CARE HOMES FOR OLDER PEOPLE
Briarfield House 8 Easson Road Redcar TS10 1HJ Lead Inspector
Penni Hughf Unannounced 26 July 2005 9:30 am 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 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 B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Briarfield House Address 8 Easson Road Redcar TS10 1HJ Telephone number Fax number Email 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 Mr Stephen Metcalf Mrs P Creed Care Home 12 Category(ies) of OP - Old Age (12) registration, with number of places Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29 September 2004 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 smoker’s room is provided to the rear of the house. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took six hours and thirty minutes and was carried out as one of the two statutory annual inspections required by the Care Standards Act 2000. A partial tour of the premises took place during chats and interviews with the provider, staff and residents and care records were inspected. Seven of the twelve residents were interviewed as well as two relatives. The manager was not on duty on the day of the inspection, although she called into the home during the afternoon. The provider and his wife also attended the home during the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection, the registered provider and the manager have improved the night staffing arrangements to provide greater safety to residents. Further discussion is planned for the 8th August with the fire authority, to maximise safety for the residents. Care plans are now much more detailed and focused on the residents and their needs and how they want their care delivered. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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 standard(s) 2 & 3 The home makes sure that all the residents who are admitted to the home have been assessed and their needs can be met. The home is also good at providing contracts and agreements about what the residents can expect whilst living at the home. EVIDENCE: Three residents files examined contained a statement of terms and conditions. These included the room to be occupied and were signed and dated by the residents. However, the fee charged was out of date, and must be amended on the fee review section of the document. The files contained pre-admission assessments and care plans from the admitting authority, together with the homes own assessment and care plan. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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 standard(s) 7 & 10 There continues to be an improvement in the care plans which provides the staff with the information they need to support and care for the residents. Further detail in recorded information will further enhance staff knowledge and understanding. Some information is currently passed between staff verbally but not recorded. EVIDENCE: Three care plans were examined. The format of the care plans for the residents showed continued improvement since the last inspection and were now more person centred. They included sections such as “What I want to say about me”, and these were signed and dated by the residents. However, in some areas, the key worker had written in that section the things the residents had told them such as “Mrs Blank has three children”, rather than “I have three children,” which reduces the ownership of the statement by the resident. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 10 The plan also included sections about the residents’ hopes and aspirations, communication skills, mobility, orientation, ancillary health care visits such as opticians and dentists, medication, finances and daily reports. Risk assessments were included on all areas, but there was not always a risk management strategy included, to inform staff what they needed to do to reduce and/or manage the risk. It was noted that in the daily report for one of the residents, the recording style of one of the care staff seemed to indicate a less than caring attitude. When the manager called at the home during the afternoon of the inspection (she was not on duty), she informed the inspector that she had already spoken to the person concerned about the matter, and was monitoring that staff member. One of the residents made particular comment about her clothing: “My clothes are always well washed. They’re laundered and ironed and everything is brought back nice and clean.” All the residents seen and spoken to during the inspection were beautifully attired, and the hairdresser was on the premises to attend to those residents who wanted their hair doing. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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 standard(s) 12 & 15 Most residents enjoy the quiet and relaxed ethos of the home, but there were one or two who would benefit from some organised activities and outings. The home provides meals which are nutritionally good, but which are at times bland and don’t stimulate the residents appetites. EVIDENCE: During discussions with residents, the following comments were made with regard to the home and how they felt about living there: “The staff are alright, they try their best.” “I like my room, I have my TV, I watch that, I like to read, I read a lot. I prefer to stay in my room.” “I have no complaints, I don’t get bored, if I’ve got the newspaper to read I’m happy.” “What’s it like here? It’s boring. They’re all pleasant but we’re not the same type.” Residents who went out into the community from the home said that they did so with their relatives. The provider and manager both said that it was difficult to find activities that the residents wanted to take part in. They said that most of the residents did not want to participate, although they had provided bingo and domino sessions.
Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 12 Comments about the food included: “The food’s not so bad. But I’m very fussy.” “The food is all right. I couldn’t do with more food – I’m not expecting to sit down to a banquet.” “The food is okay, you get enough.” The food is excellent” “The food is off and on. Sometimes it’s good and sometimes – well.” A visitor passed comment on the fact that her relative liked porridge for breakfast, but said “I was told last week that there was no porridge until they went shopping. There was still none until I brought some in yesterday. There’s a supermarket at the end of the road.” The manager acknowledged this and apologised. On the day of the inspection, the inspector participated in the lunchtime meal, which consisted of mince, mashed potato and mixed vegetables. This was nicely presented, and ample in portion. It was, however, very bland, and the inspector felt that this perhaps underscored the muted responses from the residents. For dessert, there was an individual, bought apple pie, with cream, which again, was satisfactory but not exceptional. The manager and the provider both said that the cook often made homemade pies and cakes, and casseroles, which were very appetising. It was agreed that more attention needed to be paid to seasoning of savoury food items. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards not inspected on this occasion. EVIDENCE: Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19,21 & 26 The overall quality of the furnishings and fittings within the home is good and creates a comfortable and safe environment for those living there and visiting. The home is kept clean and hygienic. Externally, pathways present a potential tripping hazard and place residents at risk, as do miscellaneous articles accessible from the path. EVIDENCE: Since the last inspection, the outstanding requirement for the porch roof to be painted had been addressed. This would still benefit from a further coat of paint. The path round the outside of the home needed to be repaired, as there were a number of holes and cracks in the surface which constituted a tripping hazard. Also, there was an old supermarket trolley, a lavatory bowl and some old roofing tiles stored at the back of a shed, but accessible from the path, that must be removed. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 15 There were sufficient lavatories and bathing facilities in the home to meet the needs of the residents, and rooms visited when talking to residents were clean and hygienic, in a good state of décor and contained some of the resident’s own belongings, such as chairs, chests of drawers, photos and pictures. One lady also had in her room a fridge, a kettle and drink making facilities. Resident’s comments on their rooms included: “I like my room.” “I like my room, I’ve got my own furniture in it.” “My room is very comfortable.” “I have a very nice room.” The lounge and dining room and other communal areas of the home were attractively furnished, with good quality carpets and soft furnishings. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards not inspected on this occasion. EVIDENCE: Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home has improved its night time staffing arrangements to ensure that residents are safeguarded, but these need to be monitored to ensure they are robust and meet with Fire Brigade guidance. EVIDENCE: The registered provider visited the home once every one or two weeks and was not in day-to-day charge of it. He was therefore required by regulation 26 of the Care Homes Regulations 2001 to provide a monthly report to the manager and the Commission for Social Care Inspection. The Commission had only received these reports irregularly and the provider must ensure that they are provided in accordance with the regulations. This was highlighted at the last inspection. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 18 At the last inspection, it was agreed with the provider and the manager that the one staff member on duty at night, must be increased to one waking and one sleeping staff at all times, to ensure the safety of the residents. Examination of the duty rota showed that this had been put into place for a minimum of five nights a week, and a maximum of six nights a week. The Fire Brigade advice is that the provider must put into place a total evacuation plan, which must be effective at any time, day or night, with the number of staff on duty, without assistance from outside sources. When asked at this inspection if they were confident that one member of night staff could carry out such a plan, the manager and the provider were not confident that they could and agreed to ensure that two night staff were employed seven nights a week. A fire risk assessment was in place and had been reviewed in January 2005. On inspection of the fire log book. It was noted that the luminaires were being tested, but for a quarter of an hour’s duration instead of one hour. This was brought to the attention of the provider and the manager, who said that they would ensure the correct times were observed in future. During the provider’s visit, he was asked if the electrical wiring throughout the house had been inspected and tested and a certificate obtained. He said that he had spoken with the electrician, but that no certificate had yet been obtained. This must be addressed. The provider also stated that an annual development plan was in place, but was not on the premises as this was an unannounced inspection. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 1 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 20 yes 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 2 Regulation 17 Requirement The statement of terms and conditions must include the current fees charged by the home The home must ensure that activities are available for those residents who wish to participate The home must ensure that meals are both nutritious and appetising The home must ensure that the pathways around the home are mended and free from tripping hazards such as supermarket trolleys The home must ensure that after consultation with the fire authority their night staff numbers are sufficient to evacuate the building without external assistance The registered provider must ensure that he completes an inspection of the care home at least once a month, records his findings and prepares a written report, a copy of which must be sent to the Commission for social Care Inspection. This requirement is outstanding from the last inspection
B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Timescale for action 01/09/05 2. 3. 4. 12 15 19 16 16 13 01/09/05 26/07/05 01/09/05 5. 38 23 08/08/05 6. 37 26 31/10/04 Briarfield House Version 1.40 Page 21 7. 38 23 8. 38 23 9. 33 24 The home must ensure that all 01/08/05 luminaires are tested as laid down in the fire log book, for one hours duration at a time The registered provider must 01/11/04 ensure that the electrical wiring is inspected and tested and any defects remedied. A certificate to confirm this should be obtained. this requirement is outstanding from the last inspection. The registered provider must 01/01/05 ensure that he provides an annual development plan. This requirement is outstanding from the last inspection. 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. 3. 4. Refer to Standard 7 10 28 31 Good Practice Recommendations Risk assessments should include how the risk should be managed and minimised. Daily notes should be recorded in a style that respects the residents. The manager should ensure that at least 50 of care staff have attained the National Vocational Qualification level 2 in care by the end of 2005. The registered provider should ensure that the manager has attained her National Vocational Award level 4 by the end of 2005. Briarfield House B51-B01 S79 Briarfield Hse V240422 260705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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