Inspection on 27/04/06 for Brierfield House Care Centre

This inspection was carried out on 27th April 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brierfield House Care Centre 15/07/09

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 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 27th April 09:30 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.V287609.R01.S.doc Version 5.1 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.V287609.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brierfield House Care Centre Address Hardy Avenue Brierfield Nelson Lancashire BB9 5RN 01282 619313 01282 698477 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne Homes Limited Mrs Kathleen Leach Care Home 42 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (26), of places Physical disability (1) Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 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. 24th November 2005 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 a diagnosis of dementia reside in a self -contained unit that occupies part of the first floor accommodation. 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 service users in the unit. A passenger lift provides access between the two floors. The home is custom built, in its own grounds, on the outskirts of Brierfield. All bedrooms are single use and measured 11 sq m. A part time activities organiser is employed in the home and there was a programme of varied activities. There were 6 WCs, 3 bathrooms and 2 shower facilities. Written information about the home is given to all residents and the Service User Guide contains a summary of the most recent inspection report. Information about the fees charged was not supplied for this inspection as these were changing in line with Local Authority changes. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced “key” inspection, the purpose of which was to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous inspection. The results of an investigation carried out by the general manager of a complaint made about staffing levels, was also checked. The inspection took two days. The inspection collected information from: talking to residents, touring the premises, observation of life in the home, residents’ care records and other documents, discussion with members of staff and discussion with the general manager, Mrs Kathleen Leach. In addition survey questionnaires from the Commission were completed on behalf of 10 residents, and two relatives were spoken with. What the service does well: The written plans for residents’ care were generally detailed and well written, and contained useful information regarding the residents’ health, personal and social care needs. These written plans were regularly reviewed and updated. The residents who were spoken with, and those who completed the survey questionnaire, stated that they felt well looked after and that they received the care they needed from the staff. One resident said that the staff “were very obliging”. Residents said that the staff respected their rights to privacy and were understanding about sensitive personal matters. The home employs an “activities organiser”, and there was a varied programme of activities, including outings and celebrations. 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 did training according to their own needs and the needs of the residents. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 6 The home regularly carried out its own checks to find out how good the care and services provided in the home are. Residents’ money was well managed to make sure their finances were safeguarded. Some aspects of the residents’ and staff health and safety were well looked after. The building, the services and the facilities were well maintained. What has improved since the last inspection? What they could do better: There could be more information collected about the residents’ needs before admission to the home, such as mental health/psychological and hobbies, so that staff know how to meet these needs. Further details about residents’ health and care needs, should be written down, such as how to prevent falls, improve nutrition and help residents with mental health problems. The procedures followed when residents fall should be improved and district nurses involved more promptly. Ways to prevent falls should be written down so that staff know what to do. Foot - rests should be used on wheelchairs to prevent residents being injured. The way medication is managed and administered in the home must be improved with urgency. There were a number of unsafe practices such as not Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 7 completing the records and instructions properly and not following correct procedures, for example staff must always give the prescribed medication unless there is a satisfactory explanation which is clearly understood. There must always be clear and accurate instructions for the administration of medication. The home could provide more suitable activities for people who are immobile and those who can’t hear and see so that residents’ different and varying needs are met. There has been an on going problem with unpleasant smells of urine in some parts of the home and this must be eliminated with priority to improve the quality of the environment for the residents. At certain times of the day there should be more staff on duty so that residents receive the attention they need at the time it is required. Also correct procedures should be followed to ensure shifts are covered when staff are off work at short notice. The home’s reporting of incidents to the Commission, such as residents’ falls and admission to “Accident and Emergency”, must be improved. 