Inspection on 04/06/07 for Bryony House

This inspection was carried out on 4th June 2007.

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 30/11/06

Bryony House 17/03/06

Bryony House 16/11/05

Bryony House 22/02/05

Bryony House 26/08/04

Bryony House 20/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

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 Key Unannounced Inspection 4th June 2007 08:20 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.V334642.R01.S.doc Version 5.2 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.V334642.R01.S.doc Version 5.2 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 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care with nursing and accommodation for service users of both sexes whose primary care needs on admission to the home are:- OP - old age not falling within any other category. The maximum number of service users to be accommodated is 35. 2. Date of last inspection 30th November 2006 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. Accommodation for the people living in the home is situated on all floors of the home. There are toilets and assisted 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 has been 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. The fees at the home are £478.49 per week. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over one day in June 2007. During the course of the inspection a partial tour of the home was made, one staff file and five files for the people living in the home were sampled as well as other care and health and safety documentation. The inspectors had lunch with the people living in the home, spoke with seven of them, the manager and four staff members. Prior to the inspection a completed pre inspection questionnaire had been returned to the Commission that gave additional information about the home. The home had not had any formal complaints. Some concerns had been raised with the Commission just before the inspection. Some of the concerns were in relation to employment issues which are not within the remit of the Commission to look into. Other concerns were in relation to the care practices on nights at the home and what the manager at the home had done about this. The Commission had received information from the manager that some disciplinary action had been taken at the home resulting in a staff member being dismissed. The concerns were discussed with the manager and she confirmed there had been some issues over care practices at night and she had managed this under the disciplinary process and was preparing a referral to the POVA register. The issues could have been deemed as adult protection and the manager was reminded that any adult protection issues must be referred to Social Care and Health and they will decide how to proceed with the investigation. What the service does well: People wanting to live in the home could visit prior to admission to assess the facilities available. There was evidence on the daily records that the health care needs of the people living in the home were being identified by staff and followed up. The medication system was well managed and ensured the people living in the home received their medication as prescribed. There were no rigid rules or routines in the home and the people spoken with confirmed they could spend their time as they chose. There was a programme of activities available in the home on the notice board and the people living in the home were also notified of these in the monthly newsletter. The newsletter also kept them informed of new people admitted to the home, forthcoming birthdays and any information in relation to staffing. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 6 There were no restrictions on visitors to the home during daytime hours and they were seen to come and go throughout the course of the inspection. The people living in the home were encouraged and enabled to make decisions and exercise choice and control over their lives. The menus at the home were varied and nutritious and although there were no stated choices at lunchtime there was an extensive list of alternatives available for the people living in the home to choose from. It was evident from the food records being kept that alternatives to the main menu were often served. There was a fairly stable staff team at the home some of them had worked there for a long time which was good for the continuity of care of the people living in the home. The people living in the home made some very positive comments about the staff team and friendly relationships were evident. Staff were well trained and worked well as a team. The staff spoken with were very knowledgeable about the individual needs of the people living in the home. The manager ensured the smooth running of the home in a competent manner. The health and safety of the people living in the home and the staff were well managed. The home provided the people living there with a very good standard of comfortable accommodation. What has improved since the last inspection? A comprehensive assessment of need was being undertaken for all the people wanting to go and live in the home to ensure the staff could meet the identified needs. The systems in place for care planning and risk assessments had improved. A lot of work had been undertaken to improve the care files since the last inspection. All the files included a detailed assessment of daily living needs that identified the individuals’ needs and in most cases a care plan had been drawn up from the assessment. Further improvements were needed in some areas. Staff were respecting the privacy of the people living in the home more effectively. The issue raised at the last inspection in relation to some of the people living in the home being wary of raising issues seemed to have been resolved. Daily records evidenced that they were raising issues and these were being addressed. