CARE HOMES FOR OLDER PEOPLE
Briar Hill House 51 Attlee Crescent Rugeley Staffordshire WS15 1BP Lead Inspector
Ms Rachel Davis Key announced Inspection 09:50 30th May 2007 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 Briar Hill House DS0000063821.V334088.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. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Briar Hill House Address 51 Attlee Crescent Rugeley Staffordshire WS15 1BP 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) 01889 576622 01889 574611 pauline.kincaid@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Pauline Kincaid Care Home 28 Category(ies) of Physical disability (28), Physical disability over registration, with number 65 years of age (28) of places Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 28 PD - Minimum age 60 years on admission Two PD Service user s- Minimum age 40 years on admission Date of last inspection 21st February 2006 Brief Description of the Service: Briar Hill House is a 28 bedded care home (with nursing care) located very close to Rugeley town centre. It is owned by Methodist Homes for the Aged (MHA) and the registered manager is Mrs Pauline Kincaid. It is registered with the Commission for Social Care Inspection to meet the needs of adults with a physical disability. The fees charged are from £575:00 to £668:00 per week. The home is on two levels and each floor has 14 bedrooms, a large lounge, spacious dining room and an individual kitchenette. All bedrooms are single occupancy and have an ensuite facility, which includes a lavatory, washbasin and a walk-in shower, seven of the bedrooms have a separate adjoining lounge area. A variety of specialist equipment is available to assist the people who use the service. There is a hairdressing area and a relaxation room available and the home has a garden with a water feature and summerhouse. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection (5 days notice given) took place over seven and a half hours. This was a ‘key inspection’ and the core standards were assessed, this was the first inspection of this service for this inspector. The methodologies used were: A day of preparation before the inspection, including scrutiny of the preinspection questionnaire completed and returned by the manager, and the five questionnaires completed by the people who use the service and four by relatives. During the visit the inspector met and spoke to the majority of people living in the home, eight visitors, one volunteer and two members of staff were interviewed. Observations were made of staff and resident interaction around non-personal care tasks, lunchtime and the medication administration and systems were also seen. A tour of the home was taken and some of the people living in the home showed the inspector their bedrooms. Care plans were checked and the records of two staff (one employed since the last inspection) including recruitment and training documents were seen. This is the first inspection since February 2006, a visit to the service was made in September 2006 to investigate a complaint received by the Commission for Social Care Inspection. There have been three complaints about the service delivered at Briar Hill House since the last inspection, people living in the home know who to speak to if they are unhappy. What the service does well:
The home has strong, motivated leadership from the registered manager who provides the staff with extensive and focused training. As a result the nursing and care staff are well informed resulting in an enthused team, who are able to provide good quality care. The home prioritises the needs of the people who use the service ensuring that their wishes and feelings are continually assessed and met. The home operates a person centred approach and demonstrates a very good understanding of the individuals care needs.
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 6 The home provides an excellent range of care planning documents and risk assessments for each resident, demonstrating a commitment to enabling people who use the service to have some control over their lives. Residents’ descriptions of the home were as follows: “I receive good care and support.” “Staff are brilliant.” “The food is always very nice.” “Staff are most attentive.” “The activities coordinator works tirelessly.” Relatives’ comments included: “They are always ready to listen to your queries and to reassure you.” “The nurses and care assistants have taken time to explain what is going on every time I visit, I don’t have to ask.” “Staff respond well but they are also proactive in identifying potential problems and dealing with them.” When asked within a questionnaire “what do you feel the care home does well” relatives had recorded the following: 1. 2. 3. 4. 5. 6. 7. Attention in care by staff is first class Enough staff to give care Facilities are good Getting people involved in activities Very professionally run Room decorated before admission Whole building is nice and well maintained. Health needs are closely monitored and access to other health professionals is arranged as required, emotional needs appear to be addressed with care and sensitivity. The home ensures staff are not employed without full employment checks therefore confirming they are suitable people to work with vulnerable adults. All newly appointed staff undergo an excellent induction programme to promote good practice, confidence and understanding in the service delivery, there is a commitment to National Vocational Qualification training for all staff.
