CARE HOMES FOR OLDER PEOPLE
Brownlow House 142 North Road Clayton Manchester M11 4LE Lead Inspector
Sue Jennings Unannounced 21 June 2005 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brownlow House Address 142 North Road Clayton Manchester M11 4LE 0161 231 7456 0161 231 0032 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) Mr Bradley Scott Jones Mr Russell Scott Jones Mr Bradley Scott Jones Care home only (PC) 31 Category(ies) of Old age, not falling within any other category registration, with number (OP) (29) of places Physical disability (PD) (2) Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 The home can accommodate up to a maximum of 29 service users requiring personal care only by reason of old age (OP) 2 Two named service user requiring care by reason of physical disability (PD) may be accommodated. Should either of the service users no longer require the services offered by the home then the place shall revert to that of old age 3 The care staffing levels do not fall below the minimum levels specified in the Residential Forum Guidance for Staffing in Care Homes for Older People. 4 The dependency levels of service users are assessed on continuous basis and staffing levels adjusted where appropriate to ensure continued compliance with the Residential Forum Guidance for Staffing in Care Homes for Older 5 The service should employ, at all times, a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 28 January 2005 Brief Description of the Service: Brownlow House is a registered care home providing personal care only for up to 31 older people over the age of 65 years. The home is a detached building set within its own grounds with a garden to the rear of the property and a parking area to the front of the building. The property has access both at the front of the building and the rear by steps and ramps. The home has three floors of accommodation accessed by stairs and a passenger lift. The basement of the property accommodates the laundry and the boiler for the heating system. The accommodation comprises of 3-shared bedrooms each accommodating a maximum of two people and 25 single bedrooms. One of the single rooms has en-suite facilities; all other bedrooms have a hand basin. There is a large lounge to the rear of the property leading onto the dining room. At the front of the property there is a lounge, there is also a small television lounge for use by residents who prefer to watch television rather than being involved in group activities.
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a five-hour period on Tuesday 21st June 2005. During the course of the inspection time was spent talking to the senior care assistant in charge, residents and several members of staff to find out their views of the home. Time was spent examining records documents and a sample of residents care plans. A tour of the building was also carried out. The majority of requirements from the previous inspection had been addressed and there was evidence that this home was working hard to develop the service and meet the National Minimum Standards. During this inspection only a selection of the key National Minimum Standards were assessed therefore in order to gain the full picture of how the home meets the needs of residents this report should be read with the previous and any future reports. Since the last inspection the home had not received any complaints. What the service does well:
The home provided sufficient information to prospective residents for them to make a decision about moving in. The manager visited residents in their own home or in hospital before admission to the home. This was to make sure that the home was able to meet their needs. Residents spoken to felt that they were treated with dignity and respect by the staff and management of the home. It was evident that staff and residents had a good relationship. One resident said ‘I have never been as happy’. All residents were registered with a local General Practitioner. District nurses visited the home on a regular basis. There were clear records of any medical intervention including GP, district nurse visits, chiropody and opticians plus a record of any out patient appointments or hospital admissions. Residents said that ‘I can come and go when I want’ and ‘visitors can come at anytime’. One resident said ‘the staff are lovely’ and of the manager one said ‘this lad is much better than the last one he does all he can to make sure
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 6 things are alright’. Another resident who had been at the home for a number of years said ‘the place is much better it was gloomy before, it has been decorated and we have had new furniture, we have nothing to grumble about’. One resident said ‘ there is nothing to complain about but if there was something wrong I would tell the gaffer’. When asked about the meals residents agreed that ‘the food is not bad at all and we can have anything’. One said ‘you can get a drink 24 hours a day here’, ‘good choice of food and plenty of it’, and ‘you can have whatever you want to eat’. What has improved since the last inspection? What they could do better:
The last inspection report highlighted a number of areas that did not meet the National Minimum Standards. One of the issues was that residents and or their representatives should sign their care plans. This was still not being done and the home have been asked again to show that residents are involved in the development of their care plan by making sure the care plan is signed. The home was asked at the last inspection to make sure all staff had training in relation to the protection of vulnerable adults. Discussions with the senior care assistant in charge at the time of the inspection indicated that this had not yet been arranged but was planned. The home will be asked again in this report to make arrangements for all staff working in the home to receive appropriate training. It should be noted that the timescales for the home to address the above issues had not elapsed at the time of this inspection. The corridor leading to a fire exit was being used as a smoking area. In addition, the fire extinguisher was being used to wedge open the fire door in this area. This posed a potential risk to the health and safety of residents and the senior care assistant was reminded that the fire door was a safety measure fitted to help contain a fire. The senior care assistant was asked to remove the chairs and coffee table from this area and to make sure the fire door was not wedged open.
