CARE HOMES FOR OLDER PEOPLE
Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN Lead Inspector
Ann Stoner Key Unannounced Inspection 10:00 21st November 2006 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 Brigshaw House DS0000001427.V306637.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. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brigshaw House Address 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN 0113 2868421 0113 2868421 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) Cymar Care Homes Limited Mrs Pauline Barker Care Home 21 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (21) of places Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th October 2005 Brief Description of the Service: Brigshaw House provides a service for up to twenty one older people, some of whom may have dementia, but do not requiring nursing care. The home is situated in Allerton Bywater, a former mining village midway between Leeds and Castleford and is close to local amenities and public transport. The building comprises of an older house with the addition of purpose built accommodation. There are seventeen single and two double bedrooms, good dining facilities and spacious sitting areas. There is car parking space at the front of the home and at the back there are extensive and well kept gardens, which are quiet and private. Copies of previous inspection reports are available in the front entrance of the home. On the 21st November 2006 the manager said that the fees were £368.00 per week. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk The last inspection was unannounced and took place on the 4th October 2005. There have been no further visits until this unannounced key inspection, which took place between 8.45am and 5.15pm on the 21st November 2006. The purpose of this visit was to monitor standards of care in the home and to look at progress in meeting the requirements and recommendations made at the last visit. Before the inspection a pre-inspection questionnaire was sent out to the home, this provided some information for this report. The people who live in the home prefer the term ‘resident’ and this will be used throughout this report. Before the inspection I sent out survey cards to residents, relatives and health care professionals and had a telephone conversation with two relatives. I received four completed survey cards from residents, nine from relatives, two from GPs and one from a district nurse. Comments from the survey cards and telephone conversations can be found throughout this report. During the inspection I spoke to residents, visitors, staff on duty and the manager, I looked at records, made a tour of the building and watched staff working with residents. Feedback at the end of this inspection was given to the manager and the deputy manager. I would like to extend my thanks to everyone who contributed to the inspection and for the hospitality during the visit. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The manager spends a good deal of time carrying out caring and cooking tasks, and this takes her away from some of her management responsibilities. This must be addressed so that she has sufficient time to implement and improve the home’s records, which a number of requirements and recommendations relate to. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 7 Care plans must have clear and detailed instructions so that staff know the precise way in which care should be given. Wherever possible care plans must be signed and agreed by the resident or their relative or representative, and they should be reviewed at least once a month to make sure that the resident’s needs are still being met. Risk assessments must be carried out to identify those people who may be at risk of falling and where risk is identified a care plan must be put into place showing what staff should do to minimise any risks of falling. Similarly, a nutritional assessment should be carried out when residents are admitted to identify those people who may be at risk of poor nutrition. The home’s pre-admission assessment should give details of the resident’s needs so that the home is sure staff can meet these needs. Each resident should have an up to date copy of the home’s terms and conditions so that they are clear about the rights and responsibilities of all concerned. Some changes are needed to the way that the home orders medication to make sure that it follows guidelines issued by The Royal Pharmaceutical Society. The home must only administer medication to residents that has been prescribed specifically for them. This included the administration of oxygen. When oxygen is being used proper warning notices must be displayed and care plans must be in place giving staff clear instructions on its use. Before staff administer oxygen they must be trained by a health care professional. The home needs to keep more detailed records about complaints so that details of any investigation can be produced at a later date. To make sure that staff follow proper procedures in the event of any suspicion or allegation of abuse, a copy of the local authority multi-agency adult protection procedures should be obtained, and senior staff should have training on how to use the procedures. To make sure that new staff are safe and suitable to work with older people, two written references and a full employment history is needed, and copies of the CRB (Criminal Record Bureau) disclosure must be kept for inspection. To make sure that recruitment is fair, interviews should be carried out by a minimum of two people. Original photographs should be kept on staff files because photocopies are sometimes difficult to distinguish. Staffing levels must be reviewed to make sure that there are always enough staff on duty to meet the needs of residents. To make sure that staff are trained properly induction training must meet the Skills for Care induction standards. Staff should have a minimum of three paid training days a year. An annual training plan must be developed, and all staff must carry out mandatory training such as infection control, first aid and food hygiene. Moving and handling training must only be delivered by people qualified to do so.
