CARE HOMES FOR OLDER PEOPLE
Brierfield House Care Centre Hardy Avenue Brierfield Nelson Lancashire BB9 5RN Lead Inspector
Mrs Pat White Key Unannounced Inspection 13th August 2007 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 Brierfield House Care Centre DS0000022499.V341110.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. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brierfield House Care Centre Address Hardy Avenue Brierfield Nelson Lancashire BB9 5RN 01282 619313 01282 698477 brierfield@ashbourne-homes.co.uk 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) Ashbourne Homes Limited Mrs Kathleen Leach Care Home 42 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (26), of places Physical disability (1) Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to provide personal care for a maximum of 42 service users A maximum of 41 service users who fall into the category of OP (Older People) One named service user who falls into the category of PD. A variation application must be submitted to the CSCI to remove this category when this person no longer resides in the home. 11th October 2006 Date of last inspection Brief Description of the Service: Brierfield House is a residential care home registered to provide care and accommodation for 27 older people and 15 older people with dementia. The 27 older people occupy the ground floor and part of the first floor. They have the use of a lounge, a dining area and a conservatory on the ground floor. The residents with dementia related needs reside in a self -contained unit occupying the rest of the first floor. The dementia unit has its own dining area, lounge and separate staircase access to the outside grounds, part of which was adapted for exclusive use of the residents in the unit. A passenger lift provided access between the two floors. The home is purpose built, in its own grounds, on the outskirts of Brierfield. All bedrooms are single and en suite. There were 6 WCs, 3 bathrooms and 2 shower facilities, all with equipment and adaptations to assist people with restricted mobility . Fees were given as £366 - £422 per week and cover all aspects of care, accommodation, food and laundry. Hairdressing, chiropody, papers, magazines and some trips are not included in these fees. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection site visit was carried out on the 13th and 14th August 2007. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents, and discussion with the manager and other members of staff. The inspection also included spending about 2 hours observing the care being given to a small group of residents in the dementia unit who were unable to speak about their views about the home. Seven residents spoke about their views on the home. Survey questionnaires from the Commission were sent to the home for residents and relatives to complete. Questionnaires were also sent to general practitioners (GPs) and social workers. Nine residents, 6 relatives and one GP returned these questionnaires. Some of the views of these people are included in the report. What the service does well:
The way people’s needs were assessed before they went to live in the home made sure that these needs were understood by the staff and a decision could be made about whether or not the home could meet their needs. The written records of resident’s needs were well written, and covered most of the important matters regarding health and personal care needs. The written plans for residents’ care were in general detailed and well written, and contained useful information regarding the residents’ health, personal and social care needs. This included a written assessment of the risks faced by residents and how the risks could be reduced. These written plans were regularly reviewed and updated. The observation of people in the dementia unit showed that in general residents appeared comfortable, settled and alert, and that the staff on duty were kind and caring towards them. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 6 The home provided pleasant, bright and modern accommodation for the residents. It was attractively furnished and decorated. All the bed - rooms are single and en suite. The way the home recruited care staff to work in the home was thorough and helped to protect residents from unsuitable staff. There was a good programme of staff training, and staff had opportunities to attend training according to their own needs and the needs of the residents. The home regularly carried out its own checks to find out how good the care and services provided in the home are. Some aspects of the residents’ and staff health and safety were well looked after. The building, the services and the facilities were well maintained. What has improved since the last inspection? What they could do better:
The written information provided to people when they move into the home needed updating and should describe the facilities in the home correctly, for example explaining that there is a specific dementia unit for people with needs related to dementia. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 7 People were being admitted to the dementia unit without an assessment that identified needs related to the diagnosis and which showed that these needs would be most appropriately met in a specific dementia unit. Thorough mental health assessments should be carried out to make sure that people are admitted to the part of the home which is best suited to their needs. Residents with mental health problems should also not be admitted to the home unless their needs are understood and it is clear that the home can meet the needs. Some parts of the written information about the health, personal and social care needs of the residents could be further improved. There should be more details about mental health, personal care, oral care and hobbies and interests, and should include residents’ preferences, to assist staff understand how care should be provided. Additional risk assessments should be completed on the use of bed wedges and the use of alcohol based gel in residents’ rooms to ensure residents are not at risk from these measures. Call leads were missing from many of the rooms, apart from those mentioned above, and residents could not call for help in an emergency or general assistance from staff. These must be replaced, apart from when it has been assessed that the resident is at risk from such a lead (see above). Medication management in the home must be improved so that all residents receive the right medication at the right time. This includes making sure that all medication is given as prescribed and that staff know exactly when to administer “when required” medication. Information came to light at the site visit which showed that residents’ dignity was not always respected. The manager must make sure that staff show respect to residents at all times and that they assist residents to live their preferred lifestyle. At the time of the site visit there had not been an activities coordinator for some time and this meant that there were insufficient suitable leisure activities for the residents. This needs to be addressed so that residents are occupied and more fulfilled. One resident said that there was not always enough to eat and staff said that frequently not enough desserts were supplied to the dementia unit. This must be improved so that all residents have the amount and variety of food to suit their preferences and choice. The observation of people in the dementia unit showed that when assisting residents with eating staff could be less rushed and more personal. This could make meal times more relaxed and enjoyable for these residents. The way complaints are dealt with in the home must be improved so that comprehensive written information is available about these matters, and that people making complaints are informed in writing of the action taken and the Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 8 outcome, so they are clear whether or not their complaints have been dealt with satisfactorily. The home must improve the way it deals with allegations of abuse and follow Government guidelines so that residents are protected and safe. Some parts of the premises could be improved. Some doors were damaged by wheelchairs and needed restoring. There was an unpleasant odour in some of the bed - rooms, which must be eliminated. The bathroom on the ground floor with a domestic style bath was being used for storage. This facility should be developed according to residents’ preferences and so increase the choice of facilities. At the site visit there were examples of staff not treating residents appropriately. Though there was a comprehensive staff training programme, the attitude and skills of some staff could be improved, so that residents’ needs and the role and duties of care staff are clearly understood so that all residents are cared for appropriately. Residents’ money must be managed more safely to prevent money being lost or stolen. Some aspects of health and safety should be improved. All appliances and equipment should be tested appropriately to make sure they are safe and residents must be protected from toxic and infectious conditions such as stale drinks. 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. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 9 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 Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 10 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): 1, 3 & 4. Standard 6 not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission procedures assisted residents and relatives to make a choice of whether or not the home would be suitable. However not all the residents’ needs were clearly identified on admission or clearly understood by staff. EVIDENCE: The home had a Statement of Purpose, and Service User Guides were seen in the residents bedrooms. However the Service User Guide on display had the details of the previous manager and did not explain that the home has a specific unit for people with dementia related needs. The completed questionnaires for the Commission showed that most residents and relatives felt that they had enough information prior to moving in to help them make a decision about moving into the home.
