Random inspection report
Care homes for older people
Name: Address: Brindley Court Nursing and Residential Home Station Street Longport Stoke-on-trent Staffordshire ST6 4ND two star good service 06/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Yvonne Allen Date: 0 4 0 5 2 0 1 0 Information about the care home
Name of care home: Address: Brindley Court Nursing and Residential Home Station Street Longport Stoke-on-trent Staffordshire ST6 4ND 01782828428 01782828429 brindley.court@ashbourne.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Yvonne Jacqueline Hof Type of registration: Number of places registered: Conditions of registration: Category(ies) : Modelfuture Limited care home 52 Number of places (if applicable): Under 65 Over 65 52 0 old age, not falling within any other category physical disability Conditions of registration: 0 52 The maximum number of service users who can be accommodated is: 52 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 52 Physical disability (PD) 52 Date of last inspection 0 9 0 3 2 0 1 0 Care Homes for Older People Page 2 of 13 Brief description of the care home Brindley Court Care Centre provides personal and nursing care for up to fifty-two male and female persons. The home provides accommodation for mainly older people but can accommodate up to thirteen people, aged between 35 and 60 years on admission who have a physical disability. The home is a two-storey purpose built brick building. It has fifty-two single bedrooms and each of them has an en-suite comprising of a toilet and wash hand basin. The home has lounges and dining facilities on each floor. A passenger lift that is accessible to people allows easy access around the home. There are appropriately adapted bathing facilities to each floor. There is a central kitchen and laundry. Externally, the home has pleasant secure gardens for service users to enjoy and there is ample parking space. The home is situated close to the A500 and is within easy access of local shops, bus service, a train station and road networks. The fees charged by the home at the time of the inspection visit ranged from 360.00 to 540.00 pounds. Care Homes for Older People Page 3 of 13 What we found:
This Unannounced Random Inspection was carried out by two inspectors - Yvonne Allen and Peter Dawson. We visited the service on Friday 30th April and Tuesday 4th May 2010. These visits were carried out as a result of concerns raised during the professionals meeting which was held as part of the on going Large Scale Investigation run by Stoke On Trent Social Services. When we arrived at the service on 30th April we were met by the Registered Manager Yvonne Hof. We were informed that there were 47 people living in the home and that 22 of these were requiring personal care and 26 nursing care. There were two nurses on duty and five care staff until 7.30pm which is the time when night staff arrive. One of these care assistants was from a Care Agency. We were informed that the mealtime assistant was not working at the moment due to illness but that extra care staff had been booked to work over the weekend to account for this. The staff duty record for the weekend ahead reflected this. We met with some of the staff on duty including the deputy manager. The registered manager Yvonne Hof informed us that she was on call all weekend. She told us that she feels supported and that the Company Quality Manager has been visiting the home up to three times per week assisting with improvements. During this first visit we met with two of the people who live in the home about whom Social Workers had raised concerns. One of these people was receiving enteral feeds via a PEG. We looked at the process for this and found that the feed regime was being adhered to and appropriate records were being maintained. The person told us that he is satisfied with the care he receives in the home. This person was nursed in bed on an alternating pressure mattress which was correctly in use at the time of the visit. When we returned on the 4th May we went back to the gentleman and he appeared somewhat chesty and looked unwell. He told us that he felt a little uncomfortable. We highlighted to the nurse on duty on the unit who told us that this person was often like this especially if he had slipped low in the bed. This persons care plan told us that the person was prone to getting chest infections. The doctor was present at the time of the inspection visiting other people in the home. We also noted that an item (plastic syringe) had been left on the bedside locker opened and used and re-covered ready to be used again. This was a single use item and, in order to prevent cross infection, should not be re-used. Prior to our inspection the infection control nurse specialist had visited the service and had raised the re-use of single use items as a concern. We also identified that the gentleman was unable to have a bath as the Parker bath was broken. The person had been assessed by the Occupational Therapist as requiring a full body sling for transfers into the bath and the service were awaiting delivery of this. Meanwhile the gentleman was having a daily bed bath. The nurse in charge told us that staff encouraged the gentleman to sit out of bed every day but that he refuses to do this. This is documented in his plan of care. Care Homes for Older People Page 4 of 13 During our first visit to the service on 30th April we also met with another person who lives in the home. This lady requires at least two liters of fluid intake per day in order to maintain her health. The lady was able to tell us that she received plenty of drinks and there were drinks placed within her reach. However the recording of fluid intake was poor in that there was no fluid intake record for this lady since 26th April 2010. Therefore there was no record to evidence that this person had received two liters of fluid daily. We left an