CARE HOME ADULTS 18-65
Bromhall Road 110 Bromhall Road Dagenham Essex RM9 4PH Lead Inspector
Rhona Crosse Unannounced Inspection 09 September 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Bromhall Road Address 110 Bromhall Road, Dagenham, Essex, RM9 4PH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 308 2900 0208 308 2999 The Avenues Trust Limited CRH Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number PD Physical Disability (8) of places SI Sensory Impairment (8) Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: There are no conditions of registration. Date of last inspection 15 March 2005 Brief Description of the Service: Bromhall Road is situated in a residential area of Dagenham. Bromhall Road is a residential care home offering 24 hour care for 8 service users. Any nursing needs are met by input from Community Nursing staff who visit the home as required. Bromhall Road (numbers 110 and 112) are 2 purpose built bungalows connected by an internal corridor. Each bungalow has accommodation on ground floor level for 4 service users. All accommodation is in single occupancy rooms with an adjoining en-suite. There is ample parking space within the grounds. Staffing levels are set for each bungalow. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection to Bromhall Road was an unannounced inspection to the home therefore none of the staff knew the inspector was coming. The inspection commenced at 9.30 am. The manager was not at the home as she was on leave. Two senior support workers (one from each unit) assisted with the inspection. Two service users left the building to go to day centres. The home was appropriately staffed at the time of the inspection. A nurse from the Community Learning Disability Team was visiting a service user and asked the inspector to send a questionnaire to the team for completion. An inspection of care plans, risk assessments, medication records, daily records, records of meals taken and financial records were inspected. The premises were inspected. Staff could not show that the current Statement of Purpose and the Service Users Guide has been changed in line with requirements made at the last inspection in March 2005. The home was clean and tidy with no unpleasant odours. Storage space within the home is poor with wheelchairs being stored in the bathroom of one bungalow. A delivery of incontinence pads was also stored in this bathroom. The grounds were inspected, these were poorly maintained. Staff stated that they carry out the gardening. It is unacceptable for staff to have to undertake major garden work. The borders are full of weeds and the grass is in need of cutting. Avenues Trust must provide a gardener to maintain the grounds to a reasonable level. Staff time should not be taken away from the care of service users to carryout gardening tasks. The home was visited by the local Fire Safety Officer and requirements were made from this visit. One requirement was that a fire drill must take place by 31/8/05. This has not been achieved. This is poor management. What the service does well:
Risk assessments have been completed as required at the last inspection in relation to privacy as service users are unable to use the locks on their bedroom doors to ensure their privacy. For one service users a record of epileptic seizures is completed after each seizure. This is seen as good practice. A record such as this can be used to establish if the medication prescribed requires adjustment. Service users were asked if the inspector could look at their rooms. No objections were raised.
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 6 Although the home could not evidence daily the activities that are being undertaken, from recordings on the staff rota it was established when some outings took place. Service users were well groomed and staff interacted well with them during the inspection. Bedrooms are being personalised with staff assisting the service users. The home was appropriately staffed when the inspector arrived to carry out the unannounced inspection. Staff were busy carrying out their duties. The home was free from odours despite the continence needs that have to be dealt with on a daily basis. What has improved since the last inspection? What they could do better:
A great deal of work is required to bring this home up to the National Minimum Standards and Care Homes Regulations in relation to records evidencing the care the home is providing. It was a requirement at the last inspection (March 2005) that care plans must be provided for each service user and these must be updated as changes occurred. This had not been achieved. The date for compliance with this requirement was 30/6/05. It was stated by both senior support workers that the area manager was working on care plans for the service users.