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 7 New staff were undertaking induction training in line with the specifications laid down by Skills for Care to ensure they were equipped with all the necessary skills and knowledge to care for the people living in the home. The manager had completed the Registered Manager’s Award giving her all the required qualifications. 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. The summary of this inspection report can be made available in other formats on request. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 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 Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre admission assessment process ensured the staff at the home knew the needs of people being admitted and could make an informed decision as to whether the home could meet their needs. People were able to visit the home prior to admission to assess the facilities available. EVIDENCE: The files for three people recently admitted to the home were sampled. All the files included a comprehensive assessment of the individuals’ needs which covered all the required areas. These included some past history, personal care and well being, communication, diet and weight, mobility and social activities. The manager stated these were completed on the pre admission visit and that if people did not wish to visit then she would go out and complete the assessments. It was difficult to determine from the assessment forms when they had actually been completed. They had a space for admission date and another space for date but no indication of what date this was. On Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 10 two of the forms the admission date differed from that given on the pre inspection questionnaire, the other date was only completed on one form and appeared to have no relevance. This was pointed out to the manager and it was recommended that the date and location of the assessments are clearly detailed on the forms. It was also recommended to the manager that some records were made of pre admission visits to the home as to how the day had gone and if any issues or difficulties had been encountered by the individual or the staff and how these were to be overcome on admission. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments needed to be further developed to ensure they included sufficient detail to enable the needs of the people living in the home to be met and ensure all identified risks were minimised. The medication system was well managed and safe. EVIDENCE: The files for five people living in the home were sampled. Three of the people had recently been admitted to the home, one had been living there for many years and the other for two years. It was evident that a lot of work had been undertaken to improve the care files since the last inspection. All the files included a detailed assessment of daily living needs that identified the individuals’ needs and in most instances where they required help, what they were able to do for themselves and their likes dislikes and preferences. The care plans were drawn up from the assessment of daily living needs. Two of the files sampled had no care plans. The manager stated these were the Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 12 only two that had not been done. Although the individuals concerned were fairly independent and there were quite a lot of information in their assessments and their needs had been identified they still required care plans so that staff were aware of how they were to meet their needs. Also since admission to the home some needs had changed, for example, from the daily records it was evident one of the individuals was reluctant to accept assistance with personal care there was no detail of how this was being addressed. The manager did comment she thought this might be due to the individual being male and not wanting personal care from female carers. This was being tested on the day of the inspection as there was a male agency carer on duty. Another assessment detailed that the person was an enthusiastic reader, devoted to crosswords and word puzzles and avid newspaper reader but there was no detail anywhere of how these needs were to be met. The other three files sampled did include care plans. The detail in these was variable. For example, one file included a very detailed plan for staff of the indicators of a possible seizure and what they should do, there was good detail about an individuals’ difficulty with ongoing urine infections and how staff were to try and avoid this and it was clear from the care plans the areas where people were independent and required no help. However much more detail was needed in some areas as the statements were very general and did not detail how staff were to meet the identified need. For example, ‘regular night checks’ and ‘enable to maintain contact with family and friends’. There were also some statements which did not appear to have any relevance and did not relate to the assessment documentation for example, ‘encourage to drink more’, ‘encourage to mix with other residents’ and ‘allergic to all seafood’ apparently the individual was not allergic to sea food and did eat fish with no adverse reactions. The manager needed to ensure the care plans were further developed so that there were details of how staff were to meet any identified needs. Risk assessments for the people living in the home had been further developed. All the files sampled included manual handling risk assessments. These were generally appropriate but where a hoist had been identified as needed the type of hoist and sling size needed to be detailed. Nutritional screenings and tissue viability assessments had also been undertaken for the people living in the home. It was noted that one of the tissue viability assessments had not been fully completed and this could have had a bearing on the outcome of the assessment. Also two of the nutritional screenings did not reflect information on the assessments that two of the individuals had lost weight and this would have had a bearing on the outcome of the assessment. It was also evident from one of the weight record charts that one of the individuals had lost weight since being in the home and this had not been updated on the nutritional screening and no action had been taken to monitor this weight loss. This was discussed with the manager and a system needed to put in place that ensured any significant weight loss or gain was monitored. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 13 Only one of the files sampled included any personal risk assessments and as stated above these were in relation to seizures and urine infections. The people living in the home needed to have risk assessments in place that detailed how staff were to minimise any identified risks, for example, behaviours that may be seen as challenging and visual impairments There was evidence on the daily records that health care needs were being identified by staff and followed up, for example, one individual had complained of their ear hurting and the G.P. was called it was then recorded that the individual had refused to see the G.P. However another recording stated that one of the people living in the home had a broken tooth and needed to see the dentist but there was no mention of the dentist being called. When discussed with the manager she stated this person had refused to see the dentist, this needed to be recorded. Another entry in the daily records stated that a urine specimen had been collected for a suspected urine infection but there was no mention of the outcome of this. The files sampled did include a separate sheet for recording visits from health care professionals but in most cases these were not being used. One of the people living in the home had been assessed for incontinence aids, this was on the professional visit sheet, but this person had also been referred to the G.P., seen the optician and the dentist. Two of these were detailed on the daily records and the other was only evident as there was a prescription on file from the optician. As at the last inspection it was strongly recommended that all visits by health care professionals were documented separately from the daily records to make them easier to track. If this is not done information quickly gets lost amongst numerous daily record sheets. Medication continued to be administered via a 28 day monitored dosage system which was well managed. Medication had been booked in and acknowledged as being received and administered appropriately. Copies of prescriptions were being kept and there were photographs of the people living in the home with their MAR (medication administration records). Controlled medication was being recorded and administered appropriately. One of the people whose medication was audited was self administering however there was no evidence of a risk assessment being undertaken for this or any compliance checks being carried out. For another person their partner was administering their eye drops again there was no evidence of any risk assessment for this. Some issues were raised at the last inspection in relation to the privacy of the people living in the home, staff not always knocking bedroom doors and toilet doors being left open. These issues had been addressed at the time of this inspection. The inspectors spoke to some of the people living in the home who chose to spend a lot of time of their bedrooms and staff respected this. The individuals spoken with did not raise any issues in relation to their rights to Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 14 privacy not being upheld. All the bedrooms in the home were of single occupancy and all residents could have keys to their rooms if they wished. There were several areas in the home where individuals could meet their visitors in private if they wished. There was a telephone for the use of the people living in the home in the conservatory and some people had their own telephones in the bedrooms. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home and there were activities on offer for the people living in the home if they wished to take part. The people living in the home were able to exercise choice and control over their lives. The meals served in the home met with the needs of the people living there. EVIDENCE: There were no rigid rules or routines in the home and the people spoken with spoken with confirmed they could spend their time as they chose. There was a programme of activities available in the home on the notice board and the people living in the home were also notified of these in the monthly newsletter. The newsletter for June 2007 detailed activities including, a quiz, friends coffee afternoon, bingo, beetle drive and outside entertainers coming into the home. There were also regular keep fit and exercise sessions. The hairdresser visited the home twice weekly. Birthdays were celebrated and these were detailed in the newsletter. There was evidence in the newsletter that the activities did vary, for example, there had recently been a garden party, someone had visited from the national history lecture service and there was concert planned for July. One of the people living in the home was seen walking around the Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 16 extensive gardens and others stated they liked sitting out in the garden. As at the last inspection staff were documenting some of the activities that individuals were taking part in but not all. This needed to be done to evidence the social needs of the people living in the home were being met. It was also noted that some of the people living in the home chose to spend a significant amount of time in their bedrooms. There also needed to be evidence that these individuals and those who could not or did not want to take part in group activities were given one to one time. This was discussed with the manager and she was hoping this would improve as the key worker system developed. There were no restrictions on visitors to the home during daytime hours and they were seen to come and go throughout the course of the inspection. Daily records evidenced when the people living there had visitors and that some of them were taken out by relatives and