Inspection on 19/03/08 for Brierfield House Care Centre

This inspection was carried out on 19th March 2008.

CSCI 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 CSCI 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 15/07/09

Brierfield House Care Centre 20/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brierfield House Care Centre Hardy Avenue Brierfield Nelson Lancashire BB9 5RN Lead Inspector Mrs Pat White Unannounced Inspection 19th March 2008 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.V365143.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.V365143.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 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.V365143.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. 22 January 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 £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. 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.V365143.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 inspection site visit to Brierfield House was carried out on the 19th March 2008. The site visit was part of an inspection 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 and that had been the subject of an Improvement Plan submitted to the Commission. Since that time two Random Inspections, on 30/11/07 and 22/01/08, have also been undertaken as part of the plan to improve the service, and at which the Improvement plan was monitored and the pharmacy inspector from the Commission inspected medication practices. Following the Random Inspection on the 30/11/07 enforcement action was taken against the home on some serious matters of concern regarding medication. These matters were considerably improved at the Random Inspection on 22/01/08 (see below). This inspection undertaken on 19/03/08 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 acting manager and operations manager (the “management team”). Eight residents spoken with gave their views on the home. In addition survey questionnaires from the Commission were sent to residents, relatives, staff and health professionals asking them for their opinion of the home. At the time of writing this report 1 resident, 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 about the residents, staff, services provided and it’s own assessment on the quality of the services. Some of this information is also included in the report. What the service does well: 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. The written records of resident’s needs were in general well written, Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 6 and covered most of the important matters regarding health and personal care needs. 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. 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 management team 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 safeguarded. The building, the services and the facilities were well maintained. What has improved since the last inspection? Since the last key inspection in August 2007 there have been a number of improvements. Some residents have had their mental health needs re assessed and this has led to better understanding of these needs and the support required (see below). The care plans of these residents had been updated accordingly so there was more up to date relevant written information to assist staff. Most aspects of medication management and practices had improved and medication was being administered safely and at the right time to help ensure that residents’ health is maintained. An activities coordinator had been employed since the previous key inspection and had improved the opportunity for meaningful activities for most people. The food served in throughout the home has improved with varied and interesting menus being introduced. Also the choice of food served to the people in the dementia unit had improved and the people living there had the same choices as the other residents living in the home. The experience of meal times for most residents had improved and there was more supervision to ensure that the residents received the help and support they needed. The way complaints and allegations of abuse were dealt with in the home was better than at the previous key inspection. Better records were kept and the correct procedures were followed in the event of an allegation or suspicion of abuse. Some staffing problems had been identified and staff were gradually undertaking specific training, and having supervision with the managers, to Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 7 help them understand residents’ varied, and in some instances, complex, needs. The hot water pipes had been lagged to protect people from the dangers of hot surfaces. The home was cleaner than at the previous key inspection and there were no unpleasant odours. What they could do better: Some residents would still benefit from a mental health assessment, and written information about assessments undertaken with other residents should be in the home and used to plan the care and support needed. This written information was not available and there was a lack of clarity and understanding about what was happening to some residents. The assessment of the risk to people of falling out of bed should determine what method would be best to prevent this, and should be updated as circumstances and the risk changes. Some care plans were still not as up to date and as accurate as they should be and some matters were outstanding from the previous inspections. This contributed to some confusion about the care and support needed. For example the care plan of one resident had not been updated in respect of moving and handling requirements following a specialist assessment, or in respect of nutrition requirements. Another resident’s care needs had changed considerably but the care plan had not been changed or up dated. A legally compliant controlled drug cupboard must be available to store controlled drugs to help prevent mishandling and misuse. Although complaints and allegations of abuse were now being dealt with according to procedures there were still concerns about the number allegations of theft of money by residents and some allegations of abuse by staff against residents. Residents must be better protected. Some parts of the premises could be further improved and the wheelchair damaged doors and door - frames