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 7 It is a requirement that each service user has a care plan completed by the home once they are admitted. It is exceptionally poor practice that the home have not provided service users with care plans. Each service user must have a care plan written for all their needs, such as mobility, stoma care, epilepsy, personal hygiene, elimination, sleep, dietary needs, swollen legs, ankles and feet and so on. A care plan must also be written for any challenging behaviour along with intervention that staff should take, this should be specific to the service user. Care plans must have long and short term goals including any skill teaching and skill maintenance that is being carried out as part of the care planning process to enable service user to improve their skills and reach their potential. A very short timescale will be given for this to be achieved for all service uses. If this is not achieved by the new timescale set formal action will be taken against the home. Daily records are poor and do not reflect the way a service users spend their time, these were more of a record of personal care. The format should be changed. Some records were not dated and some had no name to identify who the service user was. This must be addressed with information fully recorded. From the daily records inspected there is mention of one service user having swollen feet. This is recorded on two separate occasions. No action is recorded as to how staff dealt with this or if the service user was referred to the GP. This is of concern as the service user in question has had a blood clot in the leg that required hospital treatment in the recent past. Meal choices were inspected. Repetition of ‘chicken’ on two consecutive days was observed this is poor practice. Staff who cook the meals must take into consideration the main meal that was provided the day before and not repeat this on the next day (albeit in a different form, roast chicken and chicken casserole). For one service user who has been assessed by the speech and language therapist as requiring a ‘soft’ diet, records showed that this person was provided with Pizza and chips for one main meal, another meal recorded a chicken pie and a steak pie. Roast potatoes are also recorded all of these foods are not classed as ‘soft’ diet options. These are inappropriate foods for this service user to be provided with. This places the service user at risk of choking and aspiration. The home is failing to take appropriate care of a vulnerable service user. The staff must ensure that they follow the written guide lines for meal choices provided by health professionals to ensure the health and well being of the service user identified. At lunch time on the day of the unannounced inspection the service user had an appropriate soft meal provided. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 8 Other food records had missing entries where the home could not evidence what meals had been provided. Medication was observed to have been dispensed from the monitored dosage system into an unnamed pot and left on the kitchen work surface. This is poor practice, this was pointed out to the staff member responsible and also the senior support worker who was assisting with the inspection. Medication should be taken from the monitored dosage system and given directly to the service user. There is no record of how service users spend their leisure time. This must be addressed with a daily record completed. A toilet seat in an en-suite room of a service user has been broken for some time (2 weeks) this was reported to Kelsy Housing who carryout the maintenance work on the property. A date of 30/9/05 has been given by Kelsy Housing for this work to be dealt with (a further 21 days). This is an inappropriate length of time for a service user to be unable to use the toilet in the en-suite. Avenues Trust must chase this work up and seek a more realistic timescale for maintenance work to be completed where it is relevant to the comfort and dignity of the service user. Service users finances were inspected. It was of concern that two were incorrect and that money spent on their behalf was not recorded receipt by receipt. One day’s expenditure of several items were added together and deducted as one amount spent. Each receipt must identify what has been bought and must be recorded and the amount deducted separately. It was a requirement at the last inspection that the Statement of Purpose be updated to hold the required information as per the Care Homes Regulations no changes appeared to have been made from the format the staff showed the inspector. The Service Users Guide was also to be put into formats suitable for the people for whom the home is intended this does not appear to have been carried out. This must be addressed. Due to the concerns outlined in this report, Avenues Trust must take urgent and robust action to address these matters, particularly as there are major areas of risk identified to service users. Failure to take suitable action will result in the Commission considering taking legal action. 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. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 Standard 1 was not met as the requirements of the last inspection in March 2005 had not been complied with in relation to updating the Statement of Purpose to include all the information required by legislation and the Service Users Guide is not in a format suitable for the service users the home is intending to care for. Standard 2 was well managed with information readily available. EVIDENCE: Due to requirements relating to the Statement of Purpose and the Service User Guide not being addressed this standard cannot be met. This must be addressed within the new timescale given. A written pre admission assessment is carried out prior to admission for all service users. Information from placing authorities was also observed to be held on each service users file. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 were inspected. Standards 6 and 7 are poorly managed with no current care plans being in existence. Without appropriate care plans it is not possible to monitor whether service users needs are being met in line with the care plan and records of their preferred choices. The home must improve the paperwork to evidence the care they are providing and bring the home in line with the National Minimum Standards and the Care Homes Regulations. EVIDENCE: It was a requirement at the last inspection (March 2005) that care plans must be provided for each service user and these must be updated as changes occurred. This had not been achieved. The date for compliance with this requirement was 30/6/05. It was stated by both senior support workers that the area manager was working on care plans for the service users. It is a requirement that each service user has a care plan completed by the home once they are admitted. It is exceptionally poor practice that the home have not provided service users with care plans.