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 7 A number of prescribed medications were regularly not required by residents to whom they were prescribed. It was recommended that these items be reviewed by the prescribing GP. 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. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The home carried out an assessment of prospective residents care needs before their admission. Prospective residents and their relatives/friends are able to visit the home before making the decision to move in. EVIDENCE: All new residents admitted to the home were given a copy of the Service User’s Guide and there was a copy of both documents within the main office. The home carried out a pre-admission assessment to ensure prospective residents are only admitted on the basis of a full assessment. The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. A care plan was developed based on the preadmission assessment and the Care Manager’s assessment. During the inspection, it was observed that the staff employed to work in the home had the skills and experience to meet the needs of the residents accommodated. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 10 Residents spoken to confirmed that either they or a relative were able to visit the home before making a decision about moving in. All placements were made on a 6-week assessment period after which a review was held. One resident said that they had come to the home on a trial stay and liked it so much they decided not to go home. All placements were reviewed after 6weeks. The resident, relatives, the registered manager and the Care Manager, attended the review meeting before any long-term arrangements were made. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The home had made progress in improving the care planning process. However, the involvement of residents in the process was limited and the systems and procedures for recording in daily records needed improvement to demonstrate that residents care needs were being met. EVIDENCE: It was noted that the home had continued its efforts to improve the standard and usability of the individual plans of care. A limited number of care plans were inspected. The individual plan of care included risk assessments. There was no evidence to demonstrate that the resident/representative had been involved with the drawing up of the plan of care or signed and agreed their care plans. All residents were registered with a local General Practitioner (GP). There was a small treatment room adjacent to the office and residents could also see their GP in the privacy of their own room if they preferred. There was evidence to show that access to other specialised services was available according to residents assessed needs. During the inspection a district nurse was visiting the home and was observed taking the resident into the private treatment room adjacent to the office.
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 12 During the inspection it was noted that two residents were being cared for in bed and the person in charge was advised to obtain nursing assessments for the two residents to ensure that the home was operating within the conditions of registration as well as being able to meet any identified nursing needs. A number of residents were spoken to and said that staff treated them with respect and dignity when being given personal care. The residents said that they were comfortable with staff helping them with bathing and personal care. The Medication Administration Records had a list of medication, which was no longer used. The person in charge was advised to arrange a review of medication to make sure that only current medication is listed on Medication Administration Records. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Residents were supported to participate in community activities and were offered a nutritious, well balanced, healthy and varied diet. Residents were able to maintain contact with family and friends and were able to exercise choice and control over their lives. EVIDENCE: Some residents had links with a local coffee morning group. The senior member of staff spoken to, stated that links within the community were being developed further. Visitors were welcomed into the home by staff and were able to visit at any time. There were no restrictions placed on visitors to the home unless at the request of the resident. Residents said they were able to see their visitors in the privacy of their own room or if they wished in one of the quiet lounges or other communal areas within the home. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 14 One resident said that they were able to ‘have visitors when they wanted’ and ‘I can go and visit with my family at weekends ‘. The residents spoken to all said that they were able to choose what time they get up and go to bed ‘there are no rules’. There was a large dining area alternatively residents could have their meals in the privacy of their own rooms if they preferred. The home provided a nutritious and varied menu, which had been compiled following consultation with the residents at the home. The home provided a breakfast, cooked main meal at lunchtime with a choice of meals available, a cooked tea and a light supper. Throughout the day drinks both hot and cold plus biscuits/fruit were available. Residents said that the ‘food was good’ and a choice was always available. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The residents were aware of the complaint procedure and they knew how to make a complaint The home’s policies and procedures served to protect the residents from abuse but staff training in this area was required. EVIDENCE: The residents had been given a copy of the home’s complaint procedure. All complaints were logged and details of the investigation and any action taken recorded. The home had not received any complaints since the last inspection. One resident said ‘I have no complaints’ and indicated that they would speak to the care staff or manager if they were unhappy with anything. Another said ‘the staff here are perfect’. Another resident said ‘I don’t have any complaints the staff do all they can for us’. Other residents spoken to said that they would feel comfortable talking to the staff or manager if they had any concerns. The home had a Vulnerable Adults Policy and a Whistle Blowing Policy. A copy of the Department of Health ‘No Secrets’ document was kept with the policy and procedure for the Protection of Vulnerable Adults. Staff had not received training on the action to be taken in the event of an allegation of abuse and this was confirmed during discussions with one member of staff.