needed restoring. The attitude and working practices of the staff group must be improved so that all residents are treated with respect and kindness by all members of staff, and this includes being spoken to respectfully at all times and being attended to for care needs within a reasonable timescale. The way staff were recruited to work in the home could be further improved. The references should be obtained from previous employers if at all possible Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 8 and alternatively genuine character references should be obtained. More rigorous checks should be undertaken to determine why people have left jobs in care to establish if there are reasons to refuse people employment. The overall management of the home must be improved. There should be continuous strong management in the home to ensure that the staffing issues identified continue to be addressed so that permanent improvement is maintained. The home’s own internal quality monitoring measures should identify and address the problems within the home, so that the Commission is reassured that effective action is being taken. 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.V365143.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.V365143.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 was 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 and documented following re assessments of need and there was a lack of certainty about how and if the home could meet the needs of some residents. EVIDENCE: The home had a Statement of Purpose, and Service User Guides were seen in the residents bedrooms. However information in the Service User Guide seen, referred in places, to another home in the area which could cause confusion to the residents. This was rectified by the end of the site visit. The Statement of Purpose also referred to nursing assessments being undertaken by the nurse in charge, and this document and the Service User Guide did not explain that the home has a specific unit for people with dementia related needs. Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 11 The 4 relatives who completed questionnaires for the Commission felt they did not have enough information prior to moving in to help them make a decision about moving into the home. There had been no recent admissions to the home so the admissions procedures could not be fully assessed. However some residents whose care had been monitored over a number of inspections required re - assessments of needs. The records of some of these showed that the process and documentation were incomplete or inaccurate, and there was a lack of clarity about what should be happening following the reassessment. The mental health assessment for one resident was not in the home and it was unclear what the next step was. One resident previously identified as being in need of a mental health assessment had not been referred, and senior staff spoken with were not clear about whether this was necessary or going to happen. One resident had received a specialist moving and handling assessment but the care plan had not been sufficiently updated with accurate instructions and there was a contradiction in the information on the specialist assessment and the care plan. Most staff in the dementia unit had undergone dementia training to help them understand the needs of these residents and the time spent in this unit showed that in general the residents here 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. Three residents said that they had to wait an unacceptable length of time for assistance, another resident said that some staff were rude and impatient. 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, though there had been considerable improvement in many respects. Of the 4 relatives who completed the questionnaires one felt that the home “always” met the needs of the resident, 2 said “usually” and one said “sometimes”. Brierfield House Care Centre DS0000022499.V365143.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 up dated and accurate information in all matters relating to health, personal and social care. Residents had access to appropriate health care professionals, and medication management and procedures were safe and helped to maintain residents’ health. Not all staff treated residents with respect or upheld their dignity. EVIDENCE: The care plans of seven residents were viewed, including 2 in the demetia unit and including 3 that had ben looked at previously to check progress made. Some parts of the documentation 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, or up dated with relevant accurate information following reassessments , for example those relating to mental health, nutrition and moving and handling (see previous section). Also there was no Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 13 up to date care plan for one resident whose care needs had considerably changed. For this resident there was insufficient information and guidance on all aspects of care and in particular regarding the giving of fluids. Staff had been giving these in the wrong way. This was discussed with the management team and action was taken to rectiy this before the end of the site visit. Also for two residents whose records were viewed there was insufficient up date information and clarity regarding nutrition, inspite of this being discussed at a number of inspections and assurance being given that this would be addressed. 