Inspection on 27/10/09 for Brown Edge House

This inspection was carried out on 27th October 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Brown Edge House Nutgrove Road St. Helens Merseyside WA9 5JR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Phil McConnell     Date: 3 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brown Edge House Nutgrove Road St. Helens Merseyside WA9 5JR 01514264114 01514264114 brownedgehouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Clarencare Limited Name of registered manager (if applicable) Miss Jane Pennington Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admissions to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 20. Date of last inspection Brief description of the care home Brown Edge House is located in the Nutgrove area of St Helens Merseyside. The home is registered with Care Quality Commission to accommodate 20 people. The home is close to local amenities, with public transport networks close by. The home is built on two floors, with a passenger lift being available. The rear garden is very well maintained, with car parking provision at the front of the property. The present fees are £408 per week. Care Homes for Older People Page 4 of 32 Over 65 20 0 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Various information was gathered in order to be able to assess the National Minimum Standards for Care Homes for Older People, including: The Annual Quality Assurance Assessment, this is a document which the registered manager completes every year and it contains information about the service being provided. We use this information, in part to focus on our inspection activity. An unannounced Key Inspection was carried out on the 27th of October 2009 by the Care Quality Commission (CQC) and a further visit was undertaken on the 30th of October 2009. The registered manager ( Jane Pennington) was not present during the first site visit. Unfortunately the office was locked, therefore it was not possible to have access to much of the homes documentation, which is needed for inspection purposes. A second Care Homes for Older People Page 5 of 32 visit was arranged when the manager would be at the home. There was an opportunity during the inspection to speak in private with several service users, visitors and discuss matters with several members of staff. A number of surveys from service users and members of staff were received by the Care Quality Commission (CQC). The feedback received was generally positive. Peoples files were examined, with all relevant documentation being in place including, initial assessment documentation and care plans. A number of the staff files were examined and they also contained all of the necessary documentation needed for inspection purposes including, recruitment information and evidence of training that had been provided. However, for one person employed at the home, no evidence could be found of a staff file, appropriate Criminal Records Bureau (CRB) disclosure or a Protection of Vulnerable Adults (POVA) check. Throughout the site visit there was the chance to observe the support and care that was being provided to individuals, which was generally done in a caring, appropriate and professional manner. Although there was some concern about the administration of medication during a mealtime. The organisations policies, procedures and the health and safety documentation were examined and it was discovered that some of the required health and safety procedures and inspection checks had not been satisfactorily carried out. A tour of the premises was carried out, with a number of issues being identified, that are included in the body of this inspection report. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: A copy of the Service User Guide and the Statement of Purpose was available in the library. However, some of the information in the document was incorrect. It is recommended that it is checked and kept up to date with relevant information. This is needed to enable prospective service users, make informed choices. The provision of chiropody care should be much better managed, in order to ensure that everything is done to promote peoples health and wellbeing. It is recommended that it is not the best practice to administer medication during meal times. It is better if people can have protected meal times, where they can enjoy uninterrupted meals. The Medication Administration Records (MAR) should be correctly maintained. It was discovered that there were no recorded amounts of two items of tablets for two service users. The controlled drugs (CD) cupboard should be securely fastened to a solid wall as required. Care Homes for Older People Page 7 of 32 Incontinence pads should be discreetly stored, especially in peoples bedrooms, in order to promote dignity and respect. Consideration should be given to ensuring that the activities programme is meaningful and provides people with stimulation and motivation. One person was observed to be struggling with her meal. It was clear that she was unable to cut her food up. It was commented, we usually do cut her food up when asked why not today? The reply was, I dont know. It was explained that the person was struggling with her food, with none of the staff appearing to notice this and that it did not promote the persons dignity or respect. The use of communal toiletries, razors and blocks of soap should cease. This practice could potentially be unsafe for people using the service and does not promote the management of infection control. The car park is in need of some attention .This will help prevent risk of injury. It is recommended that the cleaning rota displayed in the kitchen is adhered to.This will give the assurance that the cleanliness of the kitchen is satisfactory. It is recommended that hand soap gels and anti-bacterial gels are made available in all communal toilets and bathrooms. This will help manage the control of any potential infections in the home. There is a need to strengthen the recruitment procedures, particularly with regard to Criminal Record Bureau (CRB) checks. This will help ensure that everything possible is done to protect vulnerable people. The manager must ensure that gas equipment and installations are appropriately inspected, with a CORGI certificate of inspection being made available for any regulatory inspection. This will demonstrate that peoples health and safety is positively considered. The portable appliance testing (PAT) of electrical items must be carried out for all electrical items in the home and annual checks maintained. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service User Guide and the Statement of purpose should be up to date and contain relevant information. This is needed to enable prospective service users, make informed choices. Evidence: Four service users files were examined, including the last person to go and live at Brown Edge House. The files contained copies of the homes own pre admission assessment documents. The assessment documents were sufficiently detailed, with significant and appropriate information. This demonstrated that relevant information is gathered in order to determine if a service could be provided at Brown Edge House. The AQAA states that the, Service User Guide (SUG) is fully compliant and regularly updated by the management. There was a copy of the SUG and the Statement of Purpose available in the homes library, however some of the information was incorrect, for example, out of date fees, incorrect staff training information and Care Homes for Older People Page 10 of 32 Evidence: incorrect address for the Care Quality Commission (CQC). The statement of purpose and the service user guide should be readily available and contain up to date information, to enable prospective service users make informed decisions about whether to choose to live at Brown Edge House. Care Homes for Older People Page 11 of 32 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provision of chiropody care should be much better managed, in order to ensure that everything is done to promote peoples health and wellbeing. Evidence: Four service users care plans were examined and it was evident that they contained appropriate and sufficient information, which is reviewed every four weeks. It was also apparent that the care plans are devised from the initial admission assessments. Individual records are maintained regarding peoples specific health care needs including, GP visits and appointments, hospital and consultant visits, District Nurse visits and Chiropodist visits. One of the service users asked the inspector if she could have her toenails cut? She removed her slippers to show that her nails were very long and it was clear they had not been treated for sometime. The senior carer was asked how often the chiropodist visits? she said, The NHS Chiropodist attends to the service users every six months. The records for this lady and four other service users were examined. It was evident that chiropody visits ranged from four month intervals to eight months. It was suggested to request an immediate visit from the Chiropodist. Care Homes for Older People Page 12 of 32 Evidence: Three days later on the second inspection visit to the home, it was discovered that people had still not had their toenails cut. This was discussed with the registered manager and she stated, the chiropodist said, they will come when they can. It was suggested to contact a private chiropodist and an assurance was given that she would continue to address this issue. The situation was still the same five days later. The manager said, people dont want to pay and the NHS service have asked us to stop contacting them. The manager was informed that it is important that peoples foot care is regularly carried out by a professional chiropodist. It was suggested to the manager, that if people or their families are not prepared to pay for a more regular chiropody service, then disclaimer contracts and risk assessments should be in place to demonstrate this. The present long periods between treatments is not acceptable. There needs to be a better managed system in place, to ensure that peoples health and welfare is appropriately monitored and maintained. There was a medication policy in place, informing the staff the correct procedures to follow in the administration of medication. The medicine administration records (MAR) were examined and it was discovered that generally good records are maintained, however the the quantity of two items of medication for two people had not been recorded. This could potentially result in medication errors occurring. The mid-day administration of medication was also observed during the first visit and it was concerning to see three people being interrupted during their meals to be given medication. The person administering the medication was asked why people are being interrupted during their meals to be given medication. The reply was,we dont usually do this, but we are running late and thought it would be OK. Advised that it is not the best practice to administer medication during meal times. It is better if people can have protected meal times, where they can enjoy uninterrupted meals. Unused medicines are being returned to the pharmacist, with appropriate records being maintained. The medicines are stored in secure locked cabinets, which were very well organised, clean and tidy. Although the container for controlled drugs (CD) was observed to be incorrectly stored. It is a legal requirement that CD cupboards are fixed to a solid wall or a wall that has a steel plate mounted behind it. The manager was informed of this requirement. During the first site visit it was observed that a large number of incontinence pads were on view and indiscreetly stored in the bedrooms of six people, compromising peoples dignity and respect. The senior carer on duty said, that these