CARE HOMES FOR OLDER PEOPLE
Briercliffe Lodge Rainhall Crescent Barnoldswick Lancashire BB18 6BS Lead Inspector
Mrs Jennifer M Turner Key Unannounced Inspection 10:30 23rd August 2007 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 Briercliffe Lodge DS0000009479.V336388.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. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Briercliffe Lodge Address Rainhall Crescent Barnoldswick Lancashire BB18 6BS 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) 01282 816638 01282 816638 briercliffelodge@aol.com Mrs Gillian Eyton-Jones Mrs Rebecca Eyton-Jones Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing levels as specified in notice of proposal to grant registration subject to conditions dated 25 October 2002 13th December 2006 Date of last inspection Brief Description of the Service: Briercliffe Lodge is registered to provide accommodation and personal care for seventeen older people. The home is owned and managed by Mrs Gillian Eyton-Jones and Mrs Rebecca Eyton-Jones. The home is a detached property set in its own grounds, with outdoor seating areas and car parking facilities. It is located in a residential area on the outskirts of Barnoldswick. Accommodation is provided on two floors in thirteen single and two double bedrooms. The upper floor bedrooms can be reached by using a stair lift. There are comfortable lounges, dining rooms and a conservatory. There are two assisted bathrooms and seven bedrooms with en suite facilities. At the time of the inspection, the scale of fees ranged from £342.50p £390.00p. Additional charges are made for hairdressing, private chiropody, holidays, personal magazines and newspapers and individual activities. Information is available in a Statement of Purpose and Service Users Guide. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Briercliffe Lodge on 23rd August 2007 over a five hour period. At the time of the inspection there were fifteen people accommodated in the home and there was one person in hospital. During the course of the inspection, one of the proprietors, a Senior Carer, two care assistants, the cook, a number of residents and relatives were spoken to. A number of residents and staff files were examined, procedures and records were also examined, lunch was taken with the residents, activities were observed and the premises were viewed. Feedback was offered to the proprietor at the end of the inspection. Information from an Annual Quality Assurance Assessment document, two questionnaires received from residents, three questionnaires received from health professionals and four questionnaires received from relatives contributed towards the findings. Requirements made following the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well:
Prior to people moving into the home, their needs were assessed. They were consulted about the level and type of care they required and could visit the home to look for themselves at the facilities offered. A comment made by a resident was, “my daughter found out all the information”. Important information needed to support people in every day living was recorded and used to plan the care they required. This helped to personalise care and show staff what they should do to achieve this. The diverse healthcare needs of the residents were monitored. Staff worked with visiting health professionals for the benefit of residents who felt that they received the care and support they needed. Comments made in surveys indicated that medical support was available if it were needed. The service offered a range of activities that met peoples’ needs and meant that they could enjoy a full and stimulating lifestyle with a variety of options to choose from. They were able to have some say in what activities were provided through the forum of the residents meetings. A variety of activities took place both in the home and within the community. Residents commented
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 6 that they enjoyed “music and movement”, quizzes, dominoes, or “just reading”. A forthcoming barge trip was eagerly discussed. One resident commented, “I can join in or sit and watch if I like”. The service was good at making visitors feel welcome. Visitors spoken to said, “we’re always made welcome”. “They keep us informed by speaking to us when we visit or by ringing us”. Information from the four relatives surveys received indicated that they were kept up to date with important issues about their relative. Residents said that their visitors were “made welcome” and they could “speak with them in private”. Meals were well balanced and nutritional, catering for a wide variety of dietary needs of the residents. Those spoken to said, “the food is good and they give you a choice”, “the food’s fine” and “there is always a choice at mealtimes”. Breakfast was served throughout the morning to suit the wishes of the residents. The routines in the home were well established and residents had a choice in the times they went to bed and got up in the morning. One resident said “I like to go to bed early and get up early”. The staff were observed to seek the views of residents throughout the inspection and residents said they felt comfortable to comment on life in the home. Residents and other people associated with the home said they were satisfied with the service, felt safe and supported. They said, “staff are very attentive and nothing is too much for them”. All staff working in the home knew the importance of taking the views of residents seriously and listening and responding to issues raised. The complaints procedure was clearly displayed and residents and visitors had a clear understanding of the procedure. The service had a highly developed recruitment procedure with staffing levels being sufficient to meet the diverse needs of the current residents. The registered person had a good understanding of equality and diversity throughout the recruitment, induction and training process. The registered person was able to describe a clear vision of the homes values and priorities. Quality Assurance processes were continually used. The homes development plan indicated that the environment was being continually improved with furniture and furnishings being regularly renewed. What has improved since the last inspection?
