Inspection on 13/12/07 for Briarmede

This inspection was carried out on 13th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Briarmede 04/07/06

Briarmede 16/01/06

Briarmede 08/08/05

Briarmede 03/11/04

Briarmede 19/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Briarmede 426/428 Rochdale Road Middleton Manchester Greater Manchester M24 2QW Lead Inspector Jenny Andrew Unannounced Inspection 13 December 2007 08:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briarmede Address 426/428 Rochdale Road Middleton Manchester Greater Manchester M24 2QW 0161 653 2247 F/P 0161 653 2247 briarmedecarehome@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Adrian Peter Riley Mrs Patricia Riley Adrian Peter Riley Mrs Tina Riley Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 32 service users, both male and female to include: up to 32 service users in the category of OP (Older People) The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection. 4th July 2006 Date of last inspection Brief Description of the Service: Briarmede is an adapted building offering 24 hour personal care to 32 older people. The home has a total of 24 single and four double bedrooms. Six of the single rooms have en-suite facilities. Bedrooms are located on both the ground and first floors. A passenger lift is provided. The home is situated on the main Middleton to Rochdale Road. Access to the home is via one step into the front door. Public transport passes on a regular basis and the home is also in easy reach of the motorway network. A car park is provided to the rear of the home. It offers parking for approximately 12 cars and is accessed by one of two entrances. The home’s Service User Guide advised residents and their relatives that the most recent Commission for Social Care Inspection (CSCI) report was available in the reception hall. At the time of this inspection weekly fees ranged upwards from £334.98 £349.98 per week, dependent upon whether the room was shared or had ensuite facilities. Additional charges were for hairdressing, chiropody, newspapers, toiletries and outings. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted nine hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of some of the staff were also looked at to make sure the managers were doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, both the managers, the deputy manager, one senior, one care assistant, six residents, the cook, activity worker, two domestics and a relative were spoken with. Before the inspection, comment cards were sent out to service users, staff and relatives/ carers asking what they thought about the care at the home. The response to these was poor with only one staff and four relatives returning the cards to us. This information has also been used in the report. Before the inspection, we asked the managers of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The managers completed this document in great detail and it was evident that a lot of time had been spent identifying what things they felt they did well and what things they still needed to improve upon. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. What the service does well: Briarmede provides care for residents in a homely setting. One relative said this was why she chose the home on behalf of her mother. Residents said they liked living there and that they had no complaints whatsoever. Staff were described as “very good”, “caring”, “nice”, “helpful” and “kind”. Before people moved into the home, one of the management team would visit them either at home or in hospital to assess that they would be able to meet their needs before they agreed to them coming to live there. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 6 When residents were assessed as being at risk of malnutrition, the manager made sure that their daily food and drinks were recorded and their weight monitored so they could take the right action if people continued to lose weight. The cook was also aware of people’s likes and dislikes and tried to make sure they were given food they enjoyed. The home was kept well maintained and a lot of the rooms had been redecorated and refurbished. Residents were happy with their bedrooms and said they could use them when they wanted. More than half of the staff team had achieved NVQ training qualifications, which meant they knew how to do their jobs safely and provide the right level of care to the residents. The managers were committed to providing good training opportunities to their staff. As well as health and safety training, the staff went on abuse, dementia awareness and other specific training, so they could meet the needs of the people in their care. What has improved since the last inspection? There was a big improvement in the activities and entertainment programme and residents were very pleased with the outings and activities provided. One person said, “I really enjoyed going out for a Christmas meal” and another person said, “The craft sessions are marvellous and keep me occupied”. In order to give individual attention to the more dependent residents, two sittings were organised at mealtimes. This meant that staff could spend time encouraging people to eat their meals and assisting them on a one to one basis when this was needed. So that the staff would be able to safely meet the needs of people who had mobility problems, a new mobile hoist had been bought. Infection control practices had really improved with dispensers for gloves/ aprons and paper towels being fitted throughout the home. Also staff were given special alcohol rub dispensers to help reduce the spread of infection. The laundry had been extended and provided much better facilities for the washing and ironing of residents’ clothes. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 7 What they could do better: Some of the care plans were incomplete and did not give a full picture of what each person needed help and support with in order to have their needs met. They also needed to be more person centred and include information about people’s preferred routines and likes/dislikes. Whilst some improvements in the way medication was given out were noted, there were still things that needed to be improved so that residents’ health care needs would be fully met. The manager needed to make sure he followed the home’s safeguarding policy and notify Social Services as soon as any concerns were noted in this area. A risk assessment needed to be done so that the managers could be sure that residents’ safety was not at risk when the home had only two staff on between 9.00 – 10.00pm. New staff must not start work at the home until two satisfactory references have been obtained. This would help to ensure that the right people were being employed to care for the people living at the home. Whilst new staff were doing the home’s own induction training programme, it was not thorough enough and the manager needed to make sure it met the Skills for Care Common Induction Standards. This would make sure that new staff would get all the training needed to help them care safely for the people they were looking after. The managers had done a lot of work to improve the life for Briarmede but they now needed to concentrate on putting system so they could check the quality of services offered residents and relatives to have some say in how the home was people living at into a place a and encourage being run. The way residents’ finances were recorded needed to be done as soon as money was handed in so that accurate accounts were in place showing exact balances of monies held. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming to live at the home to make sure their needs would be able to be met. Standard 6 has not been assessed, as the home does not provide intermediate care. EVIDENCE: The home’s policy is to visit prospective residents in their home or hospital before they are admitted so that they can be sure their needs can be met. This is usually done by one of the managers and the deputy manager. The files for three residents were checked, two for those most recently admitted. All three contained pre-admission assessments. When people were funded by the Local authority, care manager assessments were also in place. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 10 Potential residents and/or their relatives were given a copy of the service user guide either when they visited the home or during their assessment visit. During the inspection, a relative came to have a look around the home and the deputy manager gave her a brochure. A relative was spoken to during the visit. She said she had looked around many homes before choosing Briarmede and had decided on this home because she felt it was homely and friendly. Where residents were admitted with specific medical conditions, the manager said she tried to provide training so that the staff would be able to understand the person’s condition and thus ensure their needs would be met. Training courses arranged over the past couple of years have included, motor neurone disease, diabetes, dementia care, pressure sore care and optical awareness. Further dementia training had been booked for up to ten people in February 2008. Recently both owners, the deputy and team leader attended training in respect of the Mental Capacity Act so they would understand the implications of the Act and how it impacted on the way they completed care records. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Some care plans lacked detail and did not provide the staff with sufficient information to ensure the needs of each person would be fully met. Further improvements were needed in respect of providing a safe medication system. EVIDENCE: Three care plans were inspected, one for a resident who had only lived there for two weeks and the others were chosen to check on specific issues. The newly admitted resident had been weighed upon admission and a personal care sheet was in the file, although it was not being completed daily. The care plan only addressed three areas and did not focus on other important areas. Whilst it is acknowledged that two weeks is only a short time, an initial care plan covering all needs should be in place, which could then be expanded upon. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 12 Another care plan was checked and again, the care plan did not address all areas of care. This person had been assessed as at high risk of falls, but the care plan did not address mobility and what they were doing to try and reduce the risk. The manager said she did not feel the person was at high risk in which case, the person completing the falls assessment had done it incorrectly. In any event, the care plan did not accurately reflect the care needed. The third plan was more detailed and gave a better overview of the person’s needs. The good practice of making reference in care plans to people’s privacy and dignity needs and their ability to make own choices is acknowledged. In the main, the care plans were reviewed on a monthly basis but this was usually by way of a date and signature rather than meaningful comment being made as to progress or changes. The manager said she was making arrangements to include relatives in the care planning process and asking them to come in to sign care plans, if residents were not able to do so. Little