items would be removed, stored out of sight and the information entered into care plans, in order to further promote dignity and respect. Care Homes for Older People Page 13 of 32 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The limited provision of meaningful activities, does not give the assurance that people will be sufficiently stimulated or motivated. Evidence: There was an activities programme displayed in the home, stating that activities are available three days a week. They included bingo, dominoes, cards, quizzes and eye spy. The AQAA says, We have the equipment and materials for a variety of art and craft activities as well as games and pastimes. It was evident that the provision of activities is left to carers who are on duty on the three specified days. No records were available for who had taken part in any of the activities or when they had taken place. No activities were observed taking place on either of the two site visits. The home was decorated with many items regarding Halloween celebrations including, a sign saying Haunted House on the door into the home, skeleton hanging from the staircase, skull candles situated around the home, decorations and many other items scattered around relating to Halloween. The manager was asked if the service users were in agreement with the decorations? She replied, I dont know, nobody has complained and its just a bit of fun. Although some of the service users said, we have had nothing to do with it the staff have done it I dont like it But one person Care Homes for Older People Page 14 of 32 Evidence: did say, I am looking forward to the Halloween party. It appears that people were not fully consulted or included in the decorating of the home. The notice board also contained information and contact details for different religions, with a communion service being carried out each week by a local minister. It was commented that a number of people usually attend. Some of the comments received from visitors were, They dont do a lot of activities and It could be better Some comments from people using the service were, Not a lot of entertainment We have bingo, but not much else We did go to the Safari Park. I have never laughed so much and some comments in the returned surveys were, Would like to go out more, shopping etc and could do with having more activities. It was apparent that there is a limited provision of stimulating, meaningful and motivational activities available. There needs to be a proactive move to ensure that individuals interests are catered for and everything possible is done to provide motivation and stimulation, in order to promote peoples wellbeing. There is an open house policy at Brown Edge House, with the AQAA stating, we do not advertise visiting times, preferring always for visitors to arrive when they want, to enjoy the pleasure of their relatives company. Feedback received from some visitors was, we visit most days and are always made welcome the staff are always friendly and I know I can visit at anytime. There was the opportunity to have a meal at the home in the dining room with the service users. People commented that they enjoyed the meal, with comments being, very nice, enjoyed the cake as well lovely dinner and usually the meals are good. There is a six week planned menu, with alternative meals available if people want something different. During the visit people were observed having an alternative meal to the one advertised for the day. This demonstrated that people do have a choice, with alternatives available. A discussion took place with the cook on duty and it was apparent that specific dietary needs for service users are catered for when necessary and good informative records are maintained in the kitchen, giving specific details of individuals dietary needs and peoples likes and dislikes. During the meal one person was observed to be struggling with her meal. It was clear that she was unable to cut her food up. No assistance was offered to the person from the care staff. The senior carer commented , we usually do cut her food up when asked why not today? The reply was, I dont know. It was explained that the person was struggling with her food, with none of the staff appearing to notice this and that it did not promote the persons dignity or respect. Care Homes for Older People Page 15 of 32 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is a satisfactory complaints policy and procedure in place. It is of concern that vulnerable people are not adequately protected. Evidence: There was a policy in place, which gave guidance about how to make a complaint or raise a concern that somebody may have. There was a copy of the complaints procedure displayed in the entrance to the home, although it did contain the wrong address for the Care Quality Commission (CQC). In the feedback received it was apparent that people are familiar with the complaints procedure and would know what to do if they needed to complain about anything, relating to the service. The Annual Quality Assurance Assessment (AQAA) stated, we listen sensitively to complaints and grumbles and record them accordingly using the format displayed inside the Complaints book (Complaints and Grumbles books are kept available in the staff station). Any Grumbles are dealt with quickly. The AQAA also stated that one complaint had been received in the last twelve months and it had been dealt with within the required twenty eight day period. A policy was in place regarding, how to respond to the allegation or suspicion of abuse being made, which had been reviewed in April 2008. New staff members are given training on the Safeguarding of Adults during their induction period. In discussion with some of the members of staff, it was evident that they are fully aware of the issues regarding the safeguarding of vulnerable people. Care Homes for Older People Page 16 of 32 Evidence: However it was concerning to discover that one person employed