Inspection on 04/07/06 for Briarmede

This inspection was carried out on 4th July 2006.

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 13/12/07

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 Diane Gaunt Key Unannounced Inspection 4th July 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.V292758.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.V292758.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 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.V292758.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. 16th January 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 4 double bedrooms. Four of the single rooms have en suite facilities. 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. 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 £331.42p £346.42p per week, approximately £1436 - £1501 per month. Additional charges were for hairdressing, chiropody, newspapers, toiletries and outings. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on CSCI records and information provided by people who live at Briarmede, their relatives, professionals who visit the home, the staff at the home and the joint managers one of whom is also an owner of the home. Visits to Briarmede took place on 04 and 05 July 2006. The lead inspector and a CSCI pharmacy inspector both visited the home during these two days. The home had not been told beforehand when the inspectors would visit. The pharmacy inspector looked at arrangements for medication and the lead inspector looked around the building and looked at paperwork that has to be kept to show that the home is being run properly. To find out more about the home the inspector spoke with seven residents, five visitors, two senior carers, three carers, the cook, the assistant officer, a District Nurse, the hairdresser and the joint managers. Comment cards asking residents, relatives and professional visitors what they thought about the care at Briarmede had been given out a few weeks before the inspection. Two social workers and one GP filled the cards in and returned them to the CSCI. What the service does well: What has improved since the last inspection? Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 6 Registered managers were in post and were reviewing every aspect of care at the home. Relatives continued to be more involved in reviews of residents’ care and agreement to risk assessments and records reflected this. Monitoring of food and fluid intake had improved and menus had been adjusted to provide more nutritious and balanced meals. Communication and referral to District Nurses had improved and staff had attended a session on pressure care which helped them to understand the importance of their role. Building work was nearing completion, additional en-suite bedrooms and wide access toilets had been provided and the shower relocated and upgraded. A number of policies and procedures had been reviewed and updated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents were assessed and given information about the home so they knew what it was like before they moved in. EVIDENCE: The home’s policy is to visit prospective residents in their home or hospital prior to admission and there was evidence on the files of the four most recently admitted residents that this had happened. The files also showed that care management assessments had been completed by social workers. Two residents who hadn’t lived at the home for long said it was helpful to meet someone from the home before they moved in although information recorded at the assessment was not shared with them. Assessments held on file supported this. 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. Information regarding terms and conditions was originally included in the Service User Guide but recently this had been overlooked. Once this was Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 9 drawn to the attention of the managers during the inspection the situation was rectified. Contracts were issued to all permanent residents although a number were awaiting signature and return at the time of the inspection. Where the Social Services Department (SSD) had commissioned short term or respite care contracts were made between the SSD, the resident and the home. Feedback from discussion with residents who moved into Briarmede recently indicated that people were given sufficient information about the home prior to moving in. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 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, 8, 9, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were treated with respect and their privacy upheld. In the main, health and care needs were met but poor recording and limited review with residents and/or relatives, ran the risk of staff being inconsistent in their approach. Medication record keeping was poor and did not support the safe administration of medicines, putting residents at risk of not receiving prescribed medication or of medicines being given incorrectly. EVIDENCE: Four care plans were inspected, two of which related to residents who had lived at the home for a relatively short time. Two other plans were inspected to check on specific issues. The care plans encompassed health and social care needs but some did not address each care need in sufficient detail. Most but not all care plans had been regularly reviewed by staff on a monthly basis, in some instances this was by way of a date and signature rather than meaningful comment being made as to progress or changes. Evidence of resident or relative involvement was seen on two of the care plans, one of which had recently been reviewed with relatives. The care plans of the two residents who had moved in recently had not been signed or agreed with them Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 11 although each was able to understand and endorse the plans. Some residents and relatives spoken with said they had been actively involved in review. Others who visited regularly said they would consult with the manager or officers when they visited and assumed changes were made to