CARE HOMES FOR OLDER PEOPLE
Briarfields Raby Crescent Belle Vue Shrewsbury, Shropshire SY3 7JN Lead Inspector
Patricia Scott Unannounced 14 July 2005 09:15
th 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. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Briarfields Address Raby Crescent Belle Vue Shrewsbury Shropshire SY3 7JN 01743 353374 01743 232943 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) Coverage Care Shropshire Limited Carole Jane Williams Care Home (PC) 40 Category(ies) of 40 x Old age, not falling within any other registration, with number category (OP) of places Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th December 2004 Brief Description of the Service: Briarfields is registered with the Commission for Social Care Inspection to provide a residential care service to 40 older people. The home is situated in Belle Vue close to Shrewsbury town centre. It is a well established home set in its own grounds. Briarfields is one of a number of care homes run by the ‘Coverage Care’ organisation. The registered manager Ms Carol Williams manages the home on a day-to-day basis. Briarfields offers single room accommodation for 38 service users and one shared room. The home has been designed to provide sitting, recreational and dining space in 4 separate areas. The garden is well maintained and accessible providing a safe attractive area for residents to use. A separate day centre is also on site. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 14th July 2005 commencing at 09.15. The National Minimum Standards for Care Homes for Older People focus on achievable outcomes for service users – that is the impact on the individual of the facilities and services of the home. Evidence was looked for that the standards were being met and a good quality of life enjoyed by service users through: • Discussions with service users, families and friends, staff and managers. • Observation of daily life in the home • Scrutiny of written records (including care plans for 4 service users). The statement of purpose was used to assess how far the home’s objectives to be able to meet service user requirements and expectations were being met. Reports regarding an overview of the conduct of the home are sent to CSCI on a monthly basis by the Head of Operations for Coverage Care. These, as well as the risk assessment from the last inspection were taken into account to determine the core standards focused on and depth of inspection. The commission does not have any concerns with this home. What the service does well:
The home provides for the needs of elderly people through small group living and a wide variety of activities. Service users were seen to be treated in a respectful and dignified way and some of those spoken with stated that they were well cared for at Briarfields. One service user who had recently been admitted stated that the transition from her own home to Briarfields had been a difficult time for her, but in allowing her to bring in her personal ‘bits and pieces’ the staff had made the move a lot smoother. After appropriate risk assessment, service users are not discouraged or unduly restrained from undertaking activities solely for fear that for example, they may hurt themselves. (see below, what they could do better). Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 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 Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 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) 1,3 The homes statement of purpose and service user guide is good providing service users and prospective users with details of the services the home provides, enabling an informed decision about admission to the home. EVIDENCE: The information provided to service users gives details of needs assessment to be conducted prior to admission and examination of care plans on the units confirmed that this process had been carried out. The statement of purpose and service users guide were on display in the foyer. Service users recently admitted said that it was their relatives who chose the home but that they had been provided with information about the home to read. Another said that he had moved to Briarfields from out of area and was not familiar with the home or the town. He was unsettled in himself at first but rated the home as 100/100 and could not fault it.
Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 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) 7,8,10,11 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. Personal support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life as well as at the end of life. EVIDENCE: Care plans looked at for 4 service users on Rosewood unit were consistently completed and had all the useful information in them that is necessary to enable a care worker to provide the right care for that individual in a way that meets their wishes and preferences. The information that was read showed that individuals receive the level of care which their own situation requires. All care plans seen had been signed by the service user where possible. Visits by other health care professionals are documented e.g. GP, monitoring of memory loss by a CPN (Community Psychiatric Nurse). Regular monitoring and review of a service user’s condition takes place to ensure that the correct treatment and care is being given. A service user was particularly unwell during this visit and staff had contacted the GP, obtained
Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 10 medication and carried out frequent monitoring of this person’s condition which was relayed back to the GP. Staff were heard talking with service users in a respectful manner and of noting their individual needs and wishes that tied in with that written in the care plans. For example one service user was identified as needing extra support when eating and drinking due to a swallowing difficulty. A member of staff sat patiently by her side during breakfast and offered assistance when needed. As service users made a gesture to move away from the breakfast tables, staff were on hand to assist them to their preferred seating place, outside or in the lounge. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 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) These standards were not assessed at this inspection EVIDENCE: Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. EVIDENCE: The complaints log was seen. There have been three complaints since the last inspection made directly to the home. All had been dealt with and satisfactory outcomes achieved for the complainant. On the whole, all service users spoken with were very happy with life at Briarfields. They said they knew who they could speak to if they were worried about anything. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,24 The standard of the environment within this home is very good providing service users with an attractive and homely place to live. EVIDENCE: A general tour of some bedrooms and communal spaces demonstrated that the home is purposely designed into small group units each with its own lounge/kitchenette and dining area. These were all in a good state of repair and comfortably furnished. It is easy for elderly frail service users to find their way around their unit. The monthly report on the overview of the home details routine decoration and maintenance of the building due to be carried out. Of particular note was the extent to which service users rooms were personalised. One service users was really pleased that she had been able to bring in her own things and said it helped her to ‘feel more at home’. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 14 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) 27 There is a good match of well-qualified staff offering consistency of care within the home. EVIDENCE: There were enough care staff in numbers and skill mix to meet the need of service users. Domestic and catering staff are employed to ensure the critical care role is not impeded. Staff observed carrying out their duties were seen to be responsive and understanding of individuals wishes and needs. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 15 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) 31,38 The manager is supported well by the deputy manager in providing clear leadership in her absence and demonstrating an awareness of her roles and responsibilities. EVIDENCE: The deputy manager has been in post for 3 weeks and confirmed that she had been given an induction into her role. The safety of service users is covered by the Health and Safety as Work Act and by the general risk assessment requirements of the Management Regulations. Risk assessments were seen for the use of bed rails with individuals. The deputy manager stated that bed rail assessments are made by the staff in the home to ascertain the type of rail to be used for a bed. Staff do not receive specific training on this matter.
Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 16 The report into the conduct of the home for the month of June 2005 stated that all health and safety checks are in place and up to date, such as; fire book, water temperatures, risk assessments, fridge temperatures and shower head checks. A service user had his own electric heater in the bedroom which did not have a safety test sticker on it. Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 17 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 3 N/A 3 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/A 13 N/A 14 N/A 15 N/A
COMPLAINTS AND PROTECTION 3 N/A N/A N/A 3 4 N/A N/A STAFFING Standard No Score 27 3 28 N/A 29 N/A 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 N/A N/A 3 N/A N/A N/A N/A N/A N/A 3 Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 18 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 Regulation Requirement none were made 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. 2. 3. Refer to Standard 38 37 38 Good Practice Recommendations Be mindful of Regulation 18(1)(a). Provide training appropriate for staff who who are responsible for selecting, fitting/using and checking bed rails Include maintenance of bed rails in the records for routine checks of equipment and health and safety audits. Include service users own electrical items in the portable appliance testing of the home Briarfields E56 E01 S20663 Briarfields V239256 UI 140705 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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