CARE HOMES FOR OLDER PEOPLE
Briarwood Nursing Home Whitmore Road Blaydon Tyne & Wear NE21 4AN Lead Inspector
Mrs Katie Tucker Key Unannounced Inspection 17th August 2006 9:00 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 Briarwood Nursing Home DS0000018169.V304213.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. Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Briarwood Nursing Home Address Whitmore Road Blaydon Tyne & Wear NE21 4AN 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) 0191 414 8374 0191 414 7439 Mental Health Concern Mrs Janet Mole Care Home 33 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (21), Mental disorder, excluding learning of places disability or dementia (12), Mental Disorder, excluding learning disability or dementia - over 65 years of age (12) Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 8th December 2005 Brief Description of the Service: Briarwood nursing home was built in the late 1960s by the local authority to provide nursing and personal care for older people with dementia care or mental health needs. The fees at the home are £634 but several grants and funding bodies pay these monies. Briarwood is divided into three units. The one unit upstairs and one downstairs are used for the care of those with a dementia type illness. The other upstairs unit provides long-term care of people with complex mental health needs. All of the units have communal areas as well as bathrooms, toilets and bedrooms. The administration area is all located at the front of the building. The home is situated in the heart of Blaydon close to the Blaydon Precinct and the main bus interchange linking to Gateshead, Newcastle and Hexham. A short distance away is the local library, GP surgeries and dentist. The home is close to the main road however pedestrian crossings are available to improve access to local facilities. It is enclosed in its own grounds and is surrounded by a mix of houses. Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried this unannounced inspection and spent 9 hours at the home speaking to people using the service, staff and visiting relatives. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Mental Health Concerns headquarters were visited so further information could be gathered about the operation of the home. Also information supplied by the home and comment cards were used to make decisions about the quality of service. Briarwood provides nursing care for people with a dementia-type illness and care for people with mental health needs. Some of the people have difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection all of the key standards were checked. What the service does well:
The manager and deputy managers are very competent and skilled. They constantly seek out the latest information about how best to care for the residents and share this with all of the staff. They know what needs to be done to provide a good service and other the last two years have dramatically changed practice. Staff now deliver cutting edge of care practices for people who have very complex mental health needs or dementia. The management team really value the residents and respect their rights. Thus the ethos of the home centres around helping people to make choices and continue to feel their opinion is important. Staff work well with residents and clearly care a great deal about them. Staff chatted to residents and listened to people’s views. There was lots of friendly banter going on through the day, which everybody enjoyed. Throughout the visit the staff worked with people in ways that reflected genuine warmth. The staff respected resident’s wishes and responded to what people wanted. Resident’s were included in all conversations and were clearly valued members of the home. Briarwood has a good staffing level and the qualified nurses specialise in caring for the needs of people with dementia and mental health needs. This means that staff can readily meet residents’ needs but also that they are always trying to find news ways to communicate with the least able residents. The staff have also shown that they are skilled at working with people who have
Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 6 extremely complex needs and at helping people to reduce the anxiety they experience. Mental Health Concern’s staff training department is extremely active and all of the staff have access to a wide range of training. The type of training offered includes access to degree and masters level courses as well as secondments onto nurse training. Mental Health Concern is not only the owner of Briarwood but also a charity. Headquarters staff champion the recognition of people with mental health needs as full citizens. They run service user boards and provide people with mental health needs opportunities to gain employment. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Briarwood Nursing Home DS0000018169.V304213.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 Briarwood Nursing Home DS0000018169.V304213.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): 3 and 6 The assessments are extremely comprehensive and readily assist staff to work with residents. Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Case tracking showed that staff have been reviewing the assessment tool to make sure all of the information needed is included. It is a very comprehensive tool, which provides a lot of information about all aspects of people’s lives and needs. Staff on all the units have made sure that a wide range of information is recorded and that people’s expectations about how to care for them is included. The assessment records now accurately reflect the needs of not only the residents with complex mental health needs but also those residents who have dementia care needs. Staff know that residents’ life histories are vital in this type of service and using this information in their everyday practice. The deputy manager is in the process of up dating the assessment tool so it helps staff provide more information about cultural and spiritual needs.
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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 Staff are able to recognize resident’s needs and make sure they receive appropriate health and social care. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Case tracking showed that the staff have a very in depth knowledge of the people using the service and their needs. The manager and deputy managers have worked with staff to make sure the care plans reflect the care that is being offered. On the whole the plans were very clear. But staff just needed to make sure they did not write plans about everything, as staff can only effectively work with people on several needs at a time. Also occasionally staff have to be very straightforward about the actual need that is being addressed. Residents, if able, or their relatives work with staff to write the service user plan. Some of the resident talked about their care plans and were well aware of what was written and why. They also discussed how staff negotiated their care and they could say what they wanted. Throughout the visit staff sought residents’ agreement to undertake any task.
Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 10 Risk assessments are in place but are difficult to use when risk-taking or identifying restrictions. Also they do not clearly assist staff to record exactly how they judge the risk to be unacceptable or what action they are taking to minimise the risk. Therefore staff have been writing these types of assessments in the care plans. The deputy manager is going to look at what tools need to be in place to help staff record this information. Also in light of the Bournewood judgement and Mental Capacity Act how staff can record and justify that the actions they take such as having locked units is the least restrictive for all of the residents. Staff have formed very good links with the local hospitals, consultants and local doctors. Many of the residents continue to see consultants and the consultants regularly visit Briarwood. Staff have repeatedly shown that they can seek out medical support when it is needed. The staff use a wide range of skills to find out what is upsetting residents and how best to resolve people’s concerns. Thus staff have successfully worked with people with people with extremely complex mental health needs and assisted people to reduce the anxiety they experience. Relative’s said ‘the staff are excellent, very capable and really know who to help people’. On the whole the medication system was working effectively. But at times when staff needed to write in the type of medication received they did not include how much was received and when. This made auditing those particular medications difficult. Staff worked well with people. They were very respectful and valued people. Residents said ‘staff were smashing and were always kind’. They said that staff listened to what they wanted and respected their opinion. Throughout the visit staff were extremely attentive and very respectful towards residents. The atmosphere was vibrant and staff appeared to genuinely care for the people using the service and the relatives. Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Staff recognise the need to make sure residents make choices about their lives and as far as possible help people remain independent. Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Throughout the visit staff responded to residents and listened to their views. People were encouraged to complete activities, which reflected their previous lifestyles. The resident’s with complex mental health needs were constantly asked their view and opinion. Case tracking showed that staff worked hard to promote resident’s ability to make decisions about everyday activities as well as those around their future. Residents’ talked about life at the home saying ‘staff are pleasant and helpful’ and talked about the various trips out. Staff on the dementia care units constantly chatted to residents and all enjoyed the friendly banter. Relatives said ‘I couldn’t be more grateful for the care, the staff do a fantastic job and there is never anything to complain about’. A part-time kitchen assistant has been employed and three days a week she makes the evening meal. The senior managers are looking at extending this role, as it has proved to be successful. A new people carrier has been purchased and people are getting out but staff found the space limited.
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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 The manager and staff proactively deal with complaints and concerns. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Residents said that the found the staff and manager ‘listen to you’. Case tracking showed that when people had raised concerns, even minor irritations staff treated these seriously and took action to resolve the issue. Staff did not dismiss people’s opinions and this was evident in how they worked with people to negotiate the care that would be provided at Briarwood. One resident discussed their reluctance to stay at the home but how they realised they had too and how staff tried to help her ‘make the best of it’. Briarwood has an appropriate protection of vulnerable adults policy and follow Gateshead Social Services Department guidance. This guidance does, however, require Mental Health Concern to put in a section about what they would do if an allegation of abuse were made. Staff do not have experience of using the procedures, as allegations of abuse have never been made but staff receive regular training and up dates. Senior managers are aware that if residents behave abusively towards one another that this must be looked at with reference to the POVA guidance and CSCI need to be alerted.
Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 13 Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 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): 19 and 26 Briarwood has been divided into units, which are homely and met residents’ needs. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Over the last year Briarwood has been completely refurbished. Up to date adapted baths and showers have been installed. The bedrooms sizes have been increased and smaller more homely units have been created for the care of all residents. One of the dementia care units has moved downstairs so residents can easily go out into the garden. The way the dementia care units have been decorated in a way that makes sure people can find their way around. Mental Health Concern has taken note of good practice guidance around environmental adjustments that can be made to assist people use the units. Over the forthcoming years these developments will be put into practice. All of the decorative works have been conducted to a high standard. Plus further work is being completed to make a separate entrance for the supportive rehab unit. A specialist gardener with dementia care experience is redesigning the garden. The home was clean and tidy.
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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 Staff are very skilled and readily support residents to meet their needs. Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Two nurses and 6 support staff work during the day. During the night a nurse and 4 support staff are on duty. Plus the manager and deputy managers work for a large part of the week in a supernumerary capacity. Domestic staff provide 40 hours cover per week and a kitchen assistant works 10 hours per week. These staffing levels mean staff can assist residents to cope with their complex mental health needs and difficulties dealing with everyday life. Relatives from the dementia care unit choose to come in during mealtimes to assist their loved ones to eat and staff on the units appreciates this. Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. Mandatory training such as food hygiene is being completed. 82 of care staff have completed NVQ training and the qualified staff are able to go on various courses including degrees. Staff records are kept centrally but these can be seen via an intranet link. Personnel staff make sure that CRB checks are completed, references obtained and full employment histories taken. The manager ensures new staff are supervised until the induction training has been completed.
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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 Overall management systems need improving but the home’s systems are effective. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The manager is competent and appropriately qualified for her role. She is also very forward thinking and is always making sure staff develop their practices so they are cutting edge. The addition of the acting deputy manager has strengthened the already effective management team. This team collaborate to keep abreast of developments in mental health and dementia care. The team are now very effective at cascading this to all of the staff. The dementia care staff are now highly motivated to use new person-centred practices and were constantly used these practices. Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 17 Recently CSCI has not been notified of incidents although agreed procedures were in place whereby alerts would be made via email. The senior manager was made aware of this problem and has taken action to resolve the problem. Mental Health Concern has a very comprehensive quality assurance that is repeatedly tested and amended when shortfalls are found. A team of finance staff at the head quarters look after the personal allowance records. Relatives and resident’s when they need information can get this from the manager via the intranet system. Only small amounts of money are held on behalf of residents. Receipts are kept. When money collects in the accounts held at head quarters this is sent to the appointee or relative to put in the person’s savings accounts. There were no health and safety issues noted at the time of the inspection. Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 18 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? No 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 12(2) Sch3 (3)(q) Requirement Information must be recorded around restrictions that are imposed. These measures must be the least restrictive. The risk assessment tool must be extended to assist staff record restrictions, risk-taking and risk reduction measures. 2. YA39 37 CSCI must be notified of incidents affecting the well being of service users. 26/10/06 Timescale for action 07/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Briarwood Nursing Home DS0000018169.V304213.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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