plans. Relatives also said they were kept informed regarding the health of the resident they visited. Regular reviews were not undertaken by care managers and in the 2 months before the inspection the home had completed written reviews for the Social Services Department. They were unsure if face-to-face reviews were to be held. Where the home could not meet residents’ needs, referral for reassessment had been made. Risk assessments on one care plan had been reviewed within the previous month but another had not. One of the assessments that had not been reviewed was with regard to nutrition, and was an area of need for this person. Moving and handling risk assessments were held on each file and were generally reviewed monthly. However, they did not always record clear, current direction to staff. Discussion with staff and observation showed that a consistent approach was not taken and staff were not familiar with the content of care plans. The home had one standing hoist which was not always suitable for residents’ needs and in one instance meant that a resident had to move elsewhere despite being happy at the home. The managers were aware of the situation and at the time of the inspection were considering the purchase of another, more suitable hoist. Two care plans inspected recorded management strategies with regard to behaviours that were challenging and staff interviewed followed this guidance. Care plans clearly recorded GP, Psychiatrist, District Nurse, CPN and care management involvement. Residents and relatives spoken with said these health professionals were contacted when necessary. The GP comment card supported these views. One resident described the care as ‘smashing’ and other residents and relatives spoken with were satisfied with the overall care provided at the home. Residents said they could have fun with staff which they enjoyed. Observation supported this view and relationships appeared to be relaxed with residents enjoying the interchange with staff. The District Nurse considered staff alerted the service appropriately with regard to pressure areas. District Nurses had held a session for carers on pressure sore care which had been well attended. None of the resident’s had pressure sores at the time of the inspection but turning charts were in place for a number of residents for preventative reasons. Two were seen but had not been consistently completed at the times advised. Staff had attended a session on nutrition provided by a Rochdale PCT dietician and said it had increased their understanding in this area. The inspector was Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 12 pleased to see this was reflected in their work, particularly with regard to the detailed observation and information recorded on food/fluid charts. One care plan recorded the dietician’s involvement in the resident’s care and noted improvement as a result of monitored intervention. The homes policy is to weigh residents on admission and monthly thereafter. Where there were reasons for concern the policy was to weigh weekly. Inspection of care plans and discussion with staff showed that this policy was not being consistently followed. Neither of the two recently admitted residents had been weighed despite one of them appearing to be underweight. Weekly weights had not been maintained for another resident. The home had been advised about the use of the Malnutrition Universal Screening Tool (MUST) with regard to nutritional assessment but had not begun to use it. The weather was exceptionally hot on the days of the inspection and the manager had briefed the staff on the Department of Health heat-wave guidance which they were following. Jugs of juice were provided in residents’ rooms and communal areas, ice cream was provided for an afternoon snack, curtains were closed to keep the sun out and window and patio doors opened to allow a breeze in. Residents who wished to sit outside were advised about the heat and provided with hats and sun-cream if they chose to go outside. Residents had been assessed for continence aids by the PCT Continence Nurse. Some residents were in need of reassessment and at the time of the inspection the home was providing additional continence aids. One of the managers was addressing the matter. Staff encouraged residents to exercise by dancing, and one carer said she encouraged residents to exercise using a ball. Armchair exercises and regular walks outside were no longer offered however. None of the residents have chosen to manage their own medicines. One resident commented that they were ‘glad to be rid of them’ because of the worry. Another resident used to keep her own inhaler but no longer wished to do so. She was happy with the current arrangements and ‘buzzed’ for care staff when she wanted her inhaler. She said they always came quickly. Following discussion with the supplying pharmacist about the packaging of medicines the manager had decided to change the way medicines were supplied to the home. Medicines will be packed into a weekly dosette box. Care staff knew the packaging was changing and the manager said that training had been arranged. Staff said their main worry was how each tablet would be identified, for example, if a doctor changed a resident’s medicine. The homes written medication policy and procedures describing how medicines were managed needed updating, the update should include managing dose changes. The manager said this would be completed with the introduction of the new packaging. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 13 The homes medication records were examined to track the management of medicines in the home. They identified a need for improvement in order to show that medicines were handled safely and given correctly. Records of medicines received into and leaving the home were up-to-date but there were mistakes in the administration records. For example, one medicine was not written onto the list of current medicines for three residents. One of the medicines was being given daily, but this wasn’t shown on the records. The use of prescribed creams, eye drops and inhalers was poorly recorded with several ‘blanks’ in the administration records. The controlled drugs register was correctly completed but the corresponding administration record was incomplete. Two residents were given medicines differently from on the pharmacy label. Carers said that the doctor had changed the dosage instructions but records of these verbal changes could not be found, so doctors’ instructions could not be confirmed. This increased the possibility of mistakes being made when giving medicines and tablets. The application of creams was poorly managed. Creams were kept in resident’s rooms. Three creams seen had no pharmacy label so there were no instructions telling carers how to apply them. Two of the creams were no longer included on the list of current medication. It was not possible to tell whether the creams were being given correctly. The manager was unable to show that a regular written check of medication handling was being carried out. Medicines were safely stored in the medicines storage room but two unwanted controlled drugs had not been returned to the pharmacy for safe disposal. Residents spoken with considered their privacy and dignity were respected at the home. Staff interviewed were able to describe good practice in this area e.g. closing doors and curtains when assisting residents, using privacy curtains etc. Relatives commented that observation during their regular visits to the home indicated staff treated residents with respect and upheld their dignity. Safety locks were fitted to bedroom doors. The majority of residents spoken with did not wish to have a key as they could lock the door from inside without one. However, previous good practice of routinely offering a key unless risk assessment indicated otherwise, had ceased. Two residents who had not lived at the home for long did not recall being asked if they wanted a key. Lockable space and keys were provided in each room although some residents chose not to use the facility. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Provision of social activities and integration into community life did not fully satisfy each resident’s social and recreational interests. A nutritious, varied and balanced diet was provided and enjoyed by residents. EVIDENCE: Observation and discussion with residents, relatives and staff indicated that there had been little change in the provision of activities since the last inspection when a requirement was made for improvement in this area. An external activities provider continued to visit the home once a week and some residents who spent their days in the lounge enjoyed these varied sessions. They also spoke positively about the monthly entertainment visits. Relatives regularly took residents out but staff only did so occasionally. Since the last inspection staff had taken residents out to a pantomime and on occasional shopping trips. An activities diary was in place but had not been completed since 30.04.06. From interviews with staff, residents and relatives it was established that in-house activities had taken place and included jigsaws, bingo and nail manicures and polish. A slide show session on Old Middleton had been held the week before the inspection and residents had particularly enjoyed this. Staff had also encouraged football fans to keep up with the World Cup competition and the lounge had been decorated with England flags. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 15 However, there was no designated activities co-ordinator to ensure a daily programme was planned and provided. The managers may wish to consider appointing one or delegating the task to a suitable worker within defined hours each week. Residents said a Church of England vicar and a Roman Catholic priest or eucharistic visitor called at the home to give communion to those who wanted it, although there were no services held at the home. One resident spoken with said that if a service were provided they would attend. The managers said they would pursue the matter. All visitors spoken with said they were well received when visiting the home, no matter what time they called. They were always offered a drink and welcomed into the home. They could see their relative in either communal areas or the privacy of their rooms. A treatment/hairdressing room was also provided if visitors wished to see residents in private but not in their bedrooms. Observation and discussion with residents and staff showed that residents were able to make day to day decisions regarding rising/retiring times, what clothing to wear, where to sit, what to eat, whether or not to be involved in activities. Residents wishes regarding involvement in their financial affairs were established on admission. None had chosen to control their own monies. The majority had asked relatives or friends to be responsible for finances. Advice regarding financial advocacy was held at the home if needed. Residents were able to bring personal possessions, including furniture with them, and evidence of this practice was seen in bedrooms. The Statement of Purpose stated that access to records was available in accordance with the Data Protection Act 1998. Menus inspected were seen to provide a varied diet over a 3 week period. Fresh fruit was served 2 or 3 times each week and residents said it was also offered as a snack and served as an alternative dessert most days. Two hot choices of lunchtime meals and a salad were offered each day and a hot and cold choice offered at teatime. Drinks were provided during the day and jugs of juice were available in the lounge, dining room and residents’ bedrooms. Food served during the inspection was sampled, it looked, smelt and tasted appetising. Residents spoke well of the food which was described as ‘very good’, one resident said they ‘couldn’t fault it’. Observation and inspection of records showed that the cook offered alternatives to residents if they didn’t want what was on the menu or were not eating well. She had also amended the menus during the hot weather to offer foods which she thought residents would prefer whilst it was very hot. Daily