Inspection on 18/10/05 for Briar House Care Home

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Briar House Care Home 28/05/09

Briar House Care Home 08/12/08

Briar House Care Home 18/06/08

Briar House Care Home 21/11/06

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

CARE HOMES FOR OLDER PEOPLE Briar House Care Home Losinga Drive Kings Lynn Norfolk PE30 2DQ Lead Inspector Mr Jerry Crehan Announced Inspection 18th October 2005 09:30 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 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 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.V249346.R01.S.doc Version 5.0 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 Ashbourne Holdings Ltd Position Vacant 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.V249346.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2005 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. Briar House is one of several homes in Norfolk owned by the proprietors. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 8 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the sixty-two service users in addition to visiting relatives, staff and the registered manager. Ten comment cards were received from service users, relatives and health professionals prior to the inspection. These largely expressed satisfaction as to the care provided at the home. Comments from GP’s were particularly satisfactory. Any areas of dissatisfaction were explored within the inspection. There has been a change in the registered manager at the home since the last inspection. What the service does well: What has improved since the last inspection? A new manager has been appointed since the last inspection, it is evident that this has had a positive impact on both service users and staff, and morale at the home is good. It appears that the manager is well thought of by service users, staff and relatives. The environment still requires improvement though it is acknowledged that improvements have been made since the last inspection. New arrangements for dining on the ground floor make better use of the communal space available at the home. More effective arrangements for storage have been made. This has improved the general appearance of the home and provides a safer environment. The provision of a portable telephone in order that service users may make or receive telephone calls in the privacy of their own bedrooms if they wish is welcomed. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 6 Although the subject of requirements in this report, care plans are improved as they more clearly set out care requirements for care staff to follow, and are evidently reviewed on a regular basis. 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. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 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 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 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, 4 The home provides clear information that would assist service users in making an informed choice as to the home’s ability to meet their needs. The needs of prospective service users are adequately assessed. EVIDENCE: The home has produced documentation including a Statement of Purpose and Service User Guide that are provided to service users and were available within the home, including the reception area. There is an admission procedure that adequately guides the manager, or other senior staff responsible for assessment, as to actions to be taken to ensure service users needs are assessed prior to a move to the home. Evidence of this was made available and confirmed by service users spoken to. The home has clear written information available to prospective service users, which would provide them with a good understanding of the home’s capacity to meet individual need, including needs arising from dementia. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 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, 11 The care planning system is clear and in the majority of instances adequately provides staff with the information they need to meet the health and care needs of service users, though there are instances when the information needed is not available. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements clearly and in detail and were evidently reviewed on a regular basis and are becoming an informative tool for care staff in individual care delivery. Care plans also referred to the involvement of a variety of community health professionals. Comments by service users spoken with supported this confirming that they have access to the GP, District Nurse and other professionals as required. A care plan for a service user with a diagnosis of dementia who had been accommodated by the home approximately two months prior to the inspection did not have an ongoing or completed ‘life story’ section in their care plan. It was evident that with regular family contact this work should have been underway, and would influence many aspects of care delivery. For example nothing was known about the service users interests or hobbies. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 10 The daily care notes for a service user with behaviour that challenges were reviewed. It was evident that the management of clearly identified behaviours occurring on a regular basis should be incorporated into the care plan and must include proactive information about positive management of behaviour that challenges. There are currently no service users accommodated at the home who take responsibility for administering their own medication. Medication records and storage were reviewed. It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. This practice was in evidence for a variety of blistered, containered and liquid medication. It is evidently clear that individual medication can become mixed, and therefore presents the risk of its being wrongly administered. On examination of care notes for a service user, it was noted that they had a known sensitivity to penicillin-containing antibiotics. However, this information was not situated in their MAR chart, it is recommended that such information is accurately transcribed in order to highlight the risk of administration of such medicines. The home has in place appropriate storage and a book used to record controlled drugs, which provides an additional level of security. The book meets the requirements of the Misuse of Drugs Regulations 2001. Both service users and relatives spoken to indicated that the right to privacy is respected at the home, and that visitors are made welcome and can be seen in private. Following a requirement made at the home’s last inspection a portable telephone has been purchased in order that service users may make or receive telephone calls in the privacy of their own bedrooms if they wish. The manager indicated that he is considering ways in which he can ensure all service users are aware of this facility. The home has evidently provided palliative care to service users at the home, and have an appropriate policy to support staff in the care of service users who are dying. Care plans sampled included reference to the wishes of service users in the event of their death. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 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): 14 & 15 Service users are able to exercise choice and control over their lives. Menus in the home offer choice and variety and are taken in pleasing surroundings. EVIDENCE: Service users indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms. A service user spoken to indicated that they continued to enjoy the responsibility of chairing the residents committee of the home. A portable telephone is now available throughout the home to support the privacy of service users wishing to make or receive calls. Service users gave a good response as to the quality of the food available at the home. A number of service users indicating that there is a wider choice available than there used to be at the home. The meals seen at the time of the inspection looked wholesome and appealing. It was also clear that there were at least two main meal options available at lunchtime. The opening up of the home’s dining area on the ground floor is welcomed as it provides a pleasing setting within which to take meals. It also increases the home’s options for service users in the main lounge area that had been, until recently, used for dining. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 12 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): 17 The arrangements for protecting service users legal rights are satisfactory. EVIDENCE: The manager indicated that currently all service users have access to relatives or friends, many of whom assist service user in managing their affairs, and that there are no independent advocates currently supporting service users. Service users are able to take part in the political process, voting by postal ballot. The manager stated that there are limited links with the local community though there are good links with the local Methodist Church. He also stated that he wishes to promote this and other community links, hoping this will be supported through the soon to be established ‘Friends of Briar House’ group. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 13 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, 22, 23, 24, 25 Service users live in a comfortable and safe environment, though there are maintenance issues that compromise service user privacy. EVIDENCE: The general maintenance of the home has regularly been a source of concern at inspections and has resulted in regular requirements where minimum standards have not been met. However, the general standard of maintenance shows signs of further improvement despite a number of outstanding minor repairs. There are adequate toilet and bathroom facilities to meet individual need; a missing lock to the door of a toilet on the first floor, and a broken lock to the door of ‘Lavender’ bathroom does not support privacy. It is also noted that accommodation used by staff for breaks on the first floor is in a particularly poor state of decoration and repair. It is recommended that this area be subject to renewal and redecoration. It is recommended that improvements to the indoor environment of the ‘Lavender’ section of the home. This area has a hard floor surface that appears to amplify sound throughout. At the time of the inspection it was suggested Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 14 that soft, tactile surfaces be included that could be wall mounted and add interest and stimulation to the environment for service users as well as assisting in reducing the amplification of sound. Effective solutions have demonstrably been found by the new manager to the storage problems at the home identified at the last inspection. This has improved the general appearance of the home and provides a safer environment. There is sufficient equipment available within the home to meet the assessed needs of service users. Service user own rooms appear to suit the individual needs and preferences of their occupants. Many service users bedrooms were clearly personalised with their own furniture and possessions, creating a homely feel in many rooms. All of the bedrooms at the home are designed for single occupancy. The home provides a satisfactory standard of accommodation that is safe, and comfortable. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 15 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, 30 Staff at the home are employed in sufficient numbers, have a good understanding of service users support needs. Staff training programme addresses service user needs. EVIDENCE: There were ten members of care staff supporting the sixty-two service users (and day care service users), living at the home in addition to the manager. Six care staff were deployed to work with service users on the ground floor, four care staff were deployed to work with service users on the first floor. There were two activities coordinators also undertaking work with service users. Comments from service users and relatives were favourable about the care provided by staff at the home. It is evident from staff spoken to and from training records seen that staff have access to induction training and a full range of mandatory training. Mandatory training includes ‘Resident Welfare’ training, which incorporates adult protection awareness. Staff working with service users with dementia is evidently provided access to appropriate training to this specialist role. The manager advised that 41 of care staff have achieved NVQ 2 training (or above), with a staff member currently undertaking the training, a further two staff registered to undertake the training and three in the process of registration. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 16 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, 35, 37, 38 The home is well managed by a new manager who is well regarded by service users, relatives and staff alike. The home is run in the best interests of service users, though further development is required to ensure ongoing review of the quality of care provided at the home. EVIDENCE: The newly registered manager was appointed to his post as General Manager several months ago. He is a level 1 registered nurse, has seven years of management experience in the care sector, has undertaken a variety of professional training and is currently undertaking the Registered Manager Award programme. Both service users and staff spoken to spoke in favourable terms about the new manager. He is evidently thought of as ‘nice’, ‘approachable’ and ‘knowledgeable’ by service users and staff. It was evident during the inspection Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 17 that the manager had familiarised himself with all of the service users at the home and knew something of their care needs. The manager described strategies employed at the home to ensure that it is run in the best interests of service users. These include monthly audits of care and premises, and the residents committee meetings. However, the manager described plans to extend these and other processes, including the introduction of two monthly staff meetings, a customer care audit (in the form of a questionnaire), and the establishment of a ‘Friends of Briar House’ committee. An advertisement for the latter was seen in the reception area of the home. These measures described are welcomed and if implemented will satisfactorily meet the standard required. Financial records were reviewed and found to be satisfactory. Service users financial interests are safeguarded by the home; their relatives manage the vast majority of service users financial affairs. The home has appropriate policies and procedures, and satisfactory record keeping practices. The health, safety and welfare of service users are compromised by the care planning issues referred to in Standard seven. It was also noted during the inspection and brought to the managers attention on two separate occasions that cleaning trolleys with their attendant cleaning materials and waste, had been left unsecured and unattended. Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 18 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 2 3 X 3 3 3 3 X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 2 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 19 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 Standard OP7 Regulation 15(1) Requirement The registered person must ensure that written care plans are prepared with the involvement of service users or their representatives. The registered person must ensure that care plans are generated clearly and accurately from assessed needs. The registered person must ensure that premises are kept in a good state of repair. The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home. The registered person must ensure the health and safety of service users including the safe storage of hazardous substances. Timescale for action 18/10/05 2 OP7 13(4) & 14(2) 23(2)(b) 24(1) 18/10/05 3 4 OP19 OP33 18/10/05 31/03/06 5 OP38 13(4)(a) 18/10/05 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 20 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 OP9 Good Practice Recommendations It is recommended that the practice of labelling drug trolley door shelves with service user names and storing their medication above the label is considered only as a guide for staff with responsibility for administering medication. It is recommended that information relating to known medicine sensitivities is made available on MAR charts in order to highlight the risks of administration of such medicines. It is recommended that the accommodation used by staff for breaks on the first floor be subject to renewal and redecoration. It is recommended that the registered person ensure continued progress toward meeting the 50 requirement by 2005. 2 OP9 3 4 OP19 OP28 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Briar House Care Home DS0000065218.V249346.R01.S.doc Version 5.0 Page 22 - 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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