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 11 The residents’ records viewed showed that senior members of staff had visited them before admission to carry out an assessment of their needs. Social workers had also carried out assessments when relevant, and a copy of these assessments had been received by the home. However two residents whose records were viewed had a diagnosis of a long term mental illness, including “severe depression”. The records and conversation with a member of staff indicated that not all staff understood the needs of people with severe depression and how these needs should be addressed. Staff had not undertaken training in this area. Another resident was exhibiting increasing aggressive behaviour and it was not clear whether or not his needs could continue to be met in the home though a multi disciplinary team meeting had suggested they could. Records also showed that one resident was admittred to the older persons part of the home with a diagnosis of dementia and transferred to the dementia unit a few weeks later. There was no written information to support this transfer and it was not clear whether or not this was the correct placement. However all staff in the dementia unit had undergone dementia training to help them understand the needs of these residents and the observation of a small group of people in this unit showed that in general they appeared comfortable, settled and alert. Not all residents spoken with indicated that they were well looked after or that their diverse needs were being met. One resident who was able to speak in detail about personal and sensitive needs stated that these needs were not fully being met in the home at the time of the site visit. One resident stated that she was being “bullied” by staff. This was immediately reported to the manager and action was taken to protect people (see “Complaints and Protection”). Of the 9 residents who completed the questionnaires six residents said that they “always” received the care and support needed, 1 said “usually” and 2 said “sometimes”. Three out of 6 relatives who completed questionnaires said needs of their relative were “always met, 2 said “usually” and 1 said “sometimes”. One said that the home “always” met the different needs of people, 3 said “usually” and one said “sometimes”. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Not all the care plans contained sufficient detail in all matters relating to health, personal and social care. Residents’ health care needs were met but medication management and procedures must be improved to further safeguard residents’ health. Not all residents were treated with respect or had their dignity upheld. EVIDENCE: The care plans of six residents were viewed, including 3 in the demetia unit. Some parts were generally well completed and there were moving and handling risk assessments and pressure areas risk assesments. There was evidence of care plan reviews to which relatives were invited. However some care plans had not been completed in sufficient detail in all relevant matters, for example those relating to mental health, personal care, oral care, spiritual matters and hobbies and interests. So staff did not have enough information to assist them in how to provide care according to individual preferences. In
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 13 particular as stated in the previous section there were insufficient details to support the staff in looking after people with complex problems relating to dementia and mental health such as “severe depression”. Records, discussion with people and the questionnaires showed that residents general health care was monitored and addressed. There was evidence of ongoing contact of residents in the dementia unit with psychiatric services for older people. Risk assessments on vulnerability to pressure areas were undertaken which linked to recorded preventative measures and district nurse involvement. Falls risk assessments were also carried out with information about management strategies recorded in the care plans. The care plans viewed included sufficient details on the promotion of continence. “Bed wedges” were used in the home to help protect people from falling out of bed. However the risk assessments did not demonstrate that wedges were the safest means, and did not state whether or not these should be used with a mat on the floor to cushion a fall. Also an alcohol based hand gel wash was in use in some residents’ rooms on the advice of the district nurse to help reduce cross infection. However no risk assessments had been undertaken to determine whether or not residents were at risk from this. A number of residents did not have call bell leads in their bedrooms, and therefore could not summon a member of staff when needed. The questionnaires returned to the Commission showed that six out of nine residents said medical support was “always” available when needed, 2 said “usually” and one said “sometimes”. Half the relatives who completed the questionnaires thought that the service “always” gave the care and support agreed. A general practioner who completed a questionnaire said that the home usually addressed the residents’ health care needs properly including the management of their medication. Some aspects of medication management must be improved to ensure medicines are given correctly. The written policies and procedures were in accordance with the Royal Pharmaceutical Guidelines but these were not always followed correctly. However there were some areas of good practice including safe storage of medication, checking the prescriptions prior to dispensing and monitoring the temperature of the medication storage areas. Also all staff who administered medication had appropriate training. However a number of practices needed improving: Some eye drops requiring fridge storage were left in the medication trolley. This may have affected the effectiveness of the eye drops. The staff signature list was not up to date so it was difficult to identify which member of staff had signed the Medication Administration Records (MARs). One resident who was spoken to had not taken all her morning medication. For a number of residents whose records were viewed there was still insufficient information on or near the MARs about when “when required” (PRN) medication should be
