CARE HOMES FOR OLDER PEOPLE
Briarwood Rest Home 1-3 Todd Lane South Lostock Hall Preston Lancashire PR5 5XD Lead Inspector
Denise Upton Unannounced Inspection 26th September 2005 1:00 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 Rest Home DS0000063007.V252505.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 Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Briarwood Rest Home Address 1-3 Todd Lane South Lostock Hall Preston Lancashire PR5 5XD 01772 626177 01772 626177 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) Briarwood Rest Home Ltd Mrs Indrannee Pumbien Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 24 service users to include up to 24 service users in the category OP (Old Age not falling within any other category). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 2nd June 2005 2. 3. Date of last inspection Brief Description of the Service: Briarwood Rest Home is currently registered to accommodate up to 24 older people who do not require nursing care. The home is located in a quiet residential area but in close proximity to the main shopping area of Lostock Hall and community facilities and resourses. The accommodation is arranged over two floors with all current service users accommodated in single bedroom accommodation, however shared rooms are available if required. Communal areas of the home consist of a main lounge area, a dining room that leads onto a conservatory and a smaller lounge that is the designated smoking area. Although bedroom accommodation does not provide an ensuite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with appropriate aids to promote independence. A passenger lift and stair lift are provided. The grounds to the house are limited in size but carefully laid out and provided with tables and seating for service users to enjoy. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over an afternoon and early evening period of one day and a short period of another day. The inspector spoke with homeowner, deputy manager and a senior care staff that were on duty during the course of the visits. In addition, 10 of the 21 residents living at the home were spoken with either individually or collectively in the lounge areas of the home and a relative of a resident was also spoken with individually. During the course of the inspection, 10 residents also completed The Commission For Social Care Inspection service user comment cards. This provided further information on how residents felt that Briarwood Rest Home was meeting the needs and requirements of people who live at the home. A number of records and policies and procedures were also examined and a tour of the building took place that included communal areas, some bedroom accommodation and kitchen and laundry facilities. The majority of the core standards regarding Care Homes for Older People had been assessed at the last inspection that took place in June 2005. The outstanding eight core standards were assessed at this inspection along with a reassessment of the requirement and recommendations identified at the last inspection. What the service does well:
Briarwood Care Home has a group of staff that work well together and are keen to provide a high quality service to residents who live at the home. Residents spoken with felt well cared for and stated they were very pleased with the individual care and support received. One resident said that she was ‘very happy with the staff’ who were ‘all very good’ and another resident reported that staff were ‘wonderful’ and she enjoyed ‘doing what I want to when I want to’. Mealtimes and the quality and variety of the food served are also very important and residents spoke highly of the meals and dining arrangements. Meals are varied, well balanced and nicely presented offering choice and variety. The staff team manage the daily activities and entertainment well, providing opportunities for residents to join with activities both inside and outside of the home. Visitors are made welcome at any time of the resident’s choice and there are good links with the local community.
Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 6 The home and grounds are maintained to a high standard providing residents with comfortable surroundings in which to live. All service users spoken with were very satisfied with their individual bedroom accommodation that is furnished in a style to suit the individual resident. What has improved since the last inspection? What they could do better:
The manager and staff at Briarwood Care Home work hard to ensure that the needs of residents are well met and that people feel comfortable living at the home. However there are some things identified at this inspection that could be improved. The homeowner/manager should complete the NVQ Level 4 qualification in care and management. This is a nationally recognised qualification that provides managers in care homes with advanced skills in providing care and in managing a care home. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 7 Although there is an induction training programme available for newly appointed staff, this should be evidenced against nationally recognised induction training standards to make sure that all new care staff receive the correct level of training. Residents monies and valuables are kept securely locked, however all transactions should be accurately recorded and receipts provided for anything placed in safekeeping. 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 Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the six standards were assessed in full at this inspection. However Standard 1 was partially assessed following a recommendation made in the last inspection report. EVIDENCE: None of the six standards were assessed in full at this inspection. However in the previous inspection report, it was recommended that the collated views of service users accommodated be incorporated in the Service User Guide. It was clearly evident that service user questionnaires had been provided and completed by a number of current service users. No new service users have been admitted since the last inspection however it is understood that when a new service user is admitted to the home, this collated information will be identified in the Service User Guide provided. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 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 & 9 partially assessed. None of the five standards were assessed in full at this inspection however Standard 7 and 9 were partially assessed following a recommendation in the last inspection report. EVIDENCE: None of the five standards were assessed in full at this inspection however it was noted that the recommendation identified in the last inspection report to ensure that care plans, wherever possible, be signed by the service user or their representative has been implemented. It was also noted that when a service user chooses not to become involved in the care planning process or sign their care plan this is now recorded. Since the last inspection all staff except very recently appointed staff have now received appropriate medication training. Briarwood Rest Home DS0000063007.V252505.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): 12, 13, 14 & 15 Service users are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. The routines of daily living are kept flexible to enable service users to live the lifestyle of their choice. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choice. EVIDENCE: During the course of the inspection it was observed that the routines of daily living and activities remain flexible and varied to meet individually assessed needs. Service users are enabled to exercise choice in all aspects of their daily life, that was confirmed through discussion with several service users. Social relationships are encouraged either through family/friends visiting at a time of the service users choice or social stimulation in the wider community. ‘In house’ activities usually take place on a daily basis. This includes bingo, board games, blackboard quiz and musical movement. ‘Pampering’ sessions are also arranged to attend to nail care and hair care. One resident spoken with said that he particularly enjoyed listening to music either from the radio or records/tapes and there is also very regular contact from various churches
Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 12 of different dominations that visit to conduct services for residents who wish to participate. In addition, occasional trips out in a mini bus are arranged as well as visits out in the community with family members. Almost all residents who were spoken with or who completed the Commission For Social Care Inspection comment card said that suitable activities were provided at the home. However one resident did say that she wished that staff had enough time to take her out in the wheelchair for a walk round more often. Details of up to date activities are circulated to residents in a variety of formats that includes individual discussion, written information about planned activities displayed in a prominent place the home and through the provision of an occasional newsletter. The home’s Statement of Purpose and Service Users Guide states that service users are able to receive visitors at any reasonable time, dependent on the wishes of the service user. A relative spoken with during the course of the inspection confirmed that she could visit her mother at any time and was always made to feel very welcome. From observation it was apparent that there is a good relationship between family, staff and residents living at the home. Policies within the home state that all residents would be encouraged to handle their own financial affairs for as long as possible if this was their wish. Information regarding the local advocacy service is made available for residents and their relatives to access independently if required. From observation and discussion, it was evident that residents are encouraged to bring some of their own possessions with them into the home to make their individual bedroom feel homely and more familiar and an inventory of these possessions is kept on the resident’s file. Briarwood Care Home offers a varied, wholesome and nutritious diet with menus designed to incorporate the known likes and dislikes of residents accommodated. Specialist diets in respect of religious, cultural or medical need can be accommodated and as observed, hot and cold drinks and snacks are made available throughout the day. Service users spoken with were positive in their comments regarding the quality and variety of the meals served, which was further reinforced through comments made on the Commission For Social Care Inspection comment cards. One resident described the meals as ‘very good’ and confirmed a choice is made available and another resident also said that the meals were ‘very good’ and that she always enjoyed the food served. Although there is a rotating menu available, main meals are generally determined by what is in season and the variety of fresh fruit and vegetables available. From observation it was noted that the teatime meal served was attractively presented and residents spoken with stated they had enjoyed the Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 13 meal. Staff discreetly and sensitively offer assistance when required both with selecting a menu and at actual meal times. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 in part None of the three standards were assessed in full at this inspection. EVIDENCE: None of the three standards were assessed in full at this inspection however it was noted that as recommended in the last inspection report, a form has been devised to record details of any complaint that may be made and the staff group received updated adult abuse training in August 2005. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 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 the following standard(s): 19 & 26 The standard of the environment within this home is very good providing service users with a safe, comfortable, attractive and homely place to live. EVIDENCE: Residents at Briarwood Care Home live in well-maintained accommodation that is domestic in character and has been designed to meet the individual and collective needs of residents accommodated. The home is situated in the village of Lostock Hall with local shops and community facilities close by. There is a large lawned area to the front of the home and a landscaped patio area with tables and seating to the rear of the building that resident’s can enjoy in the summer months. The layout of the home gives residents opportunity to move freely round the building and access all areas with ease. The home is well maintained, tastefully decorated and offers alternative lounges including a conservatory to the rear of the building and designated smoking lounge. There is a passenger lift and alternative stair lift available to access first floor
Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 16 accommodation. Bedrooms are bright, airy and comfortable furnished to suit the needs and requirements of the individual occupant. It is understood that consideration is still being given to the options available in order to install a new assisted bath or shower to the ground floor of the home. All residents and the relative spoken with were pleased with the individual bedroom accommodation and the communal space available. One resident who chooses to spend most of the waking day in her bedroom said she was very comfortable in her private space and that she just had to press the nurse alarm system and a member of staff would come if she needed any help. The home was clean, hygienic and free from offensive odours at the time of this inspection. The relative spoken with who visits on a daily basis, was keen to point out that the home was always very clean, well kept and well maintained. Policies were in place with regard to infection control and staff had protective clothing. Since the last inspection, arrangements have been made for staff to undertake infection control training that is due to take place in the near future. The home had a separate laundry area that does not intrude on service users and the washing machine has the specific programming ability to meet disinfection standards. Separate hand-washing facilities are also available in the laundry area. It is understood that the home complies with the Water Supply (Water Fittings) Regulations 1999. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 17 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 Standards 28, 29 & 30 were also partially assessed. Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their quality of life. Since the last inspection the standard of vetting prospective members of staff has improved that has helped protect service users from potential harm. EVIDENCE: Briarwood House staffing levels and skills mix are determined in accordance with the assessed needs of residents currently accommodated. Whilst it is understood that at this present time, the home owner considers that the ‘waking day’ care staffing levels are adequate to address current residents individual needs and requirements, care staffing levels should be keep under constant review and amended as required particularly if the dependency needs of a particular resident increases or a resident with high dependency needs is admitted to the home. All night staff have ‘waking watch’ responsibility and there is sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. In the main, staff spoken with stated that they considered care-staffing levels to be adequate to address current residents strengths and needs. Residents spoke highly of the staff team with several people describing them as ‘very good’ or ‘wonderful’. Another resident said that the staff group were very ‘helpful and kind’ and that he felt well cared for living at the home. The relative spoken with also praised the staff group saying that ‘staff are very patient and always pleasant and polite to all residents’.
Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 18 The standard in respect of staff recruitment was not fully inspected at this inspection. However it was evident that recruitment practices have improved since the last inspection with all the required references and clearances having been obtained and deemed satisfactory prior to a newly appointed member of staff actually commencing employment at the home. A further number of staff have also commenced nationally recognised NVQ training in care since the last inspection however it is still recommended that current induction training be evidenced against the ‘Skills For Care’ induction requirements to ensure compliance. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 19 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): 35 Standards 31 & 33 were also partly assessed following recommendations. Systems are in place to ensure that resident’s financial interests are safeguarded. However some improvement could be made to recording information to make sure an accurate record is maintained. EVIDENCE: Service users financial interests are safeguarded by the financial procedures adopted by the home. All service users, wherever possible, are encouraged to remain financially independent or assisted in this task by a family member. When the home does retains monies or valuables in respect of a service user, this in the main, is recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the service user. In respect of monies and valuables, it is recommended that if a service user does not have the capacity to sign financial documents when receiving monies from safe keeping or for monies received from a resident into safe keeping, a second
Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 20 member of staff should witness the transaction and counter sign the first staff members signature. At the time of inspection it was noted that although the actual monies of one resident was correct, the documentation maintained with regard to ingoing and outgoing expenditure had been wrongly recorded. It is recommended that the financial transactions of this resident be recorded accurately and reference made to the mistake. Likewise, a piece of jewellery had been received into safekeeping but this had not been recorded except briefly in the service user’s file, however the resident had not been provided with a written receipt. It is strongly recommended that a written receipt signed by the person receiving the item and where ever possible, the service user be always provided and a copy kept by the home when anything is placed in safe keeping or returned to the service user. Through discussion with the registered proprietor/manager, it is understood that the NVQ Level 4 qualification in care and management is now almost completed. In addition, a questionnaire has recently been developed in respect of other stakeholders to supplement the questionnaires already in existence in respect of service users and relatives. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 21 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 22 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP21 OP28 OP31 OP35 Good Practice Recommendations The registered manager should continue with installing an assisted bath or shower on the ground floor. At least 50 of the care staff team should have achieved at minimum NVQ 2 by 2005. The registered manager should continue to work towards achieving an appropriate NVQ Level 4 qualification. A second member of staff should witness and countersign the 1st member of staff’s signature if a specific service user does not have capacity to sign the document themselves. A receipt should be issued when items are placed in safekeeping or returned to the service user. Briarwood Rest Home DS0000063007.V252505.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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