CARE HOMES FOR OLDER PEOPLE
Briarwood Nursing Home Whitmore Road Blaydon Ryton NE21 4AN Lead Inspector
Katie Tucker Unannounced 29 June 2005 10:00am 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 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 B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Briarwood Nursing Home Address Whitmore Road Blaydon Ryton Tyne and Wear NE21 4AN 0191 414 8374 0191 414 1699 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mental Health Concern Mrs Janet Mole Care home with nursing 33 Category(ies) of MD(E) Mental Disorder -over 65 (12) registration, with number DE(E) Dementia - over 65 (21) of places DE Dementia (5) MD Mental Disorder (12) Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 26/01/05 Brief Description of the Service: Briarwood nursing home was built in the late 1960’s by the local authority to provide nursing and personal care for older people with dementia care or mental health needs. Briarwood has recently undergone a full refurbishment and is now divided into three units. The two units upstairs are used for the care of those with a dementia type illness and long-term care of people with complex mental health needs. The downstairs unit provides care for people who will require long term for their dementia care needs. All of the units have communal areas as well as bathrooms, toilets and bedrooms. The administration are 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 it’s own grounds and is surrounded by a mix of houses. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection of Briarwood Nursing Home, which was conducted as part of the routine yearly programme. An inspector spent 7 hours at the home and spoke to 16 service users and visiting relatives. A sample of assessments, care plans and risk assessments and the complaints procedures were examined. The staff were asked about the service user plans, the complaints procedure, access to training and any changes to working practices, as were the service users. The general maintenance of the building was checked. Briarwood provides a service for people with a dementia-type illness (memory loss) as well as for people with mental health needs. Some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were observed and judgements were made on how well the approaches that were used were working. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. During this inspection key standards were focused on but not all were checked. What the service does well:
Since taking over the operation of the home the manager has greatly assist staff improve the range of skills and techniques they use to promote residents sense of well-being. The manager and deputy manager consistently review practices to ensure they are recognised as current good practice. The manager and deputy manager are extremely competent at identifying shortfalls in the service and putting measures in place to rectify these issues. The constant high care staffing levels and number of qualified nurses, who specialise in caring for the needs of people with dementia and mental health needs, ensures staff can readily identify and meet residents needs. The manager ensures new skilled staff are recruited and recently a nurse who also has a degree in the care of people with dementia has been employed. The staff have also shown that they are skilled at working with people who have 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
Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 6 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 and Briarwood actively promote the recognition of people with mental health needs as full citizens. They run service user boards and provide opportunities for people with mental health needs to access 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 B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 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 standard(s) 3 A wide range of records are available but staff are in the process of completing them. Therefore some minor and major shortfalls will continue to exist until these are completed. EVIDENCE: A new assessment document has been introduced in the home. This has been specifically designed to provide information on the needs and experiences of those people with a dementia- type illness. This is a very comprehensive tool, which is starting to generate comprehensive information about all aspects of people’s lives and needs. A second assessment tool is in place for the younger adults who experience long-term mental health needs. Staff are in the process of completing the assessments for all of the residents. They see the development of the assessment tools as an ongoing process whereby amendments can and will be made and reviewed. Thus it is hoped that the assessment will become a very valuable and useable tool, which will assist them to meet the needs of the residents. Most people have a dementia-type illness and the generation of life histories for these people must be treated as a priority. Questions on the life histories
Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 9 need to cover people’s personality traits when they were younger, events that occurred and their feelings at that time, routines and jobs or roles. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. Thus staff can work around a routine such as a person who has always worked nightshift may have what seems to be a disturbed sleep pattern but in fact it is the norm for this person. Therefore staff can ensure that meals and activities are provided during the night. The operational manager is completing ‘formulations’ for people, which cover various aspects of people’s lives and staff once these are completed will produce narrative style pen pictures. Staff are also looking to see if they can use people’s old photographs to make these histories more pertinent and useable. Thus reminiscence sessions can be tailored around people’s lives and therefore be much more appropriate and stress-free. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 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 standard(s) 7 and 9 Although the staff in practice demonstrate that they help service users to make decisions about their lives, are aware of associated risks and plan people’s care, this is not reflected within the care plan. EVIDENCE: Over the last year the manager has been helping staff to develop the skills needed to complete care plans. Gaps and shortfalls in care planning are still apparent, especially about identifying and planning care around people’s emotional and social lives, as well as challenging behaviours. The service users have the potential to challenge staff in many ways including passive challenge whereby they will not work with staff to address an identified need. The plans as yet do not give full guidance to staff about meeting the needs of people who challenge in these ways. For example identifying primary and secondary actions and how the staff intend to work with the individual to meet the unmet needs that are leading to the display of challenging behaviour. Staff in practice demonstrate that they understand the need for various strategies and use a variety in every situation be this is not evidenced. Also one of the staff members is responsible for co-ordinating challenging behaviour training and staff receive regular up-dates in on this area of practice. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 11 Also risk-taking assessments are not sufficiently detailed. These types of plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. Staff need to be confident that people can continue to safely use their skills. It is vital that the level of risk presented to resident’s from continuing an activity would be outweighed by the service users level of skill and the quality of life it would lead too, is recorded. Some of the information recorded in the daily notes and evaluations is either very general or inappropriate. Terms such as ‘supportive Lorazepam’ are used whereas the medication was given because of its sedative powers. This type of contradictory information is unhelpful and could be misleading. Recently medical students visited and asked to complete a case study. The students have not supplied a copy of this and it would be helpful if they did. Also one of the residents has very complex needs and over the years has been examined by a number of consultants it was expected that research papers could have been written about this person and if the manager could obtain them they would prove very useful for assisting staff to further understand the person’s needs. Some of the residents because of the nature of there needs have limitations imposed upon them by the service such as needing someone to accompany them when they leave the building. Staff have started to record limitations in place for individuals. The manager is also aware that should generic limitations be in place because of Briarwood’s rules this would be recorded in a standard contract. Residents, who we able discussed their care and how staff involved them when they were completing care plans. People said they were asked their views about the service offered at Briarwood. Staff are exploring how to further the inclusion of people in the record keeping. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 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 standard(s) 12 and 15 The addition of kitchen staff will ensure those residents who are frail dietary needs can be more readily met. The range of activities on the younger person’s active rehab unit is wider and people go out more regularly. However Mental Health Concerns recognises this difference and are putting measures in place such as sensory gardens and the purchase of a mini bus to rectify the situation. EVIDENCE: Staff are very attentive to residents needs and social interactions. However staff have found promoting a greater level of independence for those on the dementia care unit more of a challenge. It was evident that staff are developing the confidence and skills to make decisions around risk-taking. The manager is continuing to look at how further action can be taken to promote this level of independence. Service users made choices about the activities that they completed. Staff worked in partnership with people and consistently asked for service users opinions on all of the units. The range of activities on the dementia care units are in the process of being tailored to individuals life experiences but at the inspection this was seen to often involve sedentary occupation. Technical instructors are employed to provide a range of activities at various times during the week. However an
Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 13 open access sensory garden is being developed. Also a people carrier is being purchased so this should give people wider access to the community. The people living on the supportive rehab unit are able following the completion of a risk assessment are able to go to local shops or further a field on their own. Residents actively choose the types of activities they would wish to pursue. Residents and relatives spoke highly about the attitude of the staff. People said ‘the staff are very kind and thoughtful’ and ‘the girls are nice and kind.’ Staff were asked to give consideration to how they could meet the spiritual needs of residents who had been devote churchgoers all of their lives. These people would if living at home continued to go to their local church and this opportunity needs to continue. Briarwood operates a cook/chill method for providing meals. Thus meals are sent to home prepared and staff then heat them. At present the home does not have kitchen staff and care staff complete this as part of their daily routine. Thus staff take time out from providing care to attend to the breakfast, dinner, tea and supper including making alternative meals and supplement. This at times can have a detrimental effect on the level of support residents receive. At the last inspection Mental Health Concern were ask to review this practice and consider providing dedicated kitchen staff who could be making the meals and alternatives throughout the day and monitoring the overall dietary intake of the service user group. Mental Health Concern are now in the process of employing kitchen assistants from the club they run for people with mental health needs. The kitchen assistants will receive the appropriate training and be able to prepare snacks and alternatives as well as operating the cook/chill ovens. This should ensure that the wait for a meal is reduced and residents receive more support prior and after meals. Also if people are not hungry at lunchtime an additional snack such as soup, finger foods or sandwiches can be provided. