Inspection on 09/07/09 for Briarlea

This inspection was carried out on 9th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Briarlea 11/02/10

Briarlea 17/12/09

Briarlea 26/11/09

Briarlea 06/06/07

Briarlea 01/07/06

Briarlea 15/09/05

Briarlea 28/04/05

Briarlea 27/09/04

Briarlea 15/04/04

Briarlea 06/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 1 0 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Briarlea Badsey Road Evesham Worcestershire WR11 7PA 01386830214 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Briarlea Care and Supported Living Limited care home 26 Number of places (if applicable): Under 65 Over 65 0 26 0 dementia old age, not falling within any other category physical disability Additional conditions: 18 0 18 The maximum number of service users to be accommodated is 26. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 26 Physical Disability (PD) 18 Dementia (DE) 18 Date of last inspection Brief description of the care home Briarlea provides residential accommodation and care for older people who may have a physical disability and/or mental health needs associated with old age. It is owned by Briarlea Care and Supported Living Limited, which is a family owned company, both directors of which are actively involved in the running of the home. The home is situated just outside Evesham in a rural area with pleasant views over the Care Homes for Older People Page 4 of 34 Brief description of the care home local countryside. It occupies a level site and apart from its road frontage, is surrounded by a level garden and orchards. The premises consist of a two-storey house. There are twenty two single bedrooms and two double rooms. The majority of the single bedrooms have en suite toilets. A passenger lift links the two floors of the home. There are two communal lounges and a large sunlounge, a dining room, three communal bathrooms and communal toilets. Car parking is available at the side of the home. For up to date details on the fees charged the reader should contact the provider directly as this information was not included within the Service Users Guide. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at Briarlea was carried out during June 2006. Since that date we have carried out a random inspection during April 2008 and an annual service review during August 2008. In September 2008 we approved an increase in registration at Briarlea from 18 to the present 26 places. This key inspection was carried out over a period of two days. Nobody within the home knew we were going to visit. This inspection was carried out by one regulation inspector and a pharmacy inspector. Care Homes for Older People Page 6 of 34 The focus of inspections is upon the outcomes for people who live in the care home and includes peoples views of the service provided. The process we use considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit we looked at the information that we have received since the annual service review. This information included the Annual Quality Assurance Assessment (AQAA). The AQAA is a document completed by the home and provides us with information about the home and how they believe they are meeting the needs of people living there. We sent a number of questionnaires to people living in the home and to their representative. We also sent questionnaires to some members of staff and to health professionals such as doctors and community nurses. We looked around the home. We viewed records in relation to some people living in the home such as care records, risk assessments and medication records. We also looked at some records relating to some members of staff and health and safety. During our visit we spoke to the registered manager, one of the directors and some members of staff. We also spoke to some people living in the home and to some visitors. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people make a choice about whether they would like to live there. There are opportunities for people to visit the home before making up their minds. The needs of people who may use the service are assessed so that individuals and their relatives can be assured that care needs can be identified and determine whether staff have the ability to meet these. Evidence: Before our inspection we asked people in a questionnaire whether they received sufficient information about the home prior to their admission. The majority of people who responded confirmed that they had received this information. We were given a copy of the homes Statement of Purpose and Service Users Guide during our visit. We saw a copy of the Statement of Purpose in the hallway of the home. It was evident that both documents were reviewed to take into account recent changes such as the increase in bedroom numbers and the establishment of the Care Quality Commission. Care Homes for Older People Page 10 of 34 Evidence: At the time of this inspection individual copies of the revised Service Users Guide were not available to people living within the home. The guide we saw contained some useful information however it did not contain all the information listed within the associated National Minimum Standard. The guide is not available in any other format such as large print, easy read or audio. The Statement of Purpose states that the home offers introductory visits to prospective residents and that the home avoids unplanned admissions except in cases of emergency. We asked the registered manager about the most recent admissions to Briarlea and were informed that the last two were both people who had used the service in the past however both current stays were arranged at short notice. We were told that under different circumstances arrangements would be made whereby people are able to visit and spend some time within the home in order to help with the decision making process. We looked to see if information