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. However for two residents whose records were viewed and had been viewed at previous inspections there was still insufficient clarity regarding nutrition and weighing. One resident was not being weighed as frequently as determined by the risk assessment. Another resident whose risk assessment indicated problems with obesity could not be weighed as there was not appropriate weighing scales in the home. This issue was outstanding from the previous inspection. “Bed wedges” were used in the home to help protect people from falling out of bed. However the risk assessments still 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. The risk assessment for one resident did not reflect the measures used. The risk assessment indicated that wedges were needed but these were not in place, a mat on the floor was used instead. There was no supporting evidence for this. As part of the inspection a specialist pharmacist inspector looked at the handling of medicines. This was done to monitor the improvement following the enforcement action taken after the random inspection on 30/11/07. We looked at the records of medicines receipt, administration and disposal and found that they were usually detailed and accurate. Medicines records were checked against current stock and it was found that most medicines were usually given correctly, ‘as prescribed’. Observation and records showed that residents were given medicines at a time that fitted into their normal morning routine and that most medicines were given at the correct time, this is important to ensure they work properly. We checked seven care plans to see if they supported the use of medicines and found that most of the care plans had been recently reviewed with medicines issues being clearly highlighted with good detailed information to help support the use of medicines prescribed as ‘when required’. Two of the care plans that Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 14 had not been reviewed lacked important information. We told the acting manager about these who said that they were to be updated very soon. Having clear written plans is important to ensure residents have their medicines administered correctly. Also for one resident whose records were viewed at the last inspection there was still no written evidence that the District Nurses had assessed named members of staff as competent to test blood sugar levels. We looked at how controlled drugs were stored and we found the cupboard did not meet the requirements of law, the manager said that it would be put right later that day. Records of controlled drug handling were made in a suitable register and the entries that we checked were detailed and accurate. Having suitable arrangements for controlled drugs helps prevent mishandling and misuse. We saw some evidence of formal training for medicines handling and staff had their competence assessed by managers before they were allowed to administer medicines. Regular checks by the managers had identified some mistakes, which they had acted upon to help prevent them happening again. We gave further advice on how to improve the content and recording of these checks to ensure all mistakes are identified. Having good checks helps ensure staff are competent and shows whether medicines are being given to residents correctly. 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. Several residents in conversation said that some care staff were rude and impatient and that they frequently had to wait an unacceptable length of time for assistance, for example being assisted to the toilet. At the time of the site visit several incidents involving carers’ conduct were under investigation. Some of these matters had not improved since the previous inspections. However one resident who had on going concerns regarding assistance with her personal appearance and some unique and sensitive care needs felt there had been an overall improvement in how the home managed and assisted her with this. One relative did not feel that the resident was treated with sufficient dignity and commented that there was no “personal caring aspect” and that “some staff left a lot to be desired”. Brierfield House Care Centre DS0000022499.V365143.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 good. This judgement has been made using available evidence including a visit to this service. There were sufficient varied leisure activities to suit the individual needs and preferences 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. The food served was varied and nutritious and suited the residents’ preferences. 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 an improvement in the provision of leisure activities for the residents. There was a new activities organiser in the home and residents were seen on an individual basis to try and establish suitable activities. Ministers from different denominations visited the home to help residents maintain their religious interests. Of the relatives who completed the questionnaires 2 felt that communication between the home and themselves was satisfactory and that they were kept informed of important matters affecting the resident and 2 felt that it was not. Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 16 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. 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. 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. Since the previous key inspection there was greater attention paid to ensure that residents were properly supervisied and that mealtimes were a calmer and more enjoyable experience than they were in the past. Drinks and biscuits were served at times throughout the day. Residents spoken with at the site visit had no complaints about the food. Brierfield House Care Centre DS0000022499.V365143.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 adequate. 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. However not all felt there concerns were dealt with satisfactorily. There were policies and procedures to help protect people from abuse but these were not always effective in protecting people. 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 6 complaints had been made in the last 12 months. Several complaints about some care issues, and the previous manager had been made to the Commission and were passed to the home to investigate under it’s complaints procedure. These were not initially investigated satisfactorily and the Commission had to request further information from the registered provider. The 4 relatives who completed the questionnaires said that they knew how to make a complaint. Three were generally satisfied with the response of the home when they raised matters of concern, one said that the home only “sometimes” responded appropriately. Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 18 Since the previous key inspection in August 2007 and up to the site visit there had been 6 allegations made against staff of potential abusive nature. Four incidents concerned allegation of theft of residents’ money, 2 were concerned with possible physical abuse and one of verbal abuse. The incidents of allegations of theft were reported to the police but their investigations were inconclusive and no charges were made. Two other 2 allegations of abuse were still under investigation at the time of the site visit, and a further allegation of verbal abuse towards residents was reported after the site visit. Since the previous key inspection the management team had ensured that the correct procedures were followed for these incidents. However several members of staff who had previous allegations made against them had been reinstated and were still working in the home and it was not clear whether the home’s actions sufficiently protected people from all forms of abuse. Brierfield House Care Centre DS0000022499.V365143.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, 25 & 26 Quality in this outcome area is good. 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, clean and comfortable accommodation, including the bedrooms, which were personalised and suited residents’ needs. 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 a seating area had been developed with tubs of plants. Brierfield House Care Centre DS0000022499.V365143.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 help 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 there were no immediate plans to restore this to a functional bathroom. At the time of the site visit there were plans to refurbish the kitchen and the Commission was subsequently informed that this work had begun and of the arrangements in place to make sure that there would be minimum disruption to the meals served. 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 house front doors. Since the last key inspection the hot water pipes putting people at risk had been lagged, and water temperatures tested at random at the site visit.were within the acceptable range. 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 were of a satisfactory standard of cleanliness and there were no unpleasant odours. This showed an improvement from previous inspections. The one resident who completed the questionnaire stated that the home was “usually” fresh and clean. Brierfield House Care Centre DS0000022499.V365143.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): 27, 28, 29 & 30 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 attitude to meet the needs of all the residents, and residents were not in safe hands at all times. The home’s recruitment procedures, though mainly in accordance with Government guidance, did not protect residents from some unsuitable staff. EVIDENCE: At the time of the site visit the home was staffed according to the rota. However according to discussion with residents, the management team and the relatives who completed the survey questionnaires not all the staff had the necessary skills and attitude to work with older people and meet the needs of all the residents. Some staff, despite of the training outlined below, did not always treat residents appropriately. This has been of concern over a number of inspections and the management team had begun to address the on going problems with some staff concerning poor practice and the “bullying” of other staff. However at the time of the site visit these measures had not yet resulted in any significant improvements in the outcomes for people living in the home. Comments made by a relative were “Some of the staff are excellent, others Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 22 leave a lot to be desired” and “I do wish staff would find time for more personal attention”. Some relatives however, including one spoken with at the time of the site visit, thought there had been a recent improvement. The written information provided by the home prior to the site visit stated that 17/29 care staff had achieved at least NVQ level 2, that is, 59 . Four more staff were currently studying for NVQs. Staff had satisfactory training opportunities and some training was compulsory such as moving and handling, fire safety and training in dementia for those working in the dementia unit. Since the previous inspections staff training had been reviewed to ensure that staff had opportunities for training in some specific matters, such as some aspects of mental health, challenging behaviour and raising awareness in other sensitive matters relating to one resident. People with specialist knowledge had been commissioned to deliver this training. However this had yet to impact on some of the staff and for example one member of staff spoken with said that she couldn’t remember whether or not she had undertaken training in “challenging behaviour”. Though the home’s recruitment procedures were mainly in accordance with the Care Home’s Regulations and guidance, these procedures in the past had not protected residents from unsuitable staff, and records viewed showed that there were some gaps in the procedures. Though these records showed that staff did not commence work in the home until Criminal Record Bureau and Protection of Vulnerable Adults disclosures had been obtained, a reference for one newly appointed member of staff was not the most appropriate, and the identity of that person had not been clarified. For another member of staff, circumstances of dismissal from another care service had not been explored and therefore any risk had not been assessed. Brierfield House Care Centre DS0000022499.V365143.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): 31, 32, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been a lack of strong effective management and leadership in the home for some time and this affected the running of the home and care practices. Quality assurance policies and procedures took into account the views of residents and relatives but the home’s own assessment of it’s services did not acknowledge or address most of the known problems. Not all residents money was managed safely. EVIDENCE: There had not been a registered manager in the home for over 12 months. During this time the home has experienced several changes in management that has resulted in a lack of continuity, direction and strong leadership. Though improvements in some areas of the home were evident, such as in the Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 24 environment, the review of residents’ needs and skills required by staff, the lack of stable and strong management has made it difficult to deal with the staffing issues, and some other problems in the home, that have been identified. At the time of this site visit, and following