in the home did not have the required criminal record bureau (CRB) recruitment checks in place. In the absence of thorough and robust vetting and checking of staff, the registered provider was unable to demonstrate that people in the home are sufficiently protected. Care Homes for Older People Page 17 of 32 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home and some of the work practices were found to be unhygienic and unsafe. There is a need to improve standards, in order to help eliminate potential risks to people. Evidence: A full tour of the premises was carried out at the first visit, accompanied by the senior carer who was on duty. The registered manager was on holiday during the first visit. The office was not accessible during the first visit, with the manager having the key to the office. This meant that the staff files and other relevant documentation was not available for examination. It was advised during the feedback given to the manager that it is a requirement for the benefit of inspection purposes to have access to all documentation within the home. Peoples bedrooms were looked at and it was evident that people are encouraged to bring into the home their own personal possessions and items of furniture. This enables people to be more comfortable, with having familiar things around them. However, some of the bedrooms are looking tired and in need of redecoration. One room had a badly stained ceiling, which had happened due to a leak in the room above. The manager commented that the decoration programme is ongoing and the damage to the ceiling would be addressed. Care Homes for Older People Page 18 of 32 Evidence: It was discovered that some of the homes toilets had blocks of dried soap. It was suggested to remove the soap and replace with hand gels. This would be more appropriate and help promote the management of infection control. We were informed at the second visit that the blocks of soap had been removed and replaced with hand gels. One bathroom was observed to contain, four used disposable razors, with one can of shaving cream on the side of the bath. One discoloured scrunchy sponge and three blocks of dried soap. There was a shelf with twenty items of perfume, deodorants, cotton buds and creams. It was very untidy and it appeared that everything in the bathroom was for communal use. The use of toiletries including, soap, razors and creams should strictly be for individual use. This does not promote good hygiene practice, acceptable health and safety practice or promote the correct management of infection control. It was commented by the senior carer, Yes I know it looks bad. Another bathroom also had blocks of dried soap and an unsecured bathroom cabinet at the end of the bath. It was suggested to remove the cabinet for health and safety reasons. However, on the second visit to the home the cabinet was still unsecured at the end of the bath. The lounge area was, as already mentioned decorated with Halloween decorations, skull candles and posters. It was discovered that both of the televisions in this room had not been portable appliance tested (PAT) This is a requirement to ensure that electrical appliances are appropriately tested to meet the necessary health and safety compliance.The conservatory was also found to contain electrical items that had not been PAT tested including another TV. We (CQC) were informed that these TVs had been brought in by service users and therefore had not been provided by the home. The manager was informed that all electrical items need to be tested before they can be used in the home. Also regarding Portable Appliance Testing (PAT) it was discovered that other electrical items had not been tested for some time, for example electrical items in the office were dated 2004 and 2006. It is a requirement that all portable appliances are tested annually. This will help ensure that the electrical appliances in the home are fit for purpose and the safety of everyone living and working in the home is actively promoted. The conservatory is the designated smoke room for service users and it was evident that at the time of the inspection only one person smokes. It was made clear by the staff on duty that the majority of service users do not use the conservatory because of the smell of nicotine. One member of staff said, people wont come in here because of the smell of smoke and another said, I am a smoker and I dont like coming in here (conservatory). It was evident that the conservatory did have a strong smell of tobacco smoke. It was apparent that the majority of people feel restricted from using this area of the home. Following the inspection we were informed by the provider that, Care Homes for Older People Page 19 of 32 Evidence: We are considering some other options for this room as it is a large area of the home, which is not being used by everyone and we would like to improve and widen the access to this communal space. A number of tools were observed on the floor near the kitchen area. It was advised to have these tools moved to a more secure and safe area. This would help any accidents happening. The kitchen was fully equipped with good quality stainless steel units, which are good for cleaning and hygiene purposes, however the cooker hood was found to be unclean and quite greasy. The kitchen cleaning rota was displayed in the kitchen and it stated that the cooker hood is supposed to be cleaned every Saturday. It was asked why it was unclean? The reply was, the cook is on holiday and she does the cleaning. It was eplained that it should not matter if the cook is off, the cleaning rota should be maintained, in order to maintain the cleanliness and hygiene of the kitchen. It was observed on the second visit that the cooker hood had still not be cleaned. The laundry was observed to be clean and well organised, containing sufficient apparatus for the needs of the people living at Brown Edge House. The outside grounds were observed