friends. The daily records provided some evidence that the people living in the home were able to choose how they spent their time and if they chose to take part in organised activities or not. They were able to choose to stay in their rooms and have their meals taken to them if they wished. The people living in the home that were spoken with stated they were always consulted about what meals they wanted to eat and staff were seen going around asking about their food choices during the inspection. People could choose what time to go to bed and get up. The daily living needs assessments detailed how independent the individuals living in the home were and where they were able to make choices. Some of the people living in the home continued to handle some of their personal money and one was financially independent. Bedrooms were personalised to the occupants choosing and personal effects were observed in all the bedrooms seen. The menus at the home were varied and nutritious and although there were no stated choices at lunchtime there was an extensive list of alternatives available for the people living in the home to choose from. It was evident from the food records being kept that alternatives to the main menu were often served. There was evidence on the daily records that staff would offer several alternatives at the same meal if someone was unhappy with what was served to them. One of the people living in the home chose to have just vegetables at lunchtime the majority of the time and this was respected by staff. The inspectors had lunch with the people living in the home. The meal was well cooked and presented. Vegetables were in tureens on the tables for people to help themselves to and there were a variety of sauces available. Staff were available to offer assistance where required. An issue raised at the last inspection was in relation to luke warm food being served this issue was still ongoing. The lunch and pudding served to the inspectors was only just warm. As it was a very short distance from the kitchen to the dining room the manager could not understand how this was happening and was to explore the issue. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home did receive a copy of the complaints procedure and were confident enough to raise any concerns they may have. It could not be guaranteed that the people living in the home were safe guarded as adult protection issues were not always appropriately reported. EVIDENCE: The complaints procedure had been viewed at previous inspections and found to be appropriate and all the people received a copy when admitted to the home. An issue was raised at the last inspection that some of the people living in the home were wary of raising issues with staff. This appeared to have been addressed. The people living in the home that were spoken with were satisfied with the service they were receiving and their relationships with staff were good. Any issues being raised by the people living in the home were being detailed in the daily records and there were several entries to this effect. For example, one of the people living in the home had had some clothes go missing when going to the laundry. This had been addressed by putting a specific system in place for this person, another entry detailed some C.Ds going missing from a small lounge area, this was in the process of being followed up and the person concerned had been given a key for the room. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 18 It was strongly recommended that the home logged all complaints made by the people living in the home in the home’s complaints log and that details of any investigations and actions taken were maintained. There had been no formal complaints lodged with the home since the last inspection. Some concerns had been raised with the Commission just before the inspection. Some of the concerns were in relation to employment issues which are not within the remit of the Commission to look into. Other concerns were in relation to the care practices on nights at the home and what the manager at the home had done about this. The Commission had received information from the manager that some disciplinary action had been taken at the home resulting in a staff member being dismissed. The concerns were discussed with the manager and she confirmed there had been some issues over care practices at night and she had managed this under the disciplinary process and was preparing a referral to the POVA register. The issues could have been deemed as adult protection and the manager was reminded that any adult protection issues must be referred to Social Care and Health and they will decide how to proceed with the investigation. The adult protection procedures were not viewed at this inspection as they had been seen at previous inspections. Staff had received training in adult protection issues. It was evident when talking to staff about challenging behaviours that they were aware of how to manage these so that they did not escalate. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided the people living there with a very good standard of comfortable accommodation. EVIDENCE: A partial tour of the home was carried out during which some bedrooms were sampled. There had been no changes to the layout of the home since the last inspection. The home was safe and well maintained. The home had ample communal space with two large lounges, a conservatory and a smaller lounge on the first floor. Dining space was adequate. All the communal areas were well furnished and nicely decorated. There were plans to replace the conservatory in the near future. There were extensive grounds to the rear of the home that were very well maintained and accessible to the people living in the home. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 20 There were numerous toilets, bathing and showering facilities throughout the home. All bathrooms and some of the toilets had been upgraded and provided the people living in the home with a variety of facilities many of which allowed for full staff assistance. There were two toilets on the ground floor of the home which were directly opposite the lounge. These toilets were used regularly and some issues were raised about the space available in these for people who had walking aids or who required staff assistance. There were also some issues raised with the inspectors about the difficulty of assuring the privacy of the people using these toilets. It was strongly recommended that ways of altering the design of these toilets were explored. 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 people living in the home 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 bedrooms seen during the course of the inspection were very comfortable, nicely furnished and decorated. The home was able to accommodate some couples allowing for them to share a bedroom and have some lounge space. All bedrooms were lockable and the occupants could have keys if they wished. All the people living in the home that were spoken with were very happy with their rooms and were very comfortable. The home was clean and odour free and there were appropriate systems in place for the disposal of clinical waste. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were being maintained by a well trained, fairly stable staff team who were able to meet the needs of the people living in the home. Recruitment procedures were robust and safe guarded the people living in the home. EVIDENCE: There had been some staff turnover at the home since the last inspection but the home retained a core group of staff that had worked there for a considerable amount of time which was good for the continuity of care of the people living in the home. Maintaining adequate staffing levels was proving problematic as the manager was having difficulty filling vacant posts with suitable staff. Wherever possible there were four care staff on duty throughout the waking day one of these would be a senior care assistant plus a care officer. On occasions the levels dropped to three and then the care officers helped out on the floor of the home. Wherever possible the home used agency staff to fill the gaps in the rota and there were agency staff on duty on the day of the inspection. Discussions with staff confirmed that senior staff did all they could to cover any gaps in the rotas. The home was advertising to fill the vacant posts however the standard of some of the applications were unacceptable and Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 22 samples of these were shown to the inspectors. There were always three night staff on duty and the home also employed domestic, catering, laundry and maintenance workers. The staff spoken with during the inspection stated that staff worked well as a team and that there were no issues with the management of the home. Some of the concerns raised with the Commission prior to the inspection were in relation to staff being abused by some of the people living in the home. Staff spoken with did not see any of the people living in the home as particularly challenging although some displayed some behaviours at particular times, for example, meal times. The staff spoken with described how they managed these behaviours quite competently. The staff spoken with were very knowledgeable about the individual needs of the people living in the home. Only one new staff member had been employed since the last inspection. All the appropriate documentation was in place including completed application form, two written references, POVA first check and CRB. The person in question had a specific type of visa which may have limited the hours they could work. This was pointed out to the manager who contacted the person during the course of the inspection and asked for clarification of the entitlement to work to be brought into the home. New staff were undertaking induction training in line with the specifications laid down by Skills for Care. The pre inspection questionnaire detailed that seventy five percent of the staff employed at the home had NVQ level 2 or the equivalent and some of those also had NVQ level 3 which is to be commended. Staff spoken with stated that they received the required training on an ongoing basis. The training matrix for home evidenced that staff had undertaken all the required regulatory training including, fire procedures, manual handling, protection of vulnerable adults and health and safety. Staff administering medication had undertaken training in this topic. Some staff had also undertaken training in care planning. The pre inspection questionnaire detailed planned future training as first aid, dementia care and key working. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager ensured the smooth running of the home in a competent manner. The health and safety of the people living in the home and the staff were well managed. EVIDENCE: The registered manager demonstrated a good knowledge of the needs of the people living in the home and the running of a residential home. She had many years experience of caring for older people, was a registered nurse and had achieved the Registered Manger’s Award since the last inspection. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 24 The home had few requirements following the last inspection and these had either been met or partially met. Tasks within the home were being appropriately delegated to other senior staff members. The home had a quality assurance system in place and the manager was undertaking the audits however the home did not have a development plan based on the findings of the audits. This was needed to show how the service was to be improved for the people living in the home. Group meetings for the people living in the home were not felt to be appropriate however they were surveyed about specific topics, for example, food and activities to get their views. Stakeholder surveys were also distributed on a regular basis. There were also numerous in house audits including, maintenance, water temperatures and staff training. The findings from all the questionnaires and audits needed to be incorporated into the annual development plan to ensure any shortfalls were rectified. The home was managing money on behalf of some of the people living in the home. 