had been collected to ensure that care needs of recently admitted people could be met. Information from the local authority in relation to one person was not included within the persons care plan file. This assessment was however located by the registered manager upon our request. The assessment form for one person was dated the same day as the admission. We were told that the individual was known and that the placement was arranged at short notice. The information was sufficient but a number of gaps within the assessment, whereby no information was recorded, were evident. Care Homes for Older People Page 11 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are generally being metand they feel that they are receiving appropriate support. However, people cannot be confident that all their needs will be met properly, or that they will receive medication as prescribed, because the records being kept are not adequate. Evidence: As part of this inspection we asked to see the care plans regarding a number of people residing within the home. A care plan is a document designed to guide staff about the level of care required by each individual to ensure that identified needs are met and people receive the support they require. Following our random inspection during April 2008 we made a small number of requirements. At that time we noted that no care plan was in place regarding an individual who had been admitted the previous week. We stated within the random inspection report that the lack of a care plan can potentially result in inconsistency in care and failure to give sufficient guidance to staff to ensure that identified care needs Care Homes for Older People Page 12 of 34 Evidence: are met. In addition we noted that no risk assessments were drawn up in relation to the same individual. During August 2008 we carried out an Annual Service Review (ASR) regarding Briarlea. An Annual Service Review does not involve a visit to the service but is a review of information we have received since the previous inspection. Prior to the ASR the registered manager verbally informed us that improvements had taken place with care planning. During this key inspection we saw an assessment of one person which was done before their admission but again no care plan was in place. The person concerned was admitted just over two weeks prior to our inspection therefore staff had needed to care for this person for a period of time without the written guidance identified as necessary for each individual at the time of our last inspection. We brought our concern to the attention of the registered manager and one of the registered providers. We carried out this inspection over a period of two days, due to the time spent looking at care planning and our discussions regarding our concerns. On the second day of the inspection a basic care plan was in place. We read the daily notes of five people. These documents were in place and evidenced that staff were providing care to people residing within the home. The notes evidenced the input of healthcare professionals such as doctors, community nurses, paramedics and dentists. We noted that paramedics were called on a number of occasions in relation to one person as staff were concerned regarding the persons health care needs. We noted that one person received prompt attention when dentures were broken to ensure that these were replaced as soon as possible to ensure the individuals well being. Some relatives confirmed that staff at Briarlea respond well if they have concerns about peoples health care needs and call appropriate services in. We looked at the care plans of the same five people to see if the information in them reflected the current care needs. We viewed a care plan which was incomplete. This person had been residing at the home for over two months. It was evident that work on preparing a care plan had commenced at some point during that period of time. As the plan was not dated it was not possible to ascertain when the plan was started. The care plan was not finished in that only 5 out of the 12 sections contained any information. The details within the sections completed were not sufficiently detailed to give staff guidance or strategies as to how care is to be delivered. We saw conflicting information regarding how somebodys diabetes was been Care Homes for Older People Page 13 of 34 Evidence: managed. Some documents stated that the diabetes is managed by both diet and medication while the personal details section of the care records and a general risk assessment stated diet controlled only. We checked the medication prescribed and found no prescribed items to manage diabetes. The records made no mention of how this persons blood sugar was managed. Records stated that the person required a low sugar diet. The assessment from the local authority described the need to manage diabetes as critical. The cook was not aware that this person was diabetic therefore the sweet available for this person was not prepared with diabetes in mind. The care plan made reference to the person having a sweet tooth and x will prefer to eat sweet food. We viewed a care plan of one person who was poorly at the time of our visit. The daily notes were detailed and showed a number of significant changes in care needs. The care plan was not up to date and did not include details how staff were to meet these needs. We were however able to speak to some family members of the individual who were very happy with the care provided at Briarlea. We viewed the risk assessments and found them to be out of date and were not reflecting current care needs. For example community nursing staff were attending one person due to her having a sore area. The skin care risk assessment described the person as having full mobility and a healthy skin condition, this was not the case. The moving and handling risk assessment