choice sheets recorded these changes. The managers had met with the cook a month before the inspection to discuss the menus and nutritional issues. As a result the cook was trying out new dishes prior to rewriting menus with the managers. The cook and the managers had attended the dietician’s session on nutrition which they said Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 16 would inform their menu review. The cook saw every resident daily as she went to ask them for their choice of meals each morning. It was clear from talking to her that she knew the residents’ likes and dislikes well and did her utmost to provide nutritious food that they enjoyed. Diabetic and soft diets were provided for those who required them. Staff were observed giving appropriate assistance to those needing it and were both supportive and encouraging. One resident liked to be assisted to eat by another resident and staff enabled this but observed to ensure this was done in an appropriate manner. Plate guards and adapted cutlery were available and in use by some residents. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 17 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives 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 which were provided to residents. Residents and relatives spoken with said they would tell senior or care staff if they had any concerns or were unhappy about anything. Those who had raised issues said they were generally addressed. The GP and social workers returning comment cards said that no one had raised complaints about the home with them. A complaints book was in use and recorded complaints and action taken to address them. No entries had been made since the last inspection. The CSCI had received no complaints during this period although two people had written anonymously to express concern about changes in management of the home and its impact on staff and resident morale. Discussion during the inspection confirmed that there had been one instance in which a situation could have been handled more professionally by management but there was no evidence from discussion with relatives, residents and staff that resident and staff morale had been affected by this incident. A procedure for responding to allegations of abuse was available as was the Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure. The Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 18 internal procedure was in need of amendment to reflect the home’s good practice in following the Inter-agency procedure under which appropriate reporting and recording procedures were followed. The owner/manager had taken appropriate action to alert care managers to protection issues during the last 12 months, although in one instance a staff member had been slow to report to the owner/manager. As a result, one of the managers had recently spoken to staff regarding ‘whistleblowing’ and those interviewed were clear as to their role of alerting and reporting. They were also familiar with the different types of abuse. Staff spoken with understood the importance of reporting malpractice. All but one senior staff member had attended POVA training provided by Rochdale Social Services Department. A minority of staff had attended in-house training and 11 care staff had received training in this area through NVQ level 2 training. Arrangements were being made for each staff member to undertake the Rochdale SSD course. Staff were not employed at the home until necessary checks had been taken. Residents spoken with said they felt safe living at Briarmede. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A safe homely environment was provided but cleanliness was not always maintained throughout, which on occasion adversely affected residents’ comfort. EVIDENCE: A tour of the building was undertaken during the inspection. Internal building work continued at the home but was nearing completion. Since the last inspection the following had been provided: two additional en suite single bedrooms, a large medication store room, a level access shower room and additional ground floor toilets. One of the toilets was large in order to allow easy wheelchair access. The toilets were located near to the lounge. In keeping with the rest of the building, each of the new areas had been equipped with aids to assist residents in using the facilities. Some attention had been paid to maintenance of the building, furniture and fittings since the last inspection in that 12 lounge chairs had been replaced and Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 20 a further 6 ordered; lounge and 1st floor corridor walls repainted; a number of bedrooms decorated; and new corridor carpets provided to the 1st floor. However, the ground floor corridor and dining room carpets were in need of cleaning, the stair carpet near the owner/manager’s office needed replacing and the lounge walls were again showing signs of wear and tear. Nine bedrooms were looked at and were all bright, airy and personalised with residents personal belongings bringing a homely touch to their rooms. The maintenance/renewal plan in place had projected timescales up until 30 June 2006 and was therefore due for review. The new plan must address each of the areas identified above. Observation showed that staff continued to use part of the dining room for breaks and to store their belongings, despite staff lockers being provided. The issue of them taking smoking breaks in this area was raised at the last inspection. The area is designated resident space and should not be used for this purpose. The garden and grounds were seen to be kept safe and tidy. A lawned garden and patio area are provided to the front of the home. The patio is easily accessed from the main lounge and residents were able to move in and out of the patio area as and when they wished. Some residents said how much they enjoyed sitting out there and one said it kept them in touch with old friends as they stopped for a chat as they walked by. The Environmental Health Officer had visited the home since the last CSCI inspection and confirmation that the home had met previous requirements and recommendations was available. GM Fire Officers had not visited recently. Whilst the main lounge and most of the bedrooms were adequately cleaned and odour free, some areas were not. Dust was noted on some units and cobwebs in some bedrooms. One bedroom had not been cleaned or the bed made by the afternoon. Residents and relatives commented that cleanliness of the home had not been as well maintained as usual due to ancillary staffing problems. This was verified by the managers. Action was being taken and a ‘bank’ cleaner was interviewed on the day of inspection. 