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. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 site visit to this service. The admission procedures ensured that residents and relatives could make a choice of whether or not the home would be suitable, and that the needs of prospective residents were assessed before admission. However the assessment does not currently adequately cover all important matters, including mental health issues, so it is not clear whether or not some residents are placed correctly and if staff understand all their needs. EVIDENCE: The home had a Statement of Purpose, and Service user guides were seen in the residents bedrooms. Since the previous inspection a copy of the most recent report had been attached to the Service User Guide. The records of four residents showed that the general manager or unit manager had visited them before admission to find out if Brierfield House could give the kind of care needed. Social workers had also carried out such an assessment, but for one resident whose records were viewed the home had not Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 10 obtained a copy of this assessment, so useful information about the person was missing. Records showed that one resident was admittred to the residential part of the home with a diagnosis of moderate to severe dementia. The in - house assessment did not record details of this so there was no written information to support the placement. Residents spoken with indicated that they were well looked after. One resident who was able to speak in detail about personal and sensitive needs praised the general manager and most of the staff for their understanding and sensitivity. However some residents said that staff were “rushed” and “didn’t have time to sit and talk” or spend time assisting with personal appearance. All staff in the dementia unit had undergone dementia training and the general manager stated that all staff throughout the home were to undertake such training. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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 site visit to this service. The care plans generally contained a good level of detail in many matters and showed what action staff needed to take. However some aspects of health care such as mental health, nutrition and management of falls, were not recorded. Medication management and procedures were poor and did not ensure the safe administration of medicines to residents. The residents privacy and dignity were upheld. EVIDENCE: The care plans of four residents were viewed, and were generally well completed with a good level of detail. There was evidence of reviews to which relatives were invited. There were moving and handling risk assessments and pressure areas risk assesments. However on some care plans not all the major matters on the care plan had been completed, for example those relating to mental health, spiritual matters and hobbies and interests. Residents general health care was monitored and addressed. Appointments were recorded in the care plans. There was evidence of ongoing contact for Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 12 residents in the dementia unit with psychiatric services for older people appointments and reviews were recorded. Risk assessments on vulnerability to pressure areas were recorded, and there were good links between these and preventative measures and district nurse involvement. However the care plan for one resident indicated that a specific falls assessment was needed but this had not been done, and the district nurses commented that staff at Brierfield House did not always follow the correct procedure of immediately reporting falls to the district nurses. The district nurses also found that sometimes there seemed to be shortage of staff on duty for the District Nurses to speak to, including senior staff, and that junior staff do not always seem informed of residents’ condition. Information and instructions from the district nurses not always passed on and specialist advice is not always incorporated into the care plan and acted on. However the District Nurses were satisfied with the overall care provided in the home. Residents were observed being pushed in wheelchairs without footrests and placing them at risk of injury. In addition the care plan for another resident identified the need for a detailed nutrition assessment but this had not been carried out. The home’s medication management and administration had not improved since the previous inspection, and the requirements made at that inspection had not been met. These were, incorrect proceures for handwritten alterations/additions to the Medication Administration Records (MARs), no clear details for the administration of “when required” (PRN) medication and for one resident the instructions on the MAR were different to those on the medicine label. In addition there were a number of other matters that gave cause for concern and these must be rectified to ensure the safe administration of medication in the home (see below). There were detailed policies and procedures covering all the areas of medication management and there were secure and good storage facilities. Areas of good practice included, the home checking the prescriptions prior to dispensing, safe administration and recording of Controlled Drugs and medication training. Correct procedures were