The changing needs of people are entered into their care plans. This ensures that staff have up to date information relating to residents and are able to meet their changing needs. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 7 Residents and their relatives are included in the care plan reviews. This ensures that people are aware of decisions that are being made about their life. Medication is reviewed every 6 months in relation to “as necessary” instructions. This means that current information is available to staff who administer medication. Records relating to staff recruitment meet the required standard. This ensures that residents are fully protected by a robust recruitment procedure. The electrical installation certificate is renewed when due, fully protecting the health and safety of people in the home. 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. The summary of this inspection report can be made available in other formats on request. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 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 Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3:6 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment procedure was carried out prior to people moving into the home. This meant that their diverse needs were known and met. EVIDENCE: Information written on a pre assessment form, completed by the proprietor, included all the required details and included various health and social care needs and abilities. This information was obtained during a pre admission visit to Briercliffe Lodge or when people were visited either in their own home or in hospital. Prospective residents were actively encouraged to spend some time in the home prior to making the decision to move in. One lady said her daughter had visited the home prior to her admission. Her daughter confirmed this. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 10 The home does not provide Intermediate Care. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7:8:9:10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ diverse healthcare needs were identified and met. Personal care was delivered in a way that promoted residents’ privacy and dignity. EVIDENCE: Three people’s care plans were examined. A variety of risk assessments were completed in response to individual needs and circumstances, and information was included in the care plan. Records showed that care plans were reviewed on a monthly basis or more frequently if required. Relatives were invited to attend reviews and records showed that residents, relatives and staff signed the documentation. Residents, relatives and staff spoken with indicated that people received appropriate medical and health support when required. Records showed that moving and handling assessments were carried out as appropriate and that people received attention from a variety of health care professionals. All
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 12 contact was recorded in residents’ files. procedures were available. Various health care policies and The medication and records were checked for three residents. All were correct. A monitored dosage system was used for the administration of medication. Policies and procedures were available to cover all aspects of managing medication in the home. Appropriate records were in place to record the receipt, administration and disposal of medication. Systems were in place for the management of controlled drugs. Records showed that all the staff designated to administer medication had received accredited training. People completed and signed an agreement upon admission stating who they wished to be responsible for administering their medication. Medication records were reviewed monthly and a six monthly review included “variable” and “as necessary” dosages. The Medical Device Alert relating to Lancing Devices was discussed. According to staff, District Nurses would carry out such practices. The residents spoken to felt the staff respected their right to privacy and all made complimentary remarks about the staff, “they are good girls and speak to us kindly” Staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred term of address. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12:13:14:15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ dietary, social, cultural and spiritual needs were being met. They were able to make choices and decisions about their life at the home so that their lifestyle met their preferences. EVIDENCE: There were some very good details in the care plans about residents’ individual routines and social activity. Residents spoken to said that they were able to make choices and were happy with the way that their lives were lived, “ I like to sit quietly and read my books”. Residents were seen to use their rooms as and when they liked. A range of activities was offered to residents and was recorded in an activity file. Records viewed showed what activity the resident had been involved with. Some residents spoken to said how they were able to entertain themselves. They enjoyed “music and movement” and staff asked people at lunchtime if they wished to join the afternoon baking session. Some people would go out with staff locally or on country drives. A forthcoming barge trip was discussed. Activities to be undertaken were discussed at the residents meeting. It was evident from the daily records that residents were
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 14 offered the opportunity to go out whenever they wished. visited the home on a regular basis to offer the Sacrament. Spiritual Leaders Visitors spoken with said that they were made welcome at any reasonable time. They could see people in private in their room or in the lounge areas or sit outside in the shade. Information relating to the visiting policy was written in the Statement of Purpose and Service Users Guide. Those residents who were able were encouraged to handle their own personal allowance, although relatives said that they were involved with the payment of fees. Information relating to advocacy was available. Residents had access to their personal records through their involvement with care plans and the review process. One resident commented that he was “involved with care plan reviews” and had the opportunity to “have a say”. Menus and records of meals served, showed that a balanced diet was being offered. There was a hot meal offered at both lunch and teatime. Alternatives to the menu were also specified. Residents could have their meals in their rooms if they wished but were encouraged to eat in the dining room for the social interaction. Drinks were served with every meal and also in-between times. The meal on the day of inspection was nicely presented and looked appetising. The atmosphere in the dining room was pleasant and unhurried. People commented that “meals are very good” and “there is always a choice at mealtimes”. The menu was displayed in the hallway and residents were aware of the forthcoming meal. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16:18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents were protected from abuse and had access to the homes complaints procedure. EVIDENCE: The complaints procedure was included in the Service Users Guide and was seen displayed in the entrance hall. The procedure contained the necessary information should a resident wish to raise a concern with the home, the Commission, Social Services, or a variety of health professionals. No complaints had been recorded in the complaints book since the last inspection. Residents were aware of the procedure and knew who to speak to if they had a concern. Although one of the visitors said she had not seen a copy of the complaints procedure, she told the inspector that she would speak to the proprietor if there were problems and “if it wasn’t sorted, I suppose I would speak to you”. A copy of the Department of Health document “No Secrets” and “No Secrets in Lancashire” were readily available along with the homes “Whistle Blowing” policy. Staff were aware of their responsibilities toward residents and said that appropriate training was available. Records showed that “Protection Of Vulnerable Adult” training took place “in house”. The registered person understood the referral system for the Protection Of Vulnerable Adults register but never had to refer anyone.