immediate requirement for the service to improve its record of fluid intake for this person in order to meet her health care needs. We also looked at fluid intake records for other people who live in the home and found that these were usually only completed up until about 4pm each day. We left a requirement for the service to improve its record keeping in order to ensure that people who live in the home receive adequate hydration. When we returned on 4th April the service had met with our immediate requirement and improved its record keeping in respect of fluid intake, both for the person identified above and for other people. During this second visit to the service we informed that there were 42 people currently living in the home. Staff numbers were adequate with two nurses on duty plus the manager and regional manager and seven care staff. The activities coordinator was also on duty together with an administrator, kitchen staff, a team of domestics and a maintenance person. During our visit on 4th April we met with a lady who lives in the home and her relatives who were visiting her at the time. The lady appeared very frail and underweight. She was being transported from her bedroom to the dining room in a wheeled easy chair by her family in order to have lunch. The family told us that they had had some concerns over the past weeks about her weight and had raised this with her Social Worker. They also pointed out the poor condition of the chair in which the lady was sat - the top of the chair was ripped and they had had to place a throw over this to cover it up. They also said that the arms on the chair were too hard and rigid for their relative. They told us that the lady had very fragile skin and bruised easily. We noted a large bruise in the middle of this ladys chest area. The family said that they were not unduly concerned about this and are confident that this bruise has occurred due to the position in which their relative sleeps with her hand over this area. We noted that the lady also had bruising over her arms. The nurse on the unit informed us that the doctor had seen the lady in respect of the bruises and that he was satisfied that the general bruising was due to the medication therapy that this lady was receiving. This information had been presented to Social Services by the home as a Safeguarding referral. We looked at this persons record of nutritional assessment, food intake and weight. We found that the lady is prescribed food supplements and there are records (on the food intake chart) to evidence that she is offered them regularly as well as having a small diet. There had been an assessment of this persons weight on March 3rd 2010 where this lady was weighed as 37.1kgs. The care plan instructions were to weigh this lady weekly and to ensure that the various meal supplements for which she is prescribed are offered regularly. There were no records to indicate that this persons weight had been monitored
Care Homes for Older People Page 5 of 13 weekly. In April this persons weight had dropped to 35.1kgs with the same reading for this week (4th May 2010). We were informed by staff members that the sit on scales have been broken for some time and that the service has now borrowed some from one of their other homes. Medical attention had not been sought for this lady in respect of nutritional needs despite her having lost 2 kgs in 1 month. There were records that dietary supplements had been given albeit these were scanty in relation to food intake charts. This ladys family did say that it is very difficult to get her to eat anything much as she refuses it. We have made a requirement in this report in respect of the above for the provider to monitor peoples weight where indicated and to promote and make proper provision for the health and welfare of people who live at the home. We looked at the system for the receipt, storage, administration and disposal of medication in the home. We observed lunchtime medication being administered. We were informed that people are able to self medicate if they wish to and that one person was doing this on the ground floor unit. There was a suitable risk assessment in place for this. We noted that for one person the care plan in place for prescribed emergency medication had not been reviewed since 2007. This was in respect of Buccal Midazolam. Prior to this visit we had received concerns about people sustaining falls in the home. There have been a number of safeguarding referrals received in respect of this for the service and it has been identified that people are not always supervised. We walked around the home and noted that people who were sitting in communal areas were being monitored by staff members from time to time. We were concerned, however that some people who are at risk of falls are still not being supervised efficiently. We discussed our concerns with the Regional Manager including the need to review the provision and deployment of staff across the home. The manager told us that she is addressing this as part of her action plan for the service, with on going monitoring. We walked around the home and looked in all of the communal areas and a selection of bedrooms. There are many areas in need of repainting, carpeting and refurbishing. There was also a mal- odour present in some of the areas. There is a bathroom which is currently out of order on the ground floor. This is in need of a total refurbishment. We spoke with the housekeeper who told us that there is usually three domestic staff on duty and one person in the laundry every day until 2.30pm. She said that there are discussions in place in relation to increasing the domestic hours. One of the concerns identified by Social Services was that, on occasions, alternating pressure mattresses had been allowed to deflate and go flat whilst people were being nursed on them. During the course of the two inspection visits we checked mattresses and identified that these were inflated and working correctly. However, during our discussions with staff members it was identified that, on the previous day, a person was put on to a flat mattress. This was as a direct result of staff not waiting until the mattress reached the correct inflation. We discussed this with the regional manager at the end of our visit. During the course of the inspection visit on 4th May several staff members approached us with their concerns about the management of the home. Staff members told us that they had raised several concerns about poor practice with the manager but that she had not addressed these concerns. Meanwhile, during the course of the visit, the Regional