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 16 At the last inspection a requirement had been made that all staff undertake training relating to the protection of vulnerable adults. It is acknowledged that the new owners of the home were working towards addressing this requirement however, the requirement is reiterated in this report. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, 25 and 26 The home was generally clean and tidy with sufficient facilities to meet the needs of residents. Specialist equipment was available on an individual basis. Resident’s private accommodation was well equipped and personalised but a number of bedrooms had an odour of urine and carpets required cleaning. EVIDENCE: The home felt comfortable and homely. All areas of the home were tastefully decorated and furniture was of a domestic nature and of a high standard. The home had a programme of routine maintenance and renewal of the fabric and decoration. Residents spoken to said ‘ The whole place has just been redecorated, it was all the same, it is much better now’. Another resident said ‘we have got new furniture as well’ and ‘it looks more comfy now’. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 18 The main lounge and dining area was open plan and was homely and inviting. Furniture had been placed to divide the lounge and the dining area. The carpet at the doorway to the main lounge was ‘puckered’ and required refitting. The person in charge stated that the carpet fitter was booked to undertake this work and a ‘caution’ sign was placed over the area. The home also had a smaller lounge situated across from the main office for service users who preferred to sit in a quieter area. There was a third lounge that was available for residents who did not want to watch television and this area was also used as a visitors lounge. All corridors in the home were wide enough for people who used wheelchairs to access independently or with support as required. During the inspection, a tour of the building was undertaken. The building was found to be clean and tidy. There was a slight odour of urine detected in a number of the bedrooms. This matter was addressed during the inspection with the person in charge contacting a professional carpet cleaner to arrange a date to have the carpets cleaned. Bedrooms were adequately furnished and well decorated. Bedrooms were personalised and there were adequate toilet and bathing facilities to meet the resident’s needs. At the end of the inspection the person in charge mentioned that CCTV cameras were in use in the main lounge area and images fed into the external office. The use of CCTV should be restricted to external and entrance areas only. As the manager was not present during the inspection this issue could not be discussed further and the Commission for Social Care inspection will contact the manager directly by letter to advise that the use of CCTV in communal areas must cease. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The staff appeared to have the skills and experience to meet the needs of the residents accommodated. EVIDENCE: At the time of the inspection the numbers and skill mix of the staff appeared to be sufficient to meet the needs of the residents accommodated. Staff spoken to confirmed that they had attended induction training and some study days. One staff member said that they had not received any training in adult protection procedures although training was planned. Residents in the home said that the staff were ‘kind’ and ‘worked hard’. Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Overall the management of the home was good and created an open and inclusive atmosphere. However, an area of risk was identified relating to safe working practices. EVIDENCE: The stairwell corridor leading to a fire exit was used as a smoking area and there were chairs and a cupboard in this area. In the event of an emergency this would be one of the areas used to evacuate the building therefore blocking this means of escape poses a potential risk to residents staff and visitors. At the time of inspection the door to this area was being held open by the fire extinguisher and posed a risk to residents staff and visitors to the home. During a tour of the building it was noted that one of the bedroom windows on the second floor could be fully opened and created a risk to residents. A requirement has been made to repair the window restrictors.
Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x 2 Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 22 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. 2. Standard 7 7 Regulation 15 15 Requirement Daily report sheets must reflect the care delivered over the 24 hour period. The care plans must be signed by the resident and or their representative. (the previous timescale of 30.6.05 not yet elapsed) Nutritional screening and the monitoring of residents weight must be recorded on a periodic basis. (previous timescale of 30.6.05 not yet elapsed) All staff must receive training with regards to the Protection of Vulnerable Adults. (previous timescale of the 30.6.05 not yet elapsed) To respect the privacy and dignity of residents the use of CCTV must be restricted to external and entrance areas for security purposes only. The carpets in a number of bedrooms identified to the person in charge were malodorous and required deep cleaning. The carpet in the lounge area was puckered near the door Timescale for action 30.8.05 30.8.05 3. 8 12 30.8.05 4. 18 18 30..05 5. 12 19 30.8.05 6. 19 13 and 23 30.9.05 Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 23 7. 8. 38 38 13 13 posing a potential trip hazard and required refitting. The window restrictor in bedroom 26 must be repaired. The furniture in the corridor leading to a fire exit must be kept clear. Fire extingushers must not be used to hold open fire doors. 30.7.05 30.8.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations It is recommended that prescribed medications which are consistantly not required by residents should be reviewed by the GP. Only current medication should be listed on Medication Administration Records. It is strongly recommended that a nursing assessment be obtained for the two residents cared for in bed to provide evidence that the home is operating within the conditions of registration and that it is able to meet any identified nursing care needs. 2. 3 Brownlow House F55 F05 s62022 Brownlow House V234572 D210605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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