CARE HOMES FOR OLDER PEOPLE
Briarcroft Dawlish Road Teignmouth Devon TQ14 8TG Lead Inspector
Stella Lindsay Unannounced Inspection 15th March 2006 10:00 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 Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Briarcroft Address Dawlish Road Teignmouth Devon TQ14 8TG 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) 01626 774681 01626 774681 Mr John Patrick Walsh Elaine Louisa Ann Walsh Care Home 20 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (20) of places Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Ground Floor to be registered for Service Users with OP category only Date of last inspection 20th September 2005 Brief Description of the Service: Briarcroft is a detached house, situated close to Teignmouth town centre and set back from the main road. There are sea views from some windows. Briarcroft is registered to care for up to 20 people over the age of 65, who may have dementia. There are keypad locks on the main entrances, and an attractive level decked area in a garden that is secure. Accommodation is on two floors with a passenger lift to the first floor. There is a spacious lounge, separate dining area and a sun lounge. All but one room is for single occupation. There is a separate self-contained flat on the lower ground floor, which is registered for two residents who are frail elderly but who do not have dementia. The flat has two bedrooms, a lounge and dining area as well as its own kitchen and conservatory. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Wednesday in March 2006, between 10am and 4.15pm. It involved a tour of the premises, and inspection of care records. As well as discussion with the Home owners, the inspector met with 14 of the residents, four staff, one visiting relative, and thanks all for their time. The Commission for Social Care Inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home please refer to the report of the Announced Inspection which took place on 20th September 2005, when most of the core standards were inspected, and six were found to have been exceeded. What the service does well: What has improved since the last inspection?
The top landing has been brightened up, with redecoration of the walls, new carpet, light fittings and a large mirror. Visitors and residents appreciated the new carpet in the lounge, and some bedrooms had also been re-carpeted. A second banister had been fitted to the stairs to the flat in the lower ground floor, on the advice of an Occupational Therapist. Recording of information gathered during the admission process had improved to include the recording of informal verbal information from the family, and the judgement that the home could meet the needs of the new resident had been clearly recorded. Staff felt that the team has ‘settled down’ with good new recruitment, and is working well together. Staff and management support each other, in order to sustain their good service to the residents. Care staff had improved their use of language when making daily records.
Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Great care is taken to ensure that the home can meet the needs of new residents. EVIDENCE: Information is gathered before a service is offered. Assessments were seen on residents’ files from Community Psychiatric nurses and Occupational Therapists. Recording of information gathered during the admission process also included the recording of informal verbal information given by the family. The judgement that the home could meet the needs of the new resident had been clearly recorded. Prospective service users should be aware that Briarcroft does not currently offer accommodation to anyone who has a diagnosis of MRSA. The Manager always visits prospective residents, to assure that people are admitted appropriately to Briarcroft, for their own well being and that of the other people living in the home. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 Residents’ privacy and dignity is maintained. EVIDENCE: Some residents’ privacy has to be maintained by staff awareness, particularly those who need help with toiletting. Those able to answer said that staff respect their right to privacy – ‘they leave me alone’ – and knock or call out before entering their room. In spite of the fact that locks have not been fitted to Service Users’ bedroom doors, the inspector was satisfied that dignity is maintained by staff promoting their good health, taking care with their personal appearance, and treating them with respect. There is a cordless telephone that can be taken to Service Users’ rooms for private conversations. It is kept in the main hall, with instructions on how to use it, and the mobile phone numbers for each of the Registered Providers. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 10 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): 13,14 Residents are able to maintain contact with friends and family, and are enabled to express choices. EVIDENCE: Residents confirmed that they go out with their families, and that the Home owners are kind to them. ‘They all welcome my son’, said one, and others talked about visits from neighbours. No volunteers are currently working in the Home. The Vicar of the local Parish Church has visited three times over the past year to take Communion. Service Users are enabled to continue day care or other links they had before admission. Staff were planning outings to please the residents. A visiting relative confirmed that good social activities are provided regularly – ‘there is social stimulus here, they don’t just leave them’. Residents or their representatives could access their care records if they wish. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The Home owners have a good record of listening and responding to residents and their relatives. EVIDENCE: The Home has a complaints procedure that contains all relevant details as outlined in this standard. It is distributed to new Service Users and their representatives in the Statement of Purpose. The Home has a good record of documenting any concerns raised, and any action taken. One complaint had been received by the Commission for Social Care Inspection, which was investigated during this inspection, and found to be not up-held. It concerned the level of staffing in the home, the adequacy of bedlinen, and the lack of receipts for some additional expenditure on behalf of residents, see Standard 35. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 12 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 Briarcroft is a bright and comfortable home, offering a variety of social spaces as well as all facilities required. The standard of maintenance and decoration is very good, inside and out. EVIDENCE: The Home owners have continued to maintain and improve the house. The top landing has been brightened up, with redecoration of the walls, new carpet, light fittings and a large mirror. Visitors and residents appreciated the new carpet in the lounge, and some bedrooms had also been re-carpeted. A second banister had been fitted to the stairs to the flat in the lower ground floor, on the advice of an Occupational Therapist. There is a secluded and safely enclosed garden with decked area. There is level access and good visibility from the lounge and dining room, to assure safety of residents when out in the garden. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 13 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 Sufficient staff are provided for good care of residents, though it would be good practice to employ a greater number of casual staff in order to cover for unexpected absences. EVIDENCE: The staffing levels were lower than expected on the day of the inspection due to staff illness, but in spite of this there were five people working in the home in various capacities, and the residents were seen to be well cared for. The rota showed that there are normally six staff on duty in the mornings as well as the home owners, who are frequently in the home and fully involved in its day to day running. There are two waking night staff. A fifteen minute handover period is allowed, for the night staff to report to the day staff coming on duty. Senior staff confirmed that there are sufficient staff to provide for outings and to accompany residents to appointments if their families are not available. A visiting relative observed that staff are patient, and deal well with any aggressive behaviour by residents. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 14 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): 35,37 Good care is taken to safeguard residents’ financial interests. EVIDENCE: No money is paid into any bank account on behalf of any resident, and no pension books are held. One resident has their financial affairs managed by the Court of Protection, one by a solicitor, and all others by their families. No residents are able to manage their own financial affairs. Small amounts of cash are held in the safe on behalf of three residents, with records kept, all checked and correct. There is a record sheet available for recording the receipt of any valuables handed over for safe keeping, but families are asked not to bring precious items to the home. Any extra expenditure, such as hairdressing, is paid for by the home, and added to bills. Itemised bills are sent monthly by the Home owner to the family or solicitor. The chiropodist and hairdresser have each made out a bill for their session of work, showing each individual’s tariff. These were available
Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 15 for inspection. The Home owner will discuss with the chiropodist and hairdresser whether they are able to issue itemised bills. Newspaper bills are sent separately, and attached to the monthly bills. All incidental expenditure is recorded. £2 per month is charged by the home as a contribution to social entertainments, but relatives are told that this is optional, and some have declined to pay. Record keeping at Briarcroft is generally very good, with all documents required during the inspection easily retrieved, clear and up to date. Individual care records are kept on separate sheets, and stored in the Care Plan, so that residents or their relatives may view them on request. Staff had made efforts to use professional language when writing their reports, and to record all slips, trips and accidents. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 16 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 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 4 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 3 X Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations The Manager should recruit more casual care staff in order to cover for unexpected absences. Briarcroft DS0000003663.V276848.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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