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19:26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Equipment provided meant that the diverse needs of the client group were met. The home was warm, clean and comfortable with a good standard of hygiene being achieved and residents lived in a safe environment. EVIDENCE: Briercliffe Lodge is a mature detached property set in its own grounds. The residents had access to the garden areas and there was a patio for use in fine weather. The maintenance and repairs book was seen and work carried out linked in with the homes Business Plan. It was signed and dated when the work was completed. The Fire record book was seen and all entries for servicing and testing the fire equipment were up to date. A portable loop system was available for use by people wearing hearing aids. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 17 Equipment in the laundry was sufficient to meet the needs of the home. From information received prior to the inspection and from documentation seen, policies and procedures were in place in respect of the control of infection. The home was clean and hygienic in all areas seen, during the inspection. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27:28:29:30 Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. Staff were recruited using current guidance and received appropriate training. This meant that the diverse needs of the residents were met. EVIDENCE: Records showed that there were sufficient numbers of staff on duty to meet the diverse needs of the residents. Staffing levels were increased if it was felt that residents required more support. There was a duty rota, which showed the names of staff and the hours they worked each day. Of the fourteen care staff, records showed that nine had completed the National Vocational Qualification at level 2 or above (64 ) with a further three care staff undertaking the qualification. The files of two staff members recruited since the previous inspection were viewed. Records showed that a robust recruiting procedure was in place. Staff confirmed that they had received job descriptions, terms and conditions of employment and a copy of the General Social Care Council Code of Conduct.
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 19 Equality and Diversity issues were addressed throughout the recruitment procedure. From reading records and talking with staff, induction training, based on the Skills for Care Standards was offered. Training records were available to examine and showed a variety of training being offered both “in house” and external. Staff said that training needs were identified during their supervision periods. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31:33:35:38 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home was run in an open and transparent way and was run in the best interests of the people who lived there. EVIDENCE: Both the registered persons had achieved a National Vocational Qualification at level 5 in Operational Management and were Registered General Nurses. The registered persons had managed the home since 1988. Comments from residents, staff and visitors gave an overall view of a family run home where everybody felt included. Records showed that the management team were committed to Quality Assurance. In addition to the
Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 21 Investors In People Award, it is a “Preferred Provider” with Lancashire County Council. From discussion with residents, their comments are sought in respect of the development of services within the home. Records showed that comments raised in service users surveys were addressed, and from these the management team developed a Quality Assurance programme and annual development plan. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. The records and monies of three residents were checked. Although the monies were correct it was recommended that to safeguard staff, two signatures should always be obtained whenever a financial transaction takes place. Training records showed that staff members had participated in training relating to safe working practices. Infection control procedures were available. Records showed that regular servicing of equipment takes place by authorised and qualified contractors. Cleaning materials were stored safely. The reporting of accidents was accurately recorded. The registered person felt that the home complied with relevant legislation. There was a set of health and safety procedures available and it was recommended that they were signed and dated on an annual basis when they were reviewed. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 22 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 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 2 X X 3 Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 23 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. 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 Refer to Standard OP35 OP38 Good Practice Recommendations Two signatures should be obtained when dealing with financial transactions. Policies and procedures should be signed and dated whenever they are reviewed. Briercliffe Lodge DS0000009479.V336388.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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