not followed in a number of areas. In some of the records viewed the MARs were not being completed correctly and there were some serious errors. There were gaps in the signing for medication that had been given, signing for medication that had not been given, use of codes that did not have a description or explanation and not all MARs were an accurate record of the medication prescribed. For two residents one medication had not been given on a number of occasions and there was no reason given on the MARs. Also codes were being used incorrectly without explanation. For one resident the MAR did not give instructions as to how the recently altered dose of Warfarin should be administered. Supplies of a medication not being taken were still being obtained and another medication, which was not prescribed, continued to be listed on the MARs. For one resident staff were carrying out blood sugar tests without written authorisation or confirmation of competence from the district nurse. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 13 Specific issues in the dementia unit were: not all medication being received into the unit was recorded on the MARS; changes to one resident’s medications had not been clearly written on the MAR and the alterations had not been dated; a mistake had also been made in hand written instructions on the MAR and it was not clear what the correct dose should be; the instructions on the MAR were different to the medication label; one MAR indicated that an incorrect external medication was being applied and also recorded incorrectly. In addition, some eye drops requiring storage in the fridge were kept in the cupboard in the office and there was no open date on another bottle of eye drops. Separate supplies of eye drops for each eye were not obtained. Medication no longer being used had not been returned to the pharmacist, e.g paracetamol. The general manager must carry out a full audit of the medication in both units, inform the CSCI of the outcome and the action taken to address all the matters identified. The residents’ rights to privacy and dignity were respected. There were locks on the bedroom doors and all bedrooms were single and en- suite. Staff were seen treating residents properly and the residents survey indicated that staff treated them well. One resident stated that staff understood and respected sensitive personal issues. Residents spoken with stated that staff treated them well, but one resident stated that staff order you around. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. There were varied leisure activities which appeared to suit the needs and preferences of the majority of residents. However those with individual needs, such as lack of mobility and hearing, felt excluded. Residents had sufficient choices in their everyday lives and were enabled to maintain contact with their relatives and the community. The food served usually met the needs and the preferences of the residents. EVIDENCE: There were a wide variety of activities to suit the interests and capabilities of most of the residents. This was generally the responsibility of the part time activities organiser. Records, and the homes notice board showed a wide range of activities such as Easter baking, egg painting, quizzes, trips out, celebrating the Queens birthday, massages and reminising. There were opportunities for contact in the local community through trips out and fund raising events held in the home. However some of the care plans viewed did not record hobbies and interests (see standard 7). Of the 10 residents who completed the questionnaire survey 7 stated that suitable activities were provided and one said sometimes. However two residents who spent most of their time in their rooms felt that suitable activities were not provided. Religious and spiritual needs were not fully recorded on some care plans (see Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 15 standard 10) and for one resident there was no evidence that she was encouraged and assisted to continue with the religious interests she had prior to admission to the home. Two relatives spoken with confirmed that visitors were made welcome at any reasonable time, according to the home’s visiting policy. At the time of the inspection visitors were in and out of the home all day. Relatives were encouraged to attend activities and events. Many residents were not able to make informed choices, but those who could express views indicated there was sufficient choice in such matters as rising and retiring times and whether or not they could stay in their rooms. Most residents had small items of furniture to personalise their rooms. One resident had the assistance of an independent advocate. Some residents managed their own finances and were assisted by staff to do this. The food served appeared nutritious and varied. There was a choice of two main (cooked) meals and desserts at lunchtime. However on the second day there was only a choice of two fish dishes, though the menu displayed stated another choice. Checking the menus on display, and observation of the meals served, showed that there were a number of differences between the printed menus on display and the actual food served, which could cause confusion and disappointment for some residents. Food was served by staff from a heated trolly and residents had little choice about portions etc. Assistance was given to those who needed it and food was served in a suitable form for those with eating difficulties. Drinks and biscuits were served at times throughout the day. However notes from a recent residents meeting indicated disappointment that home made cakes were not served. This had not been rectified at the time of the inspection. Discussion with the residents and the residents’ survey showed that residents’ were “usually” satisfied with the food served. One resident who was spoken with stated she enjoyed the food, one resident stated that it was alright on the whole but that you couldnt have a bacon sandwich for your breakfast if the cook wasnt on duty. One said she had no grumbles about the food. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The complaints procedure was accessible to residents and visitors and residents stated that they knew who to speak to if they had any concerns. There were satisfactory policies and procedures to protect the residents from abuse and residents felt safe living in the home. EVIDENCE: The home had an adequate complaints procedure. Records showed that a number of complaints had been made to the home over the last year and therefore the complaints procedure was accessible to a number of people. However it was not available in different formats and many of the residents would not be able to use it. A relative spoken with confirmed that she had been given written information about the home including the complaints procedure and stated that she had been able to sort out teething problems by talking directly to the staff. One complaint had been made to the CSCI since the previous inspection which had been passed to the home to investigate under their own complaints procedure. This was about the home’s staffing levels and is summarised under standard 27. Residents spoken with and who completed the survey questionnaire stated that they had no complaints. Seven stated that they always knew what to do if they were not happy and 3 said they usually did. There were policies and procedures to protect the residents from abuse and these had been found to be suitable at previous inspections. There had been Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 17 no allegations or suspicions of abuse in recent times. Residents spoken with stated that staff treated them well. Staff had the opportunity to attend in house training on the protection of vulnerable adults. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The home was well maintained and furnished and provided pleasant, comfortable accommodation. However there were areas of the home, including some bedding, which were unclean and had unpleasant odours. EVIDENCE: Brierfield House is a purpose built care home. The premises were well maintained, light and airy, comfortable, pleasantly decorated, and complied with fire regulations. A handy man was employed in the home. Maintenance and refurbishments were carried out when required and according to a programme of maintenance. There was a variety of disability equipment in the home, including hoists, chairs and bathroom equipment. Not all the rooms were viewed but those seen were well furnished and bedrooms were personalised. Some carpets had been replaced with easy to clean floors in some bedrooms. Some bedrooms in the dementia unit had been recently redecorated. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 19 There was a housekeeper in the home responsible for the laundry and the standards of cleanliness. The laundry of residents personal clothes had improved. All areas in the dementia unit were clean and fresh. There were no offensive odours in this area. However some other parts of the home had unpleasant odours of urine including the reception area and some bedrooms. This has been an ongoing problem in the home and must be urgently addressed. Some bedding had faeces and other stains, and some beds were badly made. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a site visit to this service. There were not always sufficient numbers of staff on duty to meet the needs of the residents, according to their dependency levels, expectations and the expectations of the staff. However there were good staff training opportunities, and adequate staff recruitment procedures, which ensured that staff team had the necessary background and skills to understand the needs of the residents. EVIDENCE: The numbers of staff on duty were not sufficient to meet the needs of the residents all the time. Some residents who were able to talk to the inspector stated that staff are always in a rush and dont have time to sit and chat. One resident stated that staff do the best they can but sometimes you have to wait for attention. Another resident stated that she would like staff to be able to spend more time assisting her with her personal appearance, but they don’t have the time. Four staff spoken with in the residential unit stated that they are rushed, especially when there are 3 care staff on duty (usually in the evening). They felt that there were alot of very dependent residents and that people have to wait for attention - if two carers are assisting a resident it is inevitable that others will have to wait. The general manager also stated that she felt that another member of staff was needed in the evening and that this had been mentioned to senior managers. In addition a district nurse stated that sometimes it was difficult to find a member of staff to speak to. A relative Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 21 spoken with stated that he felt there were not enough staff on duty sometimes, particularly at the weekend. Another complaint about low staffing levels and lack of use of agency staff during periods of staff shortage had been investigated by the