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. The issue raised at the last inspection that the hairdresser should sign for any money received from the home had been addressed. One of the people living in the home continued to manage their own financial affairs and others managed some of their money. The manager was satisfied that the people living in the home were getting the money they were entitled to. Health and safety in the home was well managed. Staff received training in safe working practices and the home was well maintained and safe. All the in house checks on the fire system were up to date and fire drills were generally carried out regularly. It was noted that the last recorded fire drill was 31/10/06 which meant this was now over due. There was an up to date fire risk assessment in the home however it was noted that this was not the most recent version available. It was recommended that the fire officer was contacted to ensure this document still complied with the regulations. The water system was regularly checked for the prevention of legionella. Accident and incident recording and reporting were appropriate. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 25 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 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 3 X 3 X 2 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 X 2 X 3 X X 2 Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 27 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 the people living in the home 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 31/05/05, 01/01/06 and 01/05/06 not met. time scales of 01/02/07 partially met.) Care plans must include evidence that the people living in the home have been consulted about them and that they are reviewed monthly. This will ensure the people living in the home receive person centred care in a way suited to them. All the people living in the home must have personal risk assessments that detail how any identified risks are to be minimised. (Previous time scales of 01/01/06 01/05/06 and 01/01/07 not met.) This will ensure the people living in the home are not exposed to any necessary risks. Where the use of a hoist is indicated on a manual handling risk assessment the type of hoist DS0000016895.V334642.R01.S.doc Timescale for action 30/07/07 2. OP7 13(4)(b) (c) 30/07/07 3. OP7 13(5) 30/07/07 Bryony House Version 5.2 Page 28 4. OP8 12(1)(a) and sling size must be detailed. This will ensure staff use the correct equipment when moving the people in the home. All the people living in the home must have: Tissue viability assessments that clearly identify when a person may be at risk. Nutritional screenings that have a corresponding management plan for anyone deemed as being at risk. (Previous time scales of 01/02/06 and 01/05/06 not met. Time scale of 01/02/07 partially met.) This will ensure the people living in the home have their needs met. There must be a system in place to ensure any significant weight loss or weight gain is monitored. This will ensure the nutritional needs of the people living in the home are met. Risk assessments must be undertaken for any of the people living in the home that are self administering their medication or where another individual living in the home is administering their medication. This will ensure individuals are able to administer their medication safely. Any issues that could be deemed as adult protection must be referred to Social Care and Health. This will ensure the people living in the home are safe guarded. The home must have a development plan in place based on the quality audits that details DS0000016895.V334642.R01.S.doc 30/07/07 5. OP8 12(1)(a) 16/07/07 6. OP9 13(2) 16/07/07 7. OP18 13(6) 16/07/07 8. OP33 24(2) 31/08/07 Bryony House Version 5.2 Page 29 9. OP38 23(4)(e) how the service is to be improved. This will ensure the service offered to the people living in the home is continuously improved. There must be evidence that fire 16/07/07 drills are carried out every six months. This will enhance the safety of the people living in the home. Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 30 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. 3. Refer to Standard OP3 OP5 OP8 Good Practice Recommendations Pre admission assessments should include the date the date they were completed and the venue. This will evidence they have been completed prior to admission. There should be a record made that gives an overview of pre admission visits made to the home that details any difficulties or issues that have been encountered. It is strongly recommended that all visits by health care professionals are documented separately from the daily records to make them easier to track. If this is not done information quickly gets lost amongst numerous daily record sheets. There should be evidence that the people living in the home that do not want to take part in organised activities are given one to one time. A record should be maintained of all the activities people living in the home take part in to evidence their social needs are being met. The temperature of the food being served to the people in the home should be explored to ensure it is acceptable to them. It is strongly recommended that the home logs all complaints made by the people living in the home in the home’s complaints log and that details of any investigations and actions taken are maintained. The two toilets on the ground floor should be redesigned to ensure privacy and easy access for the people living in the home. It is recommended that the manager contact the fire officer to ensure they have the most up to date version of the fire risk assessment for the home. 4. 5. 6. 7. OP12 OP12 OP15 OP16 8. 9. OP21 OP38 Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Bryony House DS0000016895.V334642.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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