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Briar Hill House DS0000063821.V334088.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 Briar Hill House DS0000063821.V334088.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, 4 and 5. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Briar Hill delivers a professional, flexible, reliable and focussed service. Information offered ensures that people who use the service and prospective residents can make an informed choice about the home. EVIDENCE: The Statement of Purpose and Service User Guide offer all the required information under regulation. The Statement of Purpose is specific to the home and clearly sets out the objectives and philosophy of the service, supported by the Service User Guide. It is recommended that these documents be reviewed as they are presently dated July 2005. The home also has a brochure to enable prospective clients an insight into the homes ethos and service. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 10 The care records of a recent admission were checked and contained the needs assessment as required. The management team had assessed the needs of the resident prior to admission and a subsequent care plan had been developed, this affords staff all the information necessary to provide individualistic care. Those spoken to, or information received demonstrated very positive comments about the home and their admissions: “Prior to placement we called unexpectedly and were shown round, since our relative moved in all the required information needed was given.” “Haven’t much to go on yet as early days but I can say the staff are good and the systems in place for identifying residents choices are good.” “I chose this home carefully based on quality of care and so far I have been pleased with the care my relative has received.” The registered manager confirmed that Briar Hill sends the required letter following admission confirming the home is able to meet the individuals’ needs. Standard 6 is not relevant to this home and therefore not assessed. Briar Hill House DS0000063821.V334088.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 excellent This judgement has been made using available evidence including a visit to this service. The health and personal care needs that people who use the service receive is individualised. The principles of respect, dignity and privacy are continually monitored and practiced. EVIDENCE: Since the last inspection a new care planning system has been introduced which had recently been completed for everyone living in the home. There was excellent information within these plans of care that gave a real insight into the person receiving support from Briar Hill. Care plans were person centred and covered all areas of need including personal care, recreation, nutrition, spiritual needs, sexuality, life skills, hobbies, to name a few. All people who use the service have a key worker and a named nurse, evidence was available to confirm the care plans were regularly reviewed with
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 12 input from the person who used the service. Daily records and daily statements were also evident with management plans and risk assessments in place where needed. There was evidence to substantiate that feedback is a continuous ongoing process, staff spend time with individual residents to ensure they understand decisions and actions, and robust quality monitoring systems were in place. People who use the service had access to a wide range of additional health care services according to their individual need and assessments were in place that looked at peoples tissue viability, pressure areas, nutritional needs, continence needs, hearing and sight. This list is not exhaustive. On general practitioners comment card stated: “The home provides high standards of care to service users.” Medication procedures were observed and were sound, people who use the service receive their medication as prescribed and a safe management system was in place. The controlled drugs book and a random sample of drugs were checked and no errors were noted. Medication is stored in a locked area and other equipment necessary, for example oxygen, is safely stored. Each person has a medication file with details about known allergies and all medication being administered. Staff receive medication training and the manager also ensures audits and competency checks are undertaken. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 13 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 good This judgement has been made using available evidence including a visit to this service. Activities and stimulation for people who use the service are in place, this provides daily variation and interest for people living at Briar Hill. The home encourages and welcomes visitors. EVIDENCE: The routines of the home are planned around the needs and wishes of the people who use the service. There was evidence that the home encourages residents to take control of their life and be actively involved in the running of the home. Families, staff and people who use the service confirmed that routines are flexible and that individuals can make choices in major areas of their life. The home has a member of staff who co-ordinates activities on a daily basis. Photographs were seen of activities within the home that the residents had taken part in, through observation it was evident that people who use the service and the staff team enjoyed these activities, the home also has a number of volunteers who come into the home to offer their support.
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 14 One resident stated: “The activities coordinator works tirelessly to organise a huge range of daytime and evening activities. She has recently produced a questionnaire where residents can suggest ideas for new activities.” Sufficient staff resources are provided to allow time for activities and stimulation. The home operates a key worker system, which enables closer resident staff relationships where likes, dislikes and needs are shared and also recorded. People who use the service were able to receive visitors whenever they chose, as the home has an open visiting policy, this was verified by a number of visitors on the day of the inspection. People who use the service could choose to see their visitors within their own private accommodation if they preferred to do so and this was also evidenced during the inspection process. The home has two dining areas one downstairs and one upstairs, this affords residents the opportunity of a relaxed informal and appropriate surrounding. Food was considered by the residents to be ‘very good’, the Commission observed lunch being served. The cook was also in the dining area to see and talk with the residents. Those that required support with their meal were given sensitive assistance on a one to one basis. An environmental health officer had recently undertaken an inspection and recorded the following “ You’re to be congratulated I trust these standards will be maintained.” Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 15 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 good This judgement has been made using available evidence including a visit to this service. The home has a suitable complaints procedure and ensures the people who use the service are protected from abuse in accordance with written policies. EVIDENCE: The Commission for Social Care Inspection have received two formal complaints about the home since the last inspection. These have been addressed and the requirements and recommendations made by the Commission for Social Care Inspection have been met. It was recommended on this visit that the system for recording complaints could still be improved upon and this was discussed on the day with the registered manager. The complaints procedure is available in the Service User Guide and in the foyer. People who use the service confirmed to the inspector that they knew who to complain to and would be confident in doing so if necessary. The Commission for Social Care Inspection also read a number of thank you letters and compliments that have been made over the past year about this service.