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 8 A ramp must be provided at the front entrance of the home to allow freedom of access to people in wheelchairs and those with poor mobility. Decorating and refurbishment must continue to make sure that the dining room is decorated and a lounge carpet replaced. Because the home is registered to admit people with dementia it should consider having signs and pictures around the home, particularly on bedroom, toilet and bathroom doors, large clocks, calendars and menu cards, which may help some people with memory loss. To prevent cross infection water-soluble laundry bags must be used when laundering soiled linen and liquid soap and disposable towels must be provided in all toilets. Toiletries must not be stored in bathrooms, after use they should be returned to the resident’s room. To keep people safe, bed safety rails must not be put into use unless a full assessment of risk has been carried out. When bed safety rails are in use the home must follow safe guidelines issues by the Medical Devices Agency. To minimise risk in the event of fire, a device that closes the door when the fire alarm sounds must be fitted to any door that needs to be propped open. Requirements and recommendations relating to these issues can be found at the end of this report. 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. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5. Standard 6 does not apply to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service People are able to make an informed choice before making any decision about moving in. The home’s pre-admission assessment information is not recorded in enough detail to guarantee that the home can meet all of the person’s needs. EVIDENCE: Telephone conversations with the relatives of two residents admitted since the last inspection confirmed that people have the opportunity to look round the home and have access to the home’s statement of purpose, service user guide and copies of previous inspection reports. One person said that on the preadmission visit he and his wife were invited to stay for a meal. During the inspection a resident said that the home had been recommended to her relatives and when she visited the home she thought it was ‘lovely’. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 11 The statement of purpose, service user guide and a copy of the last inspection report were on display in the entrance of the home. All those service users who returned survey cards said that they had enough information about the home before moving in. The pre-admission assessment information of three residents was sampled. The local authority was funding two residents and both had an assessment completed by a social worker. The home had completed a pre-admission assessment for both people, but the information that was recorded was poor. It was impossible from this assessment to identify the person’s needs in all aspects of their care and of the care and support they required from the home. One person was self-funding and although the home carried out a preadmission assessment this was not detailed. There was no information about personal hygiene, dressing, diet, oral hygiene, sleep patterns, mobility, communication and nothing about her strengths and abilities, or how this person’s dementia was affecting her life. There was an agreement in each file that the home could meet the person’s needs, but the copy of the home’s terms and conditions was an out of date version. Recommendations have been made to address these issues. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of resident’s needs but because information is not recorded in care plans there is always the risk that some needs will be overlooked. Poor practice when using oxygen creates a potential risk to residents and staff. EVIDENCE: From observation, discussions with relatives, residents and staff it was clear that the needs of residents are being met, but this is not documented and evidenced in the care records. One person’s dietary care plan said that her diet had changed due to her dementia and that staff should maintain her independence as much as possible. There were no instructions for staff about how to do this, but when speaking to staff they said that she no longer eats at the dining table and often has finger food. This information was not recorded. A care worker explained about the precise way that one resident is supported and assisted to wash and
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 13 dress; none of which was recorded in the care plan. There was a hospital letter in one person’s file stating that she had a vitamin B12 deficiency and said that the home should focus on giving her protein foods such as lean meat, chicken and fish based meals. Again none of this was recorded in her dietary care plan. Staff described the measures they take to prevent pressure sores developing and how they check and maintain the pressure relieving equipment, but none of this was recorded in one person’s care plan who was at risk of developing pressure sores. There was no palliative care plan in place for a resident who has suspected lung cancer, although staff were providing appropriate care and liaising with other professionals. None of the social and leisure plans were person centred and they did not link to the resident’s capacity, ability or previous interests and hobbies. Not all care plans were signed and agreed by the resident and/or their relative or representative. The care plans were not reviewed monthly and when reviews did happen there was no evidence of what factors had been taken into consideration as part of the review or of how the care plan was still effective. Care plans did not include information about resident’s likes and dislikes in all aspects of their care, although staff knew that one person did not like a bath on an evening, there was no record of this in her personal hygiene plan. There were no plans for religious, cultural or spiritual needs. There were no nutritional assessments in any of the care plans, and falls risk assessments were inadequate because they failed to identify how and why the person was at risk and did not specify the precise action that staff should take to minimise the risk. These risk assessments were not signed, dated or reviewed. Some records such as bathing and