Inspection on 27/05/08 for Brigshaw House

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Poor 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

Brigshaw House 17/11/08

Brigshaw House 24/07/07

Brigshaw House 21/11/06

Brigshaw House 04/10/05

Brigshaw House 20/05/05

Brigshaw House 05/10/04

Brigshaw House 18/05/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brigshaw House 2 Brigshaw Lane Allerton Bywater Castleford West Yorkshire WF10 2HN Lead Inspector Dawn Navesey Key Unannounced Inspection 27th May 2008 09:50 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.V365132.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.V365132.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 F/P 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.V365132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th July 2007 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 require 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 25th July 2007 the acting manager said that the fees ranged from £382 - £410 per week. More up to date information can be obtained from the home. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced visit by two inspectors who were at the home from 09.50 until 18.45 on 28 May 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection we reviewed accumulated evidence about the home. This included looking at any reported incidents, accidents and complaints. We used this information to plan the inspection visit. We looked at a number of documents during the visit and visited all areas of the home used by the people who live there. We spent a good proportion of time talking with the people at the home and visitors as well as with the acting manager and the staff. Comments made to us during the day appear in the body of the report. Survey forms were to people living at the home, their relatives and staff. Information from those returned is reflected in this report. Feedback at the end of the visit was given to the acting manager. What the service does well: People who use the service spoke highly of the home. These are some of the things they said: • • • • We chose Brigshaw House because it was small enough not to feel like an institution. It had good staff retention and carers that were always visible and interacting with residents. We had heard good reports from the home from other people who had been in here. We are in good hands. They make sure we are alright, we are well looked after. People’s relatives were also very positive about the home. Comments they made included: Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 6 • • • • X appears content, is hardly ever distressed and is assisted with meals, toileted and always looks cared for. I feel generally that staff are kind and caring towards my mother. Mum is generally clean and tidy. The care staff are always present when I visit and show care and respect for the residents. Despite the gaps in care plan information, staff could describe the care they give and overall showed a good understanding of meeting people’s needs. Staff said they try to encourage people who live at the home to be as independent as possible to increase their privacy and dignity. Staff gave some good examples of how they maintain dignity for people. People spoke very highly of the food in the home. They said there is plenty of choice and it is always well cooked. People said they liked and got on well with the staff. One person said, “The girls are lovely”. What has improved since the last inspection? What they could do better: Information on what the home can provide for people with dementia or memory loss must be included in the home’s statement of purpose. This will make sure that people know if the home can meet their needs. Some thought should be given to signage in the home to assist people with memory loss to orientate themselves. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 7 The format of information in the home such as the statement of purpose and complaints procedure should be reviewed to make sure it is more user-friendly and suitable for all people who live at the home. Staff must be trained properly. The home must develop and deliver a training plan. This must include induction training and any specialist training such as dementia and memory loss. This will make sure that staff are competent and skilled in meeting people’s needs properly. Although care plans and some risk assessment information has improved since the last inspection, there is still some work to be done. Everyone living at the home must have a plan of care that shows their health, personal and social care needs and the actions that staff need to take. This will make sure that people’s needs are met. The way medication is currently ordered should be reviewed. Sending prescriptions to the pharmacist without having first checked them could lead to errors being made. Handwritten entries on the medication administration record sheets should be checked and countersigned by two people. This will reduce the chance of any errors. People who live at the home said they were often bored. One person said, “I like watching films on television but can’t see it. I am bored every day”. A number of people’s relatives said they were concerned at the lack of activity in the home. These are some of the things they said: • • • • • There is little mental stimulation I have been concerned at the lack of stimulation in the way of activities that goes on. Mum has dementia and often comments she is bored and has all day to be bored in. She is often down in the dumps. There is very little in the way of activities other than bingo. Mum is capable of being taken out on outings run by the home, but these are few and far between It seems a shame that chatting and being a friend doesn’t seem to be part of the job. A full and varied activity programme must be developed to meet the needs and abilities of people living at the home. This will make sure that people have access to a range of stimulating recreation and leisure activities. We asked for this to be done at our last inspection of the home too. A number of issues must be addressed to make sure people are properly protected from abuse. All