the recent resignation of the manager who had been in post since April 2007, the home was being managed by a project manager, who was seconded to the home a few months ago to assist in improvements. There was also a new operations manager, following the recent resignation of the previous one, and who was working closely with the “acting manager”. A permanent manager was in the process of being appointed. Whilst the management team demonstrated commitment to making improvements in the home, particular in respect of staffing issues, there had not at that time been a significant improvement in the outcomes for the people living in the home. There were also concerns about staff being promoted despite issues regarding their conduct and practice. According to the information supplied to the Commission the home had a number of internal quality monitoring measures. There were weekly and monthly audits to highlight areas of concern and to ensure the smooth running of the home. Action plans would be put in place to improve problem areas identified. Annual survey questionnaires sent to residents and relatives. Regular staff meetings and meetings with residents and relatives were held. However the written information about the home, that must be supplied to the Commission, and which is partly the home’s own assessment of the quality of services provided, did not sufficiently address the problems that the home was facing or indicate the action that would be taken to improve identified areas. One of the measures set up to help eliminate bad practice was more rigorous staff supervision. There was evidence from the records and discussion with the management team that this was taking place, but had yet to result in improved outcomes for people living there. Not all aspects of residents’ finances were fully assessed at this site visit. However with respect to resident’s personal money, some residents’ money had not been safeguarded (see “Complaints and Protection”), with allegations of theft being made. There was as yet no action plan in place to help ensure such incidents did not happen again. 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 infection control training. 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, electrical wiring and the water supply, all had current certificates of testing. Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 25 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.V365143.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 2 X X 2 X N/A 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 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 x x 3 3 3 3 STAFFING Standard No Score 27 1 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 x 2 x x 2 Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No but some requirements only partly met 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 OP4 Regulation 14 Requirement There must be sufficient documentation and clarity about the decisions made about and following re assessments of need, including mental health needs and moving and handling requirements to ensure that residents receive the most appropriate care and support and their needs are met. The care plans should be reviewed and updated as necessary when needs change, and should include up dated and accurate information about all relevant matters such as mental health, nutrition and moving and handling, to give staff clear instructions on how these needs should be met. A legally compliant controlled drug cupboard must be available to store controlled drugs to help prevent mishandling and misuse. There must be evidence from the District Nurses that named staff are competent to test blood sugar levels. (Previous timescale of 29/02/08 not Brierfield House Care Centre DS0000022499.V365143.R01.S.doc Version 5.2 Page 28 Timescale for action 30/04/08 2 OP7 15 (2)(c) 30/04/08 3 OP9 13(2) 25/05/08 4 OP10 12(4)(a) 5 OP18 13 (6) 6 OP27 18(1)(A) 7 OP29 8 OP31 19 (5) (d), amended schedule 2 9 met) Staff must treat all residents with respect and uphold their dignity at all times. (Subject to several previous requirements) Service users must be protected from harm or abuse or from the risk of harm and abuse including financial abuse and verbal abuse The registered person should ensure that at all times there are suitable staff working in the home, with the right skills and attitude, to properly look after older people. The reasons for people being dismissed from previous care jobs must be explored and subject to risk assessment. There must be a permanent manager in post who will employ strong effective leadership and who has the right skills The home’s own quality monitoring assessment report to the Commission must identify and address the problems faced by the home. 30/04/08 30/04/08 30/06/08 30/04/08 30/06/08 9 OP33 26 30/04/08 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 include correct information about the accommodation provided in the home. The accurate Service User Guide should be given to all residents. Risk assessments should be undertaken on the use of bed DS0000022499.V365143.R01.S.doc Version 5.2 Page 29 2 OP8 Brierfield House Care Centre wedges to demonstrate whether or not these are safe for individuals and how to use them safely. Risk assessments should be updated when circumstances change and risks increase or decrease. 3 OP8 Residents should be weighed according to guidance in the risk assessments and care plan and appropriate scales should be available for all residents. There should be prompt and effective communication between staff and relative so that they are kept fully informed of all relevant matters. The doors damaged by wheelchairs should be restored. It is recommended that the bathroom on the ground floor is restored to use to offer residents more choice of bathing facilities. In staff recruitment, references should always be employment based and the identity and authenticity of the referees should be verified. The homes portable appliances should be tested within the appropriate timescales. 4 OP13 5 6 OP19 OP22 7 OP29 8 OP38 Brierfield House Care Centre DS0000022499.V365143.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 © 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 Brierfield House Care Centre DS0000022499.V365143.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. 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