Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Browfield Residential Care Home 159/161 Walmersley Road Walmersley Bury Lancs BL9 5DE The quality rating for this care home is:
two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lucy Burgess
Date: 0 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home
Name of care home: Address: Browfield Residential Care Home 159/161 Walmersley Road Walmersley Bury Lancs BL9 5DE 01617978457 F/P01617978457 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Elizabeth Motby Type of registration: Number of places registered: Mrs Jacinta Rosaleen Ormerod care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: That the home is registered to a maximum of 14 service users to include: Up to 10 service users in the category MD (Mental Disorder excluding learning disability or dementia under 65 years of age). Up to 4 named service users in the category MD (E) (Mental Disorder excluding learning disability or dementia over 65 years of age). The service should employs a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Browfield is a residential care home providing accommodation and support for up to fourteen people who are recovering from a mental illness. Fees range from 365.89 to 552.03 pounds per wekk. This is dependant on assessed needs. The home is registered to provided support for up to 4 people over the age of 65 years. The property comprises of two large terrace houses, which are adjoining. Accommodation is Care Homes for Adults (18-65 years)
Page 4 of 28 Over 65 4 10 Brief description of the care home provided on three levels and includes 10 single bedrooms and 2 double rooms. There are 3 lounges and a dining room. The home is situated on a main road approximately 1 mile from Bury town centre and is easily accessible for public transport. Local shops, pubs and other amenities are situated nearby. Care Homes for Adults (18-65 years) Page 5 of 28 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: We last inspected the home on the 22nd November 2006. This was a key inspection, which included a site visit and took place over one day, for a period of 5 hours. The service did not know that the inspector was going to visit. During the inspection care and medication records were looked at as well as information about the staff and health and safety including how the home and the equipment were kept safe. The inspector also looked around the building. As part of the inspection process the providers are asked to complete a selfassessment survey information document (Annual Quality Assurance Assessment). This Care Homes for Adults (18-65 years)
Page 6 of 28 was sent to the home before the inspection and had been completed by the manager and returned to us prior to the site visit. Other information was gathered from the feedback surveys we sent out. We received completed surveys from 6 members of staff and 5 people who live at the home. Comments have been added to the report. Discussion and feedback was held with the manager. What the care home does well: What has improved since the last inspection? What they could do better: 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Care Homes for Adults (18-65 years) Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Relevant information about the assessed needs of people is gathered prior to admission making sure that the placement is suitable and their needs can be met. Evidence: The home remains fully occupied. Due to this we were unable to review this area as no new placements have been made at the home since November 2006. Information for that person was looked during our last visit and found to meet the standard. The manager is clear about her responsibilties in this area. Arrangements are made for relevant assessment information to be provided from health and social care workers involved. Additional information being recorded during visits and over night stays. This provide further opportunity for prospective residents, staff and people already living at the home to meet with each other enabling them to make a decision about whether they would like to live there. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in the development and up dating of their care plan ensuring this reflects their needs and wishes whilst considering areas of risk. Evidence: Records were looked at for 2 people. The first file was in relation to the last person to move into the home and the second file for someone who has recently had a change in their health. Several files are held, one being an active file, the second holding old correspondence and the third are daily records. Each of the care plans clearly show the level of support the person requires. This includes areas of daily activity, routines, physical and mental health and medication. Areas of risk are also considered and assessments are completed to ensure that this is minimised as much as possible. One file also had a crisis plan, which provided information about early warning signs that staff should be mindful of as this may be
Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: related to the persons health breakingdown. Where specific needs have been idnetified records continue to evidence a contingency plan, which identifies what action is to be taken and relevant personnel involved. This information provides clear direction for staff so that people are supported safely. Additional records are held with regards to monitoring the health and well being of people. Minutes from formal reviews are held with the plan along with weight records, activity charts and meal records. Entries are also made in the daily diaries which are easily accessible to staff. These records show what events have taken place and if there are any issues which staff need to be aware of. Information is clear and easy to follow. The home has introduced a keyworker system, which is said to be working well. This provides opportunities for people to meet with their keyworker and discuss anything which is important to them. Sessions enable staff to develop their knowledge and understanding of the person, what is important to them and how they wish to be supported enabling then to make decision about their lives. Information is shared within the team so that support is offered in a consistent way. People living at the home stated within the suurveys that they felt staff listened to them and that they knew who to speak to if they needed to. One person said, Im always listened to by the staff and management if I have a problem. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to follow a lifestyle of their choosing, which enables them to increase their independence and exercise some control over their lives. Evidence: People follow a variety of activities both in and away from the home. This is very much dependent on their needs and choices. One person commented, service users appear to be happy and well settled with plenty going on. A number of people continue to attend local day centres and drop-ins as well as accessing amenities within the local and wider community such as local pubs, library and local social club. Through dicussion with the manager and from information provided we were also told that during the last year a number of people have enjoyed a holiday in Yorkshire at a holiday camp. One people continues to go away with their
Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: partner for a hoilday. This person also meets regularly with the occupational therapist who is providing support in developing their independent living skills such as cooking. Arrangements were being made following our visit for a fireworks party with black peas and parkin. Whilst looking round the home and speaking with people it was evident that they are able to spend time doing things of their own choosing and made full use of the communal rooms as well as their own private space. People were seen to come and go freely. Regular contact contiues to be maintained with family and friends and visitors to the home are made very welcome. In relation to meals the manager explained that each person had been asked to pick 2 meals they would like to see on the menu. This was collated and a new 4 weekly menu has been drawn up. One person chooses not to eat meat and therefore an alternative option is provided. Consideration is also given to healthy eating, with some people being offered low fat or low sugar alternatives. Those people however with specific dietary needs are provided with build up supplements to ensure their health is maintained. As already stated records are maintained in relation to diet and weights. This helps the staff to monitor the health and well-being of people. Where issue are identified action would be taken, for example, contact with GP or dietician. Meals are generally served in the dining room. A lighter option is served at lunch time with the main meal in the evening. Drinks are readily available. Following a visit from the food hygiene inspector areas of action were identified. The manager stated that these have been addressed and included new flooring being fitted to the kitchen. There are further plans to replace the work tops. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that the health and personal care needs of people continue to be met safely and in way in which they choose. Evidence: The health care needs of people continue to be met. The manager is clear about her responsibility in ensuring appropriate action is taken to ensure that people are not placed at risk and their changing needs are met. The home has good support from the mental health team and maintains regular contact should they have any concerns. Periodic meetings are also made with the consultants in line with the discharge plans (CPA) so that peoples health and well being can be reviewed. Access is also made available to other NHS entitlements. People are registered with a local GP as well as accessing dentists, opticians and chiropody. Other appointments may include blood clinics. Staff provide support to appointments should this be required.
Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: We looked at the medication system. A Pharmacy audit was carried out in June by the supplying pharmacist. No issues were idnetified. All items are delivered and collected by the pharmacy and a record is maintained. At present there are no controlled drugs being held at the home. Individual records are maintained with regards to the administration of medication. A photograph of the person is held with their medication administration records (MAR) so that they can be easily identified. Records were completed in full. The manager has also implemented a regular auditing systems ensuring there is good stock control and an orderly system which is safe. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place with regards to complaints and protection ensuring people are listened to and their safety maintained. Evidence: Information is held in the home with regards to complaints and protection. No issues or concerns have been raised directly with the home or with us. The statement of purpose and service user guide have been reviewed and updated and include details about how to contact us should people need too. Copies of the brochures are available to people living at the home and their visitors. With regards to safeguarding, training has previously been undertaken by most members of the team, however this was some time ago and did not incorporate the local authority procedure. The manager is in the process of arranging membership with the local training partnership group. As discussed it is advised that once membership has been arranged then formal training in this area is accessed for both the manager and staff. In the meantime the manager has been provided with copies of the safeguarding procedure and training material on a CD and has accessed workbooks. This will be completed with staff as part of the in-house training. People commented that they knew who to speak to if the had any concerns. They said,
Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Im always listened to by the staff and management if I have a problem and I talk to the staff and manager. Care Homes for Adults (18-65 years) Page 19 of 28 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is clean and well maintained for their safety and comfort. Evidence: Browfield is a large property situated on a main road approximately 1 mile from Bury. The property is in keeping with those around it and is situated close to all local amenities as well as having easy links to public transport. The home comprises of 3 communal lounges, of which two are designated smoking areas. There is also a dining room, kitchen, 10 single bedrooms, 2 double rooms with one having an ensuite shower room and 2 bathrooms. An office is provided on the ground floor. Since our last visit further redecoration and refurbishment has taken place in some of the rooms. This has included new flooring and built in furniture in some of the bedrooms, new flooring in the kitchen and additional emergency lighting. Further work has been identified to up grade one of the lounges, hall stairs and landing to one side of the building and new work surfaces in the kitchen. The manger explained that as money becomes available these will be addressed. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home continues to employ staff to carry out domestic tasks with additional work is undertaken by the care staff. The laundry is situated away from the kitchen area. Staff were seen to wear protective clothing when completing certain tasks. There were no issues identified with regards to clinical waste or cross infection. People commented, Browfield has a homely atmosphere, is well kept, clean and tidy. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safe recruitment and on going training and development ensures that people are safely supported by a staff team which is equipped to meet their needs. Evidence: Sufficient numbers of staff were on duty. Rotas showed that double cover is provided throughout the day with a wake in staff member at night. In addition to this there is the manager, one of the owners and a domestic. On call support is also available during the evenings and weekends. Since our last visit to the home there has been little turnover in staff. Two people have recently been recruited to replace those that have left. There recruitment files were examined to see what information had been gathered prior to them starting work. The manager had ensured that there was a full employment history, written references had been sought and an enhanced criminal record check had been undertaken. Practice followed appeared thorough and ensured that people at the home were not placed at risk. Both of the new staff had also been supported by the manager to complete a comprehensive induction in line with skills for care. Good evidence was provided where
Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: staff had been asked to demonstrate there understanding, which would then be discussed with the manager. This enable the manager to staisfy herself that staff understand what is expected of them and that they have the right competences to carry out their role. In relation to training the manager has made application to join the local training partnership group. Staff have completed individual training analysis identifying their training needs. This will be used to inform a training programme for the forthcoming year. The manager has set up individual training files with a training matrix. This shows the date and training already completed. Courses provided since our last visit have included food hygiene, fire, diabetes, anxiety and depression, equality and diversity, disability awareness, violence and agression. More recent training has been in relation to mental health awareness and a further update in medicaiton has also been plannned for December 2008. NVQ training is also provided. Six of the 10 staff have either completed or are currently working towards level 2. One member of staff has now progressed to level 3. The manager has previously completed level 4/registered managers award. Further support and direction is offered through formal supervisions with the manager. Information held for the new staff showed that clear information had been provided in relation to relevant policies and procedures. Other sessions had also included observations of practice and good work had been acknowledged. A sample of other staff records were also looked at. These too showed that regular meetings were held along with an annual appraisal. Records had been signed by staff. Staff commented, Browfield put on regular training, staff work well as a team and help each other, I have regular supervision meetings and can discuss issues as and when with my manager and I shadowed another member of staff for a few nights before I started working on my own. The inspector also spoke briefly to one member of staff who has worked at the home for 2 years. She said that she was happy working at the home,everything is very settled and stable and likes the work and enjoying it. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home benefits from consistent and reliable management ensuring the service is ran in the best interests of those who live there. Evidence: Management within the home remains very stable. The providers and manager work closely together on a daily basis to ensure the smooth running of the service. Systems are in place to monitor and review the service provided. The manager regularly meets with staff offering support and development. Regular training is also in place ensuring they have the knowledge and skills needed for their role. The new key worker session now also provide better opportunities to gather feedback from people living at the home. Other systems in place include auditing of medication and health and safety. Periodically questionnaires are sent out to health and social care professionals asking for their comments about the service provided. Areas of development or improvement are addressed by the manager. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: A random check was also carried out with regards to health and safety checks within the home as well as servicing. Up to date checks were in place for fire extinguishers, emergency lighting, 5year electrics, fire alarm, gas safety and small appliances. A food hygiene inspection had also been undertaken. Minor action was identified which the manager stated had been addressed. In house checks are also carried out. These include the fire alarm, fire equipment and means of escape. The emergency lighting had recently been up dated in line with the new regulations. Food, fridge, freezer and water temperatures are also monitored. The manager should ensure that water temperatures are maintained at 43 degrees for the comfort and safety of people living at the home. The manager explained that there has been no accidents or incidents. No issues had been brought to our attention in line with regulation 37. Care Homes for Adults (18-65 years) Page 25 of 28 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, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 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, Care Homes 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 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 23 All staff should receive training in relation to the local authority safeguarding procedure ensuring they are aware of the procedure to follow should an allegation be made and people are protected. Water temperatures need to be regulated and maintained at 43 degrees for the comfort and safety of people living at the home. 2 42 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 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. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!