CARE HOMES FOR OLDER PEOPLE
Brierton Lodge Care Home Brierton Lane Hartlepool TS25 5DP Lead Inspector
Paul Emmerson Unannounced Inspection 18 April 2005 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 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. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Brierton Lodge Address Brierton Lane Hartlepool TS25 5DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01429 868786 01429 267129 ANS Homes Limited Mrs Caroline Mary Barnard CRH 62 Category(ies) of MD Mental Disorder (31) registration, with number PD Physical disability (5) of places OP Old age (31) DE(E) Dementia - over 65 (31) Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 31 people aged 60 or over can be accommodated on the dementia and mental health unit. 31 older people aged 60 or over can be accommodated on the older persons unit. Four named individuals who are under the age category are allowed to reside in the home. Date of last inspection 8 December 2004 Brief Description of the Service: Brierton Lodge is a purpose built care home for up to 62 people with nursing needs. Virtually all admissions to the home are from hospital through Continuing Health Care arrangements. The home operates two specific units: on the ground floor it provides care for older people and people with physical disabilities; on the first floor care is provided for people with dementia and mental health needs. The home is square shaped, built around a central enclosed garden. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. CSCI has a statutory obligation to inspect all care homes at least twice a year. This unannounced inspection was carried out in accordance with this obligation. The inspection took place over 7 hours, on the morning and afternoon of Monday 18th April 2005. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion will be assessed during the next inspection of the home. The inspector looked around the building and a number of records were examined. 9 service users, the manager, 12 members of staff, 9 visitors, a visiting priest, a hospital consultant and a GP were spoken to. What the service does well: What has improved since the last inspection?
As required by CSCI in the last inspection report, action has been taken to improve service users’ care plans. A senior nurse employed by the home has taken over a training coordination role. Although she still works nurse care hours, most of her contacted hours are now to provide or arrange staff training. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 8 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 standard(s) 1 & 3 Admissions to the home are well managed. Service users receive appropriate information about the home and their needs are assessed prior to admission. EVIDENCE: The home has an up to date Statement of Purpose and Service Users’ Guide. These documents were seen, together with a copy of CSCI’s last inspection report, in the entrance foyer of the home. These documents, and a ‘Welcome Directory’ are made available to service users / prospective service users and their families to ensure they have information about the home. However, to ensure service users have full information about the home, the Statement of Purpose must contain information regarding the number and size of rooms. When it has been amended, a copy of the home’s Statement of Purpose must be provided to CSCI. Assessment information for two people admitted to the home in the last seven days was examined. This information contained care notes from medical staff at the local hospital and the home’s own, duly completed, referral and preadmission assessment documents. Subsequent to admission, the home’s more detailed care plan documents are completed. One of the recently admitted
Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 9 service users said: “I like it here, its quite nice, they don’t muck you about, they’re interested in you” Virtually all admissions to the home are via ‘Continuing Health Care’ arrangements after people are discharged from hospital. Initial admission to the home is for a six-week trial period. Any permanent placement is agreed at a formal review meeting at the six-week stage. On the day of the inspection two such reviews were being held. The service user and family attending one of these reviews confirmed that the admission process was appropriately managed and said they had: “received information on admission and the manager had introduced herself”. A Hospital Consultant attending one of these reviews provided positive feedback about the home and remarked: “how well she is doing since moving into Brierton Lodge”. A GP visiting Brierton Lodge said, “the home is well run, patients receive good care”. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 10 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 standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. However, it was noted that as required in the last inspection report, action has been taken to improve service users’ assessment documentation. EVIDENCE: N/A Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 11 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 standard(s) 12, 13, 14 & 15 Social activities and meals are generally well managed and provide appropriate choice and daily variation for the people living in the home. EVIDENCE: As stated previously, virtually all admissions to the home are from hospital through ‘Continuing Health Care’ arrangements. Daily life and social activities were observed to be appropriately co-ordinated and to reflect the needs and dependency levels of the people accommodated. One service user spoke about the relaxed routines of the home and said they “liked it here and could get up and go to bed when they choose”. This person confirmed that people are treated with respect. However, on two occasions staff were observed to enter a service user’s bedroom without knocking. To ensure privacy is respected, staff should be reminded that they should knock before entering service users’ bedrooms. On the day of the inspection a priest visited the home, as he does on a regular basis. Clergy of other denominations also visit the home. The home has flexible visiting arrangements. Nine visitors were spoken to and expressed satisfaction with the facilities provided. All said they were made to feel welcome when they visited their relative / friend.
Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 12 An activities coordinator is employed for 30 hours per week and spends time with service users on both floors of the home. The activities coordinator was seen spending time with individual service users: providing nail-care and enabling a service user to knit. Care staff were also seen to provide social stimulation. One member of staff became engaged in an impromptu dance to music being played in the lounge. One service user said he “liked it when they played dominoes”. Food provided is of a good standard. A four-week, rotating, seasonal menu is provided and specialist diets are catered for. Kitchen staff serve main meals. Care staff provide assistance with dining where it is required. The home’s dining rooms are attractively presented with co-ordinated tablecloths, menu cards and other decorative touches. Service users spoken to were generally happy with the food being provided. One person said “the food’s excellent, plenty of it”. However, some less positive comments were received about: the cool temperature of meals where they are supplied to people in their own rooms; dislike of meal choices on Saturdays. One service user expressed frustration at having to remind care staff delivering sweet puddings to their room that they were diabetic. These concerns should be addressed. It is also suggested that, to enhance the appearance of pureed meals, the use of food moulds should be considered. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 13 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 standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. EVIDENCE: N/A Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19 & 26 Brierton Lodge was purpose built and meets the needs of the people accommodated. The home is safe and well maintained. However, some areas of the home require redecoration. EVIDENCE: Brierton Lodge was purpose built some ten years ago and meets National Minimum Standards room size requirements. The inspector saw that service users could individualise their bedrooms with their own furniture and other personal belongings. The home is generally well maintained, a number of health & safety and maintenance files, for example bed-rail checks, were examined and found to be in order. However, issues raised by the fire officer in a recent visit to the home must be addressed. The home was seen to be well equipped with a range of specialist equipment such as pressure relief mattresses. The home also has a sensory room and a room equipped to provide occupational / physio therapy. The availability of
Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 15 such equipment ensures that the home can meet the needs of all service users and in particular those receiving ‘Continuing Health Care’. Bathrooms and WCs are appropriately equipped. However, to improve facilities, as highlighted in the previous inspection report, the service provider should continue with the programme for the refurbishment of the vinyl floors in bath/shower rooms and en-suite facilities The inspector looked around the building, which was found to be clean, tidy and free from offensive odours. Appropriate action is being taken to keep the home clean, tidy and to prevent the spread of infection in the home. Although equipment in the laundry is approaching the end of its useful life – on the day of the inspection one of the home’s washing machines was being repaired following a flood - laundry arrangements are satisfactory. However, it was noticed that sluice rooms are left unlocked when not in use. To minimise the possibility of injury to service users, formal assessments must be carried out to consider any associated risks. Any control measures identified must be implemented. Some redecoration work has been carried out recently. However, as highlighted in the previous inspection report, to ensure the home retains a homely feel, a number of areas – such as parts of the first floor corridors and a number of bedrooms - still require redecoration. Although it is acknowledged that a person has been appointed to the post of ‘handyman’, ongoing redecoration should be resumed as soon as possible. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. EVIDENCE: N/A Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these outcomes / standards were assessed on this occasion. They will be examined during the next inspection of the home. EVIDENCE: N/A Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 19 NO Are there any outstanding requirements from the last inspection? 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 1 Regulation 4, 5, 6 & Schedule 1 Requirement The homes Statement of Purpose must be amended to contain information regarding the number and size of rooms. A copy of the amended document must be provided to CSCI. Issues raised by the fire officer in a recent visit must be addressed. Risk assessments to consider the security of sluice rooms must be carried out and any control measures identified must be implemented. Timescale for action 1 September 2005 2. 3. 38 38 23(4) 13(4) 1 August 2005 1 August 2005 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. 2. Refer to Standard 13 15 Good Practice Recommendations Staff should be reminded that they should always knock before entering service users bedrooms. The system for serving meals in service users bedrooms should be reviewed to ensure food is of the preferred temperature, choice and dietary requirement. Menus generally should be reviewed. It is also suggested that, to enhance the appearance of pureed meals, the use of food
DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 20 Brierton Lodge Care Home 3. 4. 19 21 moulds should be considered. As highlighted in the previous inspection report, the registered manager should continue with the ongoing redecoration programme. As highlighted in the previous inspection report, the registered manager should continue with the programme for the refurbishment of the vinyl floors in bath/shower rooms and ensuite facilities. Brierton Lodge Care Home DB54 S150 Brierton Lodge V220052 180405 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection No 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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