monthly weights of residents did not comply with data protection. Daily records did not reflect how the resident had spent their day, and subjective terms such as ‘poor’ diet were used rather than a full description of what the person had or had not eaten. A telephone conversation with two relatives before this inspection confirmed that they were aware of their mother’s care plan and during the inspection the manager was seen updating one person about changes in his wife’s condition. Survey cards from residents indicated that they felt they received medical support when they needed. During the inspection a district nurse visited the home and said that staff always followed instructions. On a returned survey card another district nurse said that staff work in partnership with district nursing services and appear genuinely interested and caring. During a telephone conversation, one relative said that staff were vigilant at making sure the dressing on her mother’s leg stayed in place. The manager said that one GP carries out a routine fortnightly surgery at the home where all his patients are reviewed, and emergency visits are carried out as necessary. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 14 Residents said that the chiropodist visits regularly. Evidence in care records showed that residents attend outpatient appointments. The home’s system for ordering medication does not comply with the guidelines issued by The Royal Pharmaceutical Society. There is however, a good audit trail of when medication is received in the home and when it is put into use. Medication Administration Records (MAR) were sampled. Administration was recorded properly, but handwritten entries were not checked and countersigned by a second person. During the inspection staff were observed administering medication properly. There was an audit trail for unused medication and the deputy manager said that the home was not using any controlled medication at the time of this visit. During a tour of the building there was an oxygen cylinder in one person’s bedroom. There was no warning sign on the bedroom door to indicate that oxygen was in use, and there was no care plan in place for the use of oxygen. When asked about this the manager said that the oxygen had not been prescribed for this person, it was old stock that had originally been prescribed for a deceased resident. The manager was advised about the safe use of oxygen and proper procedures for ordering, storage and administration. It was clear from observation, speaking to residents and staff that the privacy and dignity of residents is respected at all times. Requirements and recommendations have been made to address these issues. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 visit to this service. Overall residents enjoy a flexible lifestyle where their individual choices are respected and their relatives and friends are welcomed and supported. People’s spiritual needs are met, but because they are not recorded once more there is the opportunity for these to be overlooked. EVIDENCE: Residents spoke about the choices they make and the level of flexibility in the home. One person said that she goes to bed about 9pm and gets up about 6.30 –7am, whereas another resident said that she gets up about 10.00 – 11.00am, and there is always a cup of coffee and toast waiting for her. She said that she prefers coffee rather than tea in the morning. There was a poster in the entrance of the home listing some of the pre-Xmas activities that are taking place. Five residents said that they sometimes get a bit bored, but they did play bingo and one person said, ‘There is always something to read and staff always have time to spend with you’. Another resident said, “Staff take time to stop and talk to you, even when they are busy”. During a telephone conversation one relative said that staff have time
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 16 to spend with people and described how Wednesday is a pampering day where residents have their hair and nails done. She also described a ‘lovely morning’ when residents were looking at wedding photographs of a member of staff who has recently married. Throughout the inspection staff were kind and patient with people and always had time to spend with them. Another relative said that her mother was happiest when doing domestic chores and that the home had been very good at giving her jobs and keeping her occupied by folding napkins, dusting and washing up. One resident said that she listens to the church service every morning during the week on Radio 4. She said, “It is very important to me, it helps me get through the day.” She also said that she gets fulfilment from watching ‘Songs of Praise’ on television on Sunday evening. The manager was aware of this important aspect of this person’s life. There is nothing in any of the care records to show any activities have taken place, and activity care plans do not reflect the person’s previous interests. Throughout the day visitors were welcomed into the home and one relative said that she is always made to feel welcome and that the home provides support not only to residents but also to their relatives. The lunchtime meal was sausage, potatoes, cabbage and carrots, followed by a choice of apple pie and custard or ice cream. This looked appetising and was enjoyed by residents, who were complimentary about the meals. One relative said that she had the opportunity to sample the food during a pre-admission visit and thought it was delicious. The manager said that the cook knows the likes and dislikes of residents and if anyone disliked like sausage they would be offered fish. Before the meal residents said that they did not know what was for lunch until it was being served. It would then be too late to cook fish if on the day they did not want sausage. There is a choice for the evening meal. During the morning residents were asked to make their choice from salmon sandwiches, turkey sandwiches or jacket potatoes with cheese. Residents said that they have toast and jam or biscuits about 8.00pm, along with a selection of tea, coffee or milky drinks. One recommendation has been made. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 visit to this service. The home responds to complaints and people feel that their concerns are taken seriously. The lack of senior staff training on the use of the multi agency adult protection procedures means that any allegation or suspicion of abuse may not be dealt with properly. EVIDENCE: The home’s adult protection policy, whistle blowing policy and the complaints procedure was seen during the planning stage of this inspection. The complaints procedure refers to the National Care Standards Commission rather than the Commission for Social Care Inspection. All of the residents, who returned survey cards, said that they felt listened to, knew how to make a complaint and knew who to complain to. During a telephone conversation with two relatives before this inspection both could not remember having any information about how to make a complaint but said that they would speak to the manager if necessary. The complaints procedure was displayed in the entrance of the home, but it was in small print and difficult to read. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 18 There was not enough detail recorded about one complaint and the homes system for recording complaints is combined with the system for recording compliments. Staff were familiar with the different types of abuse, but less clear about responding to an allegation or suspicion of abuse. The home did not have a copy of the local authority multi-agency adult protection procedures and senior staff have not received any training on how to use the procedures. Requirements and recommendations have been made to address these issues. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Internally the home meets the needs of the people that live there but access in and out of the home is restricted by the lack of a ramp and handrail. Some infection control procedures create the potential for cross infection. EVIDENCE: Bedrooms were clean and fresh and personalised according to individual taste. One person said that she thought the bedrooms were lovely, and went on to describe how she had pictures of her family displayed all around her bedroom. Another resident spoke about the lovely garden area at the rear of the home and said that she enjoyed watching squirrels and rabbits playing. There is no ramp or handrail at the front of the building making access difficult particularly for people who use wheelchairs and those with poor mobility. In a
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 20 returned survey form relatives said, “There is no ramp outside and we find it difficult to get a wheelchair out of the front door.” Some decorating and refurbishment has taken place since the last inspection. This must continue to make sure that the dining room is decorated and the carpet in one lounge, which is threadbare in places, is replaced. The home is registered to admit people with dementia but there is little signage throughout the home to assist residents who have some degree of memory loss and all corridors look alike, which can be confusing to some people. During the day some residents asked about the time and what day it was. There were no large clocks or calendars in the main communal areas to provide this information. Staff had a good understanding of the need to wear protective clothing such as aprons and gloves and said that there was always a good supply of these in the home. They also described good practice when disposing of used and soiled continence products. The home is taking part in some research into MRSA, which is being carried out by the PCT (Primary Care Trust). As a result of this, the home is able to access training on preventing and managing MRSA. Some practices increase the risk of cross infection in the home. Bedding is taken to a central laundry but soiled linen and personal clothing is washed on the premises. The home had a supply of water-soluble bags, which should be used when laundering soiled lined, but staff were unaware of the need to use these. Liquid soap and disposable towels were not provided in all toilets. Requirements and recommendations have been made. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels do not always meet the needs of residents, which means that at times people may be left unattended. The home’s induction programme does not meet recognised standards and the lack of targeted and focussed planned training means that staff may not have the skills to meet the needs of residents. EVIDENCE: There was sufficient staff on duty throughout this inspection visit. Out of nine returned survey cards returned from relatives, six said that there was always enough staff on duty, two were not sure and one person said that there was not always enough staff on duty. Out of the four returned comment cards from residents three said that there was always staff available and one person said that staff was usually available when needed. During the inspection residents said that night staff responded quickly when assistance was needed. Cleaning staff do not work weekends, and there is only one cook employed which means that care staff, the deputy manager and the manager all spend time working in the kitchen on a daily basis. Care staff said that they prepare, serve and clear away the evening meal each day. The manager said that after 4.00pm there is usually three staff on duty which means that one person works in the kitchen and two attend to residents. However, the rotas supplied
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 22 before this inspection showed that at times there are only two people on duty. The manager and deputy said that they work in the kitchen on the cook’s day off and if there are only two evening staff on duty they themselves work extra hours to help with the evening meal and administration of medication. From observation it was clear that some residents require the assistance of two staff, which means that if there are only two members of staff on duty between 4.00pm – 10.00pm there are times when they are assisting one person, other people are left unattended. Rotas do not show the senior person in charge of the shift and the amount of time both care and management staff spend carrying out cooking and cleaning tasks. The recruitment records of two workers both recruited since the last inspection were seen. In both cases there was a completed application form but there was no full employment history for one person and this had not been explored at interview. In both files there