Inspection on 07/02/06 for Breton Court

This inspection was carried out on 7th February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Breton Court 31/10/06

Breton Court 25/07/05

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 Wendy Mills Unannounced Inspection 7th February 2006 10:30 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 Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 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 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) Tenterden Care Homes Limited Mrs Mary Olive Louise Norris Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 28 Older People Date of last inspection 25th July 2005 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 for the home has recently left her post and the post of manager is currently vacant. 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 for residents’ call for assistance should it be needed. All rooms have a television point. Telephone can be installed in rooms 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 DS0000023324.V282895.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 10.30am and lasted four hours. Additional time was spent in preparation and report writing. During the course of the inspection relatives, staff and residents were spoken to, some in privacy and some in the communal areas of the home. In depth discussion was held with both the administrator for the home and the head of care. Documentation was examined, food sampled and a tour of the home was undertaken. Both direct and indirect observation was used throughout the inspection. What the service does well: What has improved since the last inspection? The way the home manages medicines has improved. Temperatures are now recorded daily and there are clear risk assessments in place for those residents who administer their own medication. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The home provides the residents, prospective residents and their supporters with the information they need in order to be able to make a decision about moving into the home. EVIDENCE: The home has a service user guide and statement of purpose that contain good information for the residents and their supporters. Certificates of registration and insurance were displayed in the foyer of the home. There is an admission and assessment policy and all residents receive an assessment prior to moving into the home. On the day of inspection, the head of care had just returned from assessing a prospective service user. Care plans show that pre-admission assessments are made and recorded. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The home promotes the health of the residents and meets their health care needs. It provides personal care in a kindly way that respects privacy and dignity. However, it should take action to monitor and prevent falls. EVIDENCE: A twenty percent sample of care plans was inspected. They were found to be up-to-date and in order. They contain sufficient information, in a clear format. This means that staff can easily understand the care needs of the residents and the way in which these needs are to be met. Residents confirmed that they are aware of their care plans and the content. Relatives and residents said that the staff are kind and helpful. Indirect observation showed that staff spoke to the residents in a kindly and respectful way. Any assistance was given discreetly. Good relationships are maintained with the local doctors surgery and district nurses attend the home approximately twice each week. Inspection of the accident book showed quite a high number of falls. One had resulted in a hospital admission but was not reported to the CSCI under Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 10 regulation 37. Discussion about the causes and prevention of falls took place and possible reasons considered, for example, the home promotes independence and encourages the residents to move around the home as much as possible and this may put them at a higher risk of falls. However, to restrict movement would restrict independence and this would not be a good thing. Falls assessments and risk assessments are in place but it is suggested that the home reviews these and the environment to see if they are any other precautions. If possible they should seek the advice of the occupational therapist and/or a chartered physiotherapist to see if anything more can be done to prevent falls. The systems for the administration of medicines in the home have been improved. The temperature of the medicines storage is now monitored daily. MAR sheets were in order and, where handwritten entries were made, these were countersigned. However some recording, for example, of Paracetamol, is entered on the reverse of the MAR sheets. Whilst this information is signed and dated, it appears untidy and could lead to errors. The home should find a better way of making these entries. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Routines in the home are flexible and residents are able to exercise choice in their day-to-day lives. There is a varied and regular activities programme that gives the residents a choice of things to do. Nutritional management in the home is good. Food intake and weight are monitored and the residents are offered a wide choice of appetising and wholesome food. EVIDENCE: Interests and preferred activities are recorded in the care plans. There is a variety of board and card games available in the home. Staff said that they encourage the residents to participate in activities such as giant crosswords, bingo, Hoy and other group games. Outings are organised and there is a forthcoming trip planned to the theatre to a “Good Old Days” concert. Some residents prefer to stay in their rooms and this is respected. 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. Residents said that they also enjoy the activities of the ducks in the pond just outside the lounge window. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 12 Relatives said that they are made welcome to the home and can visit at any time they wish. Residents said that they can choose where to receive their visitors. There is a relaxed and friendly atmosphere and the residents were able to move freely around the home. The home does not handle resident’s finances and information about advocate and volunteer agencies is displayed on the notice board. Part of the inspection took place over lunchtime. Lunch is the main meal and, on the day of inspection, smelled delicious. A sample of each element of the meal was tasted. It was appetising, well-presented and contained plenty of fresh vegetables. The storage of food was inspected. There was plenty of locally purchased produce in the home. The cook said that fresh produce is delivered twice weekly. Conversation with the cook confirmed that there is an adequate food budget and that she can provide a wide variety of menus. Residents said that they can choose to take their meals 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 said that they are asked about their choices for the next day. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home protects the residents from all forms of abuse and staff are clear about their responsibilities to report concerns. EVIDENCE: There are clear complaints and adult protection procedures. Staff were aware of their duty to report any concerns. They said that they believe that the residents are treated very well. Relatives said that they had not had cause to complain for over two years. They said that their complaints were dealt with immediately, however, there was some concern that they had not been kept informed about the recent change in management arrangements for the home and were therefore not entirely confident that any future concerns and complaints would be handled well. The home should take steps to communicate the recent changes and forward plans to the residents and their supporters. Adult protection training is incorporated into the induction programme and further adult protection training has been provided for the longer serving staff. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 & 26 The home is well maintained and the environment within the home is good. This results in a pleasant and homely place in which the residents can remain as independent as possible whilst receiving the care they need. EVIDENCE: A tour of the home was undertaken. All areas were found to be very clean and free from offensive odours. The home is warm and well decorated. Residents said that they are happy with their rooms and have been able to bring furniture from home if they wished. There is plenty of communal space and all bedrooms inspected were of a good size and comfortably furnished. New door closures are being fitted and fire testing is carried out randomly. No health and safety hazards were noted during a tour of the home. Environmental risk assessments are in place and these are reviewed regularly. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 15 Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 & 30 Poor communication about the recent changes in management arrangements for the home has led to a lowering of the normally high staff morale. Whilst the level of staff training is good, one-to-one supervision has slipped. This means the home may not identify all the staff training needs. EVIDENCE: Inspection of staffing rotas showed that there are adequate numbers of staff scheduled for duty at all times. There is generally a good level of staff training but lack of one-to-one supervision may mean that not all staff training needs are identified. Staff said they were uncertain about the long-term plans for the management of the home. They said that they do not have one-to-one supervision. This was discussed with the head of care and the administrator. The head of care agreed to arrange dates for supervision immediately and to aim to have completed supervision for each staff member by the end of March 2006. Inspection of the files of the two most recently recruited staff showed that the home has a good application form and records of interviews. References had been taken up appropriately and the files were maintained in good order. However, although there was evidence that applications for POVA and CRB checks had been made, there was no evidence on file that these checks had been returned as satisfactory. The administrator stated that the POVA checks Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 17 had been returned and were satisfactory but were at head office. She assured the inspector that she would ensure they were on file at the home without delay. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 37 The home is well run but recent changes have meant that there is some confusion amongst residents, their supporters and staff, about the leadership and direction of the home. Communication could be improved at all levels of the home. The standard of documentation and the way this is managed is very good. EVIDENCE: As mentioned under previous standards, the current management arrangements at the home have not been communicated well to residents, their supporters and staff. This means that there is a belief that the home lacks direction at the present time. It is acknowledged that the registered manager has only very recently left, however, there should be clear Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 19 arrangements in place for the interim period and these should have been communicated to all concerns. Residents meeting have not been arranged and staff supervision has slipped. This suggests a lack of clear leadership in the home at present. However, both the administrator and the head of care were very open and honest throughout the inspection. They both showed a great willingness to work to improve communication within the home. The standard of documentation and record keeping is good. All records were stored appropriately and every item of documentation requested throughout the inspection was immediately to hand, in good order and up-to-date. The administrator is commended for maintaining documentation to such a high standard. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 3 3 x Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO 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 3 4 Standard OP8 OP29 OP30 OP31OP32 Regulation 12,13 Requirement Timescale for action 28/02/06 28/02/06 28/02/06 28/02/06 5 OP33 6 OP36 Home to report to CSCI in accordance with regulation 37 33 Evidence of POVA and CRB checks having been taken up to be on all staff files 18 One-to-one supervision to be established and to include identification of training needs 24, 25, 26 The registered provider to communicate with residents, their supporters and staff about the future plans for the management of the home. 12, 21, Home to improve the way in 22, 23, 24 which it communicates with, and seeks, the views of the residents, their supporters and staff to ensure good quality assurance in the home. 18 One–to-one staff supervision to take place for all staff at least six times each year 28/02/06 31/03/06 Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 22 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 OP8 Good Practice Recommendations The home should undertake a falls audit and, if indicated, seek the advice of an occupational therapist and/or chartered physiotherapist about the prevention of falls in the home. Breton Court DS0000023324.V282895.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 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 DS0000023324.V282895.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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