Inspection on 15/05/07 for Briarfield House

This inspection was carried out on 15th May 2007.

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

Briarfield House 24/04/08

Briarfield House 05/02/07

Briarfield House 02/10/06

Briarfield House 11/04/06

Briarfield House 21/02/06

Briarfield House 26/07/05

Briarfield House 29/09/04

Briarfield House 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Briarfield House 8 Easson Road Redcar TS10 1HJ Lead Inspector Jane Bassett Key Unannounced Inspection 15th May 2007 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 Briarfield House DS0000000079.V339329.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. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briarfield House Address 8 Easson Road Redcar TS10 1HJ 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) 01642 488218 F/P 01642 488218 Mr Stephen Metcalf Miss Louise Metcalf Mrs P Creed Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2007 Brief Description of the Service: Briarfield House is a large detached two-storey house, built in 1902. It is a mellow building, which blends well with the surrounding properties and has an enclosed garden. The home is situated in a quiet residential road near to the racecourse. There are shops and a large supermarket within walking distance, and a nearby bus stop provides access to the town centre and sea front. The home provides accommodation for twelve elderly service users, in ten single rooms and one double room with en-suite shower, wash basin and lavatory. Bedrooms are comfortably furnished, and service users are able to personalise their rooms by bringing some possessions with them when they move into the home. Downstairs there is a bathroom/shower room, and separate lavatory and upstairs there is a bathroom and separate lavatory. There is a large spacious lounge, and a pleasant dining room, and a smokers room is provided to the rear of the house. The manager told inspectors that it costs £358.54 & £388.54 per week for a resident to stay at Briarfield House. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection report includes information obtained from an AQAA questionnaire, four relative / visitor surveys received by CSCI and two survey completed by residents. Two inspectors carried out an unannounced visit to the home. During the visit, which lasted six hours the inspectors walked around the building and looked at documentation including staff records and residents files. The inspectors spoke to three residents, two staff members, and the manager. What the service does well: What has improved since the last inspection? Improvements have been made in a number of areas. Work has been carried out in relation to care planning and recording of needs, however these would benefit from further development. Evidence was seen that indicated resident’s needs are assessed prior to admission. Staff have received training in relation to safe handling of medication, ‘no secrets’, moving and handling, fire safety, and first aid. Documentation seen indicated the complaints procedure has been made available to all residents including those with visual impairment as well as relatives of people living at the home. A quality assurance system has also been developed and is currently being implemented. The flooring of the first floor toilet has been replaced. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 6 The staff recruitment procedure has been made more robust. 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. Briarfield House DS0000000079.V339329.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 Briarfield House DS0000000079.V339329.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): Outcomes for standard 3 was looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed. EVIDENCE: During the inspection the file of one resident recently admitted was looked at. This was found to contain a pre admission assessment carried out by the manager, which contained sufficient information in relation to that persons needs. The manager described to the inspectors the process she would follow including receiving information from social workers and visiting the prospective resident prior to making a decision. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 9 Relatives of one resident who spoke to the inspector told her family members had the opportunity to look around the home prior to making a decision. They confirmed that care needs had been discussed. The home does not provide intermediate care. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 10 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): Outcomes for standards 7, 8, 9, & 10 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is generally based on their individual needs, however further work is required in recording the details of how needs and risks are addressed. The principles of respect, dignity and privacy are put into practice. EVIDENCE: During the inspection the records of four residents were examined. These were found to contain some good recording of past life history, residents own capabilities and spiritual needs. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 11 Records seen contained copious amounts of info within two files for each resident. Information was often repeated, and the method of recording was found to be confusing making it difficult to ascertain an accurate reflection of resident’s current needs. For example one file contained information in the assessment stating the resident suffered anxiety and depression, a plan of care was not evidenced. Records should be developed further to ensure that all identified needs have a plan of care that includes how those needs are met and reflect the residents individual capabilities and preferences. Documentation seen included a monthly review, however this was a general over view and not specific to each need identified. Risk assessment were seen to be recorded on a pro forma documentation, which included a number of issues on each sheet, some of which did not appear to be relevant to that individual resident. There was no evidence of evaluation and review. Risk assessment documentation should be developed in such a way as to record the actions that the home are to take to minimise any risk identified. Assessment should be individual to the resident. Not all risks identified had a risk assessment for example one resident self administers some of their medication, no risk assessment was evident. Daily records were seen to be kept however these did not always contain sufficient information. One file seen contained evidence that care needs had been discussed with the resident or relative. Comments received from relatives included ‘staff help my relative and have always been kind’ and ‘the personal care on a one to one basis is excellent’. A staff member who spoke to an inspector was able to demonstrate a knowledge of resident’s needs and how these are met. The home operates a key worker system to enhance liaison between staff and families. A random audit of medication identified no major concerns with storage and recording, however some hand written entries of instructions on MAR sheets still did not contain two signatures of staff as confirmation of accuracy of detail. This has been recommended at previous inspections. Evidence was seen that indicated staff have undertaken training in relation to safe handling of medication. One staff member described to inspectors the procedure that is followed and confirmed that secondary dispensation no longer takes place. The home has acquired a BNF and retains information leaflets for medications administered. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 12 The home has a policy and procedure in relation to administration of medication, this should be developed further to include the procedure staff must follow whilst administering medication and to ensure that information is specific to the service provided. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 12, 13, 14, & 15 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their life style. Social and recreational activities meet individual’s expectations. EVIDENCE: The home has developed additional documentation, which records activities that have taken place, however the log is not always clear as to who participated in what activity. Three residents who spoke to the inspector told her they prefer to spend time in their own rooms but said they were made aware of activities. Relatives who spoke to the inspector said they were always made to feel welcome. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 14 Staff and the manager told inspectors that residents are able to choose how they spend their day and are enabled to attend church if they wish. This was evidenced through information in one residents file. Comments received from residents included’ I am happy here’ and ‘ we are a happy crowd’. There are regular visits by a hairdresser. During the inspection it was seen the hairdresser uses the laundry area to dry and style the ladies hair. A more suitable area should be found. All residents who spoke to the inspector said they enjoyed the meals, comments received included ‘ good food’ and ‘I can have my meals in my room’. However two residents commented on the frequency of sandwiches at teatime. The manager and owner both confirmed they were aware of this and had purchased a number of items requested by residents. Staff in the kitchen are supplied with a list of individual residents likes and dislikes and maintain a record of meals taken. The cook told the inspector menus are discussed with residents. Residents who spoke to the inspector confirmed this. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 16 & 18 were looked at. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure, are protected from abuse and have their rights respected. EVIDENCE: The home has developed a complaints procedure that is available to all residents and relatives. Evidence was seen that this has been made available and discussed with resident with visual impairment. Residents and relatives who spoke to the inspector confirmed they are aware of procedure and know who to speak to if they had a concern. During discussions with the inspector one resident raised a concern. Evidence was seen that confirmed the manager and owner were aware of this and are investigating the issue. The manager told the inspector no other complaints have been received since the previous inspection. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 16 One resident who spoke to the inspector told her ‘ I have no complaints, I get everything I want’. Evidence was seen that indicated staff have received training in relation to prevention of abuse and the ‘no secrets’ guidance. A staff member who spoke to the inspector confirmed this. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 19 & 26 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home enables people to live in a generally safe, well maintained and comfortable environment. EVIDENCE: The inspector walked around the home and looked in a number of resident bedrooms and communal areas. Briarfields was seen to be homely, generally well maintained, clean and odour free. Bedrooms reflect individual taste and interests including people’s own furniture, pictures and ornaments. Some residents had their own telephone. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 18 Work has been carried out to replace the bathroom flooring identified at previous inspections. Lounge doors are now fitted with door guards. The laundry door that had been found to be held open at previous inspections was noted to be closed but unlocked. To access this room people have to negotiate a step, which is a possible tripping hazard, the room is also used as part office and contains some confidential information. Action should be taken to make the area more secure. Action should be taken in relation to the following concerns identified at the time of the inspection. A number of bedrooms were found to have either unguarded radiators or wall-mounted heaters. The manager and owner were not able to confirm if the heaters were of a type that had a low surface temperature. There was no evidence of any risk assessments in relation to these. Action must be taken to minimise risk of injury to residents. At the time of the inspection the heating was not in use. A wall-mounted heater in the smoking area accessible to residents. A number of steps / thresholds on both internal and external doorways that may be a trip hazard to residents with poor mobility. There was no evidence of risk assessments in relation to these. A flight of stairs used by residents with limited and / or poor mobility. There was no evidence of clear individual risk assessment in relation to these. Freezers in the smoking area accessible by residents. The disposal of clinical waste such as incontinence pads. The inspector was told these are currently being disposed of in the domestic waste. Advice should be sort from Environmental Health Department. The inspector has since been told that action has been taken in relation to this issue. Storage of cleaning products in toilet areas. Bedroom and bathroom doors were seen to be fitted with privacy locks, that allow staff access in an emergency. However a number of these doors were also fitted with bolts. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 27, 28, 29, & 30 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff at the home are trained, skilled and in sufficient numbers to support the people who use the service. EVIDENCE: Discussion with residents, relatives and staff indicated there were sufficient staff on duty to meet residents needs. Comments received from residents included ‘ they are all lovely staff’. A staff rota was seen at the time of the inspection, however this was not clear as to the person’s specific role within documented hours. The home does not employ any staff specifically to carry out domestic duties and only employs one member of catering staff on a part time basis. The inspectors were told that care staff carry out these duties when specific staff are not on duty. This should be monitored and reviewed to ensure that staff are not distracted from care duties. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 20 The staff files of two staff recently employed were examined. These were found to contain references, CRB and / or PoVA first checks obtained prior to employment, as required at previous inspections. Each file also contained an application form and record of interview. The employment history on one of the application forms contained details of years only. There was some evidence that gaps in employment had been followed up. The exploration of employment history could be further enhanced by the inclusion of specific dates of employment on reference requests. Evidence was seen that indicated staff have or are receiving induction training. Five other staff files, including the managers were examined these contained evidence of training in relation to ‘ no secrets’ guidance, moving and handling’ first aid, safe handling of medication and fire safety as required at previous inspections. Evidence was seen that a number of staff have obtained NVQ at level 2 or above. The manager told inspectors that over 50 of the staff have achieved this. Two out of four care staff files examined contained NVQ certificates. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for standards 31, 33, 35, 36, & 38. were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has developed a quality assurance system that is being implemented. Residents and relatives expressed satisfaction with the way the home is managed. EVIDENCE: The manager has previously obtained the Registered Manager award and is planning to undertake NVQ level 4 in care. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 22 The home has developed a quality audit system and has started to seek feedback from residents, relatives, other professionals and staff on the service provided. The inspectors were told the home plans to recommence resident / relative meetings. The results from the survey should be analysed and feedback given to residents and relatives as to the outcomes and any action taken in relation to these. One relative commented ‘ overall I am very happy with my relatives care, with a little bit of fine tuning Briarfields could be excellent’. Regulation 26 visits are now taking place and reports have been made available. Evidence in staff files seen indicates staff receive regular supervision. Staff who spoke to the inspector confirmed this. Accidents were seen to be recorded appropriately and records retained in residents individual files. The manager told the inspectors the home does not hold monies on behalf of residents. Records seen indicated fire alarms are tested weekly, fire drills take place and hot water temperatures are checked and recorded. The home has recently been inspected by the local fire safety officer, the inspector was shown a letter that confirmed compliance with requirements. Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a 2 X X X X X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? 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 Requirement Care plan documentation should be developed further to ensure all identified needs are recorded and met. Reviews must be carried out separately for each specific need to reflect changes in that need and how these are met. There must be an assessment for all risks identified. These must be individual to person and risk, and reviewed as required. The policy and procedure in relation to safe handling of medication should be developed further to include the procedure for administration, and be specific to the service provided. Action must be taken to minimise risk of injury to residents from unguarded radiators and wall mounted heaters. Action must be taken to minimise the risk to residents in relation to the following ●access to laundry area. ● A number of steps / thresholds DS0000000079.V339329.R01.S.doc Timescale for action 01/09/07 2 OP7 15 01/09/07 3 OP7 15 01/09/07 4 OP9 13 01/09/07 5 OP19 13 01/08/07 6 OP19 13 01/08/07 Briarfield House Version 5.2 Page 25 7 OP26 16 both internally and externally that may be a trip / fall hazard. ● the storage of cleaning products I toilet areas. Advice must be sort and appropriate action taken in relation to the disposal of clinical waste. 01/08/07 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. 2 Refer to Standard OP7 OP9 Good Practice Recommendations Daily records should be developed to contain more in depth information as to the residents care. The Registered Person should ensure that a second staff member countersigns each entry on Medication Administration Records in relation to additions or alterations of administration instructions. Recordings of activities should be developed further to be specific to who participates in which activity. A more suitable area should be found for the hairdresser. A more suitable location should be found for the freezers currently in the residents smoking area. Bolts should be removed from bedroom and bathroom doors. The hours of catering staff and the lack of domestic staff should be monitored and reviewed to ensure that whilst care staff carry out these duties it does not detract from hours provided for care duties. Action should be taken to ensure application forms include full employment history and any gaps are explored. The manager should continue to pursue a qualification to NVQ Level 4 in Care, or an equivalent. The quality assurance system should be fully implemented to seek the views of residents and their representatives. The analysed outcomes from this should be made available to all residents and representatives. DS0000000079.V339329.R01.S.doc Version 5.2 Page 26 3. 4. 5. 6. 7. OP12 OP12 OP19 OP19 OP27 8. 9. 10. OP29 OP31 OP33 Briarfield House Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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 Briarfield House DS0000000079.V339329.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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