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 12 Each service user must have a care plan written for all their needs, such as mobility, stoma care, epilepsy, personal hygiene, elimination, sleep, dietary needs, swollen legs, ankles and feet and so on. Care plans must have long and short term goals including any skill teaching and skill maintenance that is being carried out as part of the care planning process to enable service user to improve their skills and reach their potential. Guide lines and old care plans were found on files. A very short timescale will be given for this to be achieved for all service uses. If this is not achieved by the new timescale set formal action will be taken against the home. Risk assessment were in place and some work had been undertaken since the last inspection in relation to service users being unable to lock their doors to enable privacy. However further risk assessments will have to be completed in line with care plans once these are written. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15 could not be appropraitely assessed as no care plans are completed for service users. Standard 17 was assessed. These areas are poorly managed with little information held on standard 12 and 15. Although in discussion staff stated that activities take place there was little supporting evidence. Standard 17 meals and a healthy diet raised concern in relation to repetitions of main meals and a service user being put at risk of choking and aspiration due to inappropriate food being provided. Photocopies were taken of the inappropriate meals recorded by the inspector. These concerns will be passed to the appropriate agencies. EVIDENCE: Staff stated that service users use the local community for health care needs and visit shops and local restaurants. There are no daily records of how service users spend their leisure time. This must be addressed. Care plans must record the leisure activities service user wish to take part in. Daily records should show how the service user has spent
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 14 their time. Staff spoken with said that service users go out daily to local shops or to Romford and Lakeside but as these are not recorded anywhere. From staff rotas it was evidenced that trips outside the home are taking place, these trips were recorded on the staff rota. The records showed that on the 18/7/05 three service users went on a day trip to Clacton. On the 19/7/05 a trip to Hainault forest was arranged. One the 21/7/05 a day trip to Dedham village (Constable country) took place. A trip to Colchester zoo took place on the 27/7/05. On the 31/7/05 a trip to Southend also took place. Two further trips are booked for September 18/9/05 and 25/9/05 these are to be a day out and a trip on a canal boat. Meal choices were inspected. Repetition of ‘chicken’ on two consecutive days was observed this is poor practice. Staff who cook the meals must take into consideration the main meal that was provided the day before and not repeat this on the next day (all be it in a different form, roast chicken and then chicken casserole on the next day). For one service user who has been assessed by the speech and language therapist as requiring a ‘soft’ diet, records showed that this person was provided with Pizza and chips for one main meal, another meals recorded as eaten are a chicken pie and a steak pie. Roast potatoes are also recorded. All of these foods are not classed as ‘soft’ diet options. These are inappropriate foods for this service user to be provided with. This places the service user at risk of choking and aspiration. The home is failing to take appropriate care of a vulnerable service user. The staff must ensure that they follow the written guidelines for meal choices provided by health professionals to ensure the health and well being of the service user identified. Other food records had missing entries where the home could not evidence what meals had been provided. This is poor practice Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 and 21. Whilst the medication documentation and storage were appropriate, medication administration was of concern as medication had been put into an unnamed pot and left on the kitchen worktop. EVIDENCE: There was a lack of care plans to evidence the personal care and support that service users would wish. However there is only one male carer (all other carers are female) and the home accommodates all male service users. Therefore any male requiring their personal care to be carried out by another male by preference would not always have this achieved. As there are no care plans relating to the choice of gender care it could not be established if this standard was being met, other than the service users appeared to react well to the female staff on the day of the inspection. Service users physical needs are not being met due to information not being acted upon by staff. This is in relation to specific written guide lines not being followed for a service user who has to have a ‘soft’ diet. For another service user there were two different dates were records were made relating to swollen feet. No other entries showed what action, if any,