staff must receive training on safeguarding adults. Staff must be given clear procedures on what to do if they suspect abuse of people at the home so that they can respond properly and promptly. And all staff must have a CRB (Criminal Records Bureau) check before starting work at Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 8 the home. This will make sure that people who work at the home are suitable to work with vulnerable people. Decorating and refurbishment must continue and should include work on bathrooms and toilets and the equipment in them. Locks on toilet doors must be repaired. This will make sure that all areas of the home are comfortable and maintain people’s privacy and dignity. The arrangements for infection control must be reviewed. This is to make sure that people are not put at risk from cross infection. Management of the home must be improved. All staff must receive regular supervision. This will make sure that staff are properly aware of their job role and responsibilities and given clear guidance on what is expected of them. Records in the home must be kept in good order. Confidential records must be kept securely. This will protect the rights and best interests of people who live at the home. The home’s quality assurance surveys should be distributed annually and extended to include people living at the home and health and other professionals. Feedback from the surveys should be analysed, the results published and used to form a development plan for improving the service provided. We made this recommendation at our last inspection too. A number of health and safety issues must also be addressed. All staff must receive moving and handling training. This will make sure their practice is safe and people are not put at risk. And where doors need to be propped open, a device must be fitted that activates door closure on the sound of the fire alarm. This will make sure that people are safe in the event of a fire. We said the home must do this at our last inspection too. A number of requirements and recommendations have been made following this inspection. Full details of them 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. The summary of this inspection report can be made available in other formats on request. Brigshaw House DS0000001427.V365132.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.V365132.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4, 5. Standard 6 does not apply to this home. People who use the service experience adequate quality outcomes in this area. Overall, people are provided with enough information to enable them to make an informed choice about the home. The admission process includes preadmission assessments to make sure that people’s care needs can be met. However, staff are not trained in meeting the specialist needs of people who use the service and this could lead to their needs being overlooked. We have made this judgement using available evidence including a visit to this service. EVIDENCE: People who live at the home and their relatives said they were happy with the choice to use this home. These are some of the things they said: Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 11 • • • We chose Brigshaw House because it was small enough not to feel like an institution. It had good staff retention and carers that were always visible and interacting with residents. We had heard good reports from the home from other people who had been in here. It was small and friendly. However, one relative said they were told when they visited that their mother would be kept occupied and this hasn’t happened since she moved in. The home’s statement of purpose has recently been reviewed and updated. The information has not been produced in alternative formats such as easy read or large print. This means it is not accessible to all people who use the service. The acting manager was given advice on how to make this information more user-friendly. The home is registered to provide a service for people with dementia and memory loss. The statement of purpose does not include how the specialist needs of people with dementia are met. Staff have some basic knowledge on the needs of people with dementia and memory loss. One said, “Everyone’s individual, we get to know them, learn what their needs are. Dementia affects different people differently”. Another said, “You need to give people extra time especially if they are upset”. Some staff have been trained in dementia awareness. Others, including the acting manager have not. During the visit, it was seen that staff were not always responding well to the emotional behaviour needs of people with memory loss problems. One person was wandering and calling out to people most of the day. Staff did not always respond to this person and her requests for assistance. The home carries out its own pre-admission assessment. Information is then used as a basis for the development of the person’s care plan. There are some gaps in the information gathered. There is a lack of information on how dementia affects people as individuals. There is also a lack of information on people’s likes, dislikes and life history. Pre-admission assessment information is based on what a person can’t do rather than on their strengths and abilities. This is not person centred and does not give a picture of the person as an individual and the lifestyle they wish. This means that some care needs could be overlooked. People who use the service are given a contract with the organisation. These are signed and up to date. There is also a transfer of bedroom agreement in place to show how any transfers have been discussed and agreed by the person using the service. This is good practice and protects people’s interests. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, & 10. People who use the service experience adequate quality outcomes in this area. In the main, people’s health and personal care needs are met. However, care plans do not always contain enough detailed information about individual needs. This means that some care needs could be overlooked. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People who use the service said they were happy with the care they receive and felt well looked after. One person said, “We are in good hands”. Another said, “They make sure we are alright, we are well looked after”. We thought people looked smart and well dressed. Relatives of people who use the service also spoke highly of the care their relatives receive. Some of the things they said included: Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 13 • • • • X appears content, is hardly ever distressed and is assisted with meals, toileted and always looks cared for. I feel generally that staff are kind and caring towards my mother. Mum is generally clean and tidy. The care staff are always present when I visit and show care and respect for the residents. Some work has been done on care plans of people who use the service to improve them. Some plans have some good, detailed, person centred information on how people like to be cared for. For example a care plan on sleep patterns showed what time the person likes to go to bed, how they like to be supported with their night time routine, what they wear for bed and how they like their bed linen. There was good information on how people’s dignity is respected. One care plan asked staff to cut a person’s food up discreetly in the kitchen before it was served in the dining room. This is good practice. However, further work is needed on the care plans and risk management plans to bring them to a standard that makes sure people’s needs are not overlooked or missed. The needs of people with memory loss or dementia are not properly identified. Information is basic and does not show how this affects people individually. The plans do not always reflect people’s current needs or how staff should support people regarding their memory loss. There is no information on the use of aids such as memory boards or life story books that can be beneficial in supporting people with dementia. Plans are based on what people can’t do rather than their strengths and areas of independence. Some care plans had conflicting information in. For example, the care plan said a bath hoist was to be used for moving and handling and then the risk management plan said a shower seat was to be used. A person at risk from pressure ulcers had no care plan for prevention of pressure ulcers or any details of equipment used. The information in some care plans was vague and lacked detail on people’s care needs. Terms such as ‘needs extra observation’, ‘constant observation’ and ‘needs supervision’ do not give staff enough direction on people’s care and support needs. However, staff could describe the care they give and overall showed a good understanding of meeting people’s needs. Staff said they try to encourage people who live at the home to be as independent as possible to increase their privacy and dignity. The acting manager has plans to introduce a new format for care plans and risk assessments and said she hoped this would address the gaps and make them more individual to the person. Records showed that doctors, district nurses, chiropodists and opticians visit people who live at the home. One person said, “They always get the doctor for us if we need them”. A relative said, “If anything is wrong we have been Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 14 informed in the past, but would appreciate to know the outcome of doctors’ visits without having to ask”. There have been some improvements to the way in which medication is stored, administered and disposed of. We checked the medication administration records (MAR) and there were no errors in medication administration. Each person’s record sheet has a clear photograph of them so that staff can easily recognise who they are giving medication to. Hand written entries on the MAR did not however have two signatures to show two people had checked them. This could lead to errors in medication administration. The way medication is ordered needs to be reviewed. The current system of sending the prescriptions directly to the pharmacy without having checked them could lead to errors. Also the room in which medication is stored is warm and could lead to deterioration of medication. The acting manager said this would be monitored and ventilation fitted if needed. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. People who use the service experience poor quality outcomes in this area. In the main, people said that they do not have enough to occupy them through the day and that they were bored. People are supported in maintaining contact with their family and friends and visitors are welcomed at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Visitors are welcomed at the home at anytime throughout the day and some people go out regularly with their families. However for those without visitors or who are unable to get out there is little or no social interaction, activity or stimulation other than the television. These are some of the things people said about the service: • My mums been happier since she went into Brigshaw House than when she lived on her own. DS0000001427.V365132.R01.S.doc Version 5.2 Page 16 Brigshaw House • • • • • • On the occasions of my visits the staff have always been friendly and shown an easy, caring relationship with the residents. I have never seen anyone flustered and there is usually an atmosphere of calm. There is little mental stimulation I have been concerned at the lack of stimulation in the way of activities that goes on. Mum has dementia and often comments she is bored and has all day to be bored in. She is often down in the dumps. There is very little in the way of activities other than bingo. Mum is capable of being taken out on outings run by the home, but these are few and far between It seems a shame that chatting and being a friend doesn’t seem to be part of the job. People said they enjoyed the activity in the home but that there wasn’t enough, especially outings out of the home. People said they would enjoy going shopping or out for meals but staff were too busy. A relative said, “Things are promised but don’t happen”. Most people said that staff did not have time to sit and have a chat with them. One person said, “They’re rushed off their feet, always busy.” There