Inspection on 25/07/05 for Breton Court

This inspection was carried out on 25th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Breton Court 31/10/06

Breton Court 07/02/06

Breton Court 04/10/04

Breton Court 20/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Breton Court Grange Road St Michaels Tenterden Kent TN30 6EE Lead Inspector Sally Gill Announced 25 July 2005 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 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. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Breton Court Address Grange Road St Michaels Tenterden Kent TN30 6EE 01580 762797 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Tenterden Care Homes Limited Mrs Mary Olive Louise Norris CRH 28 Category(ies) of Care Home for Older People - 65 and over. registration, with number of places Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 28 Older People. Date of last inspection 4th October 2004 Brief Description of the Service: Breton Court is registered to provide accommodation for up to 28 older people and admits low to medium dependencies. The company Tenterden Care Homes Ltd has owed the business since January 2002. The Registered Manager who has day-to-day control of the Home is Mary Norris. The premise is a purpose built detached property with all accommodation for residents on the ground floor suitable for wheelchair access. There are 26 single rooms, eleven of which have ensuite. The residents have the use of four bathrooms. There is a dining room and lounge over looking a large garden to the rear with mature shrubs and a secure duck pond. There is a call bell system which is desiged to help residents call for assistence should it be needed. All rooms also have a television point and a telephone by arrangement. There is car parking space to the front of the Home.The Home is set in a quiet residential area in the village of St. Michaels. Within a short distance there is a church, public house, shops including a post office and the bus stop. Tenterden town centre is approximately one mile away. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which took place on Monday, 25th July 2005 between 9.20am and 1.45pm. Additional time was spent in preparation and report writing. During the inspection the Inspector spoke to seven residents, three in private and the remainder in the lounge. Also, she spoke to the Registered Manager, her deputy and six other staff from care, housekeeping, laundry and the kitchen. Surveys were received back from eighteen residents and two relatives the majority of which were totally positive. Where comments were regarding improvement these were fed back to the Registered Manager. The Inspector examined various records including care plans, risk assessments, medication administration record charts, daily notes, staff files including training and supervision, the fire safety logbook and accident reports, menus and the duty rota. A tour of the building was not undertaken but communal areas, the laundry, kitchen, three resident bedrooms (by invitation) and one vacant bedroom were seen. What the service does well: Residents spoke positively about the food provided, with comments varying from “the food is good” to “the food is excellent”. The lunchtime menu has a choice of four dishes including vegetarian and a choice of two sweets. The emphasis is on home cooking and on the day of the inspection the residents were observed to be enjoying a wholesome and appetising lunch, served in pleasing surroundings. Residents also commented that the Registered Manager is on hand to sort any issues that they have although one resident commented that “there is nothing to find fault with everything is first class”. Residents confirmed that staff respect their privacy and provide personal care in a sensitive way and ensure their dignity. There have been no complaints since the last inspection. Staff and residents confirm that the Registered Managers door is always open to resolve any issues at an early stage. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The above work to fit radiator covers and door closures should be completed to ensure safety of the residents. When testing the fire alarm system ALL call points must be randomly tested to ensure the safety of residents and not just the main panel. Where medication is self-administered staff must audit the supply to ensure that medication recorded on the medication administration record (MAR) chart is still currently and/or relevant this relates particularly to prescription creams. The amount of medication given for self-administration must also be recorded to ensure safety. The storage of medication must be reviewed in the interest Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 7 of safety and temperature. Where senior staff undertakes medication audits these should be recorded and any anomies listed together with action taken. Generic risk assessments should be individualised to the resident so that any information not relevant to minimise the risk is removed. The Registered Manager agreed comments from relatives that access for residents in wheelchairs via the front door is difficult and consideration should be given to address/improve this. 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. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none inspected on this occasion. EVIDENCE: Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. The individual care plans contain sufficient detail to ensure residents health, personal and social care needs can be met by staff. Resident’s needs are currently met, they are treated with respect and their right to privacy is upheld. Residents where appropriate are responsible for their own medication but there are shortfalls to medication systems with potential risks to residents and staff. EVIDENCE: Two care plans, which contain risk assessments, were case tracked. Both plans sufficiently detailed the care needs of the resident and reflected any changes in monthly reviews. Residents confirmed that they were aware of their care plans and the content. Three residents complimented the staff on the way they provide assistance with their care respecting their privacy and dignity and encouraging independence. Health care needs are met mainly with input from the local doctors surgery, district nurses and occupational therapists. Where professionals are involved this information has been followed through into the care plan and the residents day-to-day care. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 11 Residents are encouraged where appropriate to self medicate with an appropriate risk assessment in place. However the system for issuing the medication to residents must be tightened with the amounts recorded on the MAR chart. Self administered medication must also be reviewed regularly to ensure that the medication is still in use/relevant to ensure residents safety this is particularly relevant to prescription creams. The storage for the homes medication must be reviewed for safety reason and to ensure the correct temperature for storage can be maintained. The audits that are undertaken by senior staff must be recorded, anomies listed together with what management action has been taken. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. The homes routines are flexible and residents are able to exercise choice in their day-to-day lives. There are regular activities organised by staff. Meals are varied and residents are offered a wide choice of appetising and wholesome food. EVIDENCE: Interests and preferred activities are recorded within care plans. One resident said that they preferred to stay in their bedroom and this is respected. Staff organise activities most days which residents confirm are enjoyed and include Hoy, crosswords, cards, sing-a-longs, reminiscence, scrabble, games, picture association, dominoes, music and films. Individual activities include daily newspapers, television, DVD’s and collage. There is also organised entertainment from the local community such as a music man and a singing group. A boat trip to Bodiam Castle with cream tea was recently enjoyed by a small group of residents. The local vicar also visits the home weekly and holds a communion service monthly. Information regarding activities is displayed on the notice board in the front hall. Most residents spoken to say that they enjoy visits from their family and friends whether regularly or occasionally. Several residents have by Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 13 arrangement a telephone within their own room and in addition there is a pay phone in the front hall. One resident told of his enjoyment that his wife visits everyday and another resident was out for the day with family. Residents confirmed that they choose where to receive their visitors and in the nice weather the garden is also used. During the inspection the atmosphere was relaxed and unhurried and good humour was observed between residents and staff. There is evidence that residents are able to exercise choice. The home does not handle resident’s finances and one resident spoke of their wish to maintain control of their finances. Information was displayed regarding advocate and volunteer agencies. Residents confirmed that meals can be taken in the dining room or served on a tray in their own room. The majority of residents confirmed that the food is good and there is a wide choice including vegetarian. Menus were displayed and residents confirmed that they are asked about their choices the previous day. The emphasis is on home cooking with cakes served daily. The Inspector observed lunch being taken in relaxed and pleasant surroundings and the meal looked appetising and wholesome with ample portions. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18. Residents views are listened to and any issues are resolved at an early stage. Resident’s legal rights are respected. Residents are protected from abuse, neglect and self-harm. EVIDENCE: Complaints procedures are displayed throughout the home. The home has received no complaints since the last inspection. All residents spoken to confirmed that they had no complaints. Residents confirmed that the Registered Manager and staff were approachable should any issue arise but that they “could not find fault”. As previously stated information regarding advocacy and volunteer agencies are displayed on the notice board. Residents are able to vote by postal and discussions confirmed staff do also escort residents to the local polling station. Residents confirmed or indicated that they feel safe at Breton Court. The home does not deal with any resident’s finances. All staff have a Criminal Records Bureau enhanced disclosure. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23, 24, 25 and 26. The standard of the environment within the home is good with planned maintenance and renewal work ongoing. Planned work to ensure safety regarding door closures, compliant with fire safety and radiator guards is not yet completed. The current method testing of fire equipment potentially places residents and staff at risk. Adaptations to doorway access could maximise independence. Resident’s rooms are personalised, comfortable and safe. The home was clean, pleasant and hygienic. EVIDENCE: Residents confirmed that they were happy with their rooms. The three rooms visited were comfortable, highly personalised and homely. Residents stated that one of the reasons they enjoyed sitting in their rooms was the nice outlook. Since the last inspection redecoration work has completed in bedrooms, toilets and