Inspection on 21/11/06 for Briar House Care Home

This inspection was carried out on 21st November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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 18/10/05

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 Key Unannounced 21st November 2006 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.V321238.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.V321238.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 briar.house@ashbourne.co.uk www.schealthcare.co.uk Ashbourne (Eton) Limited Mr Richard Bibb 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.V321238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 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.V321238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 8.5 hours on 21st November 2006. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users in addition to its staff, deputy manager and manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The manager provided comprehensive pre-inspection information to the Commission prior to the inspection. This included 1 comment card from a service user, and 8 comment cards from relatives and visitors to the home which gave broadly favourable comments about the service provided by the home, and favourable comments about the manager, though expressed some concern about staffing levels. Briar House is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is from £338 to £443. What the service does well: What has improved since the last inspection? Parts of the environment have benefited from re-decoration, especially the hairdressing salon, which is decorated and fitted to a high standard. There is a developing programme of activities, which service users speak favourably about. The activities coordinator is being supported to ensure activities are based on current good practice and research. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 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.V321238.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. New service users are admitted on the basis of a full assessment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sample files reviewed provided evidence of pre-admission assessments undertaken by the manager or deputy. Files also provided evidence of relevant assessment undertaken by other professionals working with the prospective service user. A visiting professional was spoken to; he stated that the manager of the home had visited his client prior to admission to the home to assess their needs. The service users whose assessments were reviewed were appropriately placed at Briar House. The manager confirmed that the home does not provide intermediate care. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good as service users personal and healthcare needs, including medication, are well attended to. However, social aspects of care delivery to ensure service users receive the support in the way they require, is less effective. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Sample care plans were reviewed. These set out care requirements in sufficient detail and indicate the action needed to be taken by care staff. Care plans seen included risk assessments to address individual needs arising from challenging behaviour, eating difficulties and risk from falls. Dementia assessments covering issues associated with the home’s environment, the person’s mental health, personality, their routines and sleeping patterns all assist in supporting the care plan. Physical health matters are covered in very good detail within care plans as is general safety issues. There was evidence of the involvement of a variety of community health professionals to support service user health needs, including the GP, CPN, district nurse and chiropodist. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 10 Some ‘life history’ information was available in care plans, though information is often limited. There is limited emphasis of the service users social needs recorded to inform the social aspects of their care requirements, and this should be extended (see requirement 1). There was evidence of regular review of care plans, and supporting risk assessment. However, there was little evidence of service user involvement in the drawing up of the plan, though some plans contained information for staff regarding the need for prompting some people to join in with others and activities. On review of medication no discrepancies were identified, and records were good. Senior carers or other senior staff have responsibility for medication administration. The bulk of medication is available via the Monitored Dosage System (MDS), though there is also packet and bottled medication. Medication records corresponded with stock held. Medication requiring refrigeration was also seen, this was appropriately stored and regular checks in evidence as to temperature of fridge. There was evidence through observation of practice throughout the day that service users are cared for in such a way as to support their privacy and dignity. Service users spoken with spoke favourably about the care they receive from their carers. All bedroom, bathroom and toilet’s were lockable. Service users have access to a mobile telephone in order that they may make or receive calls in private. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Social and recreational options available satisfy the needs of service users. Contact with friends and relatives are supported by the home. Meals at the home are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a dedicated activities coordinator who was attending a relevant training course at the time of the inspection visit. Care staff support the activities coordinator in providing ‘activities’, including discussions, board games, music, singing and newspaper reading. Service users spoken with indicated that there was usually an activity going on that they could join in with. At the time of the visit service user were observed playing dominoes, going for a walk, and a short religious service took place. A published programme of activities was seen, which included one to one sessions (three times a week in the mornings, picture collage, bingo, armchair exercise and sing a long. Discussion with the manager confirmed that activities at the home are in the process of change and development as a consequence of the wishes of service Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 12 users and current thinking about activities, and as a consequence of the appointment of a new coordinator. Service users spoken to confirmed that their relatives and visitors can meet with them. Meetings usually take place in the privacy of the service users room. The manager indicated that he has plans to provide another room that may be used for this purpose. During the inspection, visiting relatives were seen, and it was evident that relatives and visitors spend time with service users in the communal areas of the home also. There are currently no service users who take responsibility for managing heir own affairs. There was evidence in care records of the involvement of advocates for some service users. Several service users were spoken to after their lunch. They spoke favourably about their meal. At least three main meal options were seen to be served at lunchtime, including a vegetarian option. Options were beef hotpot, chips and peas, vegetarian Kiev, chips and peas and sausages and mashed potato. Finger foods were in evidence during the inspection visit (cheese and crackers). Special diets were available to service users and were seen being provided. They were prepared as other meals and not softened or liquidised together. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. There are arrangements in place to deal with complaints that service users are aware of. Service users are protected from abuse by appropriate policies and training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the comment cards received prior to the inspection visit from relatives and visitors to the home indicated that they are aware of the home’s complaints procedure. One comment card from a service user was received, which indicated that they knew who they could speak with if they were unhappy and that they knew how to make a complaint. Service users spoken to during the inspection visit stated that they would speak with carers, or with the manager if they needed to. A summary of the complaints procedure is available in the reception area alongside other information including the Statement of Purpose. Two complaints had been received by the home, both of which were investigated satisfactorily. The Commission had received a compliment from the relative of a service user regarding the high quality of care provided to their relative. The home had made two referrals through the Norfolk Adult protection protocol following allegations made by service users. These referrals were made appropriately, and investigated by the relevant authority. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 14 Staff spoken to during the inspection visit had an understanding of adult abuse issues, and confirmed that they had received training via the home, or within their NVQ training (training records provided conformation of this). Staff were able to demonstrate an awareness of the home’s Whistle blowing policy and its purpose. This is reflected in the referrals indicated above. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate due to the poor standard of décor on the first floor. However, other areas have a higher standard of decoration. A comfortable and safe standard of accommodation is provided for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are notable improvements to the homes environment. The hairdressing salon has been refurbished with the support of the ‘Friends Of Briar House’. It is equipped and decorated to a very high standard, looking and feeling like any salon in the community. As already indicated door locks are in place where needed. The environment was safe, bedrooms and toilets were all clean, a service user observing the inspector explained that ‘they are all clean here, and our bedroom’s’. The standard of internal decoration is very mixed. The ground floor environment is generally good, as is ‘Lavender Lane’, which has improved Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 16 through both redecoration and the provision of pictures and other objects of interest for service users. The first floor is in need of considerable redecoration. It is out of keeping with the rest of the home, with evidence of peeling and chipped paint throughout the corridor area, crack repair that has not been over painted, and yellowing areas on walls and ceilings (see requirement 2). The home’s ground were safe, attractive and accessible. The home was clean and hygienic, with cleaning in progress at the time of the inspection. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. Visitors to the home indicate a view that there are not always sufficient staff on duty. Staff recruitment practices protect service users. Staff training generally meets service user need with the exception of visual impairment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were 60 service users accommodated by the home at the time of the inspection visit, though three people were in hospital. Ten service users are residential, the remainder have a diagnosis of dementia. Service users were being cared for by a total of 10 care staff, six of whom worked on the ground floor, four of whom worked on the first floor. The manager indicated that this was the usual deployment each morning shift. The home has additional staff to undertake domestic, kitchen, laundry and housekeeping tasks, and activities. Service users indicated that they were satisfied with their care and with their carers. There was no specific evidence to indicate that needs were not being met. However, out of eight comment cards received from relatives and visitors to the home, five indicate a view that there are not always sufficient staff on duty. Two additional comments were made concerning problems with service users laundry going missing. This matter was discussed with the manager who Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 18 acknowledged the difficulty, that it had been brought to his attention and that he had taken action to try to remedy the situation. At the time of the inspection visit there were 63 of care staff working at the home with NVQ 2 or above. Sample staff files provided evidence that service users are protected by good recruitment practices. Staff training records provided evidence of induction training linked to TOPSS standards, records also contained evidence of mandatory and other ongoing training for staff. This reflected comments from staff spoken with, who said that they had received dementia care training. The deputy manager provides training in relation to recognising adult abuse. The home had recently accommodated a service user who is blind. Although staff were observed assisting this person with care, there was no evidence of specialist training for staff in supporting someone with this specialist need (see requirement 3). Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 38 Quality in this outcome area is good. The home is well managed by a manager who service users, relatives and staff speak or comment favourably about. A more a coordinated approach to provide regular, formal staff supervision is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a level 1 registered nurse, has eight years of management experience in the care sector, has undertaken a variety of professional training and is currently completing the Registered Manager Award programme. Service users, staff and visiting relatives spoken to, describe the manager (and the deputy manager) as approachable and knowledgeable. Two of the Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 20 comment cards received from relatives and visitors to the home indicate an improvement at the home since new manager took over. The proprietor undertakes regular visit to the home and audits. Good quality monitoring systems in evidence at the home include a monthly auditing programme, staff meetings (minutes seen), and ‘departmental’ meetings, a long standing monthly residents forum chaired by a service user, and an annual questionnaire to service users. This has not been fully extended to include taking the views of relatives and other stakeholders associated with the home (see recommendations). However, the manager stated that he undertakes mail shots to communicate information to relatives, and that he is planning to develop a home newsletter. He currently holds an ‘open clinic’ when he is available at the home to those that may wish to speak with him. Relatives or appointees manage service user financial affairs. Financial records reviewed were satisfactory, corresponded with monies held at the home and are evidently audited periodically. It was apparent from care staff and from personnel records that formal staff supervision is taking place periodically though not at the frequency required by the standard. The manager acknowledged this and indicated that the matter would be addressed (see requirements). The health, safety and welfare of service users are met. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1) Requirement Timescale for action 21/11/06 2. OP19 23(2)(d) The registered person must ensure that written care plans are prepared with the involvement of service users or their representatives. This Requirement is Repeated The registered person must 28/02/07 ensure that premises are kept in a good state of repair. The registered person must ensure that care staff have specialist training appropriate to the work they are to perform. The registered person must ensure that care staff at the home are appropriately supervised. 31/12/06 3. OP30 18(1)(c)(i ) 18(2) 4. OP36 21/11/06 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 Good Practice Recommendations DS0000065218.V321238.R01.S.doc Version 5.2 Page 23 Briar House Care Home 1 Standard OP33 It is recommended that satisfaction questionnaires are provided to ‘stakeholders’ associated with the home. Briar House Care Home DS0000065218.V321238.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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