and the rear garden was very well maintained with new garden furniture. The front of the premises was looking unsightly, with the car park being quite uneven in places. There maybe a safety hazard, especially for pedestrians who may have some mobility problems. There was a large amount of garden waste stacked at the side of the car park. A member of staff said, Its supposed to be getting moved, but its been there for a while now. Consideration needs to be given to having the car park properly repaired. This would help prevent any potential accidents. Care Homes for Older People Page 20 of 32 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes poor recruitment practices are putting people at potential risk. Evidence: The staffing levels were examined and it was evident that they meet the needs of the people living at Brown Edge House. The AQAA says, we strictly adhere to the minimum staffing levels set by St Helens Council as they are appropriate to the needs of our residents, We have a very low rate of staff turnover and we do not and will not use agency staff. Five staff files were examined, including the last person to be employed at Brown Edge House and they were found to contain the necessary information with regards to the experience, skills and training that staff have received with an induction programme being in place. As previously mentioned the office was not accessible during the first site visit, with staff files and other relevant information being locked away. The manager was informed that the homes documentation should be readily available for inspection purposes. If the manager is not available for whatever reason, then alternative arrangements must be made, in order to have access to the information. Some of the comments regarding the staff were, the staff are really nice all of the staff are very good and I cant fault them. The staff files examined on the second visit contained the required recruitment information including, application forms, two references for each applicant, Criminal Record Bureau Checks (CRB) and the Care Homes for Older People Page 21 of 32 Evidence: protection of vulnerable adults check (POVA) However, it was discovered that the maintenance man did not have a staff file, neither was there a CRB or POVA check in place for this person. The registered manager was informed that it is a requirement to ensure that CRB and POVA checks are carried out for all personnel working at the home, whether a person is employed on a voluntary basis, paid employment or self employed they must have the necessary checks in place. It was apparent that the present recruitment procedure does not ensure that vulnerable people are safeguarded and protected. The staff training matrix was examined and it was evident that there is a good provision of training including, dementia awareness, pain assessment and management, challenging behaviour, supporting carers and maintaining relationships and advanced dementia care. The national vocational qualification (NVQ) is also being provided to a good level. The AQAA says, All staff are either NVQ level 2 or are studying for it. In discussion with some of the staff it was apparent that staff members are content with the training provided. Some comments were, I have always wanted to do this job, I am doing my NVQ now I did my safeguarding training in September and I am taking my NVQ and all other courses when available. Care Homes for Older People Page 22 of 32 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of people is not actively promoted and potentially places people at unnecessary risk from harm or accident. Evidence: As already mentioned the manager was not available during the first site visit. The registered manager was registered earlier this year with the Care Quality Commission (CQC) having previously worked for over eight in the years in the home, including a period as the deputy manager. The comments received regarding the manager from service users and relatives were, the manager is very good she is a belter the manager is approachable and never had a problem with the management. Some comments from staff were, the manager is very nice and she is fair with everybody. There were satisfactory procedures in place regarding individuals finances, with appropriate safeguards, helping to demonstrate that people are protected from Care Homes for Older People Page 23 of 32 Evidence: financial abuse. The homes health and safety inspection certificates were examined and the following were found to be in place and up to date. The electrical inspection certificate, bath and hoist lifts, which are inspected every six months, fire equipment, emergency lighting and the passenger lift inspection certificate. However there was no gas inspection certificate available for inspection. It is a requirement that gas installation inspections are carried out by recognised members of the Council of Registered Installers (CORGI). As previously mentioned the portable appliance testing (PAT) of electrical equipment was inconsistent. For example there was no evidence to demonstrate that some electrical items had ever been checked and others had not been checked for a number of years. All portable electrical appliances must be tested, if they are to be used at the home to assess their suitability and are safe. It is essential that all health and safety inspections are carried out. This will help ensure that the people living and working at the home are protected from harm or injury. As previously mentioned the apparent practice of the communal use of razors, blocks of soap and creams, does not promote good hygiene practice or give the assurance that the management of infection control is actively promoted. This is needed to help ensure that the health and safety of people is seen to be positively considered. Care Homes for Older People Page 24 of 32 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 Older People Page 25 of 32 