Inspection on 08/05/08 for Bryony House

This inspection was carried out on 8th May 2008.

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 04/06/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bryony House 30 Bryony Road Selly Oak Birmingham B29 4BX Lead Inspector Brenda O’Neill Key Unannounced Inspection 8th May 2008 09:00 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.V363844.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.V363844.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.V363844.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 for service users to be accommodated is 35. 2. Date of last inspection 4th June 2007 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 35 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 Service user guide for the home detailed the fees as £492.75 per week and £73.50 per night for respite care. Covered in the fees are a single room, personal care, laundry, all meals and beverages and the activities programme. There is an extra charge for hairdressing, chiropody, newspapers, purchases from the shop and telephone. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate outcomes. Two inspectors carried out this key inspection over one day in May 2008. During the course of the inspection a partial tour of the home was made, three staff files and four files for the people living in the home were sampled as well as other care and health and safety documentation. We spoke with seven of the people living in the home, the manager and four staff members. Part of this inspection included gathering information around safeguarding issues. This involved us looking at specific policies, procedures and records and asking the manager, three staff and some of the people living in the home set questions. Prior to the inspection the manager had completed and returned to the Commission an Annual Quality Assurance Assessment which gave us some additional information about the home. We also sent out some surveys to the people living in the home about the service they receive. Only two of these had been returned at the time of writing this report. The home had not had any formal complaints since the last inspection and none had been lodged with us. Some concerns were raised with us prior to the inspection in relation to how the people living in the home were spoken to and that they were never taken out by staff. There was some evidence seen that staff could address the people living in the home in a child like way and this was brought to the attention of the manager. The people living in the home were taken out by staff if this was requested. What the service does well: The pre admission assessment process ensured the staff knew the needs of the people being admitted. People were able to visit the home before admission to assess the facilities available. Health care needs were being identified by staff and there was generally evidence that this had been followed up promptly. 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. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 6 The menus did not include specific choices but there was a good selection of alternatives available at all meals for the people living in the home. The food records showed that the people living in the home often had an alternative to the meal on the menu. Relationships between the people living in the home and the staff were good they described them to us as ‘good’ and ‘very good’. The rotas showed that there were enough staff on duty throughout the day and night to meet the needs of the people living in the home. Staff had access to a variety of training which ensured they had all the required skills and knowledge to meet the needs of the people living in the home. Recruitment procedures at the home were robust and safeguarded the people living there. The home provided the people living there with a very comfortable and safe environment in which to live. 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. What has improved since the last inspection? What they could do better: Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 7 Care plans needed to be updated as the needs of the people living in the home changed to ensure they received person centred care. To ensure the people living in the home and the staff were not exposed to any unnecessary risks there needed to be management plans in place for any challenging behaviours. Where the use of a hoist was indicated on a manual handling risk assessment the type of hoist and sling size needed to be detailed. This will ensure staff use the correct equipment when moving the people in the home. Tissue viability assessments needed to be completed correctly and management plans put in place where people were deemed to be at risk. The plans in place for meeting people’s nutritional needs must be correct and staff needed to ensure they followed them. This will ensure peoples’ nutritional needs are met. Some improvements were needed to the medication system to ensure it was entirely safe for the people living in the home. 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.V363844.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.V363844.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 two people admitted to the home since the last inspection were sampled. Both files included an application form which included a range of questions for the applicant very much like a self assessment. Areas covered included such things as physical and mental health, medicines and mobility. This was a new document and gave the home some insight into the needs of the individuals. The home then conducted their own assessments which covered all the required areas including, some past history, personal care and well being, communication, diet and weight, mobility and social activities. As at the last inspection we were told these were completed either on the pre Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 10 admission visit day or when staff had gone out to undertake the assessment. It could not be determined when or where these forms had been completed as they were not dated and no venue had been entered. It was recommended at the last inspection that the date and location of the assessments were clearly detailed on the forms. This had not been addressed. Bryony House DS0000016895.V363844.