CARE HOMES FOR OLDER PEOPLE
Brincliffe Towers Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ Lead Inspector
Sue Turner Key Unannounced Inspection 11th May 2006 7:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Brincliffe Towers Address Brincliffe Edge Road Sheffield South Yorkshire S11 9BZ 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) 0114 255 2821 0114 255 2821 walker-jean@btconnect.com None Ash House (Yorkshire) Limited Ms Moira Elliss Layne Care Home 35 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24), Old age, not falling within any other category (11) Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. All 24 DE(E) beds are registered `or MD(E)` and are sited in a separate wing. Service users may also be aged 60-65 years. Date of last inspection 13th December 2005 Brief Description of the Service: Brincliffe Towers is a care home providing personal care and accommodation for thirty-five older people, including care for twenty-four service users with dementia. The home is privately owned, and is located in a residential area of Sheffield with nearby access to public transport. The home is a large old detached house with a modern annexe attached and has very pleasant well-established gardens, which overlook Chelsea Park. There is a small car park to the front of the house. All of the bedrooms are single although two are registered, as doubles should there be a request to share. Seven rooms have an en-suite facility. There is a passenger lift. A copy of the previous inspection report was on display and available for anyone visiting or using the home. Information about how to raise any issues of concern or make a complaint was on display in the entrance hall. The manager confirmed that the range of monthly fees from 10th April 2006 were £303 - £341 per week. Additional charges included newspapers, hairdressing and private chiropody. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this inspection, which was unannounced and took place over 7.5 hours from 7.30 am to 3.15 pm. Prior to the site visit the manager returned the pre inspection questionnaire and five service users returned the ‘Have your say about.’ questionnaires. During the site visit an inspection of the environment was undertaken. Records were examined, including: 3 care plans, complaints, staff recruitment and training, menu and fire records. All Commission for Social Care Inspection (CSCI) key standards were checked. Interactions between staff and service users were observed. The inspector spoke with a proportion of the staff on duty (4), and 5 service users. Discussions with the homes manager and provider also took place. Two relatives and a district nurse visiting on the day of the inspection were also spoken to. What the service does well: What has improved since the last inspection?
Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 6 A number of issues that were highlighted as needing attention, at the previous inspection, had all been resolved. An information sheet that recorded service users wishes regarding death, dying and funeral arrangements had been placed in the care files seen. The registered provider had started to carry out Regulation 26 visits, in which the quality of the service provided is monitored. These visits were on a monthly basis and recorded in writing. Staff spoken to said that they were receiving formal one to one supervision from their line manager, on a six weekly basis. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was not providing sufficient updated information to inform service users about their rights and choices. Each service user had a written contract, which enabled them to be clear about what services were included in the fee and what services must be purchased separately. Assessments prior to admission took place and trial visits to the home were encouraged. This enabled staff to be aware of service users needs to ensure that they could be met. EVIDENCE: Copies of a combined Service User Guide and Statement of Purpose were seen in each service users bedroom. The guide consisted of loose-leaf information about some of the services and policies at the home. Some of the information within the guide was out of date.
Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 9 Copies of service user contracts were seen on the files checked. Each clearly stated the terms and conditions of the home and funding arrangements. Staff spoken to said that assessments were undertaken prior to admission to ensure the home could meet prospective service user needs. The home’s manager or senior staff carried these out. Copies of care management assessments were seen on the files checked. Two relatives spoken to said they had visited the home, prior to admission and had chosen the home for their loved one. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Not all care plans had sufficient recorded information to ensure that the service users health, personal and social care needs were truly reflected and could be met. The homes medication practices protected the service users from being administrated inappropriate medications. Service users privacy and dignity was respected, ensuring that their rights were upheld. Service users were assured that their wishes were known and would be considered at the time of their death. EVIDENCE: Three care plans were sampled. These contained varied information on aspects of personal, social and health care needs. The plans included information on the staff action required to ensure assessed needs were met. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 11 The plans contained detail of health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Care plans seen had been reviewed each month. The quality of information in the care plans was not adequate. The manager was given examples of where information recorded in sections of the plans was not relevant or appropriate. The inspector believes that a full ‘pen picture’ of the service user cannot be established from reading the care plans. Service users and relatives spoken to said that they were assisted to access health professionals as needed and this was recorded in the care plans seen. Information about each individual service users wishes around death and dying were recorded in the files seen. A district nurse visiting on the day of the inspection was briefly spoken to. She said that the staff assisted her to carry out her role when she visited the home. She said she always found the service users well cared for and nicely dressed. The home had a policy and procedure regarding the safe receipt, recording, storage, handling, administration and disposal of medication. Senior staff administered medications when they had completed competency training. Medication and controlled drugs was checked for three service users and found to be recorded, administered and stored appropriately. Staff were observed respecting privacy by knocking on doors before entering. The interactions between staff and service users appeared respectful and caring. Service users spoken to said the staff were ‘very nice’ and ‘gave you help if you needed it’. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were able to make choices about daily living and social activities. Service users would benefit from a further programme of activities, which suited the capabilities and preferences of the service users. The home had an open visiting policy, which assisted in maintaining good relationships with service users family and friends. A varied diet was provided and sufficient drinks were offered, which promoted the service users well being. EVIDENCE: Service users said they were able to get up and go to bed when they chose, and were seen to walk freely around the home, if able. Two relatives spoken to said they were able to visit at any time and one relative said the staff always treated them courteously and were eager to help and give them advice. One relative spent each day with her mother, was given lunch and hospitality. Staff were seen to ask service users about their preferences regarding clothes, meals and bath times. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 13 Service users spoken to said that there were activities on offer at the home. An entertainer came once a month and there was an exercise class once a fortnight. Staff organised other activities when possible. All service users spoken to said they would like more activities to be available, above all they would like more activities and trips outside of the home. All service users spoken to said that they were satisfied with the food served. They said they were offered choice and variety and described the food as ‘good’, ‘alright’ and ‘plenty of it’. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 14 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes record of complaints was clear and accessible and evidenced that appropriate action was taken following any concerns raised. Staff had not been provided with essential training in adult protection procedures to ensure service users were safe, and to inform staff of the procedures to follow if an allegation was made. EVIDENCE: The homes complaints policy was on display in the entrance area of the home. It contained relevant information and informed the reader who to contact external to the home, should the complainant wish to do so. The homes record of complaints was organised, as a consequence information was easily obtained. The manager said that there were no outstanding complaints. Since the last inspection CSCI have not received any complaints about the service. Staff spoken to were aware of their responsibilities in reporting any complaints or allegations to the appropriate person. The homes adult protection policy included information on local procedures. Staff spoken to said that they would report any allegations of abuse to their senior manager. Staff, who were in a management role and were left in charge of the service in the manager’s absence, said they had not received any training in adult protection procedures, however they were able to describe types of abuse that service users could be susceptible to.
Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 15 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate facilities, aids and adaptations were provided to meet the service users needs and maximise their independence. Homely touches had been provided to create a comfortable environment. The environment within the home was not maintained to an adequate enough standard and was not free from offensive odours. EVIDENCE: The homes location was very impressive, with many rooms looking out over Chelsea Park and pleasant gardens. The home was in the main well maintained. Appropriate aids, hoists and adaptations were provided to meet the needs of the service users. All areas of the home were accessible to the service users. Homely touches had been provided to create a comfortable environment. In the main communal areas were well maintained, and service users bedrooms were personalised.
Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 16 The inspectors carried out a full environment check and found a number of areas within the home to be in need of decoration, cleaning and tidying. Observations of the environment were: • Skirting boards around the home were damaged and marked • The main kitchen was in need of a thorough clean and tidy up • The heated trolleys were in need of a thorough clean • The laundry was untidy and the floor had not been swept • Wall tiles in the laundry were missing and the paintwork was scuffed and marked • The carpet in the EMI lounge was stained and marked • The toilets in the EMI wing were odorous, the soap disperser was broken and they were in need of redecoration • The EMI corridor carpet was stained and marked • Two bedrooms were odorous • The first floor bathroom was untidy, spillages were on the floor and the hoist chair was in need of cleaning. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 17 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were employed in sufficient numbers to meet the service users needs. Recommended levels of NVQ trained staff had not been achieved and staff had not received all mandatory training, which did not ensure staff had the competencies to meet the service users needs. There remained a number of shortfalls in the details held and recorded in staff recruitment files, therefore not ensuring the protection of service users. EVIDENCE: The homes rota indicated that agreed levels of staff were being maintained to meet the needs of service users. In the main service users and relatives spoken with felt that enough staff were provided. One service user said that ‘at times they seem short of staff, which is a pity, as all the staff are very nice’. One relative said that staff that had been recently recruited were ‘much better quality’. Of the 22 care staff, 8 staff had achieved NVQ level 2 in care, a further 4 staff were undertaking the training. This falls below the recommended 50 of the care staff trained to NVQ level 2 in care by 2005 to ensure the staff team were qualified and competent to carry out their duties. Three staff records were checked. In the main the files contained the required information, CRB’s had been completed, Identities had been checked and
Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 18 photographs were included. However in all three files gaps in employment records had not been explored and explained. Staff spoken to said that they had received induction training when they began working at the home. Following induction further training undertaken by staff had been in medication, fire, moving and handling and first aid. Watching a video and completing a questionnaire facilitated the majority of this training. There still remained shortfalls in the mandatory training undertaken by the staff. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 19 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager’s leadership approach benefited service users and staff. The lack of service user, relative and staff meetings means that the home cannot be run in the best interests of the service users. Service users monies were safely handled, which ensured that finances were accurate and safeguarded. The health, safety and welfare of service users were in the main promoted. EVIDENCE: All of the service users, staff and relatives spoken with said the manager was approachable and supportive. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 20 Recorded quality assurance visits by the registered provider had recently commenced. A report was seen in the home for visits that were undertaken in March and April; these had not been forwarded to the CSCI. The manager said that there had not been any recent service user, staff or relative meetings. Staff spoken to said that they had received formal supervision from the manager, which they had found useful and informative. Three service users monies were checked. Receipts, records and money all tallied and all were kept securely. Up to date certificates for the gas and electrical appliances were seen at the home. Fire records confirmed that all fire appliances and systems had been checked as required and all staff had undertaken fire training at the required interval. Moving and handling equipment was provided at the home and all substances hazardous to health were securely stored. Environmental Health had recently visited the home and the manager said that all recommendations made by them had been actioned. Whilst undertaking a tour of the environment a fire extinguisher was seen propping a door open. The manager was asked to replace the extinguisher to its designated site and instruct the staff that it must not be moved and used in this way again. Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 22 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 456 Requirement There must be a Service User Guide/Statement of Purpose that includes all of the detail required in Regulation 4 and 5 of the Care Homes Regulations. The Service User Guide/Statement of Purpose must be kept updated and under review. Information within all care plans must be reviewed and updated to reflect each service users current health, personal and social needs. Service users must be consulted regarding the variety of activities offered. Further activities and trips out of the home must be provided. All staff must be trained adult protection procedures. All areas of the home must be well maintained and free from offensive odour therefore: The marked and scratched skirting boards must be redecorated. The main kitchen must be
DS0000046508.V294427.R01.S.doc Timescale for action 30/06/06 2. OP7 15 30/06/06 3. OP12 16 30/06/06 4. 5. OP18 OP19 OP26 18 16 23 01/09/06 01/09/06 Brincliffe Towers Version 5.1 Page 23 6. 7. OP28 OP29 18 19 thoroughly cleaned. The heated trolleys must be thoroughly cleaned. The laundry must be thoroughly cleaned. Wall tiles in the laundry must be replaced and paintwork must be repaired/redecorated. The carpet in the EMI lounge must be cleaned or replaced. The toilets in the EMI wing must be thoroughly cleaned. The soap disperser must be repaired or replaced. The EMI corridor carpet must be cleaned or replaced. The bathroom must be thoroughly cleaned and tidied up. The cause of offensive odours must be established and appropriate action taken. There must be 50 of the care staff trained to NVQ Level 2 or equivalent. A thorough recruitment procedure must be in operation, therefore: All gaps in employment history must be explored. An audit of staff mandatory training must be carried out. Where gaps are identified, training must be provided. Staff training records must be maintained up to date. (Previous timescale of 31/01/06 not met) Staff, service user and relatives meetings must be held. Minutes from these meetings must be recorded in writing. Fire extinguishers must not be moved from their designated positions. Timescale agreed on the day of the inspection.
DS0000046508.V294427.R01.S.doc 31/12/06 30/06/06 8. OP30 18 30/06/06 9. OP33 26 30/06/06 10. OP38 13 12/05/06 Brincliffe Towers Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brincliffe Towers DS0000046508.V294427.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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