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 1 1 5 The registered person shall produce a written guide to the care home (Service Users Guide) and also to keep the document under review. This is needed to ensure that prospective service users are given the necessary and correct information, to enable them make a decision about whether to go and live at the home. 30/11/2009 2 8 12 The registered person shall 30/11/2009 ensure that the care home is conducted so as- to promote and make proper provision for the health and welfare of service users. Chiropody provision should be more frequent, in order to help ensure the health and welfare of the service users. Care Homes for Older People Page 26 of 32 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 3 9 13 The registered person shall 30/11/2009 make arrangements for the safekeeping of medicines received into the care home. The controlled drugs cupboard should be securely fastened to a solid wall. As required by the Misuse of Drugs (Safe Custody) Regulations 1973. 4 9 13 The registered manager 30/11/2009 shall make arrangements for the recording of medicines received into the care home. The quantities of all tablets for all service users must be correctly recorded in their Medication Administration Records. This will help to eliminate potential medication errors. 5 10 12 The registered manager 30/11/2009 shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Incontinence pads should be discreetly stored, in order to ensure that peoples dignity, respect and privacy is actively promoted. Care Homes for Older People Page 27 of 32 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 6 18 19 The registered person shall not employ a person at the care home unless, he has obtained in respect of that person the information and documents specified in :paragraphs 1 to 7 of schedule 2. Only people that have had the required checks, be employed at the home. 22/02/2010 7 19 23 The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. Some of the bedrooms are in need of being redecorated and modernised. 31/03/2010 8 19 23 Equipment provided at the home for use by service users or persons who work at the care home is maintained in good working order. The Portable Appliance Testing (PAT) of all electrical appliances, coming into the home must be carried out and annually checked. In order to safeguard people from potential harm. 30/11/2009 9 19 13 The registered person shall ensure that all parts of the home to which service users 30/04/2010 Care Homes for Older People Page 28 of 32 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 have access are so far as reasonably practicable free from hazards to their safety. The car park is in need of some attention .This will help prevent potential risks to injury. 10 19 13 The registered person shall 30/11/2009 make suitable arrangements to prevent infection and the spread of infection at the care home. The use of communal toiletries, razors and blocks of soap should cease. This practice could potentially be unsafe for people using the service and does not promote infection control. 11 29 19 The registered person shall 30/11/2009 not allow a person to work at the home unless, the employer has obtained in respect of that person the information and documents specified in: paragraphs 1 to 7 of schedule 2 of the National Minimum Standards for Care Homes for Older People. There is a need to strengthen the recruitment procedures, particularly with regard to Criminal Record Bureau (CRB) checks. This Care Homes for Older People Page 29 of 32 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 will help ensure that everything possible is done to protect vulnerable people. 12 38 23 The registered person shall ensure that equipment provided at the home for use by service users or persons who work at the care home is maintained in good working order. The portable appliance testing (PAT) of electrical items must be carried out for all electrical items in the home and annual checks maintained. 13 38 13 The registered person shall ensure that unnecessary risks to to the health and safety of service users are identified and so far as possible eliminated. The manager must ensure that gas equipment and installations are appropriately inspected, with a CORGI certificate of inspection being available for the CQC. This will demonstrate that peoples health and safety is positively considered. 30/11/2009 30/11/2009 Care Homes for Older People Page 30 of 32 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 1 The Statement of Purpose should contain up to date information. This will help give a true reflection of what kind of service people can expect , if they choose to go and live at the home. It is recommended that the administration of medicines takes place at a time and frequency that preserves the principles of a protected mealtime, whenever possible and appropriate. The provision of activities is considered to be limited. It is recommended that a more proactive and person centered progamme of activities and events be introduced. This would help promote stimulation and motivation. Appropriate assistance and help should be given to service users at meal times. This will help ensure that dignity and respect is promoted. It is recommended that the cleaning rota displayed in the kitchen is adhered to.This will give the assurance that the cleanliness of the kitchen is satisfactory. It is recommended that hand soap gels and anti-bacterial gels are made available in all communal toilets and bathrooms. This will help manage the control of any potential infections in the home. It is recommended that the comments observed in the various public documents, which criticises the Local Authority should be removed. They are unprofessional and unhelpful. 2 9 3 12 4 15 5 26 6 26 7 32 Care Homes for Older People Page 31 of 32 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. 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