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 The complaints procedure is available and has proved to work effectively. EVIDENCE: Mental Health Concern developed a complaints procedure, which complies with the requirements of both the national minimum standards and Care Home Regulations 2001. This is reproduced in the service user guide and made available to residents or their representative. The manager recognises the importance of dealing with minor concerns in a proactive manner. Since taking over the operation of the Briarwood she has actively encouraged residents and relatives make their views known. Where people have raised concerns she has dealt with these to the satisfaction of all concerned and ensured the actions have been sustained. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19 The refurbishment of Briarwood has greatly improved the environment residents live in. action is being taken to make the dementia care units meet the Disability Discrimination Act 1995 and user friendly. 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 are being decorated is in compliance with the Disability Discrimination Act 1995 and reasonable adjustments are being made so that people with a dementia can more easily 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. These continue to be put in place. 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.
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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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The high staffing levels and introduction of additional kitchen and laundry staff will further enhance the care service provided and the quality of life experienced by the residents. EVIDENCE: The staffing levels at the home remain well in excess of those required by the previous registering authority and this greatly benefits the residents. The organisation has set their staffing level at a minimum of 2 first level nurse (RMN) and 7 care staff during the day. During the night 1 first level nurse (RMN) and 3 care staff are provided. Domestic staff are provided and staff are being employed to complete tasks in the kitchen and laundry. Two technical instructors are employed to provide occupational therapy and activities. The manager on the whole works in a supernumerary capacity. Skilled deputy managers support her and this combination has allowed a strong overall management of the home to develop. Since the last inspection Mental Health Concern have again increased care staff hours to meet the dependency needs of the residents. Thus two part-time posts have now been increased to full-time. Also the manager has been recruiting new staff including qualified nurses. Although agreements have been made with CSCI around skill mix of nurses the manager found a good range of highly skilled RMN’s applied for either transfer or work at Briarwood. This included one nurse, who has also completed a degree in dementia care, which it is hoped will assist all staff to readily update their knowledge and practice.
Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38 The management and administration of the home ensures the safety and well being of service users. EVIDENCE: Mental Health Concern has developed a robust quality assurance system, which includes a service user board. This board is made up of residents and relatives and they actively review the care being offered across all of the services operated by the organisation. Also a number of the operational managers visit each home to conduct different audits of the service being offered and this information is provided to the local CSCI office. There were no health and safety issues noted at the time of the inspection. Following the last inspection a number of high/low beds have been provided so staff no longer need to use bed rails or nurse people on a mattress on the
Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 18 floor, which greatly improves the quality of life and outcomes for people using the service. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 4 x x x x x x x STAFFING Standard No Score 27 4 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 x x 4 x 4 x x x x 3 Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 20 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 3 Regulation 15 (2) Requirement Social profiles for the service users with dementia-type illnesses must be included in the assessment. The assessment tools must be completed for all of the service users. Staff must continue to compile information on all areas of service users lives where limitations or restrictions are in place. (required at previous inspections -timescale 27.07.05) Care plans must clearly specify the actions to be taken. Risk assessments and risk-taking assessments must continue to be developed. Timescale for action 23.01.06 2. 7 12 (2) Schedule 3 (3) (q) 26.09.05 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 Good Practice Recommendations
B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 21 Briarwood Nursing Home 1. Standard 19 The manager should continue to develop the environment in the dementia care units so it is service user friendly. Briarwood Nursing Home B52 B02 S18169 Briarwood V219526 29 Jun 2005 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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