did not recognise that the individual was requiring assistance in areas such as repositioning. A general risk assessment showed risk of falling out of bed as low however the daily notes showed that the person was found on the bedroom floor on a number of occasions. No accident records existed regarding these incidents. The pharmacist inspector visited the home on 9th July 2009 as part of the key inspection to check the management and control of medicines within the service. We were informed that care staff who handle medication had undergone medication training by the pharmacy in July 2008. Some care staff had recently undertaken further training. We were shown the training dates to confirm this. This means that staff who administer medication have been trained to do so and ensure the safety of the people who use the service. We were shown a medication policy, which had been reviewed in April 2009. The policy included a procedure for medication administration, ordering and handling errors. However other procedures for safe medication handling were not up to date and require further review. There was no up to date written procedure for the safe disposal of medication. For example, we found two medicine tots containing tablets in a locked Care Homes for Older People Page 14 of 34 Evidence: cupboard. Inside each tot was a slip of paper with the name of a person written on it with the words disposal and Refused respectively written onto each slip of paper. We were informed that this was the normal procedure used to dispose of medication, which may be done every 4 weeks. This means that due to a lack of safe written procedures care workers were not following safe and best practice. We found that the majority of medication was locked and secured in two medicine trolleys or locked cupboards to ensure safe keeping. The two areas used for medication storage were secure. The rooms did not feel too warm for medication storage, however there was no temperature record available to ensure that the room temperature was within a safe temperature range. Medication administration records were not always clearly documented. For example, we saw the use of a code M on some medicine records, which is a code for make Available. It therefore appeared as if many peoples medication was not available to give. However, we were informed that the signature of a member of staff looked like the letter M which was confusing. The manager informed us that the member of staff would need to change their signature for the medication records. We also found that a line had been drawn on one persons medicine record instead of a signature for administration or a code with reason why the medication was not given. We were informed by the manager that a line had been used because the person was going into hospital for a test and was not to have their medication. This had not been documented on the medicine record. This means that due to poor records it was not always clear if people had been given their medicines as prescribed. We found that care staff did not always document if medicine had been given to a person. We saw gaps in the medication administration records. For example, one person was prescribed an antibiotic and on the evening of 8th July 2009. We found a gap for its administration, with no staff signature or reason for not giving it. We checked the remaining tablets and found that the antibiotic had not been given. This means that due to poor medicine records and poor practice it was not always possible to determine whether medication had been given to a person as prescribed. The record of receipt of medication was not always documented and remaining balances of medication were not carried forward to new medicine record charts. For example, we saw a supply of tablets in the medicine trolley. There was no record of receipt, no balance carried forward and the date of opening on the box was not recorded. Therefore it was not possible to check that the medicine had been given to the person as prescribed. This means that the total quantity available in the home was not accurately documented and therefore increases the risk of incorrect medication supply. Care Homes for Older People Page 15 of 34 Evidence: Information relating to medication was not available in the care plan. For example, one resident was prescribed 12 different medicines for a variety of medical conditions, however this was not documented in the care plan. The manager informed us that the medicine administration record chart would be used as the main record. This means that the persons care plan was not up to date to include all relevant healthcare information such as prescribed medication. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service offers people the chance to take part in a range of activities. Peoples autonomy and choice is respected. Meals times are relaxed and people like the food provided. Evidence: On the questionnaire we sent out most people told us that activities are arranged for residents to take part in. One relative commented always different activities for residents to participate if they wish. Another relative commented, when we asked what the home could do better, provide more activities. These comments were generally confirmed when we visited as we received some mixed comments about activities. The Service Users Guide states We encourage interaction through an imaginative activities program and for relaxing pastimes Briarlea is equipped with scrabble, jigsaws, large print playing cards and other non- strenuous items bingo is regularly organised. The AQAA states that residents are encouraged to continue interests, clubs, church, day centres. The deputy manager devises a proposed activities plan each month although this changes to meet preferences on the day. We saw the list of activities scheduled for the Care Homes for Older People