Inspection on 18/06/08 for Briar House Care Home

This inspection was carried out on 18th June 2008.

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

Briar House Care Home 28/05/09

Briar House Care Home 08/12/08

Briar House Care Home 21/11/06

Briar House Care Home 18/10/05

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ Lead Inspector Mr Jerry Crehan Unannounced Inspection 18th June 2008 09:10 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 House Care Home DS0000065218.V366714.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 House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briar House Care Home Address Losinga Drive Kings Lynn Norfolk PE30 2DQ 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) 01553 760500 01553 760510 briarhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Application Pending Care Home 62 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (62) Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21st November 2006 Brief Description of the Service: Briar House is a care home providing residential care for up to 62 older people. Within its registered numbers the home offers services to 52 people with dementia. The home is situated in a residential area in the North of Kings Lynn approximately one mile from the town centre. The home was purpose built in the late 1990’s. The accommodation is provided on two floors serviced by stairs and shaft lift. All rooms are built for single occupancy and there are only two rooms that do not have integral en-suite facilities. The home is situated in its own grounds and provides ample parking space. The home provides information about the services it provides and a copy of the most recent inspection report in the entrance foyer. Briar House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for care at the home is £417 to £550. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Before the inspection the manager of the service completed a lengthy questionnaire (Annual Quality Assurance Assessment) about the service referred to within the report as the ‘AQAA’. To complete this inspection we looked at information within the AQAA document, comments received about the service from residents, relatives and staff, and other information collected since the last inspection. We conducted an unannounced site visit that took place over 8.5 hours on 18th June 2008. Opportunity was taken to tour the premises, look at care records and policies, and communicate with residents, staff and the Manager. We observed daily life in the home and what was happening for the people who live there. Pharmacist inspector Mr M Andrews inspected the medication standard. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Due to the varying degrees of cognitive impairment it was not always possible for residents who live at the home to tell us what life in the home is like. We compared care records and discussion with staff and comments from relatives (where possible) against observation of those individuals. What the service does well: • • • • There are recreational activities on offer at the home suitable to some residents’ needs and abilities. People who use the service have access to a good diet and meals that are well prepared, which they enjoy. Prospective residents are offered the chance to look around the home before making a decision to move in. The home’s hairdressing room called ‘The Salon’, was decorated to a very good standard and presented like a hairdressers in the community. DS0000065218.V366714.R01.S.doc Version 5.2 Page 6 Briar House Care Home • • Safe staff recruitment procedures are followed at the home and new staff are offered an induction programme that they say is helpful. Relatives and staff were complimentary about the manager and her approachability. What has improved since the last inspection? What they could do better: • New residents should only be admitted to the home following a full assessment that takes account of their social interests, religious needs, and considers their personal safety and risk. The quality of information in individual care plans and risk assessments needs to improve and be regularly reviewed to protect people. Medication practices at the home place people at risk of harm. The management of laundry at the home requires the ongoing attention of the manager to ensure the privacy and dignity of residents. People who use the service are limited in what they can do to satisfy their social and recreational needs. Activities and stimulation for residents should be person-centred, based on people’s life experiences and reflect their cognitive abilities. The standard of the accommodation must be improved in appearance and interest for residents throughout the home. It should provide safe and suitable fixtures and fittings, and specialist equipment that is serviced at regular intervals. It should be free from potential hazards that may compromise the health and safety of residents. The mental healthcare of residents with dementia is not fully supported by the home’s records and practice. The Proprietor must ensure that there are suitably qualified and competent and experienced persons responsible for dementia care delivery and supervision working at the care home. DS0000065218.V366714.R01.S.doc Version 5.2 Page 7 • • • • • • Briar House Care Home • • There should be a staff complement and a deployment of staff in sufficient numbers to support the needs of people who use the service. The manager must maintain good management systems that promote good care and protection for residents. 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 House Care Home DS0000065218.V366714.