4)(a) 01/06/07 12. OP15 16(2)(i) 01/06/07 13. OP19 13(4)(c) 01/06/07 14. OP20 13(4)(c) 01/06/07 15. OP21 23(5) 30/06/07 16. OP24 16(2)(c) 01/07/07 Page 29 Bretby House Version 5.2 replaced in order of priority. This will ensure the residents are comfortable. (Previous time scale of 30/11/06 partially met.) Toilet flooring must be replaced where it does not meet the wall and is ingrained with dirt. This will enhance the infection control procedures in the home. 50 of care staff must be qualified to NVQ level 2 or the equivalent. This will ensure staff have the necessary skills and knowledge to care for the residents. (Previous time scale of 31/12/06 not met.) All staff must have induction training as specified by Skills for Care that is completed within the first twelve weeks of employment. This will ensure new staff have the necessary skills and knowledge to care for the residents. (Time scales of 31/07/06, 30/09/06 and 31/12/06 not met.) The registered person must ensure that all staff have completed the appropriate training in safe working practices to include: Food hygiene Health and safety Infection control. This will ensure the safety of the residents. The responsible individual for the home must ensure that an appropriately qualified and experienced manager is appointed for the home. This will ensure there is a person overseeing the care delivered to DS0000064275.V334294.R01.S.doc 17. OP26 13(3) 01/07/07 18. OP28 18(1)(a) 31/08/07 19. OP30 18(1)(c) 01/07/07 20. OP30 18(1)(a) 01/07/07 21. OP31 9(2) 01/07/07 Bretby House Version 5.2 Page 30 22. OP33 the residents on a day-to-day basis. 24(1)(a,b) The home must have a system in 01/07/07 place for monitoring and improving the quality of the service offered based on seeking the views of the residents. This will ensure that standards within the home are acceptable to the residents. (Previous time scales of 30/06/06, 30/09/06 and 01/03/07 partially met.) There must be receipts available for any expenditure made on behalf of a resident. This will ensure that residents are safe guarded. There must be evidence on site that: The fire alarm is tested on a weekly basis. The emergency lighting is tested on a monthly basis. That fire drills are carried out every six months. This will enhance the safety of residents and staff. (Previous time scale of 14/11/06 not met.) 23. OP35 13(6) 01/06/07 24. OP38 23(4)(c) (v)(e) 01/06/07 25 OP38 37 Any incidents in the home that affect the well being of the residents must be notified to the Commission. This will ensure the law is complied with. 01/06/07 Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP14 Good Practice Recommendations It is strongly recommended that activities are discussed with the residents, collectively and individually, to ensure they are meeting the expectations of the residents. It is recommended that care plans include more detail of the preferred daily routines of the residents, their likes and dislikes and if they are able to make choices particularly where residents had dementia so that staff are aware of these preferences. The system in place for serving meals to the residents should be reviewed to ensure they are served at the residents’ pace as meals were being left to go cold. The bottom of the garden was badly overgrown and could be hazardous to any resident wandering in that area, it is recommended this area is fenced off. Not all the bedrooms had all the furniture and fittings detailed in the National Minimum Standards. This should be discussed with the residents 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. There was no training matrix available for the whole staff team. This should be reviewed so that it is easy to identify what training has been or is required by staff. Staff supervision was not consistent and should be reviewed to ensure all staff have regular supervision with a manager to oversee and discuss their work role. 3 4. 5. OP15 OP20 OP24 6. OP26 7. 8. OP30 OP36 Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Bretby House DS0000064275.V334294.R01.S.doc Version 5.2 Page 33 - 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. 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