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 14 given, including pain - killers, food supplements, sleep medication, sedatives and laxatives. This could mean that residents were not having important medication when needed. Also for a resident whose records were viewed, one medicine was being administered differently to the instructions on the MAR and there were no supporting instructions about this from the prescriber. Also an audit of this medication showed that the MARs had been signed as given several times when it had not. Another resident’ MAR showed gaps where there was no entry at all so it was not clear if medication had been given or not. Not all hand written additions or alterations to the MARs made by staff had been signed and dated. Some pain - killers were listed on one resident’s MAR but they were not being given as staff thought they were not required. This had not been clarified with the prescriber and there were no instructions on the MAR. For another resident there was not a supply in the home of one medicine listed on the MAR. There was confusion amongst staff as to why this was the case and whether or not a mistake had been made in the ordering. Also there was a medicine delivered for a resident that was not listed on the MAR and staff were not clear whether or not and when this should be given. There were no written instructions from the prescriber. The MARs viewed, and the member of staff spoken to, confirmed that on one occasion recently the evening medication had not been given due to miscommunication about which shift should be responsible for this. As a result neither group of staff had taken responsibility and residents had gone without their medication. Residents spoken with felt their rights to privacy were upheld and several appreciated that they could spend time in their bedrooms if they wanted. However not all residents felt they were treated with dignity. One resident was concerned that her unique and sensitive care needs, which partly concerned her personal appearance, were not fully understood by staff or met. This had not improved from the previous inspection. One resident said she was being “bullied” (see previous section and “complaints and protection”). It was also observed that several men needed shaving. Also an interaction between a member of staff and a resident at lunch time was observed which showed lack of respect and did not uphold this residents’ dignity. All these matters were discussed with the general manager who agreed to address them as appropriate. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. There were insufficient varied leisure activities to suit the individual needs and preferences of the residents, but they were enabled to maintain contact with their relatives and the community. Not all residents felt they had sufficient choices in their everyday life. The food served usually met the needs and the preferences of the majority of residents. EVIDENCE: The inspection methods used, including discussions with staff, information supplied by the home and the questionnaires, showed that since the last inspection there had been difficulty providing enough suitable leisure activities for the residents. There had been no activities organiser in the home for some time and this was reflected in the responses in the questionnaires. This post will be filled as soon as possible. Only one out of the nine residents who completed the questionnaire said that there were “always” suitable activities. However one resident was encouraged to continue to attend a club that he attended before becoming a resident and residents were encouraged to follow their religious faith. Ministers from different denominations visit the home. Some interests and spiritual matters were recorded on some care plans, but
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 16 not always in sufficient detail for staff to develop and maintain former interests. Most relatives who completed the questionnaires stated that communication between the home and themselves was satisfactory and that they were kept informed of important matters affecting the resident. Visitors were made welcome at any reasonable time, according to the home’s visiting policy. Relatives were encouraged to attend activities and events, and residents’ reviews. One said we are “always informed of problems and staff are patient and vigilant”. Another said that the “home is always open to unannounced visits – I’m always made welcome”. Some residents spoken with felt they had enough choices in their everyday lives and could spend time in their rooms if they wished and could rise and retire when they wished. One resident was assisted to smoke when she wanted to. Residents could manage their own finances if appropriate. People were allowed to bring small personal possessions with them to personalise their rooms. However some residents felt their choices were restricted and one resident felt that she was not sufficiently assisted by staff to live her preferred lifestyle. The menus viewed indicated that the food served was nutritious and varied. There was a choice of two main (cooked) meals and desserts. There was also a choice of a second cooked snack meal. Assistance was given to those who needed it and food was served in a suitable form for those with eating difficulties. However for one resident, as noted in the previous section, this was not a positive experience. Drinks and biscuits were served at times throughout the day. In the residents’ questionnaire survey four out of 9 said they “always” liked the food, 4 “usually” and one “sometimes”. One said in the questionnaire that the portions weren’t always big enough. Also staff in the dementia unit said that regularly not enough desserts were delivered to the unit and alternatives had to be found. The observation in the dementia unit showed that for those residents who could feed themselves the meal was relaxed and unrushed and staff were caring and friendly. However assistance and encouragement was given to two residents in a hurried manner and in a way that they did not seem to enjoy. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure was accessible to residents and visitors and residents and relatives knew who to speak to if they had any concerns. There were policies and procedures to help protect people from abuse but these were not always followed and people had been left at risk. EVIDENCE: The home had a complaints procedure that was used by relatives, and records, including information supplied by the home to the Commission showed that 3 complaints had been made in the last 12 months. One complaint about some care issues was made to the Commission and was passed to the home to investigate under it’s complaints procedure. Records viewed showed that this was appropriately investigated and the complainant was informed in writing of the outcome. A relative had made a verbal complaint about a resident being verbally and physically aggressive towards another resident. Other residents had also been involved. Appropriate action had been taken involving the Social Services and the relatives to protect people. However records in accordance with the Care Homes Regulations had not been made and the complainant had not been informed in writing of the action taken.