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 House Care Home DS0000065218.V366714.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&3 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is available to prospective residents and their families in order that they may make an informed choice about the home’s suitability. The policy and procedure in place for assessing prospective residents is in place, but it is not well applied. EVIDENCE: The provider has a ‘Statement of Purpose’ and ‘Service User Guide’ to reflect the services provided at the home. These documents contain sufficient information for anyone to make an informed choice about long-term care. The Service User Guide contains a summary of the home’s complaints procedure, and these documents were available in the home’s reception area. A resident spoken to about their admission to the home stated ‘Everything’s fine for me, no problems, I looked around the home before moving in.’ Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 10 There is a policy and procedure in place for assessing and admitting people to the home. In the sample of assessments seen there was an assessment proforma, (pre-admission assessment), used by the manager or senior person when collecting information to ascertain the level of support required by prospective residents. There was evidence that some physical and social needs assessment for these residents had taken place that could form the basis of individual care planning and risk assessment. However, there was no evidence of an assessment of prospective residents’ social interests and religious needs, or assessment of personal safety and risk. Briar House Care Home DS0000065218.V366714.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): Standards 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home do not experience positive outcomes in this area as their health and care needs are not properly assessed and met. Medication management practices mean that people’s health and welfare is not being safeguarded. EVIDENCE: A sample of care records relating to people who live at the home were looked at and these were compared against discussion with and observations of those residents. The care records seen contained an identifying photo of the resident and some personal information. Each resident has care plans and associated assessments to assist care staff in providing care. Care plans offer little information regarding residents’ diagnosis. For instance, one resident’s care plan indicated that they had a diagnosis of ‘Alzheimer’s’ though no other supporting information about how this affected them. Another Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 12 resident’s care plan indicated a diagnosis of dementia, though no information was offered about the type of dementia they had, or how this may affect them. The care plans seen did not cover all needs. For instance, one resident’s assessment indicated that they exhibited challenging behaviour and that they suffered with diabetes, but no care plan was written as to how staff should support the person in these areas of need. Though care plans to address other identified needs, such as sleeping, were available. Care plans for residents with dementia offer very little information or guidance to staff in the form of an individual view of the person and their needs, how they communicate, or a social or ‘life history’ of the person. Without this information care staff are compromised in their efforts to provide care to meet residents social and emotional needs. This is important for people with dementia who may experience difficulty in communicating their needs. During observations many residents were asleep or unoccupied in their bedrooms and others were walking up and down the corridors. Two care records seen provided evidence of infrequent baths for these residents, with no baths recorded as provided in May or June for one resident and one bath recorded in May and June to another resident. There was evidence in care records and from staff that community healthcare services such as G.P, nursing, chiropody, optical, and psychiatric services were sought for those who required these. Several relatives commented favourably about the care provided at the home. Comments received include, ‘We feel that our relative is being well cared for’, ‘They do a good job’ and ‘All staff very friendly’. Several relatives communicated concerns about poor support for residents in maintaining their personal care. Comments received include, ‘My relative had not been washed (eyes caked with dried matter), hands and walking stick sticky, nails filthy’, ‘We have had concerns re lack of thorough cleanliness of ears, nails and hair, but lately this has improved after we voiced concerns’ and ‘My relatives personal care is sometimes lacking and they have appeared to have not been washed or shaved’. At the time of the inspection visit one resident was observed walking in the corridor dressed, but without shoes or socks, another resident was observed to be struggling with ill-fitting dentures. In some cases care plans had been evaluated and updated, but in others they had not. For instance, one resident’s needs had changed significantly following the identification of a pressure area. However the care plans had not been changed to reflect the person’s changed needs and how staff should meet them. In recent complaints received by the home, (and by other agencies), the Manager had acknowledged that recording and care planning is a problem at the home with out of date or incomplete care plans. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 13 The Commission’s pharmacist inspector conducted the inspection of the medication standard at the same time. He found there to be concerns in the way medicines are managed for people who live at the home. We observed parts of the morning medicine round and saw unsafe practices placing the health and welfare of residents at risk. The medicine round was also taking longer than scheduled according to medication records. There were concerns in the way staff were handling ophthalmic medicines, which does not ensure they are only used for their limited period of life. There was evidence that some medicines were not being obtained for people in time for them to be administered as scheduled. There were inadequacies in the home’s recordkeeping practices that meant records were not showing medicines were always being given to people as the prescriber intends. There were some medicines that had been missed and not given. There was written guidance available for staff to refer to when administering medicines to some people, but these were often inaccurate or misleading. Medicine refrigerator temperatures were not being properly monitored and medicines requiring refrigeration were not always being kept at correct temperatures. The refrigerator in Lavender unit was unclean and had other items stored in it. The medicine storage room on the first floor was also untidy and unclean. Medicines prescribed for external application are being stored non-securely in areas of the home, where there are people with dementia and who are at risk of coming to harm if the medicines were accidentally ingested. We found that records did not demonstrate that all care staff authorised to handle and administer medicines for people living at the home have received training and are being assessed as competent. There are members of staff administering insulin by injection to a person living at the home who have not had proper training or have not been assessed as competent to undertake this specialist task. A full report of the pharmacy inspection has been sent separately to the registered provider and is available subject to request. A number of relatives made comment that there are problems at the home in managing residents’ laundry, two people commenting; ‘Items of clothing – although labelled – go missing and we find that our relative is ‘given’ items that are not theirs’ and ‘The laundry service at the home fails miserably when it comes to getting the correct items back to their owners. My relative once complained that they had put someone else’s underpants on them and they refused to change them when asked by the resident’. This suggests deficits in the ability to support residents’ privacy and dignity at the home. Briar House Care Home DS0000065218.V366714.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): Standards 12, 13, 14 & 15 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be assured that the lifestyle they experience matches their expectations and social or emotional needs. There was little evidence to demonstrate that choice and control is promoted. This means that people with dementia may not experience fulfilment and a sense of well-being, though people who use the service have access to a good diet and meals that are well prepared. EVIDENCE: As indicated above in this report, social care plans are not individualised and are not based on residents’ previous life experiences. Residents displayed behaviours that demonstrate their lack of appropriate occupation and stimulation. Many residents spent long period in their bedrooms during the day of the inspection visit, spending long periods of time asleep. The daily notes seen for a resident indicated three successive days spent in their bedroom, with watching their television indicated as their only activity. The records for another resident describe their only activity for a period of two days as ‘wandering’ or ‘sat in lounge’. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 15 Staff spoken with said that when fully staffed they can sit residents together and sing and chat, and that most activities offered are group based though one to one activities are offered. Senior staff stated that a dedicated activities coordinator works three times a week and they provide a monthly newsletter where information about activities and other entertainments brought into the home is shared. Although the activities coordinator was not working on the day we visited, two staff were providing an activity to residents in the form of a game of Bingo. There are bookshelves in lounges with books, CD’s and radios, and a lounge on the first floor of the home also contained a ‘safe’ darts game and a large ‘Connect 4’ game. Comment cards were received from fourteen relatives prior to the inspection visit. When asked, ‘Does the care service support people to live the life they choose’? Two people responded that their relative ‘always’ does, six people responded that their relative ‘usually’ does, one person that their relative ‘sometimes’ does. A further five relatives indicated that they were unable to answer indicating that their relatives have dementia. The completed AQAA provided by the manager states that: ‘We have a dedicated activities coordinator who provides a weekly activities schedule for daily activities for residents to participate in should they choose to’. The document does not indicate the process by which this choice is assessed and understood for residents with dementia. There is evidence that residents’ capacity to exercise choice is not understood through shortfalls in assessment and care planning. Consequently residents’ choice and autonomy is not promoted through decision making in the routines of daily