Inspection on 31/05/08 for Brierfield Residential Care Home

This inspection was carried out on 31st May 2008.

CSCI found this care home to be providing an Adequate service.

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 Residential Care Home 10/09/07

Brierfield Residential Care Home 14/09/06

Brierfield Residential Care Home 01/12/05

Brierfield Residential Care Home 11/08/05

Brierfield Residential Care Home 28/02/05

Brierfield Residential Care Home 23/04/04

Brierfield Residential Care Home 16/02/04

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brierfield Residential Care Home Brierley Avenue Failsworth Oldham Lancashire M35 9HB Lead Inspector Michelle Haller Unannounced Inspection 31st May & 4th June 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 Residential Care Home DS0000031867.V363729.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 Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brierfield Residential Care Home Address Brierley Avenue Failsworth Oldham Lancashire M35 9HB 0161 681 5484 0161 682 7072 brierfieldshouse@masterpalm.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) Masterpalm Properties Limited Nicole Thomas Care Home 37 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (12), Old age, not falling within any other of places category (37), Physical disability over 65 years of age (5) Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 37 service users to include: *up to 5 service users in the category PD(E) (Physical disability over 65 years of age); *up to 12 service users in the category DE(E) (Dementia over 65 years of age); *up to 5 service users in the category DE (Dementia under 65 years of age); *up to 37 service users in the category OP (Old age not falling within any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 1st April 2008 2. Date of last inspection Brief Description of the Service: Brierfields is a purpose built, single storey care home for people aged 65 years and over. The owner is Masterpalm Properties who have three other homes in the area. The home is set on three wings, Acorn, Beech and Cedar. All service users are provided with single en-suite accommodation. Communal areas include one very large main lounge and dining room, a smaller lounge and quiet corners around the home, there is also a large enclosed porch that overlooks a quadrant garden. All bedrooms are single with en-suite toilet and washbasin. Most rooms have freestanding furniture, making it possible for service users to bring their own soft furnishings, accessories and other items. The fee charged by the home is £343.10 each week. The Commission for Social Care Inspection report is on display at the entrance of the home and made readily available. Brierfield Residential Care Home DS0000031867.V363729.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 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visit we looked around the building, talked to residents, relatives and staff, including the manager and one of the registered providers. We observed the interactions between people living at Brierfield Residential Home and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last key inspection. This included: The random inspection we undertook on 1st April 2008. This inspection was completed by our pharmacist inspector and focused on the way the medication is administered, stored and recorded in the home. What we found gave us some concerns so we included the pharmacist inspector on this inspection, to re-look at the medication and to see what the manager had done to address the concerns we had raised with her on 1st April 2008. The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information we have about how Brierfield Residential Home has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications’. We also received 19 Commission for Social Care Inspection (CSCI) surveys that were returned to us by people using the service and from other people with an interest in the service such as staff and relatives. We have included comments made in these surveys throughout the report. The home charges £360 each week for care. report is on display in the home. A copy of the previous CSCI Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the previous inspection the manager has made sure that all staff have on file references from two different sources. Since the previous inspection care files and other documents in the home have become better organised. This process should continue until all forms and records provide a clear picture of the care, treatment and other events for each person living in Brierfield Residential Care Home. This will help to confirm that what is happening meets their needs in a manner that is acceptable to them and statutory agencies. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 standard (6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People moving into Brierfield have their needs assessed before they move into the home so that the correct support can be offered as soon as they start to receive a service. EVIDENCE: Six care files, including that of the most recent admission, were examined; each contained assessments completed by Social Services or a referring agency such as Age Concern, and additional pre-admission assessment undertaken by the manager. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 10 The manager stated that, whenever possible, initial assessments take place in the person’s home or whilst in hospital. This information included a history of previous health, social and psychological, areas of risk were also highlighted such as moving and handling, skin care and dietary needs, such as the need for a soft diet or diabetic diet. This information was seen on all files The manager stated that the home continues to provide people with the opportunity to spend time in the home prior to their admission. Those who returned CSCI surveys all felt that they had received enough information about the home. People were satisfied with the process of moving into the home and confirmed that steps were taken for the manager to meet people before they moved. One person said: ‘yes Nicole visited her on the unit before she came’. Another person said that they chose Brierfield because ‘It was near their home’. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager ensures that people are supported with maintaining health and personal care. However, the way the staff manage the medication does not fully ensure that service users receive the right medication at the right time, which could effect their health and well being. EVIDENCE: The files examined contained care plans, which provided information about the general and specialist needs of people and how these needs must be met by staff. The care plans included how to meet physical health needs, such as how to promote continence, prevent pressure sores, deal with specific illnesses, such as urinary tract infections, and monitoring weight loss. Specialist risk assessments had also been completed and provided additional information and instructions to that in the care plans. Risk assessments that were examined looked at moving and handling risk and risks concerning pressure area care, this information is now transferred on to the care plans. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 12 Records, reports and other correspondence continue to confirm that people received input from health care professionals and were supported in attending outpatient appointments, general practitioner consultations, routine and specialist examinations including eye-tests, dental checks, podiatry, district nurse, continence advisory team and falls prevention. People were seen wearing hearing aids and prescription glasses. The care plans and assessments clearly identified where people were supported in making an informed choice about their care and where it was assessed that the impact of their choice was such that staff should continue to encourage a person to complete a task, even if they initially refused. An example of this relates to personal hygiene where staff are instructed to offer people baths at different times and in different ways, so that health and comfort are not compromised. Care files were better organised than on previous inspections. Discussion with the District Nurse indicated that the home received a lot of input from this service and that, in the main, instructions were followed. Staff who returned surveys all felt that they were always provided with enough information to meet people’s needs. They also stated that the communication in the home was good. Relatives and people using the service also felt that the health and personal care needs were attended to effectively. People who returned CSCI surveys confirmed that they felt that they always received appropriate health care. Staff also concluded that they always received enough information about the support people required. One relative commented ‘They get medical help very swiftly - sometimes even over cautious …’ and ‘They get medical attention right away.’ A resident said that ‘Staff are alright, they are careful when giving you a bath and things like that.’ Cross-referencing assessment information, observation and daily records indicated that the manager needs to improve the assessments and care plans in relation to meeting psychological needs. Although there were basic instructions about communication and requests that staff sit with people and talk to them, there was very little information or instruction telling staff how to deal with people who showed ‘hostile’ behaviours. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 13 Behavioural needs were identified but there was no evidence that these had been assessed in keeping with best practice in mental health or behaviour management terms. Furthermore, there were no instructions to staff in how to manage and monitor these behaviours using a consistent and considered approach. It is essential that residents and staff are supported in reducing the risks associated with behaviours that may indicate confusion, depression, anxiety, frustration or other emotional distress. Observation throughout the inspection period confirmed that when people were approached, they were generally spoken to quietly and treated with dignity and respect. Daily records were not always completed in enough depth to give a comprehensive picture of how a person had spent their day, however the language used was kindly and, at times, the information showed that staff did work to the instructions in care plans. It was also possible to track the progress of people through the information recorded in weight charts, bath charts and incident summaries, showing that staff did recognise the need report and record any event or changes. People’s needs are also communicated at the change of every shift through a verbal handover. A good level of personal care and grooming is achieved at Brierfields. During the inspection everyone was always clean, hair was neatly brushed, the men who wanted to shave had been supported in completing this task successfully. Ladies were fully dressed, wearing tights or stockings and men wore socks. People’s shoes and slippers were clean. The wardrobes for some people were checked and each contained clothes that were laundered and ironed, and labelled with that person’s name. Discussion with a relative and information received through the CSCI relatives’ survey indicated that this is not always the case and there were times when people had clothes in their room that did not belong to them. Discussion with the manager confirmed that she was aware that this was an ongoing problem, she confirmed that different strategies had been put into place to reduce this but that she hadn’t found one that was foolproof as yet. She agreed to discuss this with staff who were responsible for putting away clothes. Signatures and amendments demonstrated that care plans were reviewed monthly. The signatures of people or their relatives also confirmed that those receiving support were involved in the planning process, and where people might not fully understand about their care a relative who was involved had signed. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 14 At the time of the inspection pressure area and wound care was discussed with the manager. The district nurse is dealing with six people with wounds associated with pressure area care and ulcerated legs. The information in care plans confirmed that the district nurse’s involvement was sought. But these need to provide additional instruction about the application equipment, such as pressure relieving mattresses and cushions. The care plans should make clear the additional steps staff must take to prevent and monitor pressure sores. Especially, if the risk of development is assessed as high. The manager must instigate a more consistent approach to pressure area care so that staff are fully aware of the observations they must make and the actions they must take to reduce the risk of pressure areas breaking down. There was also concern raised about the possible reason why some people had developed leg ulcers. This matter was discussed with the manager who agreed to look into the matter further and take steps to prevent tissue damage whenever possible. Since the last inspection, and in response to information received about the home, our pharmacist inspector undertook a medication inspection on 1st April 2008. She looked at medication, storage, administration and management in the home. On that occasion the pharmacist inspector identified a number of shortfalls in the management of the medication and made a number of requirements to make in this area more safe. Administration of the morning medicines was observed on this inspection. Care was taken to ensure any special instructions such as ‘before food’ were followed, helping to ensure medicines work properly. But, it was of concern that some people did not have their medicines until quite late in the morning. This means that where medicines are repeated later in the day, the time between doses may be too short. The times that medicines are administered needs to be looked at to ensure enough time can be left between doses of the same medicine, while not needing to rush. We saw that some people had difficulty using their inhalers. Doctor’s advice needs to be sought, to see if there are better alternatives for them to use. Some people had chosen to self-administer some of their medicines but written risk assessments had not been completed. We saw that some people who managed their own medicines were very independent, but others needed more support from care staff. Assessments are needed to help ensure staff know what support people managing their own medicines may need, to do so safely. Medication records were generally up-to-date for each person and medicines received, administered and disposed of were recorded, enabling medicines handling to be ‘tracked’. Regular audits (checks) are carried out to help make sure medicines are handled in accordance with procedures. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 15 Comparison of medicines records and stocks showed that medicines were mostly given as prescribed. But, there was reliance on systems put in place by management to ensure medicines were given correctly. For example, highlighting where records needed to be signed. On the occasions that these systems were ‘missed’ people were at risk of not having their medicines correctly. As identified at the previous inspection handwritten records were not checked for accuracy and signed by a second person. There was a lack of information about the correct use of medicines prescribed ‘when required’ or ‘as directed’. To help ensure consistency, there should be individual guidance about when these medicines should be given. Controlled drugs (a class of medicine described in law) were not well managed. Records were poorly completed and it was not possible to confirm that the cupboard met with current law. Storage needs to meet with current law, and records accurately maintained to help ensure their safe handling. The previous inspection identified that the medicines policy could be usefully expanded to provide clearer guidance, for example, about supporting safe selfadministration; the manager said this was in progress. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. T his judgement has been made using available evidence, including a visit to this service. Aspects of the service concerning recreation and activities has reduced, however people at Brierfields continue to benefit from a service that is supports individual choice, encourages family involvement and provides meals that are enjoyed. EVIDENCE: The activities offered to people living at Brierfield has reduced since the last key inspection. There is no longer a programme of activities and care staff do not automatically take responsibility for organising activities, such as board games, arts and crafts, sing-alongs, discussions or other activities that will keep people motivated. Staff have received training in the importance of continued activities and hobbies for people in residential care homes, as the training records and certificates confirmed that many have completed a course called ‘yesterday, today and tomorrow’ that concentrates on possible activities and events that can organised in residential settings. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 17 Staff have also completed a course called ‘Life story’, this tells them about the seeing people as individuals and the important of a person’s social history in making sure that people are regarded as individuals, an indication of their expectations and also help with ideas of what may be of interest to them in respect of developing a varied activities calendar. There was no evidence however, that staff made use of this training at any time during the inspection. It was noted that some of the residents attempted to entertain themselves by singing the chorus of songs, and yet care staff failed to build on this by putting on appropriate music that would help them to remember words or ask them if they would like a sing-along. Observation throughout the period of the inspection, but particularly on Saturday, 31st May 2008, showed that although staff were never unkind or dismissive, they lacked spontaneity with the residents. Staff were able to walk past people without giving eye contact or a friendly smile. On a number of occasions there were no staff present in the main lounge for periods of up to 30 minutes, even though there were four on duty. During this time many people who did not have visitors just sat at the dining tables. In the afternoon some people were encouraged to sit in the smaller lounge, however on checking what was going on in the lounges on four separate occasions, at no time was a member of staff seen to be organising an activity or spending time with people. The television in the main lounge was on and remained on the same channel for the entire day, no-one paid any attention as to whether anyone was actually watching a programme. The most interaction seen, apart from when personal care needs were been directly attended to, was when staff sat in the main lounge to write up the daily records. There is no daily activities or events calendar and staff do not automatically organise activities. There were no activities observed in the home during the inspection period that included a Saturday afternoon. Entries in some of the daily reports confirmed that a recent outing had included a pub lunch and entertainers had been to the home. Residents said that they enjoyed the act of worship that took place regularly in the home. This lack of interaction and failure to offer activities is of concern because people may lose social skills and become de-motivated and disinterested in life. However, it was also observed that some people were happy speaking to each other, reading or watching whatever was happening in the home. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 18 Residents who returned surveys were divided in their opinion about the availability of accessible activities. Three people felt that they could always access what was available and three felt that they could usually or sometimes access activities. People’s comments concerning activities that did occur were also positive. One person stated: ‘They are always given a gift on special occasions, for example, a red rose on St Valentine’s Day, Easter egg at Easter and people are given Christmas presents. They sometimes have bingo and a church service - she joins in with what she can.’ Residents who commented said that they could carry on with hobbies, for example, someone said ‘I love knitting and crochet and will join in with whatever happens.’ One person said: ‘They have singers in which she enjoys.’ A resident said: ‘Activities are up to the person - they put on concerts and try to entertain you.’ Another observed: ‘We’ve not had activities this week - not much to do reallynot many trips out but we used to do.’ Everyone said that the routines in the home were flexible and that they could receive visitors when they wanted. During the inspection period relatives and friends came and went freely. They were made welcome and related very well to staff. People also made themselves or their relative’s drinks if they wanted. People also felt that they were kept in touch with what was happening in relation to their relative and also felt that people were treated the same. One person commented: ‘No matter who or what you are all clients appear to get the same service’. Discussion with the manager in relation to activities showed that she was aware that activities in the home had reduced, she said this was because an activities co-ordinator was not always available. We discussed the possibility of all staff having a responsibility and skills to offer activities and encourage social interaction with people. The training calendar was examined and this confirmed that a number of staff had completed specialist training about providing activities for people in residential care. We discussed the advantages to people of making sure that staff use the information and knowledge gained through training to make living in the home more interesting. People enjoy the meals provided in the home. There breakfast choice ranges from cooked items such as eggs, bacon, sausages and beans, or cereal and toast. It was noted that people came to breakfast at their own pace and ordered what they wanted, this was then freshly cooked. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 19 The lunchtime meal on the first day of inspection was a choice of poached chicken, mashed potatoes, mixed vegetables and gravy, followed by peaches and cream. The menus showed that people are mostly offered three cooked meals a day (including breakfast). The lunch and evening meals are varied and included traditional British dishes such as liver and onions, meat pies, and casseroles, fish and meat roasts, tripe and onions, corned beef hash and cottage pie. The menu states that either a baked potato with filling or sandwiches will be offered as an alternative to a cooked meal. It was noted that staff gave people extra meals, snacks and drinks whenever they were asked for. All the residents who returned CSCI surveys confirmed that they ‘always’ liked the food. People were very complimentary about the food. Relatives said ‘When I’ve seen it, it looks very nice’ and ‘Yes she has a good appetite’. This person also said that fruit was readily available as well as given when requested. Another person said ‘… says it’s (the food) good she says: “they do feed you well here”’. A resident commented ‘The food is always good – I’ve never had anything I don’t like.’ Food charts for people were examined and provided detailed information about their nutritional intake. In addition, certificates confirmed that staff had received training in how to assess and improve the nutritional status of older people. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager takes steps that should ensure that complaints are treated seriously and provide adult protection guidelines to promote the safety of people. EVIDENCE: Since the last inspection we have been involved in one investigation under the protection of vulnerable adults. This was concerning pressure area care. The investigation carried out by Oldham Metropolitan Borough Council (OMBC) Safeguarding Adults team concluded that the evidence indicated that the home had acted correctly and all necessary steps had been taken to reduce the risk and get treatment for this person. We have also received complaints from a number of sources about the home. Mostly concerning staff inaction, staff conduct and problems with administration of medication. Complaints have been passed to the provider to respond to the complainant. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 21 The manager informed us of the outcomes of their investigations and the action that they had taken, and this appeared satisfactory; however, during this inspection it was noted that some aspects of the complaints were still apparent, such as staff inactivity at weekends. When the manager responds to complaints she must also put in place policies, procedures, guidelines and a means of checking that staff do not revert to bad practice. Records kept about complaints and concerns included copies of the manager’s response to complainants and CSCI. Everyone who returned CSCI surveys confirmed that they knew how to complain. Each file examined had a copy of the home’s complaint procedure, and this had been signed as received by the person or their relative and this provides sufficient information about the steps to take concerning complaints and a description of how complaints will be dealt with and the right to take a complaint further if dissatisfied with the outcome People who were spoken to all felt that they were able to complain or express concerns, and would talk to the manager about these. They said ‘if I had a complaint I would go to Nicole (the manager) straight away’ and ‘I’ve never complained but would talk to the manager.’ All staff who returned CSCI surveys confirmed that they knew that they could raise concerns to organisations outside of the home, such as Social Services or CSCI. Staff knowledge in respect of protecting vulnerable adults needs to be improved as, according to the training record provided by the manager, only two staff have received updated training since the last inspection. Discussion with staff also indicated that there were knowledge gaps in relation to adult protection. There was also some evidence that incidents between residents were not fully investigated or dealt with in accordance with the safeguarding adults protocol. There is a flow chart displayed in the staff room outlining the actions that staff must take if they suspect or witness abuse. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The environment provides a homely and clean place for residents to live in. EVIDENCE: During this inspection all the communal areas and a number of bedrooms were entered. Bedrooms and en-suite areas were clean and people had furnished them with as they liked. There was also comfortable seating placed in different alcoves and areas of the home so that people could sit and rest, read or watch, or be on their own without having to return to their bedroom. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 23 People were observed making use of the different lounge and sitting areas throughout the home. Particularly popular areas included a small lounge over looking the front of the home and an enclosed veranda style link-room overlooking the landscaped inner garden. The small lounge though pleasantly decorated had broken glass on the outer side of the double glazed window, and there were cracks in the window behind the radiator in the link-room. The carpet, in the main, dining area and lounge was very stained and soiled, as was some items of furniture, such as side-tables, chairs and table legs. The corridor carpets were also very dirty. In spite of this, only one room in the home held an unpleasant smell. The trolley on which plates were returned to the kitchen was also caked in dried on food. A number of the bed-bases were also soiled and dirty and need to be replaced. These matters were discussed with the manager and one of the registered providers for the home, and they agreed that these would be dealt with. The home does employ cleaners who work every day except Sunday. People were observed mobilising around the home independently, using hand rails, walking frames or walking sticks and other aids and adaptations that had been provided. The laundry in the home was not checked on this occasion. On previous inspections this area has been clean and well organised and the equipment, fixtures and fittings had met the required hygiene standards, in that, all the surfaces were washable and there was a washing machine with a sluice and disinfection-washing programme. Everyone who returned a CSCI survey felt that the home was always clean and fresh smelling. People’s comments included: ‘The home smells clean’ and ‘… room is beautiful and clean.’ Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence, including a visit to this service. The manager ensures that staff are provided in sufficient number and with appropriate skills to meet the needs of people living in the home. EVIDENCE: On the first day of inspection, which was a Saturday, there were 36 residents living in the home and the staff complement consisted of four care assistants, including a senior carer, two domestic staff, one laundry staff, one cook and a kitchen assistant. The person in charge said that normally there were five carers but one carer was off sick. On checking the care needs of people in the home it was found that about nine people needed two care staff to assist with moving and handling throughout the day and the remainder were either fully independent or needed one to one assistance on occasion. Observations throughout the day showed that staff did not appear rushed, but neither were they very evident. At one point in the morning there were 30 people sitting in the main lounge/dining room and link area, and no care staff came into the room or could be seen for about 45 minutes. When staff did walk through they did so without speaking to people. This also occurred after lunch, except that some people were encouraged to move from the main lounge and to sit in the small lounge instead. Again, there were prolonged periods when staff were not immediately available. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 25 Staff did respond to people when a request was made and they had a good rapport with relatives. Staff who returned CSCI surveys all felt that they received training appropriate to the work they do. The training record confirmed that, since the previous inspection, courses had included: ‘Life Story’ - about the importance of respecting people’s life histories and how to help them to share this information; ‘Yesterday, Today and Tomorrow’, an intensive course about the needs and experiences of people with dementia; ‘moving and handling’ and ‘health and safety’. The manager stated that she accesses training from the OMBC partnership. She also stated that all staff had undertaken the Skills for Care common foundation course so that a base line of their knowledge could be assessed and additional training needs identified. Eighteen out of 26 staff have achieved National Vocational Qualification in social care at level 2 or above. Staff who were interviewed were able to describe some of the things they learned on courses, however they were not sure about how this could be applied in practice. People who returned CSCI available. People also felt jobs. Comments included: called and informed if there surveys felt that there were usually staff readily that staff were trained and competent to do their ‘Yes, usually there is enough staff on duty - I get are any problems. Staff are nice - they are lovely.’ The most recent recruit had references from two independent sources, both of which were traceable, and all other criminal record checks and additional proof of identity were in place. A number of references were character references that had been dated quite recently. The manager explained that this was because some information from the staff files had gone missing and this was her way making sure that there were two references on file for each person. Staff who were interviewed stated that they liked working at Brierfield and identified that staff got on well, saying ‘There is a good atmosphere and all the staff get on’. Staff also said that they were able to work in a flexible way and that sometimes staff came in to take people to a local supermarket if they wanted to go. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager has the training and experience to provide leadership, however it is clear that additional steps are needed to ensure that staff have enough guidance to make sure that the service they provide is in keeping with all expectations. EVIDENCE: The manager is registered with Commission for Social Care Inspection (CSCI) and has completed National Vocational Qualification training level 4 in care, and has also recently gained (May 2008) the Registered Manager’s Award. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 27 The roster confirmed that the manager is generally on duty for at least 37 hours each week; and people said that she was readily available. Comments about the manager from staff included: ‘The manager is a credit and does a fantastic job with all residents and relatives’ and ‘The manager is always there, be it in person or on the phone’. Residents commented ‘I have no complaints, they’re kind and take good care of us - she (the manager) has a good staff team - I give them ten out of ten.’’ Relatives were also mostly positive; one person said that they found the manager ‘approachable’; another person stated that ‘Nicole and the girls have been most helpful with me - anything I’ve asked for or wanted, they have assisted.’ Information provided by the manager in the CSCI Annual Quality Assurance Assessment (AQAA) indicated that the quality assurance system gives relatives and others the opportunity to comment and make suggestions about improvements and how the home is run. A monthly newsletter had been introduced but these had not been sustained since the last inspection. The accounts of three people were examined. The amount detailed in the accounts book tallied with the amount held on their behalf by the home. A receipt book is used to record all expenditures and funds passed over to relatives are signed for. Records and dated stickers confirmed that fire safety equipment in the home had been checked during June 2007 and hoists were serviced in September 2007. This means that some equipment, such as the hoists, is due for maintenance. Staff have received training in health and safety and observation of moving and handling practices in the home appeared safe. Risk assessments are completed and it was observed that staff complied with moving and handling instructions that are detailed in individual care-plans. The accident records, however, did show that people were, at times, having accidents that may have been avoided; this was discussed with the manager. Staff were seen using personal protection clothes, such as aprons, while they served meals, however according to the training record most staff still need to receive specialist infection control training. The training calendar did show that the majority of staff had completed control of substances hazardous to health (Coshh) training and also fire safety training. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 28 With regards to fire safety, the home has had a fire safety assessment and recommendations arose from this. There was no evidence that steps had been taken to comply with these. This was discussed with the manager, who said that the owners had dealt with this. The manager must be able to provide evidence for confirmation. One area for improvement with respect to management and conduct at Brierfield concerns the management of staff and the way in which they relate to people living in there. Staff seemed to lack enthusiasm and related to people almost only if they were approached. Areas of the home were very dirty and yet a team of domestic staff are employed and equipment made available. People sit for hours with nothing to do and yet staff have received appropriate training. Staff are uncertain about their role in relation to adult protection and yet the home employs a high proportion of qualified staff. The CSCI has received a number of complaints, some of which have been partially substantiated, and the manager co-operates fully with the inspection process and appears to have taken steps to prevent recurrence. Even so, this inspection has identified that, for various reasons, unacceptable conduct is repeated or other issues have arisen. It is essential that the manager and the registered providers organise effective supervision for all staff, regardless of their role with in the home. This monitoring must be in sufficient depth and frequency to result in good practises becoming imbedded in all aspects of the home and this must be sustained at all times, in all aspects of the care provided in the home. All staff must be aware of the standard of work they are to maintain. The manager and registered provider must demonstrate that staff fully understand their responsibilities in relation to providing emotional support, and also protect people from harm by being proactive and taking the initiative in relation to all care. As a part of this process, one of the registered providers must complete the Regulation 26 report. This must record their view about the premises, record of events and complaints. Their assessment must confirm that they are satisfied that issues have been dealt with effectively and professionally. They must also record what actions they have taken to remedy any problems they have uncovered. A copy of their report should be sent to the CSCI. Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 30 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 Standard OP8 Regulation 13(4)(c ) Requirement The registered person must ensure that pressure area and tissue viability monitoring and assessment are completed consistently. The registered person must make sure that people’s psychological care needs are fully assessed and met. To protect people’s health and well-being, sufficient medicines must be kept in the home to ensure continuity of treatment. (Previous timescale of 05/05/08 not met). When people manage their own medicines, assessments must be completed to help ensure they receive any support they may need. (Previous timescale of 05/05/08 not met) To ensure safe handling of controlled drugs, records need to be clearly and accurately maintained. Action must be taken to resolve any discrepancies. Timescale for action 01/10/08 2 OP8 12(1) 01/10/08 3 OP9 13(2) 07/07/08 4 OP9 13(2) 07/07/08 5 OP9 13(2) 16/06/08 Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 31 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. 6 7 Standard OP9 OP18 Regulation 13(2) 13(6) Requirement Controlled drugs must be kept in a cupboard that complies with current law. The registered person must make sure that staff fully understand the policies relating to adult protection and their responsibilities in this area, so that people are protected from harm and continued abuse. The registered person must conduct a visit to the home on a regular basis and record the things that have been checked. This will show that support and guidance have been given to the manager as she takes action to raise the standard of care in the areas that this is needed. Timescale for action 04/08/08 01/10/08 8 OP38 26 01/10/08 Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 32 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 OP9 Good Practice Recommendations Guidance should be drawn-up so that staff are clear when ‘as required’ (PRN) medication should be administered. The medication policies should be reviewed and expanded to give clearer guidance to staff about the handling of medication in the home. Written audits of medication handling should be carried out and action plans drawn-up to help bring about improvement. The registered person should make sure that a varied programme of activities is introduced so that people benefit from opportunities to enjoy entertainment that will help to keep them motivated and interested in life. The registered person should introduce a programme of refurbishment and cleaning that will help to ensure that all areas of the home is hygienic, clean and pleasant to use. The registered person should support the manager in maintaining a high standard of conduct and professionalism of staff, making sure that they know exactly what is expected of them in all aspects working in the home, so that people can be certain that staff actions will be consistent and promote their wellbeing in all aspects. 2 OP12 3 4 OP26 OP31 Brierfield Residential Care Home DS0000031867.V363729.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way 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. 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