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. However, it was noted that paper towels were not provided in the staff toilet and communal soap was left in one bathroom. The laundry was being extended to offer better facilities. Work was due to be completed within a month of the inspection. It was sited away from the food Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 21 preparation area and the floor had been coated in impermeable paint. All laundry was being attended to at the time of the inspection indicating efficient management and provision of sufficient equipment. Briarmede DS0000025466.V292758.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were protected by the home’s recruitment and selection practices and staff were trained and competent to do their jobs, although insufficient staff on occasion meant that residents needs were met by staff who were rushed and overtired. EVIDENCE: Inspection of three weeks rotas showed that although the home planned to provide enough care hours each week, staff sickness and vacancies meant that on two of those weeks insufficient staff were provided to meet the minimum requirement. Feedback from residents and relatives was mixed with regard to whether there were sufficient staff on duty each day. They said that staff were very busy and had a lot to do but managed to provide the care needed. Residents were particularly pleased that staff answered call bells quickly. They described staff as very pleasant and caring. They were aware that the home was recruiting staff at the time of the inspection and knew that a core staff group were working long hours on occasion to cover the required hours. They and the staff interviewed considered this affected morale as those staff who had agreed to work extra shifts were feeling tired. The home had a clear commitment to training and provided training related to role, health and safety and qualification training for all care staff. Of nineteen care staff, 11 had successfully completed NVQ level 2 as had the two officers. A further four were on the course and three had enrolled to begin the course in Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 23 September 2006. In addition, 2 senior staff had achieved NVQ level 3 and were undertaking NVQ level 4 and the two officers were undertaking NVQ level 3. In-house induction as well as TOPSS induction was given in order to provide a knowledgeable workforce, although a record of in-house induction was not always kept and staff were not issued with important policies and procedures. Staff spoken with said they shadowed experienced staff until they felt confident and were considered competent to work alone. Twenty staff had attended the Learn Direct TOPSS induction and new starters were awaiting the next course. The manager was in the process of changing from TOPSS induction and foundation standards to Skill for Care common induction standards. The foundation standards were not always achieved within the recommended timescale. A system to monitor whether staff received 3 paid days training per annum had started at the beginning of January 2006. Training related to role included optical awareness, motor neurone disease, diabetes, dementia care, pressure sore care, nutritional screening, palliative care, risk assessment, managing aggression and communication skills. Three staff files were inspected and contained evidence of POVA 1st (Protection of Vulnerable Adults) in relation to most recently appointed staff and CRB (Criminal Record Bureau) checks with regard to longer serving staff members. 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.V292758.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The joint managers were of good character and fit to be in charge. Recent review of systems, policies and procedures was beginning to be used to improve the service and run it in the best interests of residents. EVIDENCE: Since the last inspection two joint managers have been registered with CSCI. One of the managers is also a registered owner. Since becoming registered they have been working to more clearly define roles within the management team i.e. themselves and the two officers. However, this process was not complete and there were a number of unresolved issues. There was no evidence that this was affecting staff or resident morale however. It was agreed that the CSCI would be informed in writing once the tasks and responsibilities of each role had been defined and agreed. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 25 One of the manager’s was nearing completion of the NVQ Level 4 in Health and Social Care and the other had an HNC in Care Management. Both had registered to take the Registered Manager’s Award later in the year. During the period when there was no registered manager at the home a number of areas had been neglected and although they were beginning to be addressed, further work was necessary in order for the responsibilities of the role to be fully discharged. Examples can be found throughout the report and are reflected in the unmet requirements. However both managers were aware of the shortfalls of their service and were beginning to take action to address each area. 