living, such as activities. Staff and residents confirmed that visitors and relatives could attend the home at any time. There were visitors to the home at the time of our visit. The completed AQAA provided by the manager states that one of the things the service could do better is ‘Provide a better link with the community by ways of our own transport’. The majority of residents who commented on the meals on offer at the home indicated a view that they usually liked them. One resident said that they ‘can’t fault the food’; another resident said they had had a ‘very nice lunch’. This was reflected in the three comment cards received from residents, prior to our visit to the home, with two residents indicating that they ‘usually’ like the meals at the home, and one resident indicating that they ‘always’ like the meals at the home. The lunch on offer on the day of the inspection visit was roast chicken with carrots, sprouts and potatoes. The meal looked appetising, was well presented and taken by residents in either communal or private setting depending on their preference or their needs. Specially prepared meals were observed being Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 16 provided to those residents who require them. Residents evidently enjoyed their meals and commented that lunches are usually good with choices on offer. There was evidence in residents’ care plans of nutritional screening using the ‘MUST’ system of nutritional assessment to help to ensure that the dietary needs of residents are met. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 17 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): Standards 16 & 18 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for responding to the concerns and complaints of people who use the service are in place, however, adult protection issues have not always been correctly reported by the home. This means that people’s health and welfare may not be being safeguarded. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the home’s guide for residents issued at the point of admission to the home. This guide was available in the reception area of the home. The manager’s record of complaints was seen. This contained records of four complaints, (two of which concerned lost or spoiled items of clothing), which were investigated and managed appropriately. The AQAA document provided to us by the manager states that one of the things the home does well is a ‘monthly complaints audit, act upon complaints quickly and competently’. The Commission has been made aware of five concerns and complaints since February 2008 that were passed to the home for investigation or which the manager was already aware of and investigating. The manager or proprietor Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 18 investigated these in accordance with the complaints procedure, but did not necessarily reach a satisfactory outcome and one of these complaints has not been satisfactorily concluded. There have also been five ‘Safeguarding’ referrals concerning the protection of vulnerable adults, two of these requiring investigations by the appropriate authorities. The outcome of one of these investigations showed concerns in relation to the lack of proper health care planning, record keeping and assessment of risk. There is a ‘Safeguarding’ policy in place at the home to provide information and to assist in protecting vulnerable adults from abuse. The staff spoken with during the inspection visit were aware of this policy and clear about the action they would take if concerned about the possibility of abuse taking place at the home and were confident that they could deal with this appropriately. One of the recent ‘Safeguarding’ referrals raised issues about staff understanding of residents’ and colleagues’ rights to confidentiality, and more importantly the adequacy of Safeguarding reporting at the home. Records provided by the home show that 57 of staff have received training in adult protection, and there was training taking place at the home at the time of the inspection with three staff in attendance. The exercise being considered was a fictional scenario to consider whether and what abuse may be taking place. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 19 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): Standards 19, 20, 21, 22, 24 & 26 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home do not have a safe internal and external environment to live in. This means that people’s health and safety is not safeguarded. EVIDENCE: A tour of the premises was completed. There is an adequate range of communal accommodation for dining and recreation on both floors. Access to the upper floor is via the stairs or by using the lift. People do not have independent access to the upper floor via the stairs, but can use the lift if they know how. The home was generally tidy, but areas were in a poor state of decoration and repair. For instance, some walls are cracked with missing plaster and dirty in Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 20 places, some areas have been partially decorated with evidence of filler in walls in corridors on the first floor and undercoat paint, (the manager was unsure as to when redecoration could continue), some toilet seats were broken in toilets still in use, no plugs available for baths, shower attachments leaking, first floor shower not working and ground floor bath out of use. The ratio of assisted baths and showers is below the minimum requirement of an assisted bath or shower for every eight residents. There were problems with other fixtures and fittings. For instance, some bedrooms have residents’ name plates to provide them with some basic assistance in recognising their own accommodation, however, many occupied bedrooms do not have name plates. Several residents were seen trying to orientate around the building without success. Numerous bedrooms were seen with broken furniture such as, chests of drawers with broken handles, (or no handles at all in one case), a chest of drawers with collapsed and unusable drawers, (this resident’s clean laundry had been placed on their bed), several wardrobe door handles missing and several bedroom lights that either do not work or do not have light shades. The bath panel in the ‘Orchid’ communal bathroom was coming off. Not all bedrooms seen provided residents with lockable storage space for valuables. The home’s hairdressing room called ‘The Salon’, was decorated to a very good standard and presented like a hairdressers in the community. The Lavender lane corridor walls were decorated with objects of interest, which were also tactile and could be manipulated by residents. There were well-tended and attractive gardens to the side and rear of the home. Some items were observed to be stored inappropriately, some causing a potential hazard to residents and staff. For instance, there were individually marked boxes for residents’ clothing in the laundry, however, there was insufficient shelf space to store all of these and several were stored on the floor, an unlocked room on the first floor contained large quantities of cleaning and soap products, (this matter was brought to staff attention and addressed at the time of the visit), a broken hoist was stored in a bathroom and a pack of incontinence pads had been stored in a communal toilet. An unlocked sluice room on the first floor corridor contained dirty/used incontinence pads. This door is not lockable from the outside, but lockable from the inside only presenting a risk to residents, (this matter was brought to staff attention and addressed at the time of the visit). The wall light fittings in the first floor corridor were uncovered and presenting a potential hazard to residents and a radiator in the same corridor was broken with no cover. Some of the bathrooms contained unnamed toiletries and products that could place people with dementia at risk. We entered some of the bedrooms and found similar products in residents’ en suites such as disposable razors. The manager confirmed that there were no risk assessments in place to ensure Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 21 that steps were taken to protect people from harm. Unnamed toiletries and disposable razors in communal bathrooms suggests people do not have a choice in terms of what products they prefer to use and presents a potential infection control risk. Products such as these should be named and stored in a safe place for the use of that individual only. The manager confirmed that there is a portable hoist available on the first floor, but that the hoist available on the ground floor was out of action and could not be used, leaving one portable hoist in operation at the home. The manager confirmed that the service for these hoists was overdue, and that bath hoist servicing was also overdue with no service date yet confirmed. A lapse in good infection control practices was noted as a staff member dealt with dirty laundry without wearing protective clothing. Disposable gloves and aprons were evidently available to all staff, who were otherwise seen to be using them when required. According to training records provided by the home in the last two years two ,(of the thirty-seven), care staff at the home have received training in infection control. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home cannot be assured that their needs will be met by adequate numbers of competent staff. This means that peoples health and welfare is not being promoted and safeguarded. EVIDENCE: There were fifty-nine residents accommodated at the home at the time of the visit. From observation and from information provided by the manager there are nine carers throughout the day and either five or six carers are on duty at night depending on staff experience and seniority. Observations and other information showed the numbers and skill mix of staff on duty during the inspection were not sufficient in meeting the needs of the residents currently accommodated. We observed residents on the first floor walking around the corridors without apparent purpose. Residents in other parts of the home lacked stimulation and occupation resulting in them either being asleep or seeking attention through other means. There are deficits in the personal care available to residents described by relatives, and care plans that are incomplete or not being followed. Some comments from relatives indicate views that there are ‘Not enough staff on duty’, and ‘At weekends difficult to find anybody when drop in’. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 23 Staff are being provided with training in key areas such as moving and handling, first aid, fire safety and in the protection of vulnerable adults, and staff spoken with describe a satisfactory induction process that helped to equip them to carry out their responsibilities. From the home’s records dementia awareness training has been completed by 13 of staff at the home. The vast majority of staff at the home have not had this training, therefore the vast majority of staff on duty at any time in the home have not undertaken any basic training in providing care to people with dementia. Training records demonstrated that almost 50 of care staff that have gained their NVQ level 2 in care or above, with other staff currently undertaking this training. Several care staff have received specialist training to help to equip them to meet the needs of residents with a visual impairment. A review of sample staff files provided evidence that residents are protected by good recruitment practices undertaken by the manager and proprietor. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home cannot be assured that it is being managed in a way that promotes their health safety and welfare. This means the service is not currently being managed effectively. EVIDENCE: The Manager has now been in her current post for 10 months and was previously the Deputy Manager of the service. She is currently in the process of applying to the Commission to be registered. Comments received from staff and relatives concerning the manager were favourable, for instance, ‘Manager always makes herself available to anything we may be wanting to know’ and ‘Good, supportive manager.’ Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 25 Further to issues described above with regard to deficits in the specialist mental healthcare delivered at the home for residents with dementia, the proprietor should allocate a person in charge of dementia care at the home. They should have an enhanced level of knowledge and training of dementia in order that they may properly supervise, (and train), other staff, (See Requirement 16). There are several processes at the home for monitoring the quality of the service it provides. There are systems in place that provide staff with formal supervision of their work and there are regular staff meetings. The Manager and the Proprietor carry out quality audits covering a range of topics and they send monthly monitoring reports to the Commission. The manager stated that there are monthly residents’ meetings. The manager stated that a more formal quality assurance exercise that seeks the views of residents and relatives is due to be carried out. This kind of exercise has been carried out by the home previously. Relatives or appointees manage most residents’ financial affairs. Financial records reviewed were satisfactory and are evidently audited periodically for the protection of residents and staff. A number of health and safety concerns have been highlighted in this report. For instance a lack of risk assessments, an environment that presents potential hazards, un-serviced equipment and potentially hazardous products that are accessible to residents. Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 3 2 1 X 1 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) & 17(1) & Schedule 3 15(1) & 15(2) (b) Requirement Prospective people to use the service must have their needs fully assessed in order that they receive the correct support to meet their needs. People who live in the home must have their needs fully assessed, reviewed and written into care plans so that staff know how needs should be met. People who live in the home must have their social and emotional needs assessed and written into an individualised plan so that staff know how their needs should be met. People who live at the home must be supported where necessary in maintaining their personal care needs. This is to ensure the dignity and support health and welfare of residents. People who live in the home must be supported to bath regularly and records of this must written into their plan of care. DS0000065218.V366714.R01.S.doc Timescale for action 18/06/08 2. OP7 30/06/08 3. OP7 16(2)(m)( n) 31/07/08 4. OP7 12(4)(a) 18/06/08 5. OP8 12(1)(a) 18/06/08 Briar House Care Home Version 5.2 Page 28 6. OP12 16(2)(n) 7. OP14 12(2&3) 8. 9. OP18 OP19 13(6) 23(2) (b&d) 10. OP19 13(4)(a) 11. OP21 23(2)(j) 12. OP22 23(2)(n) 13. OP22 23(1)(a) &(2)(c) 13(3) 14. OP26 15. OP27 18(1)(a) People who use the service must be provided with facilities for recreation to suit their individual needs. People who live in the home must be offered choices in respect of the way that they live and be encouraged to make decisions about how they wish to conduct their lives. People who live in the home must be safeguarded from harm so they are protected. The premises must be in a good state of repair to ensure people live in a safe and suitable environment. This requirement made at the inspection 21/11/06 remains unmet. People who live in the home must have an environment that is free from hazards to their safety so that they are protected from harm. People who use the service must be provided with an adequate number of bathrooms with suitable equipment. So that their needs can be met. People who live in the home must have an environment that promotes independence so that their health and well-being is enhanced. The premises and any specialist equipment used must be suitable for the assessed needs of the residents. People who live in the home must be safeguarded by suitable arrangements to prevent the spread of infection. People who live in the home must have their needs met by adequate numbers of competent staff so that their health and well-being is promoted. DS0000065218.V366714.R01.S.doc 31/08/08 31/08/08 18/06/08 30/09/08 18/06/08 30/09/08 30/09/08 30/09/08 18/06/08 30/09/08 Briar House Care Home Version 5.2 Page 29 16. OP30 18 (1)(c)(i) Staff must receive suitable 31/10/08 training in dementia care to ensure that the mental health needs of people using the service are met. 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 Good Practice Recommendations Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE 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 Briar House Care Home DS0000065218.V366714.R01.S.doc Version 5.2 Page 31 - 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!