evidence was seen of this at the time of the visit. When reviewing and updating care plans, the management team should look at a more person centred way of recording which should include people’s likes/ dislikes, preferred rising/retiring times, etc. It was also felt the care plans could be more of a working tool. The manager said she had booked 12 staff on a care planning course in January 2008 and was hopeful this would give them a better understanding of what should be recorded on a care plan. A key worker system was in place but due to the staff turnover, this was not working effectively. However, the manager was in the process of re-allocating key workers and had asked each worker to find out their residents’ interests or preferences so that they could go out and buy them a small present for Christmas day. In previous years, everyone had been bought the same gifts and they felt by changing this, it would be more individual and personalised. Residents’ health care needs were being addressed upon admission with risk assessments being done in respect of falls, skin, nutrition and moving and handling. These were regularly reviewed. The Malnutrition Screening Tool was being utilised and residents’ weight was being regularly recorded. Where residents were assessed as being at high risk, fluid and dietary charts were used to monitor exactly what their intake was and these were seen. Since the last inspection when it was identified that the home only had a stand aid, a mobile hoist had been purchased. Care plans clearly recorded health care professionals visits to the home together with the action the home needed to take as a result of the visits. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 13 Feedback from the four returned relative comment cards differed in respect of whether the home was meeting the needs of the people they visited, with two saying the home always met their needs and two saying they usually did. However, all four felt they were kept up to date with important information, e.g., when their relative was being admitted to hospital or if they were poorly and needing a doctor’s visit. Two pharmacy visits took place in August and October 2006 due to concerns about the way the medication was being handled. These inspections resulted in several requirements being made to improve practice and make the system safer. Following these visits, one of the managers had been doing medication audits to check the system but these were no longer regularly being done. On this visit, the recording, handling, storage and disposal of medication was again checked. Improvements in the system were identified, e.g., application of creams, better management of pain killing medication, but some areas were still in need of attention. When medication administration records (MAR) were not printed, for whatever reason, handwritten recordings of medication and dosage were not being signed by two people in order to ensure the recordings were accurate. The manager said she would ensure the staff were instructed to do so. People identified as being underweight, were being prescribed a powder to include in their drinks to thicken it and provide additional nutrients. Whilst this was being given, it was not being recorded either on the MAR sheets or on the dietary/fluid intake sheets and this must be addressed. There were still occasions when staff had failed to sign the MAR when they had administered medication and they were also not using the code letters when people had not had their medication. This was simply being recorded with an x. The manager must now address these shortfalls. The storage of medication was satisfactory except for controlled drugs. Since the last inspection, the legislation had changed about how controlled drugs should be stored. A metal cupboard affixed to a wall is now a requirement and the present system of storing these drugs is unsatisfactory. The disposal of medication was in order, although concerns had been raised to us that the home was returning large quantities of medicines each month and then reordering the same items. The manager said this was following their pharmacy inspection, when she had been advised to clear out unused medication due to the large quantities they were holding, some of which were out of date. Stocks of medication were now satisfactory and over-stocking was no longer a problem. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 14 Whilst we were advised that only staff trained in medication administration gave out medication, two files did not contain any evidence of this training. One of the seniors responsible for giving out medication on the day of the visit confirmed she had done medication training with her previous employer but had not brought in her training certificate. This must be addressed. The other person had not received accredited medication training and had only been shown how to do it by another member of the management team. This person should not be giving out medication until formal training has been done. A requirement was made at the last inspection for the managers to review and update the medication policy/procedure in order to provide clear written guidance to staff handling medication. This process was still ongoing. Residents spoken with considered their privacy and dignity was respected by the staff currently working at the home. Staff were able to describe good practice in this area, e.g., closing doors and curtains, keeping people covered when assisting them to dress and undress and talking through exactly what they were going to do to help them. Safety locks were fitted to bedroom doors and lockable space was provided in each bedroom. Very few people currently living at the home had chosen to have keys but the manager should ensure that any new residents are offered this facility. One male carer was spoken to who confirmed that he asked female residents if they were happy to be assisted by him. This was not, however, recorded on individuals’ care plan files and this should be rectified. The manager had booked staff on Social Services Department “Dignity in Care” courses which were being held up until the end of March 2008. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives and activities were organised regularly so that people would have social stimulation. EVIDENCE: The more independent residents spoken to said they were able to make daily choices in respect of what time they went to bed, what to eat, where to sit, whether to have a bath or shower and what to wear. Those people who were reliant upon staff for all their personal care needs also seemed satisfied with their daily routines, although one person commented they would like to be able to stay in bed for longer in the morning. The four returned questionnaires from relatives indicated they felt residents were given choices in their daily routines and one person commented, “The staff give Mum a sense of independence with the comfort of knowing people are around to give her the support she needs”. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 16 Previous inspections had highlighted the need for an increase in social activities and stimulation and requirements in respect of this had been made. It was pleasing to note on this visit, that this shortfall had been addressed. A programme of special monthly entertainment was displayed on the notice board and residents spoken to said how much they enjoyed and looked forward to this entertainment. More trips out into the community had also been arranged and two residents spoken to said they had recently been out on a Christmas meal. During the summer trips to the local garden centre had been arranged and more recently several residents had enjoyed a trip to the theatre. In an effort to address the shortfall of daily activities, two activity co-ordinators visited the home and covered three half days per week. One worker did arts and crafts sessions and one such session was in progress on the afternoon of the visit. Several residents had been making cards for different occasions which were then sold for charity and, with the assistance of the worker, had also made small presents to give to their relatives. The activities were age appropriate and clearly enjoyed by those taking part. During the visit, one of the staff spent time with a resident, reading her Christmas cards and this person was clearly appreciative of this. Feedback from speaking to residents indicated they enjoyed the activity and entertainment programme and were satisfied with what was on offer. One relative’s returned comment card felt a further area for improvement would be to have more sing-songs. The owner/manager said he was in the process of installing televisions in all bedrooms so that if people wanted to retire to their bedrooms in the evening, they would be able to watch the television. The religious needs of the present resident group were being met. The manager said residents were asked upon admission about their religion and whether they would want to take part in communion or go out to church. The Annual Quality Assurance Assessment (AQAA) recorded that a priest came in regularly to give communion and a church representative visited mid-week to do bible readings with certain residents. Whilst residents could choose to handle their own finances, at the time of the inspection, the relatives were tending to have control in this area. Feedback from residents spoken to was generally positive about the food, although two people said they sometimes found the meals repetitive. Other comments made included, “very good”, “nice” and “always a choice”. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 17 From checking the three week menus, it was noted that sometimes the same meal appeared on a weekly basis. The manager said they had recently employed a new chef who would be working with the cook to review and change some of the meals currently on the menus. She said this would be done in consultation with the residents. The current menus, offered a choice of two hot meals at lunch time or a salad together with dessert and either sandwiches or a hot snack were available at teatime. The choice of meal at lunch on the inspection day was braised steak, mashed potatoes and carrots or fish fingers, chips and beans followed by apple crumble and custard. We sampled the steak and vegetables and found the meal very tasty. A large menu board, just next to the serving hatch, displayed the choices of meal. The special dietary needs of the residents were being met and the cook was knowledgeable about people’s individual needs. Observations made during the inspection included people being encouraged to eat their meals and being asked if they wanted more to eat or drink. A recent new practice had been to introduce two sittings at lunch time. The first sitting was for the more dependent people so that the staff could take more time to assist them on a one to one basis. This seemed to work well. Plate guards and adapted cutlery were available if needed in order to promote people’s independence. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Relatives and residents knew who to go to with concerns and complaints and. appropriate systems were in place to protect residents from abuse. EVIDENCE: The home had a complaints procedure, which was included in the service user guide and statement of purpose. Copies of the guide were provided to each resident. Residents spoken to said they would tell senior or care staff if they had any concerns. Relative returned comment cards all confirmed they knew how to complain, with one stating, “I can make a complaint to CSCI if needed”. One relative said that when they had made a complaint, it had been addressed that day to their satisfaction. A complaints book was in use and since the last inspection six had been logged and been appropriately followed up. The Commission for Social Care Inspection (CSCI) had been contacted twice in August 2007, once anonymously, in respect of inadequate staffing levels. This was checked out during this visit. The manager confirmed that during August there were occasions when the home were short staffed due to a high turnover of staff. Details of staffing are addressed in the staffing section below. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 19 A procedure for responding to allegations of abuse was available, as was the Rochdale Inter-Agency Protection of Vulnerable Adults (POVA) procedure. The managers were continuing to send staff on the Social Services POVA training courses in order to ensure they were clear about what to do if they suspected abuse was taking place. The home had been involved in one safeguarding alert this year and had cooperated fully with the Social Services staff. The owner/manager was in the process of investigating another issue internally and discussion took place about the need to share any safeguarding alerts with the Social Services department under the POVA guidelines. The management team had all attended training on The Mental Capacity Act to increase their awareness of their responsibilities under this new legislation. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A homely, comfortable and safe environment was provided for residents. EVIDENCE: Inspection of the building during this site visit confirmed that the home was safe and well maintained. Over the last two years, the owner/manager had continued to improve the accommodation and implement the home’s maintenance programme. Following requirements made at the last inspection, the hall, landing and stairs carpets had been replaced and several carpets had been cleaned. This was an ongoing process. In addition, new flooring had been fitted in the dining room and new furniture had been provided. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 21 As bedrooms became empty, they were being re-decorated and refurbished. Over the last 18 months, eight had been completed. Toilets and bathrooms had also been re-painted. Future plans included the fitting of two spa baths in order to try and offer residents different therapeutic bathing experiences. Returned questionnaires from relatives and feedback from speaking to residents, all indicated satisfaction in respect of the cleanliness of the home. One relative said, “The home is always clean and tidy”. There was no malodour present in any areas of the home that were checked and it was evident the domestics worked hard in respect of this. It was, however, noted that the kitchen was in need of cleaning, especially the wall tiles which, in places, were covered in grease. The manager said this had already been identified and action would be taken to address this. The home had now applied a no-smoking policy in the building. Staff, visitors and residents wishing to smoke had now to use the first floor patio area. A visit by the Environmental Health Officer had taken place in February of this year. The owner/manager confirmed he had taken action to address the shortfalls that had been identified. The home was well equipped with the necessary aids and adaptations needed to meet the needs of the people currently living there. The addition of the wide access toilets near to the lounge meant that people with physical disabilities could more easily use the toilets, thus increasing their independence and maintaining their dignity. Residents spoken with were pleased with their individual rooms and there was evidence they had brought in a number of personal possessions to make them feel more homely. All bedrooms were fitted with door locks and lockable storage space to ensure residents’ valuables were kept safe. The Annual Quality Assurance Questionnaire recorded that infection control was an area that had been improved upon since the last visit. The following good practice was noted: all bedrooms, toilets, bathrooms, kitchen and laundry had liquid soap and paper towel dispensers; dispensers for disposable gloves and aprons were installed around the home so that staff had easy access to them; alcohol rub dispensers were provided around the home and made available to staff in mobile dispensers so they could carry them around; staff wore white aprons for assisting with personal care and changed to blue when assisting at mealtimes. Since the last inspection, the laundry had been extended in order to provide better facilities. A sluice was provided in this area and it was clean and tidy. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. After a period of considerable instability in staffing, there was now a good match of well-qualified staff offering consistency of care to the residents but shortfalls in recruitment practice could place residents at risk. EVIDENCE: Information on the AQAA showed there was a good age mix of staff and out of a team of 21 carers, two male care assistants were employed. This enabled the male residents to choose to have their personal care needs met by someone of the same gender. At the time of this inspection, the home had 25 people living there, although four were in hospital. From checking staff rotas for the week of the visit and the following week, it was identified that, in the main, sufficient staff hours were provided to meet the needs of the residents. However, discussion took place about evening staffing levels as between 21.00 and 22.00 hours there were occasions when only two care staff were on duty. Given that some people required two staff to assist them for all personal care tasks, the managers should undertake a risk assessment to assess whether this level of cover is safe for the people currently living at the home. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 23 In general, residents spoken to felt there were sufficient staff on duty during the day but one person said that during the evening, they sometimes had to wait a while for attention. The manager was reminded that staffing levels would need to be reviewed and possibly increased at certain times, when those people in hospital were discharged home. The manager said they had experienced a lot of staffing problems over recent months, resulting in some staff leaving. She did, however, feel that the current staff team were committed to their jobs and to ensuring the needs of the residents came first. At this time, there were two vacancies, one for a day care and one for a night care assistant. The new management structure, e.g., deputy manager and third officer was also felt to be working well and the manager felt she was now getting the support she needed. Sufficient ancillary staff were employed, including a part-time activity co-ordinator. The staff spoken to felt that staff morale was good and that they now had a good team who worked well together. The managers were committed to offering good training opportunities to their staff in respect of role, health and safety and NVQ training. The training matrix showed that as soon as new staff started work, relevant training courses were sourced and booked. Staff files contained evidence of training undertaken. The manager also made it clear that upon appointment, if a carer did not already have an NVQ qualification then they must enrol on a course as soon as possible. It was to the home’s credit that at the time of the inspection, 62 of the staff had attained NVQ level 2 or above. Three staff files were checked, two for staff who had been employed quite recently. All three files contained completed application forms, Pova first checks and some training certificates. One file contained a Criminal Record Bureau check and the other two were waiting for the checks to be returned. The manager said during this time, the staff were not working unsupervised. One of the files for a carer who had started work at the end of November, did not contain any references. The manager said he had sent off for them but they had not yet been returned and they had appointed subject to satisfactory references being received. This practice should cease and only staff with satisfactory references must be recruited to work with vulnerable people. The file for one new senior staff did not contain proof of her medication training although she was responsible for this task. She confirmed that she had done this training with her last employer but had not got the certificate. The manager should ensure that when staff confirm they have done training that they bring in their certificates which can then be copied and held on file. Copies of the General Social Care Council “Code of Practice” were issued upon appointment. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 24 The staff personnel files did not all contain a photograph of the staff member. This is an unmet requirement from the last inspection. The manager was still using the home’s in-house induction training programme, which did not meet the Skills for Care specification. Discussion took place about this and the need to introduce this induction training for all new staff. Many of the units can be cross-referenced to NVQ competencies as there is no need to complete some sections if staff have already done their NVQ training. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Whilst the home operated adequately, the service would benefit from an increase in management monitoring, reviewing and staff supervision, which would improve the outcomes for the people living and working at the home. EVIDENCE: Two managers jointly ran the home, one of whom was also the registered owner. They both had their designated responsibilities and this seemed to work well. Since the last inspection, the managers had completed their Registered Manager’s Award and the owner/manager had also undertaken NVQ level 4 in health and social care. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 26 It was clear that the managers had worked hard during the past 12 months to improve care practice and formulate a team of staff who had commitment to doing their jobs well. There were, however, still areas that needed to be addressed especially in relation to care planning, recruitment practice, quality assurance, Skills for Care training and staff supervision. The home had recently had an Investor’s in People review and their certificate had been renewed in June 2007. However, other than this quality initiative, the managers needed to implement the outstanding requirement from the last inspection in respect of introducing a quality assurance and monitoring system. From checking records, it was apparent that very few staff meetings took place, except for management meetings. Minutes showed that only one full staff meeting had taken place in March 2007 and two had taken place in March for night care assistants. One resident meeting had taken place