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 18 The questionnaires showed that residents and relatives knew who to speak to if they were not happy and that most knew how to make a complaint. Four out of 6 relatives who completed questionnaires were satisfied with how their concerns were dealt with. In the last 12 months there had been two allegations of abuse towards residents by members of staff. Correct action was not taken for some time and the home’s procedures, including the whistle blowing procedure, were not followed. This potentially put residents at risk. Eventually investigations were undertaken and 2 members of staff were suspended. The investigations were inconclusive and the members of staff were reinstated. In order to protect residents the staff concerned were being supervised, and had undertaken further training. Just prior to the site visit a resident had reported money missing. This had not been found and the police were notified. No charges were made. However the Social Services were not notified and therefore the safeguarding adults procedures were not followed. At the time of the site visit a resident made another allegation of abuse against a member of staff. This member of staff was suspended and the safeguarding adult procedures were followed to protect people living in the home. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 19 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, 20, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was maintained and furnished to a satisfactory standard and provided pleasant, comfortable accommodation, including the bedrooms, which were personalised and suited residents’ needs. The home was clean and fresh in most areas but there was an unpleasant odour in some bedrooms. EVIDENCE: Brierfield House is a purpose built care home. The premises were maintained to a satisfactory standard, were light and airy, comfortable, pleasantly decorated and furnished, and complied with fire regulations. Maintenance and refurbishments were carried out when required and according to a programme of maintenance. A handy man was employed in the home so that smaller jobs could be completed quickly. The outside grounds at the back of the home had been improved and a seating area had been developed with tubs of plants.
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 20 The rooms viewed were well furnished and bedrooms were personalised. Some bed room carpets had been replaced with easy to clean floors to eliminate unpleasant odours. Some parts of the home had been recently redecorated. However a number of door frames had been badly damaged with wheelchairs and needed restoring. One bathroom on the ground floor, with a domestic bath was not in use, and one toilet needed repairing. Many of the bedrooms did not have call bell leads and residents could not summon assistance. There was a self contained demntia unit on the first floor which had been developed in accordance with the needs of people with dementia, for example sensory plaques and bedroom doors had the appearance of real house front doors. Standard 25 was not fully assessed but some hot water pipes were not lagged and residents could potentially be at risk. There was a housekeeper in the home responsible for the laundry and the standards of cleanliness. All the residents who completed questionnaires said that the home was “always” fresh and clean and one said “there has been a big improvement in the last six months”. However at the time of the site visit there were still some bedrooms with unpleasant odours. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all staff had the right skills and knowledge to meet the needs of all the residents and residents were not in safe hands at all times. The home’s recruitment procedures, though in accordance with Government guidance, did not protect residents from some unsuitable staff. EVIDENCE: At the time of the site visit, due to short notice absence the unit manager in the older person’s part of the home was cooking, so there was a member of the care team short. There was also evidence that not all the staff had the necessary skills and knowledge to meet the needs of all the residents. As noted in previous sections staff did not have the knowledge and skills to fully understand the needs of people with mental health problems and some staff did not have the attitude or behaviour desirable for those working with older people. This was in spite of the training opportunities for staff outlined below. Also in the evening of one of the days of the site visit residents who required supervision were left unattended in the lounge and one resident behaved in an aggressive manner towards another. Of the nine residents who completed questionnaires, only four said that staff were “always” available when needed, 3 said “usually” and 2 said “sometimes”. Of the relatives who completed questionnaires only two out of 6 said the staff “always” have the right skills and experience and 3 said “usually”. One person said that often commented that staff hadn’t got time to do things or they forgot.
