CARE HOMES FOR OLDER PEOPLE
Briarwood Nursing Home Whitmore Road Blaydon Tyne & Wear NE21 4AN Lead Inspector
Mrs Katie Tucker Unannounced Inspection 8th December 2005 10:00 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.V254160.R01.S.doc Version 5.0 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.V254160.R01.S.doc Version 5.0 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.V254160.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th June 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. 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 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.V254160.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Briarwood inspection was carried out as part of the routine yearly programme. No one working for Mental Health Concern was told that the visit was to take place. An inspector visted Pinetree Lodge and spent 8 hours at home. The inspector looked at the residents’ records, staff training records and staff information. The staff were asked about the residents’ records, the guidelines for protecting residents, their training, staffing levels and changes to working practices. The residents and relatives were asked similar questions. Pinetree Lodge provides a service for people with memory loss. So some of the people have difficulty making their views known. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection key standards were focused on but not all were checked. What the service does well:
The manager and deputy manager are very competent. They understand the needs of the service and care a great deal about the resident’s. And, they are very skilled at identifying where there are gaps in the service being offered and putting successful measures in place to improve practices. The manager and deputy manager constantly kept abreast of new developments around looking after people with mental health care needs. Where new practices are appropriate for the service they help staff introduce them at the home. Staff work well with residents and clearly care a great deal about them. Staff chatted to residents and listened to people’s views. The staff valued resident’s wishes and responded to what people wanted. Thus people could choose what meals they had even when this was a choice different to what was available. There was lots of friendly banter going on through the day, which everybody enjoyed. 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 identify and meet residents’ needs. 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. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 6 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 opportunities for people with mental health need to gain employment. A full redecoration programme has been completed. This programme has also included making bedrooms larger, upgrading all of the facilities and providing dementia care services downstairs so that people can readily access the enclosed garden. 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.V254160.R01.S.doc Version 5.0 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.V254160.R01.S.doc Version 5.0 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 Staff are in the process of completing the wide range of assessment records are available. Therefore 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 give information about the needs of people with a dementia- type illness. It is a very comprehensive tool, which provides a lot of information about all aspects of people’s lives and needs. Staff on the dementia care unit are at times only putting a limited amount of information in. An assessment tool is in place for the younger adults who experience longterm mental health needs. The staff on younger adults unit have been using this tool for some time and write full and detailed information in these records. Staff know that residents’ life histories are vital in this type of service. People with dementia tend to revert to previous routines and patterns of behaviour. When staff know the history they can work more effectively with people and reduce people’s anxieties and frustrations. Once the staffing issues have been resolved they are intending to concentrate on this aspect of the service.
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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 and 10 Although the staff in practice show that they help service users to make decisions about their lives, are aware of associated risks and plan people’s care, this is not always reflected within the care plan. EVIDENCE: The staff have a very in depth knowledge of the people using the service and their needs. The manager is working with staff to make sure full assessment information and care plans are put in place. 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. Generic risk assessments are in place, which refer physical needs but not other risks such aggression, social and emotional vulnerability. Also there are no risk-taking plans. These would identify the strengths people have and the common day risk that would be acceptable for someone to take. Because of the nature of their needs some of the residents cannot do everything they would want. Staff need to record information about people’s
Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 10 choices and wishes that cannot be respected. Also Briarwood’s house rules need to be recorded in a standard contract. Staff have formed very good links with the local hospitals. Many of the residents continue to see consultants. Also staff have repeatedly shown that they can seek out medical support when it is needed. Staff have successfully worked with people to reduce the anxiety they experience. The staff use a wide range of skills to find out what is upsetting residents and how best to resolve people’s concerns. Staff worked well with people. They were very respectful and valued people. Residents said ‘staff were very good and were always kind’. They said that staff listened to what they wanted and respected their opinion. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 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): 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. The addition of catering staff will benefit the service. EVIDENCE: Staff are very attentive to residents needs and social interactions. Staff are spending more time helping residents on the dementia care unit to keep the skills and to do as much for themselves, as they can. Staff continue to develop 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. Staff worked in partnership with people and consistently asked for residents’ opinions on all of the units. 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 and relatives have spoken highly about the attitude of the staff. People have said ‘the staff are very kind and thoughtful’ and ‘the girls are nice and kind.’ 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
Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 12 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 reduce the level of support residents receive. Mental Health Concern agreed to provide dedicated kitchen staff for Pinetree Lodge. This has not yet happened. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The manager follows the local authorities protection of vulnerable adults procedures. EVIDENCE: 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 have had training around protecting residents. The Social Service Department is in the process of organising training for all the staff working in care. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 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 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 are being looked at to make 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. 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. 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 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 care staffing levels at the home remain well in excess of those required by the previous registering authority and this greatly benefits the residents. The core staffing team is 2 first level nurses (RMN) and seven care staff are on duty during the day and during the night a 1st level nurse (RMN) and four care staff but often more staff are on duty. The manager is not counted in the staffing numbers. The manager is in the process of recruiting staff to work in the kitchen and laundry, which will allow care staff to concentrate solely on the care needs of residents. Mental Health Concern has a dedicated training department. This department provides staff with opportunities to go on a wide range of training. 90 of care staff have completed NVQ training. The nurses and care staff are able to go on various courses including degrees. Plus secondment opportunities are provided for staff that wish to complete nursing qualifications. 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 was made aware that there have been some changes to the regulations around employment and new staff now need to be 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, 35 and 38 The manager is competent and makes sure the service meets the needs of residents. Shortfalls in fire training could affect residents’ safety. EVIDENCE: The manager is competent and holds appropriate management qualifications as well as being a registered nurse. She constantly makes sure her practices are line with recognised good practice. With her skilled deputy manager support they provide strong overall management of the home. 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 people’s savings accounts.
Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 17 The Fire Log book again showed that staff had not received the required number of instruction periods and drills. Staff that complete night work must have fire instructions every 3 months and new starters, including students must receive two periods of instruction in the first month. All instructions and drills must be accurately recorded otherwise staff cannot demonstrate they are competent and safe in this area of practice. Staff confirmed that they all were receiving updates in two weeks time. The manager is continuing to review the number of qualified first aiders so sufficient are on duty over the 24 hour period. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 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 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X X X 3 X X 2 Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 15 (2) Requirement Social profiles for the service users with dementia-type illnesses must be included in the assessment. (Required at the last inspection – timescale 23/01/06) All service users assessments must be completed. Information must be recorded around restrictions that are imposed. Care plans must clearly specify the actions to be taken. Risk-taking assessments must be developed. 3 OP38 13(4)(a) 23(4)(d) All staff must receive fire instruction, in accordance with the guidance contained within the fire logbook. 16/02/06 Timescale for action 08/06/06 2. OP7 12(2) Sch 3(3) (q) 08/06/06 Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 20 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. Refer to Standard OP19 Good Practice Recommendations The manager should continue to develop the environment in the dementia care units so it is service user friendly. Briarwood Nursing Home DS0000018169.V254160.R01.S.doc Version 5.0 Page 21 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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