bathrooms. One vacant bedroom was having new flooring laid. New storage has been built in the laundry and a new dryer purchased. Work has Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 16 continue to fit low temperature guards to radiators however this work should be completed to ensure safety to residents. Fire equipment is regularly tested but not all call points usually only the main panel therefore to ensure safety all call points must randomly be tested. The grounds are well maintained and enjoyed by residents with mature gardens and a fenced duck pond. There are aids and adaptations around the home to ensure the independence of residents. However relative’s comments indicated that wheelchair access via the front door is difficult which the Registered Manager agreed therefore consideration should be given to address/improve this. There are pleasant and comfortable communal areas to sit and relax which are furnished to ensure a homely environment. The home was clean and hygienic and residents confirmed that this is always so. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, and 30. There are adequate numbers of staff on duty. Care staff are trained and have the skills and experience to meet the needs of the residents. A robust recruitment procedure is followed. EVIDENCE: The staff duty rota indicates that there are four staff on duty 8am – 2pm, three staff 2pm – 8pm and two waking night staff 8pm – 8am. In addition to the rota the Registered Manager works full-time. During the day there are additional staff with kitchen, laundry and housekeeping duties. Residents said or indicated that they receive all the assistance from staff that they require in a relaxed and timely manner. One resident said that staff had commented that this is one of the best homes to work in this area. All staff spoken to confirmed that morale was high. Care staff were observed interacting and assisting residents which was done in a kind and gentle way often with the use of good humour. The Registered Manager ensures that all new staff undertake induction training to TOPSS specification and this will include shadowing of experienced staff. Eight staff have obtained an NVQ level 2 or above with another six currently ongoing, once completed this will then more than meet the 50 target. There has also been a wide variety of specialist training since the last inspection Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 18 including safe handling of medicines, adult protection, loss and bereavement, disability awareness and nutrition in older persons. Two staff files were sampled which evidenced a robust recruitment procedure is followed. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38. There is suitable management system in place to support the delivery of care. Resident’s wishes and preferences are reflected in the day-to-day operation of the home. Resident’s financial interests are safeguarded. There is a potential risk to the health, safety and welfare of residents and staff. EVIDENCE: The Registered Manager is a qualified nurse and is currently undertaking NVQ level 4 in management. She has completed her assessor’s award. There are clear lines of accountability within the home and externally although the Registered Manager has day-to-day control of the home. The Registered Manager communicates a clear sense of leadership and has strategies for enabling staff. Files indicated that staff supervision is to agreed timescales. Staff confirm that there is an open door policy within the home and they feel well supported. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 20 Results of this year quality assurance survey are displayed within the home and a copy given to the Inspector. Residents are encouraged to manage their own finances, the home does not manage or hold any residents finances. Records are maintained in accordance with the Regulations. The records of accidents, which have occurred in the home since the last inspection, do not show anything untoward that requires further investigation. Information supplied and staff confirmed that items of equipment within the home remain in good working order. Improvements have been made to the gas supply. There has been further staff training in fire, first aid, food hygiene, infection control and manual handling to ensure the health and safety of residents and staff. The fire safety logbook showed that not all calls points are randomly tested. Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 2 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 4 3 x 3 3 3 2 Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? 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. 2. Standard 38 9 Regulation 23(4) 13(2) Requirement Door closures to be fitted inline with advice from FO (previousl timescale of 01/09/05) Review storage of medication to ensure safety and temperature (by 30.09.05). Record quanities of medication issued for self medication (by 22.08.05). Regularly review medication that is self medicated to ensure still relevant/required (by 22.08.05). Record medication audits together with issues highlighted and actions taken (by 22.08.05). Randomly test all call points on fire alarm system Timescale for action 31 April 2006 30 September 2005 3. 19 23(4) 22 August 2005 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 25 7 Good Practice Recommendations Radiators should be guarded or have low temperature surfaces Invidualise generic risk assessments to ensure all information is relevant to the resident H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 23 Breton Court 3. 22 Review front door access to improve wheelchair access Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Breton Court H56-H05 S23324 Breton Court V229341 250705 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!