was only one written reference and CRBs (Criminal Record Bureau) disclosures were not available for inspection because the manager said that she destroys these after a 6-month period. There were records of the recruitment interview but in both cases the manager conducted the interview alone. An original photograph of the person should be held on staff files, as photocopies from other documents, such as a driving licence, can at times be difficult to distinguish. The manager produced a copy of the home’s induction programme but this appeared to be more of a staff handbook rather than an induction programme. It was not based on either the TOPSS (Training Organisation for Personal and Social Services) or Skills for Care induction standards. Age Concern delivered some in-house training on dementia care about 18 months ago, but staff recruited since have not received any training on dementia. Staff said that district nurses have given training sessions on pressure area care and catheter care. The manager said that during the last 12 months priority has been given to getting staff through their NVQ (National Vocational Qualification). The home could not evidence that staff have a minimum of three paid training days per year. There was no annual training plan and no records of when mandatory training updates were due. The manager said that she identifies training needs by observation and assessing the current skills and strengths of staff but she does not have a dedicated training budget to access any training that is not free of charge. Requirements and recommendations have been made. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The amount of time the manager spends on caring and cooking tasks is often at the expense of management duties, which means that the required records are not always in place, accurate or up to date. Some practices in the home pose a potential risk to the health and safety of residents. EVIDENCE: The home has an informal atmosphere, which is welcoming and creates a domestic homely environment for residents. It was evident throughout the inspection that the manager spends a great deal of time working alongside care staff and is respected by staff, residents and visitors to the home. During
Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 24 a telephone conversation one relative said, “The manager is brilliant and leads from the front” another relative said, “The manager is always in the kitchen cooking”. However, the amount of time that she spends carrying out care and cooking tasks is reflected in the standard of record keeping in the home. This is something that must be addressed. The registered owners have developed a quality assurance questionnaire but these are not distributed as often as they should. However, the informal atmosphere in the home lends itself to people discussing quality issues on an informal basis. The same can be said of staff meetings, which are irregular and the minutes of the meetings are not very detailed. Residents’ finances were sampled and were in order. During the inspection one relative handed over £20.00 on behalf of a resident for safekeeping. The manager immediately issued this person with a receipt and made a record of the transaction. In one resident’s room bed safety rails were fitted to a divan bed. These fitted snugly near to the top of the bed, but towards the bottom of the bed there was a 6 – 8” gap, creating a risk of entrapment. There had been no assessment made before the bed safety rails were put into use, about whether this was the best option for this particular resident. There was also no information as how and when the bed rails should be checked and whose responsibility is was to carry this out. The manager agreed to deal with this issue immediately. A number of different toiletries were accessible in two bathrooms, creating the opportunity for the use of communal toiletries and cross infection. Wooden door wedges were in use throughout the home to prop open doors, and some residents said that these are in use during the night. This poses a serious risk in the event of a fire. A number of accident forms were seen in care plans. It was not always clear whether staff had witnessed the accident and where staff did not witness an accident, there was no record of when the person was last seen and by whom. The manager was unaware of the need to complete a monthly analysis of all accidents in the home so that any patterns or trends can be identified. The manager and the deputy manager deliver moving and handling training to staff, but neither are trained moving and handling coordinators. Not all staff have received infection control training and there is not a trained first aider on every shift. All staff in the home are involved in preparing and serving food but their food hygiene training consists of watching a video and then answering questions all completed ‘in-house’. Someone from the organisation delivers fire training annually to staff, but if someone is on leave or ill there is no guarantee that the training will be repeated. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 25 Before this inspection visit the manager sent copies of COSHH (Control of Substances Hazardous to Health) risk assessments, a copy of the home’s fiveyear electrical wiring certificate and records of weekly water temperatures. The pre-inspection questionnaire completed by the manager shows that servicing of equipment takes place as required. The manager produced evidence during the inspection of a Legionella check taking place. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Care plans must give staff clear and specific instructions about how to meets all aspects of the resident’s health, personal and social care needs. Wherever possible care plans must be signed and agreed by the resident and/or their relative or representative. 2 OP7 12 A risk assessment must be carried out to identify those at risk of falling. Where risk is identified a prevention of falls care plan must be put into place. Only medication that has been prescribed for the resident must be administered. This includes oxygen. When oxygen is in use warning notices must be displayed. Before staff assist in the administration of oxygen they must be trained by a healthcare professional and satisfy this person that they are competent to carry out the task.