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 still not provided. A number of policies and procedures had been reviewed and updated since the last inspection and the process was ongoing. Of those inspected, it was noted that policies and procedures relating to abuse, referral and admission were in need of review. The home acted as corporate appointee for a number of residents. Additionally, relatives left money in the home’s safekeeping for residents. Inspection of the records in relation to three residents showed that two had not been updated since the beginning of June 2006 and the other since April 2006. Records did not clearly record incomings and outgoings and as monies were pooled at the home it was not easy to establish how much was held for each person. The managers had audited the records a few days prior to the inspection were aware of these shortfalls. As a result of their findings they were considering the re-allocation of this task. With one exception maintenance and servicing of equipment and safety checks had been undertaken within required timescales. A rolling programme of induction training in relation to health and safety issues was in place and inspection of training matrix and interviews with staff confirmed the majority of staff had completed it. One of the managers was actively seeking further health and safety and infection control training at the time of the inspection. All senior staff had completed 1st Aid training ensuring one per shift was trained. A fire lecture had been held since the last inspection but not all staff had attended this or had a fire drill. A health and safety policy was in place and procedures posted on the notice board. With one exception accidents had been appropriately recorded and reported. The unreported incident had occurred prior to the managers being registered. Since her Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 26 appointment one of the managers was monitoring accidents and action taken to prevent further occurrences. An officer and three carers were observed to be wearing open toed, backless sandals which were inappropriate and unsafe when assisting residents to move. The issue had been raised on a previous inspection. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 27 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 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 1 X X 2 Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 12 Requirement All risk assessments must be regularly reviewed and staff work consistently with the recorded required action. Timescale for action 18/08/06 2 OP8 12 Residents must be weighed at 31/07/06 least monthly and more regularly if weight loss is noted. (Previous timescale of 31/01/06 not met) The registered person must regularly audit the management of medication to make sure medicines are given correctly and that accurate records of medication handling are maintained. The registered person must ensure that there is a complete and accurate list of currently prescribed medication for every resident and the time and date of administration. The registered person must audit the management of creams to make sure they are used and recorded as prescribed. The registered person must review and implement the DS0000025466.V292758.R01.S.doc 3 OP9 17(3)(a) 31/07/06 4 OP9 17(1)(a) 05/07/06 5 OP9 13(2) 17/07/06 6 OP9 13(2) 31/07/06 Briarmede Version 5.2 Page 29 7 OP9 13(2) 8 OP12 16 medication policies and procedures. The registered person must ensure that verbal dose changes are clearly recorded for later verification in accordance with a written protocol. Activities suitable to the needs of residents must be regularly provided, recorded, monitored and reviewed. (Previous timescale of 31/03/06 not met) A new maintenance and renewal plan must be written to include the owner’s maintenance plans for the year and address each of the areas identified in the report. A copy must be sent to CSCI. Sufficient care and ancillary staff must be provided to meet the needs of service users. (Previous timescale of 31/01/06 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 31/01/06 not met) All staff must attend an annual fire lecture and have an annual fire drill. (Previous timescale of 31/10/05 not met) Staff must wear appropriate footwear for the safety of both the residents and themselves. DS0000025466.V292758.R01.S.doc 31/07/07 31/08/06 9 OP19 23 31/08/06 10 OP27 18 31/08/06 11 OP33 12 31/08/06 12 OP37 17 31/07/06 13 OP38 23 31/08/06 14 OP38 13 31/07/06 Briarmede Version 5.2 Page 30 15 OP38 23 An annual gas safety check must be arranged and the certificate forwarded to CSCI. 31/07/06 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 Refer to Standard OP3 OP7 Good Practice Recommendations Assessment of potential residents should be shared with them prior to admission. Residents and relatives involvement in the writing and review of care plans and risk assessments should be recorded on file. Care staff should encourage residents to exercise by offering suitable activities. Resident or relative agreement to risk assessments/strategies should be recorded. A regular audit should be carried out to show how well the home is managing medicines and to identify where improvements need to be made. Shelves over radiators should be made good. Staff should take their breaks and store their belongings in designated staff areas. Residents should be given a bedroom key on admission unless risk assessment indicates otherwise. If they do not wish to have one, a record of their decision should be held on file. Staff should receive copies of terms and conditions of employment no later than 8 weeks after the start of their employment. An induction record should be kept in respect of each staff DS0000025466.V292758.R01.S.doc Version 5.2 Page 31 3 4 5 OP8 OP8 OP9 6 7 8 OP19 OP20 OP24 9 OP29 10 OP30 Briarmede member. 11 12 13 OP33 OP35 OP36 Policies and procedures should be reviewed regularly. Clear, up to date records of monies held for residents should be kept and monies should not be pooled. Care staff should receive formal supervision 6 times per year. Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 32 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 © 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 Briarmede DS0000025466.V292758.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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