Inspection on 17/03/06 for Bryony House

This inspection was carried out on 17th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bryony House 08/05/08

Bryony House 04/06/07

Bryony House 30/11/06

Bryony House 16/11/05

Bryony House 22/02/05

Bryony House 26/08/04

Bryony House 20/02/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bryony House 30 Bryony Road Selly Oak Birmingham B29 4BX Lead Inspector Brenda O`Neill Unannounced Inspection 17th March 2006 09:30 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 Bryony House DS0000016895.V285157.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. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bryony House Address 30 Bryony Road Selly Oak Birmingham B29 4BX 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) 0121 475 2965 0121 680 1300 Bryony House Committee Christine Hilton Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2005 Brief Description of the Service: Bryony House is a purpose built residential home situated in a residential area within the Bournville Village Trust, providing care for up to 38 older people. There are shops and a church in the locality and easy access to the public bus service. Community facilities such as shops and churches are within walking distance. The home is a large three-storey building with a lower ground floor. The residents’ accommodation is situated on all floors of the home. There are toilets and bathrooms on all floors and all the bedrooms have en-suite facilities. Lifts and stairs connect the separate floors. One shaft lift connects the ground floor with the lower ground floor and the other connects the ground floor to the first and second floors. There are also six flights of stairs throughout the home. On the ground floor are the main kitchen, laundry, office space, a dining room, two lounges and a large conservatory that leads out to the rear garden. A further lounge was being established on the first floor of the home and there is a hairdressing facility on the second floor. At the front of the home there are parking spaces for several vehicles and there is a very attractive large private garden to the rear of the property. At the time of this inspection the extensive refurbishment to modernise and upgrade the home was almost complete. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day in March 2006 and was the second of the two statutory visits to the home for 2005/2006. To get a full overview of all the standards assessed this report should be read in conjunction with the report written following the inspection on November 16th 2005. During this inspection a partial tour of the premises was carried out, three resident and two staff files were sampled as well as other documentation. The inspector spoke with the manager, assistant manager, care officer and five of the twenty four residents. What the service does well: What has improved since the last inspection? The system for the administration of medication had improved making it safer for the residents. Regular staff drug audits were being undertaken and the manager was addressing any discrepancies. The manager had developed a well detailed, written handout for all staff in relation to adult protection which gave details of the types of abuse and where staff could report this to if they suspected or witnessed any abuse. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 6 The majority of the staff had had updated training in moving and handling improving the safety of themselves and the residents. A quality assurance system had been purchased and the manager was working through this looking at ways of developing the service offered to the residents. 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. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 7 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 Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 8 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): EVIDENCE: Standards 3 and 5 were assessed at the last inspection and found to be met. Standard 6 is not applicable to this home. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 9 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, 8, 9 Care plans and risk assessments needed to be further developed to ensure they included sufficient detail to enable the residents’ needs to be met and ensure all identified risks were minimised. Medication management had improved and ensured residents were not put at risk. EVIDENCE: Three care plans were sampled during this inspection. All the care plans included documentation entitled ‘needs assessment and support plan’. Included in the documentation were some of the individual needs of the residents but in most instances there were no details of how staff were to meet the needs. Comments by staff included such things as ‘assistance to be given as required’, ‘needs help getting in and out of the bath’, ‘hearing aid in right ear’, ‘top and bottom dentures’ but there was no detail of if the person could look after their own dentures or hearing aid or the types of assistance needed. Care plans needed to be much further developed and take into account the likes, dislikes and preferences of the residents and include to what extent they were able to self care. Some of the staff had recently had training in care planning and some new documentation was being developed to try and address the shortfalls. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 10 Two of the files sampled included manual handling risk assessments however these did not include details of how the residents were to be assisted if they fell and were uninjured. One of those sampled was for a resident who needed assistance to stand and sometimes needed the use of a hoist. There were no details on the manual handling risk assessment of how this person was to be assisted to stand or of who decided if the hoist was needed, which hoist or what sling size was to be used. The only personal risk assessments on the files were in relation to falls and one file had no risk assessments at all. Personal risk assessments needed to identify all risks and how these were to be minimised by staff. There was good documented evidence in the daily records of the residents’ personal and health care needs being met. Health care needs were being identified, followed and monitored by staff, for example, one of the residents had had very restless nights and this had been monitored and then followed up by a change of medication, one resident had been noted to have swollen feet and this had been followed up. The residents spoken with were satisfied that they could see the doctor if they wished and some of the residents went out with their relatives to visit the doctor’s surgery. One of the residents also spoke to the inspector about regular visits from the district nurse. It was strongly recommended that visits by health care professionals were documented separately from the daily