DS0000001427.V306637.R01.S.doc Timescale for action 31/01/07 31/01/07 3 OP9 OP38 13 (2) 31/12/06 Brigshaw House Version 5.2 Page 28 4 OP9 13 (2) The home’s system for ordering medication must be reviewed so that it complies with guidelines from The Royal Pharmaceutical Society. Handwritten entries on Medication Administration Records must be checked and countersigned by a second person. The home must keep a detailed record about how complaints are investigated, who carried out the investigation and the people involved during the investigation. The home’s policy and procedure about how to make a complaint must be accessible to all residents and their relatives and/or representatives. Senior staff must access training on how to use the multi-agency procedures. The home should obtain a copy of the local authority multiagency adult protection procedures. 31/01/07 5 OP16 22 31/01/07 6 OP18 13 31/03/07 7 OP19 23 (n) 8 OP19 23 (d) 9 OP26 13 Access must be provided to and from the home for people who use wheelchairs and those with poor mobility. Decorating and refurbishment must continue to make sure that the dining room is decorated and the carpet in the main lounge is replaced. To prevent cross infection watersoluble bags must be used when laundering soiled linen. Liquid soap and disposable towels must be provided in all toilet areas. 31/03/07 31/03/07 31/01/07 Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 29 10 OP27 18 11 OP29 19 Staffing levels must be reviewed to make sure that there are sufficient staff on duty at all times to meet the needs of residents. Two written references must be obtained for all new staff. A full employment history must be obtained and any gaps in employment must be explored. Criminal Record Bureau disclosures must be retained for inspection. New staff must receive induction training that is based on the Skills for Care induction standards. The home must develop an annual training plan that is based around mandatory training, the conditions and needs of the residents and the current skills of the staff group. A system must be developed that shows when mandatory training updates are due. A review of the tasks undertaken by the manager and the deputy manager must take place to make sure that they are not routinely carrying out cooking, caring and cleaning duties. The home must maintain a quality assurance system for evaluating the service provided at the home. The results of the evaluation must be analysed and used in future planning and development of the service. Bed safety rails must not be put into use without a full assessment where all other
DS0000001427.V306637.R01.S.doc 31/01/07 31/01/07 12 OP30 18 (c) 31/03/07 13 OP31 18 28/02/07 14 OP33 24 31/03/07 15 OP38 13 31/01/07 Brigshaw House Version 5.2 Page 30 options and the risks associated with the use of bed safety rails are considered. When bed safety rails are in use the home must follow the guidance stated in the Medical Devices Agency document ‘Advice on the safe use of bed rails’. Where doors need to be propped open, a device must be fitted that activates door closure on the sound of the fire alarm. Moving and handling training must only be delivered by people qualified to do so. All staff must receive training in infection control, first aid and food hygiene. Training updates must take place as necessary. All staff must receive fire training at intervals of no more than 6 months. Toiletries must not be stored in 31/12/06 bathrooms. After use any toiletries used by residents must be returned to their room. 16 OP38 13 31/01/07 17 OP38 13 & 18 31/03/07 18 OP38 13 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 OP2 OP3 Good Practice Recommendations Each resident should have an up to date copy of the home’s terms and conditions. The home’s pre admission assessment should give details about all aspects of the resident’s care needs and specify what support is needed. Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 31 3 4 5 6 7 8 9 OP7 OP7 OP7 OP8 OP15 OP16 OP22 Entries in daily records should describe actual behaviour rather than the being subjective. Daily records should reflect how the resident has spent their day. Care plans should be reviewed monthly and should show what factors have been taken into consideration as part of the review and how the plan is still effective. Records of bathing and monthly weights should be held in individual care plans. Nutritional assessments should be completed for all residents on admission and must be reviewed as and when necessary. The home should consider introducing a system where residents can look at a menu before their meal is served. The system for recording complaints should be separate from the system where compliments are recorded. To assist those people with some degree of memory loss signs should be provided throughout the home, particularly on bedroom, toilet and bathroom doors. Large clocks and calendars should be provided in communal areas. Staff rotas should show the senior person in charge of the shift. Rotas should reflect the amount of time care and management staff spend on cooking and cleaning tasks. Recruitment interviews should be carried out by a minimum of two people. Both people conducting the interview should sign and date the interview record. Photographs held on staff files should be originals rather than photocopies. All staff should have a minimum of three paid training days a year. Where accidents are not witnessed by staff a record should be made of when the person was last seen and by whom. The manager should keep a monthly analysis of all accidents in the home so that any patterns or trends can be identified. 10 OP27 11 OP29 12 13 OP30 OP38 Brigshaw House DS0000001427.V306637.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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