Page 17 of 34 Evidence: month of July. It was reported that entertainment takes place about once per month. The list of activities was also included within each care plan showing whether each individual had taken part. We noted gaps in these records. The manager told us that this was a case of staff not recording rather than the event not having taken place. We saw an entry within the diary saying that Holy Communion was due to take place on the first day of this inspection. Although we did not witness this we were assured that this had taken place. The homes newsletter, which was on display, made reference to Holy Communion taking place on the first Thursday of each month. People living at Briarlea are able to bring in personal possessions to make their own room more homely and individual. On the questionnaire we asked people if they like the meals in the home. People told us that they either always or usually like the food provided. We were told that night staff prepare a cup of tea for those who wish to have one at about 6.00am. Breakfast is served from 7.00 am onwards. Most people have this meal on a tray in their bedroom. No cooked breakfasts are provided. The menu for the mid - day meal is written on a white board near to one of the lounges. On the first day of our visit lunch consisted of pork chop, stuffing, mash, peas and carrots. The sweet was a bakewell tart. We had some concern, as recorded within the previous section, regarding staff knowledge of one resident who was recorded as needing a low sugar diet. We were told that 3 carers are on duty during the afternoon. One person will lead the activity session within the sunlounge while another prepares or finishes the afternoon tea. The third carer is available to meet the needs of other residents. Although we were assured that staff have had basic food hygiene training and that they have aprons available, particular attention needs to be given to ensure that infection control is maintained when care staff are responsible for both preparing food and meeting the personal care needs of residents. We were informed on the AQAA that the local district council environmental health department have awarded Briarlea a good rating. We briefly viewed the records regarding fridge and freezer temperatures and found them to be in good order. Care Homes for Older People Page 18 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the homes complaints procedure needs some amendments people know how to complain if necessary. The home protects people from abuse and staff are aware of their responsibilities in relation to safeguarding people. Evidence: The homes complaints procedure was on display in the entrance hall. We also saw the procedure within the Service Users Guide. The homes procedure was clear and made reference to the commission at our new address in Birmingham. It does however need to be amended to reflect the fact that people can refer their complaint to us at any stage. The procedure within the service users guide was not so clear. The procedure is not available in other formats such as audio tape. Since our key last inspection we have received two written complaints about the service provided at the home. We looked at the first complaint during our random inspection visit in April 2008 and found that the home had investigated the matter satisfactorily. The most recent complaint was also addressed by the provider in a timely way. We spoke to a number of members of staff about the action they would take if they were aware of actual or potential abuse taking place. The responses were sufficiently suitable for the role people were employed as within the home. Staff on duty Care Homes for Older People Page 19 of 34 Evidence: confirmed that they have received training in relation to safeguarding and the protection of vulnerable people in the past. Since the last inspection Briarlea has needed to make one safeguarding referral. The incident proved to be a learning point for the home should any similar event ever occur in the future. Although a poster provided by Worcestershire Adult Services on safeguarding was on display more recently produced information was not available within the home. The registered manager undertook to obtain this information. Care Homes for Older People Page 20 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and generally well-maintained environment. Some risks need to be monitored more carefully so that the environment is as safe as possible for people. Evidence: Briarlea is located near to the market town of Evesham just outside Badsey village. The original house was extended in 1989 and was recently extended further. The home is set in three acres of garden, orchard and field. Since our last inspection we have approved an application to increase registration from 18 to 26 places. Bedrooms are located on both the ground and the first floor. The home currently has 22 single bedrooms and 2 doubles. All but 3 of the single rooms and the double rooms have en-suite facilities. The AQAA completed by the registered manager prior to this inspection stated that some decor looks tired. We previously reported that some improvements were needed to some parts of the home but that these were waiting for the building work to be completed. We were told about improvements that have taken place such as up grading to some Care Homes for Older People Page 21 of 34 Evidence: of the older en - suite facilities. Some bedrooms have been redecorated. We were told of plans to improve additional bedrooms in the future. Parts of a corridor are in need of improvement as the decor and floor covering look tired in appearance. The carpet on the back staircase, primarily used by staff, is very worn and a potential hazard. Since our previous inspection a new key code device has been fitted to the front door. Staff are aware of the code and visitors are