records to make them easier to track. The manager needed to ensure that all residents had simple tissue viability and nutritional screenings undertaken to highlight any issues that may need monitoring or following up with the relevant professionals. Medication continued to be administered via a 28 day monitored dosage system. The management of the medication system had improved since the last inspection when numerous discrepancies were identified. Staff had stopped using tipex on the MAR (medication administration record) charts, guidelines for the administration of PRN (as and when necessary medication) had been drawn up, where variable doses of medication could be administered the amounts were being identified making the system auditable and regular staff drug audits were being undertaken and any discrepancies were being investigated. Several of the boxed medicines were audited during this visit and two discrepancies were found both of which were for nighttime medication and signified that staff had signed for medication and not administered it. The manager was aware of the issue and was to address it. There was also controlled medication in the home and this was found to be stored and administered correctly. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 11 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): 14 Residents were able to exercise choice and control over their lives. EVIDENCE: There was evidence in the daily records that residents were able to choose how they spent their time and if they chose to take part in organised activities or not. Residents were able to choose to stay in their rooms and have their meals taken to them if they wished. Residents spoken with stated they were always consulted about what meals they wanted to eat and that they could choose what time to go to bed and get up. Several of the residents continued to handle some of their personal money and two were financially independent. Residents were encouraged to personalise their rooms to their choosing and personal effects were observed in all the bedrooms seen. Standards 12, 13 and 15 were assessed at the last inspection and found to be met. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 12 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): 18 Staff were given written guidelines in relation to adult protection but to ensure they were equipped with the necessary skills and knowledge to recognise and report abuse formal training needed to be undertaken. EVIDENCE: The manager had developed a written handout for all staff in relation to adult protection which gave details of the types of abuse and where staff could report this to if they suspected or witnessed any abuse. Although the handout was quite detailed and easy to understand it was still necessary for all staff to undertake some formal training in relation to adult protection to ensure they were equipped with the necessary skills and knowledge to recognise and report any suspicions or incidents of abuse. There was a copy of the most recent multi agency guidelines for adult protection on site and the home also had their own procedures. The manager needed to ensure that the home’s procedures were in line with the multi agency guidelines. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 13 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): 19, 20, 21, 22, 24, 25, 26 The extensive refurbishment of the home was almost complete and the home offered residents a very good standard of accommodation. EVIDENCE: The home had been undergoing extensive refurbishment and modernisation for a considerable amount of time and this was almost complete. A partial tour of the premises was made and it was found to be safe and well maintained. The home had ample communal space with two large lounges, a conservatory and a new smaller lounge was being developed on the first floor. The two lounges on the ground floor had been refurbished, one had had new furniture and new chairs were on order for the other one. There were plans to replace the conservatory as it was in need of repair. There were extensive grounds to the rear of the home that were very well maintained and accessible to the residents. There were numerous toilets, bathing and showering facilities throughout the home. All bathrooms and some of the toilets had been upgraded and provided Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 14 residents with a variety of facilities many of which allowed for full staff assistance. All bedrooms had en-suite facilities of toilet and wash hand basin and some had floor level showers fitted. The aids and adaptations throughout the home appeared to meet the needs of the residents and these included, shaft lifts, level entrances and exits, grab and hand rails, assisted bathing and toilet facilities, emergency call system and there were mobile hoists on site for use as necessary. The inspector viewed some of the bedrooms and spoke to some of the occupants. The residents spoken with were very happy with the newly refurbished rooms. All bedrooms had en-suite facilities installed, new double glazed windows had been fitted, a new heating system installed and all had new flooring, curtains and linen. All bedrooms were lockable and residents could have keys if they wished. At the time of the inspection the three rooms on the lower ground floor were just being completed one of these had a small lounge area included and another had a small kitchenette installed. At the time of the inspection the home was found to be clean, considering the amount of building work that had been undertaken, hygienic and odour free. The laundry had been refurbished and was appropriately equipped with washing machines with sluice facilities and tumble driers. There was also a newly installed commode pot washer/disinfector in a separate room. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 15 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 Very good staffing levels were being maintained by a stable staff team. Over fifty percent of staff were qualified to NVQ level 2 or the equivalent. The manager needed to ensure that there was documented evidence that all new staff had undertaken appropriate induction training to ensure they were equipped with the necessary skills and knowledge to fulfil their roles. EVIDENCE: Very good staffing levels were being maintained at the home. On the day of the inspection there was a care officer, a senior care assistant and three care assistants on duty in addition to the manager. Also in the home were four domestic assistants, one laundry assistant, cook, two kitchen assistants, administrator and maintenance operative. Several of the staff had worked at the home for a considerable amount of time which was very good for the continuity of care for the residents. All the residents spoken with were very positive in their comments about the staff which included, ‘they are very good’, ‘they are jolly and helpful’ and ‘they are kind and answer the buzzer quickly.’ Recent training undertaken by staff included manual handling, care planning, dementia care videos and handling of medication. Over the last year staff had also had updated training in infection control, health and safety, first aid, fire procedures and food hygiene was ongoing. Thirteen of the twenty two staff had achieved NVQ level 2 or the equivalent and some of these had also done NVQ level 3 giving the home in excess of the required fifty percent of trained staff. The files for the two most recently employed staff were sampled and although the manager stated they had worked with senior staff for the first four weeks Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 16 of their employment there was no documented evidence of any induction training and it could not be established what had been covered during this period. There was evidence detailing they had undertaken some medication training and training in fire procedures but nothing in relation to manual handling or other statutory training. The manager needed to ensure that there was documented evidence that all new staff had completed induction training in line with the specifications laid down by Skills for Care. The recruitment files for two staff recruited from overseas were sampled. Both of the files included application forms, references, photographs, proof of I.D. and proof that they were eligible to work in this country. Only one of the files included a police check from the country of origin. The manager stated she had received the other one but it could not be located on the day of the inspection. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 17 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, 33, 35, 38 The manager ensured the smooth running of the home in a competent manner. The health and safety of the residents and staff were well maintained. EVIDENCE: The manager of the home had recently been registered with the CSCI. She had been employed at the home a little over a year and demonstrated a good knowledge of the residents in her care and the running of a residential home. She had many years experience of caring for older people, is a registered nurse and was undertaking her Registered Manger’s Award which would give her the required qualifications when completed. She was well aware of the shortfalls in the home, for example, the need to develop care planning and risk assessments for the residents and was committed to addressing these. She had been working hard to try and get staff training updated as much of this had lapsed prior to her being employed. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 18 The home had a quality assurance system in place that had been purchased from an outside agency that the manager was working her way through. She was ensuring that all the policies and procedures in the home tied in with the system. The system involved seeking the views of the residents and any other stakeholders in the home including questionnaires and staff meetings. The manager was also looking at ways of further developing the key worker system which would help with the feedback from the residents about the service being provided. The home managed small amounts of personal allowance on behalf of several residents. The records for this were sampled. There was documented evidence of income, which was generally from family members for which they were given receipts, any expenditure made and two staff signatures for any transactions. Receipts were available for all expenditure. All the balances checked were correct. Although the balances of the money held were regularly checked the checks were not documented. It was strongly recommended that any audits were documented and signed by two staff so that if there were any errors it would be clear how far back staff needed to go. Two of the residents were financially independent and several handled small amounts of their own money. Health and safety at the home were well managed. Staff were receiving training in safe working practices and the home was well maintained and safe. The manager demonstrated how staff had to be constantly aware of the dangers of having builders in the home and constantly reminding them of the hazards for the residents. The inspector was informed that the only requirement made following the last inspection in relation to health safety about having evidence on site that the gas boilers had been serviced had been met. Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 19 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 1 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Bryony House DS0000016895.V285157.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(b) (c) Requirement All residents must have care plans that detail how all their current needs in relation to health and welfare are to be met by staff. Previous time scales of 31 May 2005 and 01 January 2006 not met. All residents must have personal risk assessments that detail how any identified risks are to be minimised. Where any challenging behaviours are identified there must be strategies in place for managing these. Previous time scale of 01 January 2006 not met. All residents must have manual handling risk assessments that include details of the actions to be taken by staff in the event of a fall and any other handling methods to be used. Previous time scale of 01 January 2006 not met. All residents must have tissue viability and nutritional DS0000016895.V285157.R01.S.doc Timescale for action 01/05/06 2. OP7 13(4)(b) (c) 01/05/06 3. OP7 13(5) 01/05/06 4. OP8 12(1)(a) 01/05/06 Bryony House Version 5.1 Page 21 5. OP9 13(2) 6. 7. OP18 OP18 13(6) 13(6) 8. OP29 19(1) 9. OP30 18(1)(a) 10. OP31 9(2)(b)(i) screenings. Previous time scale of 01 February 2006 not met. The numbers of tablets remaining in containers must correspond with those received into the home and the amounts administered. All staff must undertake training in adult protection. The manager must ensure that the home’s adult protection procedures are in line with the multi agency guidelines. There must be evidence on site that a police check has been undertaken prior to staff being employed from overseas. The manager must ensure that staff complete induction training in line with the specifications laid down by Skills for Care. The acting manager must complete her Care Manager’s Award. Previous time scale of 31 December 2005 not met. 01/04/06 01/07/06 01/05/06 01/05/06 01/06/06 30/06/06 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. 2. Refer to Standard OP8 OP35 Good Practice Recommendations It is strongly recommended that records of visits by health care professionals are documented separately from the daily records to make them easier to track. It was strongly recommended that audits of resident’s personal money accounts were documented. 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