Care Homes for Older People Page 6 of 13 Manager held a staff meeting where staff were invited to come and speak with her about any concerns they had. During the course of the inspection visit the registered manager Yvonne Hof left due to feeling unwell. The Regional Manager Alison Bentley assured us that there will be plenty of management support in place at the service and that she herself will be providing this for the time being. She also told us that a relief manager will be assigned to the home in the interim. As a result of many concerns raised by staff who work at the home in relation to the management of the service, we have left a requirement that the overall management review of the service which has commenced, must continue in order to ensure that people are safe and that their needs are met. What the care home does well: What they could do better:
There has been inefficient management of this service and a failure to meet some of the needs of people who live in the home. Some of the staff who work at the home have raised concerns with management about care issues including poor practice. These concerns have not been listened to, nor has action been taken to address them. There has also been a lack of action taken to address concerns raised by Safeguarding investigations. There has also been a failure to monitor and meet the nutritional needs of an elderly frail lady who lives in the home. The service also failed to keep appropriate records of fluid intake for a lady with specific hydration needs. This placed this lady at risk of dehydration. Other people who live at the home and who are assessed by the service as requiring monitoring of their fluid intake have not had this monitored efficiently. Thus also placing them at risk of becoming dehydrated. There has been a failure to keep people safe particularly people who are at risk of falls. The service has not provided adequate supervision of people and this has resulted in people sustaining falls and Safeguarding referrals being received. This will need to improve in order to keep people safe. The service will also need to ensure that people are not placed on deflated alternating pressure mattresses as this will place people at risk of developing pressure damage. The service will need to improve the presentation of the home including redecoration and refurbishment of many areas. Care Homes for Older People Page 7 of 13 The service will also need to review and improve the number of hours dedicated to housekeeping and cleaning of the home. The service will also need to address the recommendations made by the Primary Care Trust in relation to infection control. The above actions will help to ensure that people live in a clean safe and comfortable environment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 12 12(1)(a)The registered 14/05/2010 person must promote and make proper provision for the health and welfare of people who live in the home. The service will need to ensure that people are not placed on deflated alternating pressure mattresses as this will place people at risk of developing pressure damage. 2 8 12 12(1)(a) The registered 14/05/2010 person must promote and make proper provision for the health and welfare of people who live in the home. People who are at risk of malnutrition must have their weight monitored according to their plan of care and must be referred for medical attention where indicated. 3 8 12 12(1)(a) The registered person must continue to promote and make proper provision for the health and 14/05/2010 Care Homes for Older People Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action welfare of people who live in the home. Records of fluid intake must accurately reflect the fluid intake for that person throughout a 24 hour period. 4 31 24 24(1)(a)(b) The registered provider shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home including the quality of nursing care. The overall management review of the service which has commenced, must continue in order to ensure that people are kept safe and that their needs are met. 5 38 13 13 (4)(c) The registered person shall ensure that unnecessarry risks to the health or safety of people who live in the home are identified and so far as is possible eliminated. People who are at risk of falls must be monitored and kept safe. 14/05/2010 14/05/2010 Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 9 The service should regularly review arrangements and care plans in respect of emergency medication. This will help to ensure that medication is administered safely to people. The service will need to improve the presentation of the home including redecoration and refurbishment of many areas. This will help to improve the environment in which people live. The service will also need to address the recommendations made by the Primary Care Trust in relation to infection control. This will help to ensure that people who live in the home are kept safe. The service will also need to review and improve the number of hours dedicated to housekeeping and cleaning of the home. This will help to keep the home clean and free from offensive odours. 2 19 3 26 4 26 Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