requested to ring a bell to call a member of staff to let them out. Briarlea has two comfortable lounges and a large sunlounge where people using the service are able to sit and relax. A dining room is provided in the central part of the home, further dining facilities are provided within the sunlounge. We viewed a number of bedrooms. New furniture was in place in the rooms we saw. In our report following the random inspection in April 2008 we stated that we noted that wardrobes were free standing; it is recommended that wardrobes be secured to prevent accidental toppling. During this visit we found that wardrobes remained unsecured and therefore continued to be a risk of falling on to people. Since the inspection we have been informed that brackets have been purchased to carry out this task. Radiators were seen to be covered to prevent accidental scalding. We were informed that thermostatic controls are fitted to baths. We saw a thermometer in one bathroom. We were told that staff check the temperature of bath water however no records of temperatures are held. These devices are not fail safe and as a result the home should have suitable systems in place to monitor temperatures to safeguard people against the risk of scalding. Window restrictors are in place to prevent accidental or deliberate falling to the ground. No systems are in place to ensure that these devices are functioning correctly to safeguard people. The home was clean and the majority of areas were free from odours. The home has a new laundry and plumbing for a sluice machine should one be required in the future. Hand gel dispensers are located around the home as a means to improve infection control. We were concerned to find some bars of soap and other toiletries within a communal bathroom. These could be a risk to cross infection. We were also told by a number of people that a dish washer would be beneficial. During this inspection we were told that the registered persons are currently trying to find a suitable machine to fit within the Care Homes for Older People Page 22 of 34 Evidence: kitchen. Having a dish washer could not only free up some staff time but could also improve infection control. We were concerned to find a bottle of bleach in an unsecured cupboard in a communal bathroom. The bathroom upstairs is not used. Having no hoist over the bath makes access difficult for some people. The bathroom has carpeting on the floor which is not ideal as a means of reducing infection control. The appearance of the back garden has improved since building work has finished and now offers people an attractive place to sit and relax. Plans are in hand to reduce the access to fields at the rear of the garden. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are trained care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised to meet peoples care needs. Evidence: We were told that staffing levels consist of 3 carers throughout the waking day. This is an increase in staffing levels since our last inspection and since the increase in the number of people able to reside within the home. Night staffing levels remain the same at 2 carers. From the AQAA it was evident that agency staff are not used. Care staff need to carry out additional duties such as laundry and preparation of the afternoon tea. The AQAA stated Good recruitment procedures. We looked at the file of two recently appointed members of staff. Generally the recruitment of staff is carried out in line with good practice and to satisfy the associated regulations. It was evident that a CRB (Criminal Records Bureau) disclosure was obtained prior to staff commencing work with individuals. We raised a couple of issues with the registered manager regarding references in that their authenticity needs to be checked and they need to be obtained prior to employment starting. Care Homes for Older People Page 24 of 34 Evidence: Training records evidenced that staff receive induction training on commencing duties at the home. This training consists of viewing a range of videos in areas such as food hygiene, safeguarding (adult abuse), moving and handling and fire prevention. A training matrix was able to be cross referenced with other training records such as certificates. These records as well as discussions with staff evidenced that training is provided within the home using an external training orgainsation. We saw evidence of recent training on health and safety and fire safety in residential care homes which involved a total of 15 members of staff over two separate sessions. Information was on display in the staff area of forthcoming training sessions. At the time of this inspection a total of 7 carers out of 23 held a NVQ (National Vocational Qualification). In addition a further 2 carers hold a level 3 award and the deputy manager holds a level 4. Other members of staff are currently working towards their NVQ. Assuming no other staff changes take place, once these people have achieved their award, the home will of achieved 50 of staff with an NVQ which is the national minimum standard. Care Homes for Older People Page 25 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed in the best interests of people living there. Improvements in some management systems and the introduction of a quality assurance system could ensure that people are safer and can have greater confidence in the service. Evidence: Our report following a random visit to Briarlea in April 2008 stated that the registered manager had informed us that she holds the Registered Managers Award (RMA) and assessor awards for NVQ (National Vocational Qualification). The associated National Minimum Standard states that the registered manager should hold a qualification at level 4 NVQ, in management and care or equivalent. It was therefore identified that the manager does not hold the qualifications stipulated. Within the