is a Church of England service held once every six weeks in the home. People said they looked forward to this. There is no structured activity programme in the home. Staff said they organise things when they can. This seemed to mainly consist of bingo games. Staff said that being short staffed always affected their ability to arrange any activity or just sit and chat with people. One person said, “You feel awful, always rushing about and saying I’ll be back in a minute, we have no time to just spend with them”. There were large periods of time when people were unsupervised in the lounges or just wandering about. There was little interaction with the staff other than to be given medication or a cup of tea. Staff said they were aware of how little time they can spend with people as they are so busy carrying out other tasks. The layout in one of the lounges means that some people cannot see the television. One person said, “I like watching films on television but can’t see it. I am bored every day”. Social care plans do not properly identify people’s social care needs. Their needs are not properly met in this area. The acting manager said that more staff had recently been recruited and she was hoping to improve staffing levels and increase the level of activity on offer. People said they could choose when to get up, go to bed and have a good choice of meals and snacks. Staff gave good examples of how they encourage people to be independent and to make every day choices such as choosing what to wear and what to eat. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 17 People spoke very highly of the food in the home. They said there is plenty of choice and it is always well cooked. Meals are served plated up from the kitchen. At the last inspection it was recommended that people might benefit from being able to serve themselves from tureens. The acting manager said she has introduced salt and pepper pots for the tables and is looking for cool sided teapots for the table to increase people’s independence. She then hopes to introduce tureens and serving dishes. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 18 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): Standards 16 & 18 People who use the service experience poor quality outcomes in this area. People who use the service and their relatives, in the main, have their views listened to, taken seriously and acted upon. The systems in place to protect people who use the service from abuse do not properly protect them and leave them vulnerable and at risk from abuse. We have made this judgement using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure displayed in the home. Records are kept of any complaints received and details of any investigation carried out. The policy has recently been updated. It would now benefit from being produced in a user-friendly format to make it more accessible to people who use the service. Some people said they would complain if they needed to. One person said, “We have nothing to grumble about”. Another said, “I would talk to the carers if I wasn’t satisfied, you only have to report it and it gets seen to”. There is currently a safeguarding adults investigation at the home, regarding allegations of ill treatment of people who live at the home. There is concern that staff have not followed the whistle-blowing (reporting) procedure and allegations have not been reported promptly and properly. Staff we spoke to said they had been reluctant to report allegations and had not been aware of Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 19 the whistle-blowing policy. Management within the home also do not seem to have been fully aware of the need to report any incidents involving safeguarding to the local authority or police. This has left people unprotected and vulnerable to abuse. All staff have now been issued with a copy of the organisation’s whistle – blowing procedure. The acting manager said she is now aware of what to do when allegations of abuse are made and is aware of her responsibility to report them to the local authority or police if necessary. Some staff have received training in safeguarding adults, others have not. The acting manager has now arranged training with a local adult protection unit. She said all staff including her would be going through the training in the coming months. Most staff now seem clear on their responsibility to report any suspicions or allegations of abuse. Most staff were clear on the different types of abuse. However, there was some inconsistency from staff in that some staff did not know who to report issues to outside of the home. The home now has a copy of the local authority multi-agency policy on adult protection. However, the home does not have a clear procedure giving staff instructions on what to do if they suspect abuse. This again, does not properly protect people from abuse. During the visit, the acting manager discovered that there was no evidence in the home of some staff having had Criminal Records Bureau (CRB) checks done prior to starting work at the home. In a survey we received a member of staff said, “I was working before my CRB check came back. This practice has still been going on with new staff”. Some staff confirmed they had a CRB before starting work and we saw some records of new staff that also showed they had a CRB check. The acting manager said she would investigate with the organisation’s head office for the records of CRB checks and if records could not be found new ones would be completed. She agreed to inform the CSCI of the outcome of her investigation within 14 days. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 20 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. People who use the service experience adequate quality outcomes in this area. Overall people live in a comfortable and safe environment. Some practices put people at potential risk of cross infection. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Some areas of the home have been re-decorated since the last inspection. This includes some bedrooms, some bathrooms and toilets. Some other bathrooms and toilets are still in need of this to make them more attractive and comfortable. Some equipment in the bathrooms and toilets, such as raised toilet seats and urinals looked in need of cleaning to make them more hygienic. We also found three toilets that did not lock. These must be fixed in order to protect the privacy and dignity of people who use the service. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 21 Some thought has been given to signage in the home to assist people with memory loss to orientate themselves. Discussion took pace with the acting manager about developing this further to include themed corridors and the use of different colours for toilet and bathroom doors. People said they were happy with their rooms and had been able to bring their own things for them. People said they were clean, warm enough and they always had hot water. People spoke positively about laundry arrangements in the home. One person said, “They follow my requests, iron things nicely”. Another person said they always got things back quickly and they had not had any problems. There are attractive gardens to the home. People said they liked to sit out in the summer. There is plenty of shade and tables and chairs. Some people commented that the garden upkeep was not as good as it used to be. Paths in the garden do not have any handrails. This could be a health and safety hazard for anyone with mobility problems. Some thought should be given to making these paths safer. We found an unlocked store cupboard in the home. The cupboard contained pots of paint, broken furniture and a saw that could be hazardous to people who live at the home. There was also a box of confidential records. The acting manager said this is normally locked and said she would make sure it was kept locked in the future. Overall we found the home to be clean and tidy. However, we noticed that some bedrooms had an offensive odour. Staff said they were using special cleaning products to deal with this. Staff showed some understanding of infection control management. Most staff said they had received training as part of their NVQ (National Vocational Qualification). However, we noticed a number of infection control issues in the home. Some sinks had bars of soap at them rather than liquid soap. Toilet rolls were uncovered and stored next to toilet brushes. The foot-operated mechanism of the clinical waste bin in the laundry was broken. All of these could be potential areas for cross infection. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 22 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): Standards 27, 28 29 & 30. People who use the service experience adequate quality outcomes in this area. Staff are not always trained and skilled in meeting all the needs of people who use the service. At times the numbers of staff on duty do not meet all the needs of people living at the home. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Some improvements have been made to the staffing levels since the last inspection. There are usually three care staff on the morning and evening shifts and two staff on the night shift. There are kitchen staff until 7pm most days and two domestic staff who work weekdays 9am to 1pm. The acting manager is available weekdays between 10am and 3pm. The home has had a number of staff vacancies recently. The acting manager has had a recruitment drive and has five new staff waiting to start. Rotas we looked at showed that with the new staff, numbers of care staff should increase to five on day shifts. The current staff team has been working extra shifts to cover some of the staffing shortfalls. It is recommended that the use of bank or agency staff be Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 23 considered in the future to make sure there is enough staff to meet people’s needs properly. People who use the service and their relatives spoke highly of the staff. These are some of the things they said: • The girls are lovely. • They appear to meet the needs of the elderly frail residents. • They understand needs, they are very attentive. • There are enough staff about except when people are off sick. • Staff said however that they were often short staffed and rushed in their work. They said: • • • • We don’t have enough time to spend having a chat with residents. We are running around like scalded cats, we don’t have enough staff. We are willing but tired with all the overtime. There needs to be enough staff on shift at all times to reduce pressure on staff and residents. Most staff said they were satisfied with the training but found it difficult to recall any recent training events. One said, “I didn’t even have an induction”. Another said, “I have not been trained in moving and handling or first aid”. None of the staff we spoke to had received training on the specialist needs of people with dementia. (As mentioned in the Choice of Home section of this report) The acting manager said that staff complete an induction that includes working alongside a competent or senior member of staff and completing an induction package on the home. This includes an introduction to the organisation and policies and procedures. The acting manager is not familiar with Skills for Care common induction standards. However, a manager from another home within the organisation has been brought in to organise this for future staff. Records of staff training were poor. It is difficult to see who has done what training and when their updates are due. There appears to have been a very random approach to staff training. This has resulted in some staff receiving training but not all staff. The acting manager said that training in the last year has included, dementia awareness, adult protection, first aid and moving and handling. She also said she was working on putting the records in order and introducing a training plan for the home. She was not aware of how training needs had been identified in the past but said she was planning to introduce staff supervision to do this. The acting manager said that well over half of the staff have completed their NVQ level 2 in care. She said this would continue for new staff when they had worked through their induction. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 24 We looked at staff’s recruitment records. These were found to be satisfactory except for the CRB checks as mentioned in the Complaints and Protection section of this report. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 25 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): Standards 31, 33, 35 & 38. People who use the service experience poor quality outcomes in this area. The management of the home is not well organised and this results in some practices that do not promote and safeguard the health, safety and well being of people living at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: The registered manager is currently absent from the service. An acting manager is in day-to-day charge. She said she has an NVQ 4 in management, another management qualification in care services and many years experience of working with older people. She has not had any specialist training in the Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 26 needs of people with dementia. She is currently making herself familiar with the running and immediate management tasks to be done in the home. We received comments on the management of the home from people who use the service and their relatives. These are some of the things they said: • • • • The home is well managed at the moment, things are a lot better, staff seem happier. They keep us well informed. We have had concerns in the past felt we received conflicting information. We don’t have relatives’ meetings. Comments about the management of the home were mixed from members of staff. Comments included: • • • • • • • • The acting manager is supportive and approachable. Due to recent events staff morale is at an all time low. Not enough verbal information. There is poor communication between staff and managers within the home regarding client care. There are many areas that need to be improved, especially managerial side and comms (communication). Management are always there for you. Don’t feel supported, feel isolated. Better recently, happier place. Feel can speak out without fear. Records showed that staff have not been receiving supervision from the manager of the home. The acting manager said she plans to introduce this. This must be done to make sure staff are properly aware of their job role and responsibilities and given clear guidance on what is expected of them. This will also make sure that communication between staff and management is improved. As mentioned in the Health and Personal care section of this report, all records such as care plans and risk management plans must be kept to a good standard. More thought should also be given to how people can contribute and be involved in developing their own records. This will make sure plans are more individual and person centred. The acting manager said that a number of records currently appear to be missing from the home. She said she has spent a lot of time looking for these and trying to put records in better order. During the visit we found some confidential records in an unlocked storage cupboard. The acting manager said she would make sure the cupboard was kept properly locked in the future. As mentioned in the Staffing section of this report, there were poor records of staff’s training, supervision and CRB checks. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 27 Records for the safekeeping of the money held on behalf of people who use the service were in place. It is recommended that whenever money is handed over on behalf of a person living at the home, a signature be obtained from the person handing over the money and the person receiving the money. This should be at the time of the transaction and will make the system safer for people. We looked at questionnaires that had been sent out by the home. The information was not current and there did not seem to have been any analysis of the information. If this information had been looked at properly, it would have highlighted people’s concerns about the lack of activity in the home. People who use the service and their relatives said they did not have meetings in the home and were not asked their views on the running of the home. This does not properly respect the views of people who use the service. Questionnaires had not been sent to health or social care professionals who have contact with the home. This would be good practice and make sure the home got feedback on how they could improve the service. Records were not available for Regulation 26 visits. These are visits were the area manager should visit the home once per month to make sure the home is being properly managed and people are happy with the service. The acting manager said she was aware there had been gaps in the frequency of these visits and that this could have led to the lack of identification of shortfalls within the home, especially regarding the whistle-blowing procedure. The home has a maintenance person who is responsible for monitoring of health and safety within the home and to make sure that regular checks are carried out. No written records of these checks could be found. There was however, a record of jobs carried out by the maintenance person. On looking round the home, we found a number of doors propped open with tables or door wedges. This practice poses a risk in the event of fire and must cease. This was identified at the last inspection and the provider was required to make sure that where doors need to be propped open, a device is fitted that activates door closure on the sound of the fire alarm. Staff said they had done health and safety training as part of their NVQ. Most staff have received moving and handling training but records showed that two staff who work nights had not. All staff must receive this training to make sure their practice is safe and people are not put at risk. The acting manager said she had just completed environmental risk assessments for the home. The records were not available as they had gone to the head office for typing. She said she had sought the advice of a local health and safety officer in developing these. The acting manager said that all safety checks on equipment, appliances and electrical wiring were up to date. Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 28 Accident records are kept for each person on their individual files. There was some evidence to show that these are reviewed and analysed. Brigshaw House DS0000001427.V365132.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 2 3 2 2 3 X 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 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 2 2 Brigshaw House DS0000001427.V365132.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 OP1 Regulation 4 Requirement The home’s statement of purpose must include information on how it meets the specialist needs of people who have dementia or memory loss. This will make sure that people know if the home can meet their needs. Staff must be trained in the specialist needs of people who have memory loss or dementia. This will make sure that staff can meet people’s needs fully. Care plans and risk assessment information must give staff clear and specific instructions about how to meets all aspects of people’s health, personal and social care needs. This will make sure that people’s needs are not overlooked. Previous timescales of 31/01/07 and 30/11/07 have not been met in full. Timescale for action 31/07/08 2. OP4 18 31/12/08 3. OP7 15 30/11/08 Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 31 4. OP12 16 A full and varied activity programme must be developed to meet the needs and abilities of people living at the home. This will make sure that people have access to a range of stimulating recreation and leisure activities. Previous timescale of 30/09/07 has not been met. All staff must receive training on safeguarding adults. This will make sure people are protected by properly trained staff. Staff must be given clear procedures on what to do if they suspect abuse of people at the home so that they can respond properly and promptly. All staff must have a CRB check before starting work at the home. This will make sure that people who work at the home are suitable to work with vulnerable people. 31/08/08 5. OP18 13.6 31/08/08 6. OP18 13.6 30/06/08 7. OP18 OP29 13.6 11/06/08 8. OP19 23 Decorating and refurbishment must continue and should include work on bathrooms and toilets and the equipment in them. This will make sure that all areas of the home are comfortable for people. Previous timescale of 30/11/07 has not been met in full. 31/12/08 Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 32 9. OP19 23 All toilets in the home must have the ability to be locked. This will protect and maintain people’s dignity. 30/06/08 10. OP26 13.3 The arrangements for the control of cross infection must be reviewed. Bars of soap must be removed from hand washing sinks, uncovered toilet rolls must not be stored next to toilet brushes and the clinical waste bin must be foot pedal operated. This is to make sure that people are not put at risk from cross infection. A staff training plan must be developed and provided. This must include induction training and any specialist training needed to meet the needs of the people who live at the home. 30/06/08 11. OP30 18 31/08/08 12. OP36 18 This will make sure that staff are competent and skilled in meeting people’s needs properly. All staff must receive appropriate 30/06/08 supervision. This must be done to make sure staff are properly aware of their job role and responsibilities and given clear guidance on what is expected of them. Records in the home must be kept in good order. Confidential records must be kept securely. This will protect the rights and best interests of people who live at the home. All staff must receive moving and handling training. This will make sure their practice is safe and people are not put at 13. OP37 15 and 17 31/08/08 14. OP38 18 31/08/08 Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 33 15. OP38 13 risk. Where doors need to be propped open, a device must be fitted that activates door closure on the sound of the fire alarm. This will make sure that people are safe in the event of a fire. Previous timescales of 31/01/07 and 31/07/07 Have not been met. 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The format of the statement of purpose should be revised to make sure that it is suited to the needs of the people living at the home. This will make sure that everybody has information they can understand. 2. OP3 Pre-admission assessments should include more person centred, individual information on people’s needs. This will make sure people’s needs are properly met. The way medication is currently ordered should be reviewed. Sending prescriptions to the pharmacist without having first checked them could lead to errors being made. Handwritten entries on the medication administration record sheets should be checked and countersigned by two people. This will reduce the chance of any errors. Consideration should be given to offering people more opportunities to socialise in the local community. This will meet people’s wider social needs. The home’s complaint policy should be made suitable for the needs of people living there. This will make sure that DS0000001427.V365132.R01.S.doc Version 5.2 Page 34 3. OP9 4. 5. OP13 OP16 Brigshaw House everybody has information they can understand. 6. OP19 Some thought should be given to signage in the home to assist people with memory loss to orientate themselves. Handrails should be considered for the paths in the garden in order to make them safer. When short staffed, some consideration should be given to the use of bank or agency staff so that staff shortfalls are covered and people’s needs are fully met. The home’s quality assurance surveys should be distributed annually and extended to include people living at the home and health and other professionals. Feedback from the surveys should be analysed, the results published and used to form a development plan for improving the service provided. 9. OP35 When money is handed over on behalf of a person living at the home for safekeeping a signature should be obtained at the time from the person handing over the money and the person receiving the money. 7. 8. OP27 OP33 Brigshaw House DS0000001427.V365132.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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