CARE HOMES FOR OLDER PEOPLE
Bryn Haven Brinnington Road Brinnington Stockport Cheshire SK5 8BS Lead Inspector
Kath Oldham Announced Inspection 6th February 2006 08:15 X10015.doc Version 1.40 Page 1 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 Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 2 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. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bryn Haven Address Brinnington Road Brinnington Stockport Cheshire SK5 8BS 0161-430 2337 0161 430 3770 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Borough Care Limited Ms Karen Lea Care Home 42 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (42) of places Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 42 service users to include: *up to 42 service users in the category of OP (Old age not falling within any other category). *up to 7 service users in the category of DE(E) (Dementia over 65 years of age). 15th August 2005 Date of last inspection Brief Description of the Service: Borough Care Limited, who owns Bryn Haven, also owns other homes in the Stockport area. The home is purpose built and is situated in a housing estate in Brinnington, an area of Stockport. Bryn Haven is registered for up to 42 service users. An extension to the care home has meant that all but one bedroom is single. One bedroom is a twin room. Many of the bedrooms have the facility of an en-suite toilet with hand washing facilities. There is an additional charge of £10 each week for these rooms. Two bedrooms have a shower in the en-suite. The house is set in private grounds with shrubs, lawns and patio areas at the rear. Off road parking is available at the side of the house. Ramped access is available to assist in the independent mobilisation of service users. There are lounges on the ground and upper floors. A lounge on the ground floor is designated for service users who smoke. A conservatory is situated at the side of the house where lounge seating is available. A large dining room is situated next to the conservatory. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place on 6th February 2006, commencing at 8.15am. Time was spent speaking to service users, visitors and friends, observing staff practice and routines, and in discussion with the manager. The requirement and recommendations of past inspections were also monitored to see how the home had developed. A pharmacy inspector from the Commission for Social Care Inspection undertook a thorough inspection of medication administration, storage and record keeping on 19th October 2005, where areas were identified that needed attention. A separate report was sent to the home on conclusion of that inspection. The requirements and recommendations of that inspection were also monitored on this inspection. The home had worked hard to address the requirements and the good practice recommendations, having achieved compliance. The focus of this inspection was predominantly how service users felt about living at the home and their views and opinions of life within a residential care setting. Comment cards were sent to the home prior to the inspection for distribution to service users, visitors and families. Additional comment cards were taken on the inspection for further distribution. Before the inspection started, not many comment cards were received back in comparison to the response from previous inspections. The manager said that the home had recently sent out its own comment cards and this may be the reason for the lack of response to CSCI. Comments received from service users on the inspection, their relatives and visitors and from comment cards are included in this report. Forty-one people were living at the home at the time of the inspection. One service user was in the double room and would be afforded that arrangement for the duration of her stay at Bryn Haven. The home was full. During this inspection only a selection of the key National Minimum Standards were assessed. In order to gain the full picture of how the home meets the needs of service users, this report should be read with the previous and any future reports. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection?
The requirements and recommendations made following the pharmacist’s inspection have all been complied with which provides additional safeguards for service users. Since the last inspection, all staff have attended adult protection training to further promote their understanding of what constitutes abuse and as an additional safeguard for service users. For new staff this is now incorporated into their induction at head office. The appropriate levels of care and support identified at previous inspections have been maintained. The statement of purpose has been amended since the last inspection to reflect the changes made to the senior staff team. A copy of the statement was provided to the Commission for Social Care inspection at the inspection. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 7 What they could do better: 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. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 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 the following standard(s): None of the standards in this section were assessed during this inspection. They were assessed and reported in the report of the inspection undertaken in August 2005 when they were met. EVIDENCE: Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7&9 The home meets the health care needs and privacy of service users. EVIDENCE: Staff confirmed that there was verbal handover at each shift change. Discussion with the manager and staff indicated that these mechanisms meant that staff were aware of the changing needs of the service users. Several service users were spoken to during the inspection. None expressed negative views about the care they received and all were very positive. One service user reported that Bryn Haven “is a nice home, the staff are good and treat you well.” Another said, “the staff are great with me.” All service users’ comment cards, which were returned, reported that their privacy was respected. Staff were observed to be pleasant and courteous with service users. Staff were seen to have good interactions with service users and were observed dealing with individual needs.
Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 11 One service user spoken with said the staff were “very nice”. Another service user said “I like it here, they are all very nice”. Staff were aware of service users’ care needs and described the changes and additional support the service users were receiving. Service users said they were well cared for and were looked after. A service user said the home calls the doctor if they are unwell and takes them or arranges hospital appointments. The recording within the care plans has improved and staff are being supported to detail the individualised care within them for each service user. The development is ongoing and the recommendation to continue this is included in this report. Monitoring of the medication requirements and recommendations issued by the CSCI specialist pharmacy inspector were monitored and were all fully achieved. The home has worked well to address these. The home has a comprehensive medication policy, which complies with the national minimum standards and reflects current practice issued by the Royal Pharmaceutical Society. An accurate record is maintained of medication received by the home and returned to the supplying pharmacy, which provides the necessary safeguards to service users and staff. Service users said they receive their medication regularly and staff inform them what the tablets they take are for. One service user said she lets staff know if she is in any pain and they give her medication to help this. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 12, 13 & 15 Service users have a flexible lifestyle in the home and maintain contact with their families and friends. EVIDENCE: An entertainer visits the home and service users said they enjoyed specific entertainers. Some activity takes place during the day; this was reported to be enjoyed by service users. One service user said “you know there is always something on everyday that you can go to if you want”. A further service user said they were “so busy at the home taking part in the entertainment, going out with friends and chatting”. She “hadn’t realised in her later life she would be so active even though her legs weren’t as good as they used to be”. A number of service users go out with relatives or friends for walks or visits to their relatives’ homes. A service user said “there is a list of things on the door and include a bit of something everyday”. One service user said they enjoyed sitting in the lounge chatting to other service users and staff, listening to music, watching television or reading. Another service user said they spent their day in their bedroom with their things around them, which they said they preferred.
Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 13 Service users commented that they can receive visitors at their convenience and they receive them in the lounge or in their rooms. No restrictions were in place to determine when visitors can attend the home. A service user said they had cereal and cooked breakfast every day and couldn’t remember a time when they had eaten so well. The meals served are traditional meals, which service users said they liked. A further service user said they ate what they wanted and as they didn’t have to cook it, they enjoyed trying different things which the cook prepares and which they wouldn’t have had before. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 14 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 the following standard(s): None of the standards in this section were assessed during this inspection. They were assessed and reported in the report of the inspection undertaken in August 2005. EVIDENCE: Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 23, 24 & 26 The home was well maintained and provided comfortable living accommodation for service users. EVIDENCE: The home felt comfortable and homely. All areas of the home seen were clean, tidy and free from odour. The home had a programme of routine maintenance and renewal of the fabric and decoration. The windows that haven’t yet been replaced by UPVC windows are to be replaced during February 2006. This development will improve the appearance of the home and provide additional security, as the windows all lock and will retain the heat in the home. One service user said they were “looking forward to having new windows in her bedroom which will just finish the room off”. A partial inspection of the building identified that bedrooms were personalised by service users and their families with ornaments and furnishings.
Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 16 The bedrooms inspected contained the furniture and furnishings described in the standards. All those seen were clean and free from odours. One service user said she had everything that she needed in her bedroom and had brought things with her from home to make it more her own. One visitor said their cared for service user had a beautiful room and was comfortable and happy there. A service user said the home was “spotlessly clean and staff worked hard all day cleaning and hoovering”. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 17 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staff were sufficient in numbers, skills and experience to undertake the work they are employed to do. The training provided protected staff and service users. EVIDENCE: Relative and visitor comment cards expressed the view that there were always sufficient numbers of staff on duty. All service users spoken with during the inspection were positive about the attitude and approach of the staff. A staff rota showing which staff were on duty and in what capacity was kept at the home. Duty rosters indicated that staff numbers are maintained in line with previously agreed levels. Staff spoken with stated that staffing levels were usually satisfactory and that there was little use of agency staff. Service users confirmed they received good care and were satisfied with the manner in which staff conducted themselves and the manner in which they were treated. In an effort to protect service users, the home has a thorough recruitment and selection procedure.
Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 18 Service users said staff appeared to know what they were doing and were instructed by the manager. Staff have been allocated to a number of residents to whom they provide care and support. Service users said they liked their ‘key worker’ and have a special relationship with them. A comment card said that they were “very impressed with staff, very caring and professional.” Staff presented as having the best interests of the service users at the heart of their work practice. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 19 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 32 Bryn Haven is a well managed home. Practices in the home ensure that the health and safety of residents and staff are promoted and protected. EVIDENCE: Service users and staff meetings are routinely arranged which provide them with an opportunity to influence how the home is run and contribute to the effectiveness of the home Formal supervision was being provided for staff. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 20 The management style of the home is relaxed, open and transparent. Staff felt confident in the skills of the manager and said that more senior managers were available to them. Staff also stated that they are empowered to bring new ideas and are able to put these into practice with the guidance and support of the senior team. Maintenance and servicing of equipment was undertaken to ensure all the equipment was safe for service users’ use. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X X Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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. There are no requirements arising from this inspection No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The registered person should continue the development of the care plan to further detail action needed by staff to ensure that all aspects of the health, personal and social care needs of the service user are met. Ensure daily records provide information on the care and interventions provided to service users. Bryn Haven DS0000008544.V274353.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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