general manager immediately prior to the inspection. The investigation and examination of rotas showed that there were staff shortages on several shifts in February 2006 due to short notice absences. Agency staff had not been used and the general manager concluded that staff had not followed the correct procedures for these circumstances. Company policy states that agency staff can be used if existing employees cannot cover. None have been used recently. The procedures had been reinforced at staff meetings. Some other matters referred to in the report, apart from the comments made by residents and staff, are an indication that exisiting staff do not always have the time to meet the needs of the residents. These are: District nurses instructions were not always passed on and acted upon, medication had not been properly administered and monitored, staff were not using foot rests on wheelchairs and dirty bedding had not been changed. The company is committed to NVQ training and records showed that 66 of staff were qualified to at least NVQ level 2. Brierfield House had a training programme for staff in accordance with the company’s corporate programme, and the National Minimum Standard on staff training. This included compulsory training in moving and handling, first aid and food hygiene. In addition some specialist training had been undertaken such as in dementia, pressure area care and adult abuse. Staff spoken with at the inspection confirmed their training opportunities. One member of staff had been recruited since the previous inspection. The records viewed showed that adequate procedures were being followed to protect residents from the employment of unsuitable staff. These included obtaining the appropriate police checks and exploring gaps in employment. However for the member of staff concerned only one written reference had been received when she started work in the home. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a site visit to this service. The home was managed by an experienced and qualified manager but the number of legal requirements had increased and there were some outstanding matters from the last inspection. Quality assusrance policies and procedures were implemented which take into account the views of residents and relatives. Residents money was managed safely and efficiently and the health and safety of both residents and staff were promoted. However the home was not notifying the Commission of all incidents affecting the health and welfare of the residents. EVIDENCE: The registered manager of the home (the general manager) is a registered general nurse with many years nursing experience and about 12 years experience as manager of Brierfield House. Mrs Leach completed the Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 23 Registered Managers Award and NVQ level 4 in Care a few weeks prior to the inspection. There were clear lines of accountability within the home and the organisation, with the general manager being responsible for 2 unit managers, the teams of care staff and the ancillary staff. She in turn was responsible to a senior general manager and a regional manager. The regional manager has carried out monthly visits to the home under Regulation 26. However most of the previous requirements and recommendations had not been met and there were considerably more legal requirements from this inspection. Brierfield House has carried out numerous quality monitoring exercises according to company policy. These involved residents’ surveys and monthly internal “audits” on different aspects of the service. Brierfield house had recently completed a residents’ survey. Residents meetings were held to which relatives were invited. An action plan is always produced after inspections stating how requirments and recommendations will be met. However on this inspection some requirements and a recommendation remained outstanding. Inspection of the financial records of the fees paid, and the spending money, of two residents showed that the residents’ finances were managed safely and accurately. Two residents managed their own finances with the assistance of staff. Appropriate records were kept of the fees charged, Social Services service agreements and fees paid. Also appropriate records of residents’ spending money were kept, including money kept in the office safe, money given to residents and that spent on their behalf. For the two residents whose finances were checked the amount of residents money in the safe matched the balance in the records. The health and safety of the residents and staff was promoted by the home’s policies and procedures. Records and staff spoken with confirmed that there was a continuous programme of moving and handling training, fire training and first aid training. Some had completed an infection control course. According to information supplied to the CSCI, and discussions with the manager, the gas installations, the central heating system, electrical wiring, portable electrical appliances, equipment including the lift and the water supply, all had current certificates of testing. Fire precautions were satisfactory - the equipment had been checked within the last 12 months, there had been a fire drill in April 2004 and the fire alarm was tested weekly. Accidents were recorded appropriately, but not all notifiable incidents under the Care Homes Reulations, including admissions to Accident and Emergency and deaths, were reported to the CSCI. Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 24 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP3 OP3 Regulation 14 (1)(b) Requirement Timescale for action 28/04/06 31/05/06 3. OP7 4. OP8 5. OP8 The pre admission assessments undertaken by social workers must be obtained by the home. 14 (2)(a) The needs of the resident identified at the inspection must be reassessed and the CSCI notified of the outcome. 15 (1) The care plans must set out in detail, how all the health, personal and social care needs of the residents are to be met, and the action care staff need to take. This must include mental health issues, hobbies and interests and spiritual matters. 12 The registered person must (1)(a)&(b) ensure that residents’ health care and treatment are properly carried out at all times, through acting on the instructions and advice of the district nurses and through effective communication between staff in the home. 13(4)(b) Risk assessments must be (c) carried out, and appropriate management identified, for residents at risk of falling the interventions must include correct notifications to the DS0000022499.V287609.R01.S.doc 31/05/06 31/05/06 31/05/06 Brierfield House Care Centre Version 5.1 Page 26 6. OP8 13(4)(b) (c) 7. OP8 14(1)(a)& 17(1)(a)s c3(3)m 8. OP9 17(1)(a) sch 3,3(i) 9. 10. OP9 OP9 13(2) 13(2) 11. 12. OP9 OP9 13(2) 13(2) 13. OP9 13(2) 14. OP9 13(2) 15. 16. OP9 OP9 17(1)(a) sch 3,3(i) 13(2) District Nursing team. Staff must use foot - rests on wheelchairs unless there is a written risk assessment to support this is against the residents’ best interests. Nutrition assessments must be undertaken for those residents for whom nutrition screening has identified the need. (Recommendation at the previous inspection) Medication administration must always be accurately recorded on the MARs and the correct codes must be used which all staff understand. Medication must not be omitted without the reason being clarified and the use of correct codes. The MARs must contain accurate instructions and information for the administration of medication, including when changes occur Following consultation with the GP supplies of medication must be cancelled when not needed. The MARs must be an accurate record of the medication prescribed and must not list medication that is not prescribed. Written authorisation and confirmation of training from the District Nurses for care staff who carry out blood sugar testing. Only medication that is prescribed, including creams and ointments, must be administered, and the MARs must be an accurate record of this. All medication being received into the home must be recorded accurately Medication requiring storage at lower temperature must be kept DS0000022499.V287609.R01.S.doc 28/04/06 31/05/06 19/05/06 19/05/06 19/05/06 19/05/06 19/05/06 31/05/06 19/05/06 19/05/06 19/05/06 Brierfield House Care Centre Version 5.1 Page 27 17. OP9 13 (2) 18. OP9 13(2) 19. OP9 13 (2) 20. OP9 13(2) 21. OP9 13(2) 22. OP12 16(2)(m) (n) 23. 24. OP26 OP26 23 (2)(d) 16 (2)(k) in the fridge according to the instructions on the label. Opening dates must be written on eye drops and creams if they are to be discarded after a specific date. All medication no longer being administered, including paracetamol, must be returned to the pharmacist All handwritten alterations/additions to the MARs (transcribing) must be double signed and dated. (Previous timescale of the 24/11/05 not met) Clear criteria for the administration of PRN medication must be recorded on or near the MARs. (Previous timescale of the 24/11/05 not met) The instructions on the MARs must always be the same as the instructions on the medication label. (Previous timescale of the 24/11/05 not met) All the residents must be consulted about suitable leisure activities, and individuals’ needs provided for, including religious needs. All bedding must be kept clean and free from faeces stains The registered person must ensure that all parts of the home is kept free from offensive odours. (Previous timescales, including 24/12/05 not met) Staffing levels must be increased at the home to meet the dependency needs of the current residents and ensure their comfort and safety. The registered person must ensure that staff do not commence work in the home until two written references have DS0000022499.V287609.R01.S.doc 19/05/06 19/05/06 19/05/06 19/05/06 26/05/06 31/05/06 19/05/06 31/05/06 25. OP27 18(1)(a) 31/05/06 26. OP29 Amd Reg 19 sch 2 28/04/06 Brierfield House Care Centre Version 5.1 Page 28 been received. 27. OP38 37 All incidents notifiable under the Regulation should be reported in writing to the CSCI. 28/04/06 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 statement of purpose should contain the views of the service users about the home and the contact numbers of the Health Authority and the Social Services. (Unmet from previous inspections) Written authorisation should be sought from residents when they agree to the home managing their medication. Risk assessments should be undertaken with those residents who wish to administer their own medication. A separate supply of eye drops should be obtained for each eye to prevent cross infection. The registered provider should ensure that there is always a real alternative choice of meals and that the menus include homemade cakes. The registered provider should ensure that the food served is the same as that written on the displayed menu. 2. 3. 4. 5. 6. OP9 OP9 OP9 OP15 OP15 Brierfield House Care Centre DS0000022499.V287609.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 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.V287609.R01.S.doc Version 5.1 Page 30 - 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!