in September of this year. Resident meetings especially are an excellent way of getting people’s views and ideas about life in the home, resulting in residents feeling valued when ideas are taken on board and changes made. Similarly, staff meetings enable staff to express their views, in a group setting, so they feel they can contribute to the way the home is run. Regular staff supervision was not taking place and this was another area that needed to be addressed. The manager said she had recently circulated some resident questionnaires about activities and outings and some had been returned. As well as targeting this area, questionnaires should also be written in respect of a wider range of topics so that the management team can measure whether people are satisfied with the service they are receiving. Questionnaires should also be circulated to relatives and health care professionals who visit the home. Whilst medication audits had previously been done, these had ceased and the management should consider re-starting these until she is satisfied that the policies are being followed. Likewise, regular auditing of care plans would give a better over-view of whether they were meeting standards. The Annual Quality Assurance Assessment document had been completed in detail and it was evident the managers had put a lot of thought into what areas still needed to be improved upon. This document could be used as a self-audit tool, so that they can measure the progress they make over the next 12 months. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 27 Prior to this inspection, we had been advised by Social Services that some residents’ finance records were unsatisfactory. The owner/manager was responsible for this area. The finance records for three people were checked. It was clear the manager was not keeping accurate records when money was paid in nor when it was paid out, although a writing pad and receipt book was produced showing amounts that had been paid in for all three people. These figures had not been transferred to individual finance sheets. This is poor practice and action must be taken to keep accurate and up to date records of all residents’ finances. The training matrix showed that staff received all their mandatory training as soon as possible after starting work at the home. No health and safety hazards were noted during the inspection. Regular maintenance checks were undertaken in line with legislation. The AQAA recorded that maintenance of equipment was up to date and observations showed that the building was well maintained. Fire precaution checks were undertaken on a regular basis in keeping with Greater Manchester Fire Officer’s recommendations. Random checks were made of the gas certificate, lifts and mobile hoists servicing and these were in order. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X 3 Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement A detailed care plan must be in place for each resident, showing how their needs in respect of health and personal care are to be met. Medication must be administered in line with the home’s medication policy, e.g., MAR sheets must be signed after giving out medication, prescribed “thick and easy” supplement to be recorded and the code letters used to state why medication has not been given. (Previous timescale of 31/10/06 not met). Controlled drugs must be stored in a metal cabinet affixed to the wall so that they will be held safely. All staff responsible for giving out medication must receive appropriate training so they will know how to do this safely. In line with the inter-agency safeguarding procedures, Social Services must be notified if there is any suspicion of abuse taking place. Timescale for action 01/02/08 2 OP9 13(2) 01/02/08 3 OP9 13(2) 01/02/08 4 OP9 18(1) 22/02/08 5 OP18 13(6) 01/02/08 Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 30 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. 6 Standard OP27 Regulation 18 Requirement Timescale for action 01/02/08 7 OP29 19 8 OP33 24 9 OP35 25 The manager must undertake a risk assessment in respect of staffing the home between the hours of 9.00–10.00pm so as to ensure the safety of the residents. In order to protect residents, 01/02/08 staff must not start work until two satisfactory references have been obtained. Quality assurance systems must 22/02/08 be introduced which should include regular resident and staff meetings, use of questionnaires, staff supervision and reintroduction of annual development plan. (Timescale of 31/08/06 not met.) Residents’ finances must be 01/02/08 accurately documented so that detailed accounts for each person are up to date. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 31 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 5 6 Refer to Standard OP7 OP8 OP9 OP30 OP36 OP7 Good Practice Recommendations Care plans should be more person centred and be used as a working tool by the care staff. Resident or relative agreement to risk assessments/strategies should be recorded. (This was recommended at the last inspection). Handwritten entries on the medication administration records should be signed, checked and countersigned. (This was recommended at the last inspection). The home’s induction training programme should meet the Skills for Care competencies so that all new staff receive the right training. Care staff should receive formal supervision six times per year. Residents and relatives involvement in the writing and review of care plans and risk assessments should be recorded on file. Briarmede DS0000025466.V351599.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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