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 22 The written information provided by the owner prior to the inspection stated that twenty four out of the twety seven permanent care staff have at least NVQ level 2 and the remaining 3 were studying for NVQs. In addition there was a rolling programme of training in moving and handling, food hygiene, fire safety so that new staff and existing staff always had the opportunity for up dated training. Staff also undertook training in “residents welfare” and looking after people with dementia. There were also future opportunities for training in pain management, incontinence care, medication awareness and wound care. The home’s recruitment procedures were in accordance with the Care Home’s Regulations and should help to protect residents from unsuitable staff. The staff records viewed showed that staff did not commence work in the home until Criminal Record Bureau and Protection of Vulnerable Adults checks had been completed and suitable references had been obtained. Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A new manager without the relevant management qualification was managing the home. Quality assurance policies and procedures took into account the views of residents and relatives. Not all residents money was managed safely, and some practices did not promote the health and safety of the residents . EVIDENCE: A new acting manager was appointed in April. She was previously the deputy manager in another residential care home and had NVQ level 3 in “care” and a Diploma in Health and Social Care. Mrs Hutchins had applied to become registered with the Commission and will commence the relevant management training as soon as possible. Senior members of staff in the company supported the manager, and the “responsible individual” made monthly
Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 24 unannounced visits to the home in accordance with regulation 26 of the Care Homes Regulations with a view to monitor the running of the home and the care delivered. Staff meetings were held regularly to assist communication between management and staff. The home had a service quality monitoring system that took into account the views of residents and relatives. “Opinion survey” questionnaires had been sent to residents and relatives last month. The results had not yet been analysed. Residents’ finances could not be assessed properly at the time of the site visit because the computer records could not be accessed due to problems with the system. However not all residents’ money was managed safely as one resident’s spending money was missing (see “Complaints and Protection”). Suitable records were kept of residents spending money handled by the home which included details of money received and spent. The home’s policies and procedures helped to promote the health and safety of the residents and staff. Records and staff spoken with confirmed that there was a continuous programme of moving and handling training, fire training and first aid training. There was a person competent in first aid on every shift. Some had completed an infection control course. The fire precautions were satisfactory and the fire equipment was serviced appropriately. According to the home’s records, the gas installations, the central heating system, electrical wiring and the water supply, all had current certificates of testing. However the portable electrical appliances and the transfer hoists required testing. There was also concern that inspite of some staff having completed infection control training a glass of cordial drink had been left on a bedside cabinet which had a growth of mould. Any resident drinking this would be potentially at risk from infection. Accidents in the home were recorded appropriately and audited monthly. Residents identfied as having frequent fall were reported to the “falls team”. The manager notified the Commission of all relevant accidents and incidents in the home so that these could be monitored Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 25 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 2 x 3 2 X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 3 X X 3 3 2 2 STAFFING Standard No Score 27 1 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 26 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. OP4 Standard Regulation 12 (1) Requirement The registered person must ensure that all aspects of the health and welfare of all the service users are understood and the needs met within the home, including those with mental health needs and those with aggressive behaviour The care plans should include enough written information about the complex and specific needs of people with dementia and mental health problems to assist staff understand these needs and how these needs should be met. The registered person must ensure that all residents have access to a call bell at all times whilst in their bedrooms The registered person must ensure that all residents receive their medication at the right time and that this is not omitted without a satisfactory reason supported by a written explanation The registered person must ensure that medication is given
