Inspection on 15/07/09 for Brierfield House Care Centre

This inspection was carried out on 15th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brierfield House Care Centre 20/08/08

Brierfield House Care Centre 19/03/08

Brierfield House Care Centre 13/08/07

Brierfield House Care Centre 11/10/06

Brierfield House Care Centre 27/04/06

Brierfield House Care Centre 24/11/05

Brierfield House Care Centre 12/10/04

Brierfield House Care Centre 06/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Brierfield House Care Centre Hardy Avenue Brierfield Nelson Lancashire BB9 5RN Lead Inspector Mrs Pat White Key Unannounced Inspection 15th July 2009 09:00 DS0000022499.V376603.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Brierfield House Care Centre DS0000022499.V376603.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 Ltd 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.V376603.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. 19th March 2008 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 £448 - £519:20p 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. The home has a Statement of Purpose and Service User Guide that provide residents and relatives with written information about the home, including about staff and the services and facilities. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means that people who use the service experience poor outcomes. This key (main) inspection of Brierfield House, including a site visit to the home on the 15th July 2009, was undertaken to determine an overall assessment on the quality of the services provided by the home (see above). 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 on 20/08/08. The key inspection was brought forward because of some ongoing concerns about the protection of people in the home and further management changes. Also as a result of some information received about the care of an individual a random inspection of medication was undertaken in February 2009 by a pharmacy inspector from the commission. This inspection undertaken on 15/07/09 included: talking to residents, visitors and staff; touring the premises; observation of life in the home; looking at residents’ care records and other documents and discussion with the manager and operations manager (the “management team”). A number of residents were spoken with and eight gave some views about the home. In addition survey questionnaires from the commission were sent to residents, relatives and staff, asking them for their views of the home. At the time of writing this report, 7 residents, 4 relatives and 1 member of staff had returned completed questionnaires. Some of the views of these people are included in the report. In addition the home provided the commission with written information prior to the site visit about the residents, staff, services provided, and their own assessment on the quality of the services. Some of this information is also included in the report. What the service does well: In general people’s needs were assessed before they were admitted to the home so that a decision could be made about whether or not the home could meet their needs (see below). The written records of resident’s needs were Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 6 generally in sufficient detail, and covered most of the important matters regarding health and personal care needs (see below). Residents and relatives who were spoken with, and who completed questionnaires said that staff were caring and friendly and that there was now a “friendly welcoming atmosphere” in the home. There was an activities organiser in the home and there were varied and frequent activities. 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 building, the services and the facilities were well maintained and safe. There were systems in place for finding out the views of residents and relatives and the management team regularly carried out its own checks to find out how good the care and services provided in the home are. What has improved since the last inspection? Some matters that needed to be improved from the last inspection had been addressed. There had been a further improvement in the organisation of mealtimes, and these times were more pleasant occasions for the residents. Correct procedures were being followed when incidents or suspicions of abuse came to light and Social Services were being notified at the right time. This should help protect the residents involved (see below). Some aspects of staff training had improved and more staff had the relevant qualifications for working in a care service such as National Vocational Qualifications and training in infection control and fire safety. This should help the staff to look after people properly (see below). There had been a lot of effort in the home to improve the attitude of staff so that residents were treated with kindness and respect. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 7 What they could do better: Some aspect of the admissions and assessment process could be improved. When residents are admitted at short notice, or as an emergency, a detailed assessment of needs should be completed within 5 days of admission and appropriate information from social services should be obtained. This is needed so that a useful care plan, giving detailed information and instructions to staff, can be developed. Also when residents are transferred to the dementia unit there should be a mental health /dementia assessment that clearly explains the specific dementia related needs and what specialist care is needed. Some of the written care plans still required up dating to ensure that they have accurate information. For example about how to manage people with challenging behaviour, whether or not people can use the emergency buzzers and procedures for infection control for individual residents. The management of people with challenging behaviour could be improved in order to protect people, and staff would benefit from more guidance and training in this. Training for more staff in this matter is outstanding from the previous inspection and should be addressed without delay. Some aspects of medication management should be improved. The records of medication coming into the home were not as detailed as they should be and some information necessary for auditing was missing. There should be more written instructions to staff about when required medication needs to be given and more instructions transferred from medicine labels so that staff know when to give medication in relation to food. The protection of people from abuse could still be further improved as at the time of writing this report there were several ongoing investigations in the home regarding allegations of an abusive nature. There were still some areas of the home that had unpleasant odours and this is an ongoing problem that has been highlighted over a number of inspections. Also the laundry procedures could be improved as some relatives told us that residents are sometimes wearing other people’s clothes in spite of clothes being labelled. This can obviously be distressing to residents and relatives and does not uphold residents’ dignity. Staff training needs to be improved as insufficient staff in the home had training in dementia and challenging behaviour. Training in these matters is important in Brierfield House to help staff understand and properly care for people with this type of behaviour. Also staff should have updated moving and handling training to ensure they move people safely and comfortably. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Brierfield House Care Centre DS0000022499.V376603.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.V376603.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Standard 6 is not applicable People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission procedures helped to determine whether or not the home was a suitable place for people to live but these were not always followed as thoroughly as they should be. EVIDENCE: The home had a Statement of Purpose and Service User Guide that gave people information about the home, the staff and facilities. Service User Guides were seen in the residents bedrooms. Though these were not fully Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 11 assessed at this inspection residents and relatives told us that they had enough information to help them make a decision about whether or not the home was suitable. The manager told us that she visited people who were interested in going to live in the home in order to carry out an assessment of their needs to help establish whether or not the home could meet these needs. Some relatives spoken with confirmed that a resident had been assessed in this way and that they had been able to visit the home to help them make a decision. However one person whose records were viewed had been admitted at short notice and there was little information on admission, and no social work assessment, to help plan the care and support required. An assessment had not been undertaken for over a week so it was unclear what these person’s needs were on admission. Another resident had been transferred to the dementia unit but there was insufficient supporting documentation to support this, and from which to develop a care plan that sufficiently addressed their mental health needs. Whilst there was no indication that these person’s needs were not being met written information is necessary to assist staff to understand these needs and provide the the right care and support. Apart from one person, the residents spoken with at this inspection and who were able to give their views indicated that they were satisfied with the way the home met their needs. Brierfield House Care Centre DS0000022499.V376603.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all the care plans contained sufficient up dated and accurate information in all matters relating to health and personal care. Not all the residents’ health needs were fully met. There were some errors in medication management which could mean medication was not aways administered correctly. Residents’ dignity was not always upheld. EVIDENCE: The care plans of 4 residents were viewed, including 2 in the dementia unit. These care plans contained a lot of information about people’s care needs. This included appropriate risk assesments and plans covering different areas of care to help staff look after people safely, including the management of Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 13 pressuure areas and prevention of falls. There was also evidence of care plan reviews to which relatives were invited. We were told that all the care plans were being updated at the time of the site visit. However on 2 care plans viewed the information was not as accurate or as detailed as it should be. One care plan did not include sufficient instructions for staff on how to manage a skin infection or include accurate information about how this resident, with poor eyesight, should use the emergency call bell sytem. Also in the dementia unit a number of residents did not have access to call bells, and we were told that these residents could not use them, or would be at risk from the call bell lead. However there was no supporting assessment of any risk, indication of why people could not use the call bell, or what alternative arrangements there were to ensure that people could summon the help they needed. This means people may not receive attention when needed. In the dementia unit we were told that one of the residents whose records were viewed had challenging behaviour, and that they provoked other residents, which sometimes resulted in incidents of aggression. There was insuffcient written information and guidance to staff regarding how to manage this behaviour and it was not clear if and how this resident and others were kept safe. Records showed that this person had sustained bruises to their face on a number of occassions, but there was not a satisfactory explanation or sufficient written information about this. Also the same resident had also been involved in an other incident when they had been at risk, and which had been the subject of a complaint (see Complaints and Protection). With respect to health care, records, discussion with people, and the questionnaires, showed that residents received the necessary health care services . There was evidence of ongoing contact of some residents with psychiatric services for older people. However at the time of this inspection there was an ongoing investigation, under “safeguarding” procedures, into the care and health care of a particular resident. Part of the investigations looked into whether or not the home had done enough to ensure that this resident received the right health care at the right time and whether their needs were being sufficiently monitored and met at the time leading up to hospital admission. In addition there were 2 other residents for whom concerns about poor personal care practices were subject to “safeguarding” investigations. One of these investigations resulted from allegations made to us by a resident at the time of the site visit (see Complaints and Protection). In addition most of those residents who completed the questionnaires felt that they sometimes did not have the care and support at the time they needed it. Two relatives who gave their views said they felt people were not assisted to the toilet early enough to prevent accidents. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 14 Because of concerns raised about the care of one of the residents referred to above, the commission carried out a random pharmacy inspection in February 2009. This inspection showed that the home’s procedures and management of medication were generally safe and that there were useful policies and procedures. However at this site visit in July we found a number of errors. The records viewed of a person on respite care showed that the way their medicines were booked in could be improved. The date the medicines were received into the home had not been recorded or the date when the resident started to take the medication. There was also insufficient information written on the medication administration records (MARs) copied from the original labels and instruction leaflets, for e.g. when medicines should be given in relation to food. This could mean that residents did not receive the medication at the right time. Also for 3 medicines viewed the number of tablets remaining did not tally with what should have been left according to the MAR. This could mean either that a mistake had been made with the booking in of the medicines or that residents were not receiving medication as prescribed. This was also the case for the eye drops of another resident where there were 4 less doses than there should be. Two examples of medication not being given were noted and there was no satisfactory explanation for this. There was also insufficient written information about how and when to give when required medication. There was also a lack of clarity as to whether one resident was applying their own cream and no written guidance about this. Lack of such written of written guidance could mean that people do not receive their medication at the right time. There was a supply of a controlled drug that was out of date and discontinued. This should have been returned to the dispensing chemist to ensure there was no mishandling of this medicine. Residents spoken with felt their rights to privacy were upheld, and several appreciated that they could spend time in their bedrooms if they wanted. Also on this site visit residents felt that in general staff were respectful and patient towards them. Relatives spoken with also felt that staff were caring and friendly. However several matters came to light that were seen as compromising people’s dignity. Two relatives said that sometimes there did not seem to be enough staff to take people to the toilet when needed, resulting in accidents, and that there were problems with laundry which sometimes resulted in residents wearing clothes belonging to someone else. The problem with the laundry has been raised before at a number of inspections and previously by relatives. The dentures and glasses of one resident were “lost”, and a relative told us that another resident frequently does not have their hearing aid in and therefore cannot hear properly. We also found that there were no locks on the toilet and bathroom door in the dementia unit, which could mean that people’s privacy and dignity was not being upheld . Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 15 Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient varied leisure activities to suit the individual needs and preferences of most of the residents, and they were enabled to maintain contact with their relatives and the community. Most residents felt they had sufficient choices in their everyday life. Mealtimes and the food served suited the preferences of some of the residents. EVIDENCE: There was an “activities organiser” employed in the home and we have been told that residents are seen on an individual basis to try and establish suitable activities for all. One resident had been assisted to travel to Australia to visit relatives and to fulfil an ambition. The information supplied by the home prior to the site visit also indicated that there were suitable and varied leisure Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 17 activities. We were also informed that activities were discussed in residents meetings and that the views of residents were taken into account. Some of the residents former interests and hobbies were recorded on the care plan, including religious persuasion, and we were told that church Ministers visited the home to help residents maintain their religious interests . Visitors were seen coming in and out of the home throughout the day of the site visit, and some who were spoken with felt that they were made welcome at any reasonable time, and that staff were pleasant and friendly. They also told us that communication between the home and themselves was satisfactory, and that they were kept informed of important matters affecting the residents. Relatives were encouraged to attend meetings and events, and residents’ reviews, and their views about the home were sought. However of those who completed the questionnaires two out of 4 did not feel that the home always communicated satisfactorily with them. Some residents spoken with felt they had enough choices in their everyday lives, could spend time in their rooms if they wished, and could rise and retire at a time of their choosing. 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 who gave their views about the home did not feel that there were always suitable activities and said that they only sometimes enjoyed the food. The menus viewed indicated that the food served should be 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 for residents who preferred this to a cold snack. Assistance was given to those who needed it and food was served in a suitable form for those with difficulties with eating. Residents spoken with said that they had enjoyed the meal served at the time of the site visit (see above). Drinks and biscuits were served at times throughout the day and a “tea party” was organised for the afternoon of the site visit. However most of the residents who completed the questionnaires said they only “sometimes” enjoyed the food Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure was accessible to residents, and residents and relatives knew who to speak to if they had any concerns though not all relatives were satisfied their concerns were always resolved satisfactorily. The home’s procedures did not ensure all residents were safe from harm. EVIDENCE: The home had a complaints procedure, and there was evidence that this was used by relatives. Most relatives in conversation, or through the questionnaires, told us that they knew how to make a complaint, and the records viewed, and information supplied by the home prior to the site visit, showed that a number of complaints had been made to the home. Records also showed that these complaints had been investigated and responses made to the complainants. Since the last inspection several complaints had been made to the commission about a number of issues including staffing matters, lack of choice for residents and safety matters (see below). This had been passed to the home to investigate. However this investigation was not initially done satisfactorily and the manager was asked to supply further information. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 19 Also some relatives who completed the questionnaires did not feel that there concerns were always dealt with satisfactorily. Since the previous key inspection in August 2008 there had been 7 further incidents reported to the commission and the social services of a potential abusive nature. Some have been dealt with as “Safeguarding” matters and as a result have come under the Safeguarding procedures of the Social Services department. This includes the 3 residents referred to in Health and Personal Care. Therefore there were 3 outstanding safeguarding investigations at the time of writing this report so the outcomes were not concluded. Whilst the management at Brierfield House had ensured that the reported incidents and allegations had been referred correctly to the appropriate agencies, there are on going concerns about people’s safety in the home, the number of incidents being reported and whether or not the home was overall ensuring that people were protected and having the right care. Staff undertook Protection of Vulnerable Adults Training as part of a rolling programme, and which should help to help protect residents from abuse. New and more in depth training in this matter was planned for later in the year. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was maintained and furnished to a good standard and provided pleasant, clean and comfortable accommodation for most residents. However there was still an unpleasant odour in parts of the home. EVIDENCE: Brierfield House is a purpose built care home. The premises were maintained to a good 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 Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 21 of maintenance. A handy man was employed in the home so that smaller jobs could be completed quickly. There was sufficient private and communal space for the residents and all the bedrooms were ensuite. We toured the premises and found that the rooms viewed were clean and well furnished, and the bedrooms were personalised (see below). Decorating and refurbishment occurred as necessary and since the last inspection a number of bed rooms had been decorated and carpets replaced, some with easy to clean floors to help eliminate unpleasant odours. We were told that there were plans to improve the conservatory and the dementia unit. However we found that the toilet and the bathroom doors in the dementia unit did not have locks on (see Health and Personal Care). Also one bedroom on the ground floor was bare and clinical with the specific systems required for infection control (laundry and disposal of nursing dressings) prominent in the room. There was a housekeeper in the home responsible for the laundry and the standards of cleanliness. At the time of the site visit all parts of the home that were seen were clean, but there were some unpleasant odours in the communal areas and in the dementia unit. Also the resident questionnaires indicated that the home was not always fresh and clean. Also 2 relatives told us that there were problems with the laundry which meant that residents wore clothes that did not belong to them even though they were labelled (see Health and Personal Care). Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all staff had the right training and skills to meet the needs of all the residents. The home’s recruitment procedures were in accordance with the regulations but the procedures did not demonstrate the suitability of all staff. EVIDENCE: At the time of the site visit the home had enough staff on duty to meet the needs of the residents. There was evidence through discussion with residents, relatives and staff that there had been further changes in the staff group, with new staff being appointed, and resulting in some improvement in attitudes and care practices. However as stated in previous sections allegations about poor practices were still being made from a number of different sources. The information provided by the home prior to the site visit stated that 50 of staff had the relevant National Vocational Qualifications, and we were told that new members of staff undertook an Induction training that was in accordance with Government guidance. Staff spoken with who were relatively new in post Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 23 felt that they received sufficient induction training that prepared them for work in the home. However training records available at the site visit showed that, only 31 of staff had undertaken training in dementia, there was no sustained programme of training in other mental health matters and only 17 of staff had completed training in challenging behaviour. There was evidence that staff, particularly in the dementia unit, needed this training, and this is outstanding from previous inspections. Also there was not a staff group dedicated to working in the dementia unit so there was no continuity of care and not all the staff working with people with dementia had the relevant skills and training. Staff spoken with at the site visit felt that morale was still improving and that they were now working more cooperatively together as a team. However some of the staff spoken with confirmed that they had not yet had relevant training (see above). Only one member of staff returned a completed questionnaire so a general view of staff was not obtained. The staff records viewed showed that the home’s recruitment procedures were generally in accordance with the Care Home’s Regulations and guidance, but that the process of employing people with a relevant disclosure on the Criminal Records Bureau could be improved. We were told that a person whose records were viewed had been given a recent relevant “caution”, but there was no evidence that any specific risks or suitability for employment had been thoroughly assessed. Also at the time of the site visit the tracking record available in the home of the Criminal Records Bureau (CRB) check for this resident did not indicate what date the disclosure had been received or include the disclosure number. Therefore there was no evidence that the process for obtaining CRBs had been followed correctly. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 21, 33 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A qualified and experienced manager managed the home but there had been insufficient stabilty of management to achieve permanent improvements in the home. Quality assurance policies and procedures took into account the views of residents and relatives. The health and safety of the residents could be improved. EVIDENCE: Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 25 A new manager had been in post for about 8 months who had the right qualifications and experience to manage a care home. However this was the third change of manager in 2 years and the home had not had the stability and continuity of leadership needed to fully address the ongoing problems in the home and ensure sustained improvements in all areas. Some matters had improved, such as the staff team and the culture in the home, but other matters remain of concern such as staff training and skills, residents’ dignity and on going allegations about poor care practices. According to the information supplied to the commission the home had a number of internal quality monitoring measures. Annual survey questionnaires were sent to residents and relatives, and there were regular residents meetings to which relatives were attended. Regular staff meetings were also held. This assisted with communication and helped to ensure that the views of residents and staff were used to develop the care and services provided in the home. The home’s policies and procedures should help to promote the health and safety of the residents and staff. Records and the management confirmed that there was a continuous programme of moving and handling training, fire training and Protection of Vulnerable Adults training. However at the time of the site visit under 50 of staff had undertaken up to date training in moving and handling and in safe handling of food. The fire precautions were satisfactory and the fire equipment was serviced appropriately. According to information supplied by the home, the gas installations, the central heating system, portable appliances, electrical wiring and the water supply, all had current certificates of testing. The home had notified the commission of all apropriate incidents and accidents so that these could be monitored to enure correct action is taken. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 N/A 18 1 3 3 2 x x 2 x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x x x 2 Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Requirement 8 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 Requirement There must be sufficient written guidance on the care plans to assist staff to understand and manage challenging behaviour and therefore protect residents from injury. The health and welfare of all residents must be promoted at all times including prompt attention in personal and health care Medication must be booked into the home correctly, and accurate records kept to ensure there is an accurate audit trail and to show whether or not residents are receiving the correct medication. All medication must be given as prescribed unless there is a satisfactory reason of why it could not be given Residents rights to privacy and dignity must be upheld at all times and including ensuring appropriate locks on the toilet and bathroom doors in the dementia unit. All residents must be protected DS0000022499.V376603.R01.S.doc Timescale for action 28/08/09 2. OP8 12 28/08/09 3. OP9 17 28/08/09 4. OP9 13 28/08/09 5. OP10 OP21 12 28/08/09 6. OP18 13 28/08/09 Page 28 Brierfield House Care Centre Version 5.2 7. OP30 18 from harm and or abuse. Staff must have appropriate training for their roles and responsibilities and including suitable training in dementia and challenging behaviour for those who work with people with these needs. (Previous timescales including the last one of 23/02/09 not met). 30/09/09 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 OP3 Good Practice Recommendations When people are admitted to the home at short notice or in an emergency a comprehensive assessment should be completed within 5 days of admission and information from the social services should be obtained. People should not be transferred to the dementia without a supporting written assessment to identify their needs and from which to develop a care plan. There should be detailed information on all matters relating to health and personal care including accurate information about how to manage infections and the risk associated with the use/none use of emergency call leads. There should be clear written instructions to support the administration of all when required medication including laxatives. When MARs are completed by hand sufficient information should be written and copied from the original labels and instruction leaflets to guide staff on the correct administration. There should be clear written instructions to staff about whether residents can and do apply their own creams. Medication, including Controlled drugs, that are out of date or not currently being given should be returned to the dispensing chemist. Residents views about activities and meals should be DS0000022499.V376603.R01.S.doc Version 5.2 Page 29 2. 3. OP3 OP7 4. OP9 5. OP9 6. 7. 8. OP9 OP9 OP14 Brierfield House Care Centre 9. 10. 11. 12. OP16 OP24 OP26 OP27 13. 14. 15. 16. OP29 OP29 OP31 OP38 reviewed to ensure that their individual needs and preferences are catered for. All complaints should be investigated thoroughly and to the satisfaction of the complainant. The room identified should be reviewed with a view to improving its appearance and making it more homely. The unpleasant odours in the home should be eliminated and the laundry systems should ensure that people keep their own clothes. The practice of moving staff around to work in the different parts of the home should be reviewed in the light of good practice guidance for caring for people with dementia. The Criminal Records Bureau tracking form should include all the relevant details such as the date of receipt, the disclosure number and the result. There should be a documented assessment of risk including the suitability for employment of people with cautions or convictions. There should be stability and continuity of management in the home to ensure that the improvements needed are clearly understood and maintained. Staff should have updated training in moving and handling and safe handling of food. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Brierfield House Care Centre DS0000022499.V376603.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!