CARE HOMES FOR OLDER PEOPLE
Briarmede 426/428 Rochdale Road Middleton Manchester Greater Manchester M24 2QW Lead Inspector
Diane Gaunt Unannounced Inspection 16th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 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.V269790.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Briarmede Address 426/428 Rochdale Road Middleton Manchester Greater Manchester M24 2QW 0161 653 2247 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 Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 30 service users to include:up to 30 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. 3rd November 2004 Date of last inspection Brief Description of the Service: Briarmede is an adapted building offering 24 hour personal care. The home is registered for 30 service users and plans to increase registration to 32 on completion of ongoing building work. The home had a total of 21 single and 6 double bedrooms, some of which were unused as work was due to begin to convert two double and one single bedroom to four singles. Bedrooms are located on both the ground and 1st 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. A lawned front garden is provided. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 8½ hours. The home had not been told beforehand that the inspector would visit. The inspector looked around the building and looked at paperwork about the running of the home and the care given. Six residents, six visitors, a District Nurse, a senior carer, two care assistants, the training officer, the deputy officer and the acting manager/registered provider manager were spoken with. Carers were watched as they went about their work. Requirements listed at the end of the report include seven that had not been fully met since the last inspection. What the service does well: What has improved since the last inspection? What they could do better:
Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 6 The home must make sure every resident is given a written contract about their stay when they move in. This should include their room number. Residents must be weighed monthly or more often if they have been losing weight. Staff should write more detail about how much food and drink poorly residents have had each day. Staff should meet with residents and relatives every six months to check that the care they are giving is what the resident wants and needs. Any areas of risk should be discussed with them and a record of their agreement kept. More activities must be provided, these should include regular exercise. Management must check how often activities are provided and keep a record of them. The owner must make sure the bath without the hoist is available to residents who want to use it. Worn lounge chairs must be replaced and marked lounge walls repainted. Shelves over radiators should be repainted or replaced. Staff must make sure that they write down about residents who don’t want to take their tablets and must only give the tablets from the packet the chemist sends them in. They should add a section about homely remedies to the policies and procedures about medicines. More staff must be provided. New staff should be given copies of terms and conditions within 8 weeks of starting their jobs. The policy and procedure about recruitment should be updated and other policies and procedures checked to see if they need to be updated. Photographs of residents, staff and details of social workers must be kept. CSCI must be told about anything important that happens to residents. Staff must all go to a fire lecture and have a fire drill every year. Management should meet with care staff 6 times a year to talk about how they do their job, what training they need and how they could improve. Senior staff should make sure residents weights are checked and make sure they do something about those losing weight. They should talk to residents and relatives about risks they take and get their agreement to how they are going to handle it. Please contact the provider for advice of actions taken in response to this inspection. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 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.V269790.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The assessment procedure in place ensured the home was able to meet the needs of residents admitted. EVIDENCE: Individual records were kept for each resident. The majority of residents had a full care management assessment. In addition, the deputy or senior/officer went out to assess potential residents in hospital or their own homes. These visits were documented and policy was to hold the assessment record on file. Of three files inspected only one held documentation relating to Briarmede’s assessment, although care management assessments were in place for the other two. In each instance the admissions were appropriate and the home was able to meet the residents assessed needs. This was confirmed in discussion with one recently admitted resident and relatives of two. The home did not confirm their assessment in writing to potential residents informing them that it was able to meet their needs. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Residents’ health, personal and care needs were set out in an individual plan of care but not always reviewed at agreed intervals, which could result in staff being inconsistent in their approach. Meeting of health care needs had improved but the home needed to more consistently monitor residents’ weight and provide regular exercise to ensure residents’ well-being. EVIDENCE: Six care plans were inspected, of which three of the residents had lived at the home for a relatively short time. The care plans encompassed health and social care needs and recorded action to be taken to meet the needs. Most but not all care plans had been regularly reviewed by staff on a monthly basis. Evidence of resident or relative involvement was seen on care plans but changes to care and risk assessments had not always been agreed with them. Six monthly reviews of care were not routinely held with residents and/or relatives, although relatives said they were generally kept informed regarding the resident’s health. Where the home could not meet residents’ needs, referral for re-assessment had been made, although in one this instance this had been undertaken when prompted by the District Nurse. Following improved care provision, multiBriarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 11 disciplinary assessment concluded the resident should remain at Briarmede in this instance. Care plans clearly recorded GP, Psychiatrist, District Nurse, CPN and care management involvement. Residents and relatives spoken with were satisfied with the overall care provided at the home. The District Nurse considered staff alerted the service appropriately with regard to pressure areas. Recent improvement had been seen with regard to observation of pressure sores and increased monitoring of food/fluid intake. Discussion with the deputy officer indicated her increased understanding in this area. In addition, District Nurses had held a session for carers on pressure sore care. Food/fluid charts were seen to be in place for a number of residents but monitoring would be assisted by more specific detail being recorded. The homes policy is to weigh residents monthly but care plans inspected did not all reflect this policy. Staff encouraged residents to exercise by dancing, but they no longer offered ball games, armchair exercises or regular walks outside. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Social activities and occupation were provided but did not meet the needs of all the residents. EVIDENCE: Residents were able to exercise choice with regard to when to get up/go to bed; where to spend their day; what to eat; whether to join in activities. The priest or eucharistic visitor called at the home to give communion to those who wanted it. There was no provision for those of other religious persuasion. Observation and discussion with residents, relatives and staff indicated that there were less activities offered than at the last inspection. An external activities provider visited the home once a week and residents who spent their days in the lounge enjoyed these varied sessions. They also spoke positively about the regular visits of an entertainer. Staff had taken residents out to a local school Christmas concert, a circus and to Blackpool to see the illuminations. Staff said they did jigsaws, played bingo and cards with some residents and regularly manicured female residents’ nails. Some visitors spoke of the lack of stimulation offered by staff. No-one had been designated the responsibility for co-ordination of activities and there was no record kept to enable the deputy to monitor their frequency or popularity. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. EVIDENCE: Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): A safe environment was provided but, during ongoing building work, the home had not been well-maintained. The home was hygienic and sufficiently clean, providing residents with a homely setting to live in. EVIDENCE: A full building inspection was not undertaken. Internal building work continued at the home and since the last inspection the number of single en suite bedrooms had been increased and a meeting/treatment room and a new office had been provided. First floor corridors had been decorated and, at the time New of the inspection 1st floor double bedrooms were being decorated. carpets were to be provided to corridors on the 1st floor shortly after the inspection. Work was due to begin to provide additional single bedrooms and further reduce the number of doubles. Plans for the future included provision of a new shower, laundry and additional ground floor toilets. A plan detailing the timescale for the remaining work had been submitted to CSCI with an estimated completion date of June 2006. Some maintenance/renewal work had been undertaken during ongoing works but this was limited. Observation showed that some walls in the lounge were in need of decoration and a number of lounge chairs in need of replacement.
Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 15 A lawned garden and patio area are provided to the front of the home. The garden and grounds were seen to be kept safe and tidy. There had been no inspections by Greater Manchester Fire Service and the Environmental Health Department since the last CSCI inspection. Areas of the home inspected were adequately cleaned and odour free, residents and relatives considered the home was kept clean enough. An infection control policy was in place and staff interviewed were able to describe safe infection control practice. Disposable gloves and colour coded aprons were provided and changed after each contact. Satisfactory practice was in place with regard to disposal of clinical waste. The laundry was sited away from the food preparation area. The floor had been coated in impermeable paint but this had worn through in a number of areas. Building work which included re-siting of the laundry was in progress at the home. Laundry was attended to efficiently, although there was some feedback that items of clothing were lost. The home has a compensation/replacement policy which staff had not always promoted. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Insufficient staff were provided to meet the needs of residents. Residents were protected by the home’s recruitment and selection practices and staff were trained and competent to do their jobs. EVIDENCE: Inspection of three weeks rotas showed that insufficient staff were provided to meet the minimum requirement. Feedback from residents and relatives was mixed with regard to whether there were sufficient staff. Rotas showed that there was a staff vacancy which the current team was trying to cover. This post had been advertised and interviews were to be held. Residents and visitors spoke positively of the majority of staff, commenting on their caring nature and ‘bright, smiling faces’. However, comment was also made about number of staff who appeared to take less interest and care over their jobs. Visitors also commented that staff took their breaks together in the residents’ dining room. Some visitors were not sure whether they sat there just for their breaks or whether they spent some of their shift sitting chatting rather than working with residents. During the inspection staff appeared to spend longer than an official break sat together in this area. The home had a clear commitment to training and provided training related to role, health and safety and qualification training for all care staff. The deputy officer and senior/officer had an NVQ level 2 as had nine care staff and three bank staff. One senior carer had an NVQ level 3 and was taking NVQ level 4. Four carers had almost completed NVQ level 2 and a further three were to be registered on it. In-house induction as well as TOPSS induction was given in order to provide a knowledgeable workforce. In the main, TOPSS foundation
Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 17 standards were addressed within the first six months of employment. A number of staff showed their enthusiasm for training and those interviewed spoke positively of their opportunities. Of note was the deputy officer who was actively increasing her knowledge in her own time via the internet and a senior carer who had completed NVQ level 3 and begun NVQ level 4. A system to monitor whether staff received 3 paid days training per annum had started at the beginning of January 2006. Three staff files were inspected and contained evidence of POVA 1st (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) checks. Two written references were sought before employment and copies of documents verifying identification held on file. Copies of GSCC (General Social Care Council) Code of Conduct were issued on appointment. Staff did not receive copies of terms and conditions within the first 8 weeks of their employment. A recruitment procedure which addressed equal opportunities was in place but was in need of review as it described outdated practice. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 33 The acting manager was working part-time and as a result was unable to discharge his responsibilities fully. The home had limited quality assurance systems for seeking the views of residents and their relatives which affected their ability to plan the service in the best interests of residents. Staff were supervised but not offered the opportunity to discuss their performance and training needs with the manager on a regular basis. EVIDENCE: One of the registered providers was acting as manager but was not registered with CSCI. Application for registration of the acting manager and the training officer, on a job share basis, was discussed and agreement reached that application would be made shortly after the inspection. The acting manager was undertaking NVQ Level 4 in Health and Social Care and the training manager had an HNC in Care Management. Both planned to take the Registered Manager’s Award. In the absence of a registered manager responsibility for management of care had rested with the deputy officer, with other tasks being undertaken by the acting manager on a part time basis.
Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 19 Whilst this arrangement had been effective on a day to day basis, a number of areas had been neglected and are reflected in this report e.g. meeting of CSCI requirements, maintenance of quality assurance systems, regular supervision of staff, management of staff breaks. The home had the Investors in People Award, but had not recently updated their annual development plan. With regard to systems for seeking feedback on their service, this was only done by review of care plans and consultation with some residents and relatives. Regular staff meetings, supervision of staff, resident/relatives meetings, circulation of questionnaires to residents, relatives, staff and other stakeholders were not provided. There was no current annual development plan at the home. A number of policies and procedures were in need of review. Staff said they did not receive regular formal supervision although they had 6 monthly appraisals with the acting manager and deputy and were offered ‘on the job’ supervision as and when it was required. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 20 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 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X 2 X X Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 Requirement Terms and conditions/contracts, including the resident’s room number, must be issued to residents on admission and a copy held on file. (Previous timescale of 31.05.2004 not met) Residents must be weighed at least monthly and more regularly if weight loss is noted. Medication administration records must be clear, complete, accurate and up-to-date. (Previous timescale of 121/09/05 not met) Medication must be administered from the original pharmacy labelled container. (Previous timescale of 12/09/05 not met) Activities suitable to the needs of residents must be regularly provided, recorded, monitored and reviewed. Worn lounge chairs must be replaced and marked lounge walls repainted. The unassisted bath must be made good and items stored in the room removed. (Previous
DS0000025466.V269790.R01.S.doc Timescale for action 31/01/06 2 3 OP8 OP9 12 13 31/01/06 31/01/06 4 OP9 13 31/01/06 5 OP12 16 31/03/06 6 7 OP19 OP21 23 23 30/04/06 31/01/06 Briarmede Version 5.1 Page 22 8 OP27 18 9 OP33 12 10 OP37 17 11 OP38 23 timescale of 31.12.2004 not met) Sufficient staff must be provided to meet the needs of service users. (Previous timescale of 31/08/05 not met) Quality assurance systems must be introduced to include regular meetings, use of questionnaires, staff supervision and reintroduction of annual development plan. Photographs of residents, staff and contact numbers of social workers must be held on file and CSCI informed of any notifiable incidents within 24 hours of their occurrence. (Previous timescale of 31/08/05 not met) All staff must attend an annual fire lecture and have an annual fire drill. (Previous timescale of 31/10/05 not met) 31/01/06 30/04/06 31/01/06 24/03/06 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 7 Refer to Standard OP3 OP7 OP8 OP8 OP8 OP9 OP19 Good Practice Recommendations Records of initial assessment of residents should be held on file. Six monthly reviews should be held with residents and/or relatives. Care staff should encourage residents to exercise by offering suitable activities. Resident or relative agreement to risk assessments/strategies should be recorded. Food/fluid charts should be completed in more detail to assist monitoring. The medication policies and procedures should be reviewed and expanded. Shelves over radiators should be made good.
DS0000025466.V269790.R01.S.doc Version 5.1 Page 23 Briarmede 8 9 10 11 OP27 OP29 OP33 OP36 Staff breaks should be planned and monitored to ensure they are taken for an agreed time, away from residents’ space. Staff should receive copies of terms and conditions of employment no later than 8 weeks after the start of their employment. Policies and procedures should be reviewed regularly. Care staff should receive formal supervision 6 times per year. Briarmede DS0000025466.V269790.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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