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 16 The recruitment procedure and Protection of Vulnerable Adults training offered to staff protects vulnerable people from abuse, Briar Hill Has all the required policies and procedures on this matter. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 17 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, 22 and 26. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Briar Hill House is maintained to an excellent standard to ensure the comfort and safety of the people who use the service. EVIDENCE: The management and staff encourage people who use the service to see the home as their own home. Briar Hill is a very well maintained, safe, comfortable and attractive which has all the specialist equipment and adaptations needed to meet individuals’ needs. Personal touches such as doorknockers on bedrooms and intimate seating areas all contribute to a “home from home” feel. Robust infection control measures were in place, examples of this include: paper towels, liquid soap, hand sanitizer, laundry management and personal protective clothing.
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 18 The home employs a maintenance person who carries out any required maintenance on an ongoing basis. On talking with staff it was evident that they were aware of issues about cross infection, and it was observed that they were sensitive towards the privacy and dignity of people who use the service. Achieving this standard of domestic housekeeping must be complimented as being commendable. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 19 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 excellent This judgement has been made using available evidence including a visit to this service. Staff at the home are well trained, competent and sufficient in numbers to meet the needs of the people who use the service. Recruitment procedures are robust and support the need to protect vulnerable adults. EVIDENCE: The number of staff on duty during the inspection was suitable to meet the needs of the people who use the service. It was evident that staffing levels were never compromised, some people who use the service require one to one support and everyone who required assistance at mealtime was able to have their own carer. Two staff files were examined and all demonstrated that a thorough recruitment practice was in place, this included 2 written references, criminal records bureau checks, application forms that covered gaps in employment and the required identification certificates and photograph. Male staff were also recruited to the home, this promotes equality and choice. All staff within the home have received positive and meaningful training, the registered manager prioritises training and enables staff members to
Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 20 undertake external qualifications beyond the basic requirements. This ensures a consistent and needs led service is offered to the people who use the service. Briar Hill empowers staff to share skills and knowledge with colleagues. The service clearly defines the roles and responsibilities of staff through accurate job descriptions and specifications. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The management closely monitor the quality of the service and make changes and improvements where identified and required. EVIDENCE: Briar House is owned by Methodist Homes for the Aged, Pauline Kincaid is the registered manager. The management team closely monitors the practices in the home and there is a robust quality assurance system, action plans are developed and reviewed as required. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 22 The Home maintains robust systems and records of all residents’ finances and property. These are audited on a regular basis. Staff are regularly supervised and records made. One relative commented, “All the paperwork and systems seem very good.” another reported “ Rugeley is lucky to have such a well run and caring facility.” The home is well maintained and records kept. The manager has completed a generic fire risk assessment and is aware of the fact that she should contact the fire officer to discuss evacuation plans for each person who uses the service. The pre inspection questionnaire completed by the manager confirmed that fire safety is checked and regular fire drills and training provided for all staff. The staff complete the Health and Safety training as well as additional advanced training, where appropriate. This was a very positive inspection. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 23 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 4 X 4 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 4 X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 4 X 3 Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP1 Good Practice Recommendations 1 2 OP16 3 4 OP38 OP38 The management team should review their Statement of Purpose (last recording of such July 2005), this will confirm that the information is a current reflection of the service offered. The manager could improve upon the recording of complaints, however minor they may appear, including the outcome, this will further evidence the homes openness and transparency. The manager should seek advise from the fire officer. This is to establish if records need to be in place regarding individuals, if a full evacuation is necessary. Although the home is proactive in promoting equality and diversity it should continue to consider ways in evidencing this within their service. Briar Hill House DS0000063821.V334088.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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
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