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 16 staff were taking to reduce the swelling or referral to a GP or other health professional. It was observed by the inspector that the service user had had past problems with blood clots forming in the legs and had been admitted to hospital -this is of concern. Another record stated an injury had occurred to a service user’s left thumb affecting the nail. After this entry was made in the daily records no further entry was recorded about this. No action is recorded as taking place and no referral to a health professional was recorded as being made. This lack of any recorded action taken by staff in these two instances places the home in a position where it cannot evidence the care that was provided. This is poor practice. Information required to be recorded about the service users wishes at the time of death was not completed for all service users this must be addressed. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23. Standard 22 will be inspected at further inspections. Standard 23 (money held in safekeeping) was not appropriately managed. Service users records were incorrect for two service users, greater care needs to be taken by staff when they record and add up purchases made for service users. EVIDENCE: A random selection of service users money held in safe keeping was made. Since the last inspection the home have introduced a system of using a sealed bag to hold each service user’s money individually. The system is called and ‘Evopak’ system and a numbered seal is used to seal the bag. The bag cannot then be opened without the seal being broken. This is seen as good practice. On opening the bags and looking at the amount recorded as the total it was observed that one service user had £2.00 over the amount recorded and another service user had 1 pence over the amount recorded. This is poor practice all amounts must be accurate at all times. Receipts held for expenditure did not always show what was purchased. For one service user who had several items purchased on the same day, the amount of all the receipts were added up and deducted as one item. This is poor practice. Each receipt should be recorded identifying the items bought on the expenditure sheet and the amount paid individually. For two service users, gift tokens were held in the ‘Evopak’ bags. However no entry was made in the record of money held. Although a gift token is not money it can be exchanged as such and should therefore be recorded as: ‘Boots gift token 20 Euros’ and ‘gift voucher £5.00’ this need only be entered
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 18 once and checked when the other entries are checked and signed as being correct. When these vouchers are used to purchase items this must be recorded as such and the items bought recorded and the receipt kept the same as any other purchase. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 and 30 were inspected. The bungalows were homely and in the main well maintained. There has been along wait for a toilet seat in an en-suite of bungalow 110 to be replaced (although reported by the home) has not been addressed. It has a completion date of 30/9/05 given to the home by Kelsy Housing. This is an unacceptable time to wait for the replacement of a broken toilet seat. Avenues Trust must therefore negotiate quicker timescales for repair of fixtures and fittings with Kelsy Housing. EVIDENCE: The home was clean and free from odours. The home has spacious corridors and bedrooms but little space for storage of wheelchairs when not in use and other bulky items. The home must look at ways of finding storage space for wheelchairs and incontinence pads as these were found stored in the bathroom of 112 which is poor infection control. The sofa and chairs in 112 has loose covers. One of the chairs had stains on the cover these need to be washed or spot cleaned to remove the stains. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 20 The lounges were well furnished, however no foot stools were observed for service users to use. The carpet in the lounge of bungalow 110 had stains on it. The carpet requires deep cleaning to remove these black marks. Also in 110 a bed was poorly made. When the inspector checked the linen on the bed it was observed that the duvet cover bottom sheet and pillow case was stained. All beds must be appropriately made with clean bedding free from stains. On the en-suite rooms it was observed that a star lock (a * star shaped key is used to activate these locks) and can be used to lock this room from the outside. This lock should be removed as a service user could be locked into the en-suite by this method. There is no need for a lock of this type to feature on any room. A bath mat in an en-suite in 110 was dirty and stained with mould this needs to be disposed of and replaced with a clean non slip mat. In the en-suite of a bedroom in 112 a cream used for topical use was touching a mouth wash product. Items used for topical use should be kept separately from items for oral use. The soap dispenser in this en-suite was empty this must e addressed to ensure staff are able to wash their hands after any personal care is provided. Labels on the outside of bedroom furniture was observed with the items enclosed identified. These labels are not used for service users in any skill teaching programme, therefore they must be removed as this is institutional practice. Kitchens in both 110 and 112 were clean and equipment was said to be working appropriately. Food in fridges and freezers was appropriately covered and labelled. A crack in a worktop had been reported to Kelsy Housing (the maintenance company) for repair. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 21 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected at this inspection they will be inspected at further inspections. EVIDENCE: The manager was not at the home at the time of the inspection therefore these standards will be inspected at further inspections. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 and 42 The home is not well managed. This is reflected in the lack of care plans and the lack of attention to what is written in the sparse daily records that affects the health and wellbeing of service users as stated in the body of the report. Standard 42 is not well managed. After a visit by the fire officer no action was taken by the manager to hold a fire drill as stated must be achieved by the fire officer. EVIDENCE: The homes insurance certificate is current the date for renewal is 31/3/06. The home is not well managed as paperwork (care plans) that should have been in place after service users moved into the home have not been drawn up. Senior staff stated that although staff had had some training in the completion of care plans they were not understanding what was to be achieved. Hence the area manager was to complete the care plans for all service users.
Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 23 The management skills of the manager are therefore called into question. The manager should be able to encourage staff to achieve the basic skills to enable them to care for service users appropriately. This also raises concerns about the capabilities of the staff currently employed. Avenues Trust must ensure that the manager and staff employed are fit for the roles they are employed to undertake. The home must be run in the best interests of the service users. This means that documents required by the Care Homes Regulations and the Regulations themselves have to be abided by to ensure the protection of vulnerable adults. A visit was made by the local Fire Officer and several requirements were made from this visit. The Fire officer stated that the Fire Authority would take enforcement action if a fire drill was not completed by 31/8/05. Records held by the home were inspected. These records showed that no record of a drill was made and staff said that no fire drill had taken place. Senior staff were made aware of this and the inspector stressed the need for a drill to take place as soon as possible. Written confirmation was asked that this had taken place to be faxed to the Commission. The home should carryout a minimum of 4 fire drills per year. Fire extinguishers had received their annual check in July 2005. Fire call points are being tested weekly and recorded. An entry made in the daily records about an injury to a left thumb of a service user had no corresponding accident report this is poor practice. Other accident records were appropriately completed. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 x x x Standard No 22 23
ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 1 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 2 3 2 2 3 3 Standard No 11 12 13 14 15 16 17 1 1 x x x x 1 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Bromhall Road Score 2 1 2 2 Standard No 37 38 39 40 41 42 43 Score x 1 x x x 1 x G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement The Statement of Purpose must be updated to hold all the information required by legislation. This was a requirement that has not been achieved from the last inspection. The date for compliance was 30/4/05 The Service Users Guide must be in a format suitable for the people it is intending to provide care for. This is a requirement that has not been achieved from the last insepction. The date for compliance was 30/6/05. Care plans must be completed for all service users. These care plans must be written for all the needs of the service users.This is a requirement that has not been complied with from the last inspection. The date for compliance was 30/6/05 . Any further failure to comply with this requirement within the timescale will recult in formal action being taken. New risk assessments will have to be completed when care plans are written up for any risks identified, including behavioural Timescale for action 30/11/05 2. YA1 5 30/12/05 3. YA6 15(1) & (2) 30/10/05 4. YA9 14(2)(b) 30/10/05 Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 26 risks. 5. YA11 15(1) & 14(2)(b) Service users must have opportunities for personal development. Long and short term goals should be set for skills teaching and skills maintenance. A programme of activities must be provided and a record kept of these. A record of meal choices must be kept for each service user at each meal. 30/11/05 6. 7. YA12 YA17 16(2)(n) 17(2) schedule 4 13 12(1)(b) 30/11/05 8. YA17 9. YA19 13(1)(b) 10. YA20 13(2) 11. 12. YA21 YA23 15(1) 17(2) schedule 49 23(2)(o) 13. YA24 24/9/05 and ongoing action. A soft diet must be provided for 9/9/05 and one service user who is at risk of ongoing choking and aspiration. Failure to action. do this places this vulnerable service user at risk.Meals provided and feeding regimes must be in accordance with the advice provided by the speech and language therapist. Health care needs of service 9/9/05 and users must be acted upon. This ongoing includes advice from health care action. professionals. (Entries in daily records made about health concerns were not acted upon) Medication must be administered 9/9/05 and from the monitored dosage ongoing system to the service user. action. Medication was decanted into an unnamed pot and left on the kitchen worktop. Information about the wishes of 30/10/05 the service user at the time of death should be recorded. Money held in safekeeping and 15/9/05 used on behalf of service users and must be correct at all times. ongoing. Vouchers must also be recorded in the record of money held. The grounds must be 30/11/05 appropraitely maintained. This should not be part of the care staffs work.
Version 1.40 Page 27 Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc 14. 15. 16. YA24 YA24 YA24 23(2)(d) 23(2)(d) 16(2) 17. YA24 23(2)(l) 18. 19. YA25 YA27 16(2) 23(2)(c) 20. 21. 22. 23. YA27 YA27 YA30 YA38 23(2)(c) 13(3) 13(3) 17(1)(a)( k) The lounge carpet in 110 must be cleaned to remove staining. The sofa covers require washing in 112. Provide a foot stool for the service user who is experiencing swollen feet so as to elevate the legs. Provide adequate storage for wheelchairs and incontinence pads (both stored in a bathroom). Ensure that all bedding is fit for use and is free from stains at all times. Provide a replacement toilet seat to the en-suite. Avenues Trust must negotiate better timescales for repairs with Kelsy Housing. Replace the dirty stained shower mat as identified. Ensure there is soap in the soap dispenser in the en-suite at all times. Keep topical creams and oral mouth wash stored seperately. Ensure that records are kept in line with Care Homes Regulations and that the home can evidence the care provided at all times. A fire drill must take place for all staff employed (minimum of 4 drills per year should be undertaken). All accidents should be recorded (injury to left thumb) 30/11/05 30/10/05 30/10/05 30/12/05 24/9/05 and ongoing. 24/9/05 24/9/05 24/9/05 and ongoing. 16/9/05 and ongoing. 30/10/05 24. YA42 23(4)(e) 30/9/05 25. YA42 17(1)(sa) schedule 3 (j) 24/9/05 and ongoing. 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 Good Practice Recommendations
G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 28 Bromhall Road Standard 1. Bromhall Road G55_S0000060787_Bromhall Rd_V248255_090905_Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex, IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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