random report we quoted guidance issued by the former commission that mitigating factors should be taken into account when the standard is not met such as an experienced and competent manager who is nearing retirement. The situation remains the same however the manager has undertaken some additional training to that provided for the Care Homes for Older People Page 26 of 34 Evidence: carers such as Deprivation of Liberty and Mental Capacity Act training. Further consideration should be given regarding the training that may be of benefit to the registered manager to ensure that the service is able to develop in the future. As indicated earlier within this report people generally receive the care and support that they need at Briarlea. Systems to ensure that medication is well managed need to improve. The documentation around care planning and risk assessments need attention, these are areas that needed improvement at the time of our previous visit. In addition we found that certain aspects of health and safety were not managed carefully enough. We therefore consider that the service would benefit from better monitoring and reviewing by management. Prior to this inspection we requested an Annual Quality Assurance Assessment (AQAA) from the home. This document contained some good information about the service. The previous key inspection report (June 2007) stated that the home had access to a commercially produced Quality Assurance System. At that time the system was not in use and consideration was being given as to how the purchased system and the AQAA could be used as a means to support each other. It was confirmed during this inspection that no further progress with the introduction of a quality assurance system had taken place. We sought copies of the Regulation 26 reports. These are monthly reports that have to be carried out by the owner or their representative following visits to the home on a monthly basis. These reports were held and evidenced that visits taken place by a responsible individual on behalf of the owner. We enquired about any recent survey undertaken to establish the views of people using the service, their representatives and other stake holders. We were told that no such exercise has taken place and no details of former surveys available. The registered manager showed us what was called a new form for seeking peoples views. The form was dated April 2008 and contained handwritten amendments therefore not as yet in use. The home does not manage anybodys money on their behalf. We were informed by staff that they receive regular supervision in line with the associated National Minimum Standard from the registered manager. The certificate of registration and certificate regarding public liability insurance were on display. Care Homes for Older People Page 27 of 34 Evidence: We briefly viewed the fire records and that that generally the system is tested on a weekly basis and in sequentail order. We were informed that the new key pad devise on the front door is not included within the fire risk assessment. We were however informed that the system becomes deactivated and therefore releases upon the fire alarm sounding. Care Homes for Older People Page 28 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Regulation 13 (4). Risk assessments must be in place which fully take into account unnecessary risks to the health, safety and welfare of residents. This is to ensure that risks to people are minimised as far as reasonably practical. 30/09/2009 2 7 15 Regulation 15 (1) and (2). Care plans must be in place for each person using the service detailing how needs in respect of health and welfare are to be met. Care plans must be kept under review and revised to reflect changing needs. This is to ensure that people receive appropriate and consistant care. 30/09/2009 3 9 13 Regulation 13 (2) The service must make 31/08/2009 Care Homes for Older People Page 30 of 34 arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. This is to ensure that medication is held safely. 4 9 13 The service must make 31/08/2009 arrangements to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on an as and when required basis. To ensure that staff are aware of medication prescribed any the reason why it is prescribed. 5 9 13 Regulation 13 (2) 31/08/2009 The service must make arrangements to ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry on the medication administration record; that the meaning of any codes are clearly explained on each record; and that the person administering the medication completes the medication administartion record in respect of each person at the time of administration. Care Homes for Older People Page 31 of 34 To ensure that medication is managed safely. 6 9 13 Regulation 13 (2) The service must make arrangements to ensure that there are procedures for the safe disposal of unwanted medication in order that medication is safely and correctly disposed of. So that safe system are in place and people are protected. 7 9 13 Regulation 13 (2) The service must make arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. To ensure that safe systems are in place. 8 19 13 Regulation 13 (4) Systems must be in place to ensure that all parts of the home accessable to people living in the home are free from hazards. To ensure the health and safety of people using the service. 31/08/2009 31/08/2009 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 32 of 34 improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Service Users Guide should contain all the relevant information in order to fully meet the standard. The guide should be available in alternative formats to assist the ability of people with differing care needs to understand the information prior to moving into the home. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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