DS0000022499.V341110.R01.S.doc Timescale for action 14/09/07 2. OP7 15 (1) 14/09/07 3. OP8 23 (2)(n) 07/09/07 4. OP9 13 (2) 07/09/07 5. OP9 13 (2) 07/09/07 Brierfield House Care Centre Version 5.2 Page 27 6. OP9 13 (2) 7. OP9 13 (2) 8. OP9 13 (2) 9. OP9 13 (2) 10. OP10 12(4)(a) according to the instructions on the MAR sheet unless there is supporting alternative instructions from the prescriber. All medication including eye drops must be stored at the appropriate temperature to ensure they remain effective. There must be a timely ordering of medication so that there is a supply of medication in the home as needed There must be effective checking and auditing of prescriptions and medication received into the home so that any errors or unexpected changes are identified and clarified. There must be clear written instructions from the prescriber to support the administration of “when required” medication and which includes written instructions to staff on when this needed. The registered manager must ensure that the dignity of all residents are upheld, and that the needs of one particular resident identified are reviewed and clearly understood by all staff. Staff must treat residents with respect at all times. (Previous timescale of 30/11/06 not met) All residents must have sufficient to eat and enough food must be delivered to the dementia unit at all times. All complaints made to the home must be investigated according to the home’s complaints procedure and complainants must be informed in writing of the action taken, the investigations made and the outcome. Detailed records must
DS0000022499.V341110.R01.S.doc 31/08/07 31/08/07 31/08/07 14/09/07 14/09/07 11. OP15 16 (2)(i) 31/08/07 12. OP16 17(2), Sch 4, 11 31/08/07 Brierfield House Care Centre Version 5.2 Page 28 13. OP18 13 (6) 14. OP25 13(4)(a) be kept of all steps taken. The registered person must ensure that the correct procedures, according to Government guidance, are followed in all allegations or suspicions of abuse, including financial abuse, in order to protect people. The registered person must ensure that residents are protected from the hazards of hot surfaces.(Previous timescale of 30/11/06 not met) The registered person should ensure that at all times staff working in the home have the right skills, experience and knowledge to look after older people. The home must ensure the portable appliances and transfer hoists in the home are appropriately tested. Residents must not be subject to toxic conditions or sources of infection 31/08/07 30/09/07 15. OP27 19 (5)(b) 30/09/07 16. OP38 13 (4)(a) 07/09/07 17. OP38 13 (3) 07/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The home should ensure that the Statement of Purpose and the Service User Guide are updated and include correct information about the accommodation provided in the home The manager should ensure that a mental health assessment has been undertaken that supports a resident’s transfer to the dementia unit and which is clearly documented and demonstrates the specific needs
DS0000022499.V341110.R01.S.doc Version 5.2 Page 29 2. OP3 Brierfield House Care Centre 3. OP7 for specialist care. The registered person should ensure that the care plans include sufficient details on all matters of health, personal and social care, including oral care, social history and hobbies and interests and preferences to assist staff in what and how care should be provided. It is recommended that the registered person undertakes risk assessments on the use of bed wedges to demonstrate whether or not these are safe for individuals and how to use them safely. It is also recommended that the risk associated with the use of alcohol based hand wash in individual residents’ rooms is assessed and appropriate action taken. The signature list of staff administering medication should be up to date so that staff completing the Medication Administration Records (MARS)can be easily identified. The MARs should be completed accurately at all times. There should be no unexplained gaps and all handwritten additions or alterations should be signed, dated and witnessed. Suitable activities should be provided in the home for all residents Residents should be assisted and encouraged by staff to make choices and live their preferred lifestyle. The doors damaged by wheelchairs should be restored. All areas of the home should be kept odour free. It is recommended that the bathroom on the ground floor is restored to use to offer residents more choice of bathing facilities. Residents money should be managed safely so that money does not become lost or missing. 4. OP8 5. 6. OP9 OP9 7. 8. 9. 10. 11. 12. OP10 OP14 OP19 OP26 OP22 OP35 Brierfield House Care Centre DS0000022499.V341110.R01.S.doc Version 5.2 Page 30 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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