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 needed to be updated as the needs of the people living in the home changed to ensure they received person centred care. Risk assessments needed to be further developed to ensure all identified risks were minimised. Medication management needed to be improved to ensure it was entirely safe for the people living in the home. EVIDENCE: The files for four of the people living in the home were sampled. All the files included assessments of daily 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. Three of the files also included a profile of the individual which gave staff some information about their past history, family and work life and of their hobbies. All the files sampled also included care plans that had been drawn up from the assessment of daily living needs. Three of the individuals were quite Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 12 independent with their personal care and there was little in their care plans. The other individual needed more assistance and this was reflected in her care plan which also detailed what she was able to do for herself. There were some good details in place for staff in relation to the communication needs of one of the people living in the home due to short term memory loss. Another care plan gave details of the needs of one of the people living in the home due to having plaster on her wrist, for example, ‘assistance to put tights on due to plaster on wrist’. When we saw this individual she had had the plaster removed and only had a support on her wrist. The daily records indicated she had the plaster removed over a month earlier. She also had been given a soft ball to use to exercise her wrist this was not in her care plan. Another of the individuals had been in hospital and had had a catheter fitted. Daily records clearly indicated staff were emptying this. His care plan indicated he was quite independent in relation to personal care and a catheter was not mentioned. The manager was advised that care plans must be changed as the needs of the people in the home change so that staff have all the current information available to them. Records showed that one of the people living in the home had some challenging behaviours which had been going on for some time. Professional help had been sought and a reassessment had been undertaken and a new placement was being sought for the individual. However there were no comprehensive management plans in place for staff to follow in relation to the behaviour. The care plan stated ‘needs to be distracted by being involved in activities.’ There was no evidence that this was being done and it was clear from the recordings that this was not an appropriate management plan. Other care plans had some well detailed management plans in place. For example one individual had a falls prevention plan in place that was well detailed, another individual who thought people were talking about him and taking his things had been given keys to both the rooms he used and checks were made with his family when he said things were missing. There was space at the end of the care plans for people to sign to say they agreed with the plans but these had not been completed. There were manual handling risk assessments in place on all the files sampled however where these detailed the use of hoist there was no indication of which hoist was to be used or the size of the sling. The tissue viability assessment and nutritional screening were a combined document. This had not been completed on one of the files. For another person staff had indicated the wrong gender for person which had a bearing on the score. Had the form been completed properly it meant the individual was at risk and needed a corresponding management plan in place. Nutritional needs were generally quite well detailed in the care plans. For example, ‘encourage small attractive meals and snacks are given to encourage appetite’ and ‘to be given a high fibre diet and weight to be monitored two Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 13 weekly’. However for this person there was no indication of the individual receiving a high fibre diet and the manager stated she was not aware that this was necessary. There were weight records but these indicated that the person was not being weighed every two weeks. They did show there had been some weight loss, there was no evidence that this had been followed up. This issue was raised at the last inspection and the manager was advised that a system needed to put in place that ensured any significant weight loss or gain was monitored. Generally weight records were inconsistent for the people living in the home and the gaps could not be explained. The files included professional visit sheets but not all visits by health care professionals were being recorded on these. Visits were often put on daily records and this information would be lost as the records built up and were removed from the files. Health care needs were being identified by staff and there was generally evidence that this had been followed up promptly, for example, one person stayed in bed not feeling well and the G.P. was called the same day. One person’s records indicated they had refused to see a dentist then had agreed and had an appointment. There was evidence that more specialised care was obtained when necessary, for example, psychiatrists. One person’s file indicated they were to be referred for a hearing aid. No evidence of this referral could be found but when we spoke to the person concerned she indicated this had been done. Staff should be more vigilant and ensure all health care referrals and appointments are detailed on the correct record to ensure these can be tracked easily. Medication continued to be administered via a 28 day monitored dosage system. Records included the names of staff authorised to administer medication but there were no sample signatures available. There were photographs of the people living in the home with the MAR (medication administration records) charts. Copies of the most recent prescriptions were being kept so that staff could refer to them. Medication was being acknowledged as received into the home and any remaining balances at the end of the 28 day cycle were being brought forward to the next MAR chart. A sample audit of the medication was undertaken. Some discrepancies were noted in the amounts of the tablets remaining in the home when checked against what had been received and administered. There were also quite a few gaps on the MAR charts where staff had either failed to sign for medication administered or use the appropriate code if it was not given. To address these issues the manager needed to ensure staff drug audits were undertaken before and after drug rounds to ensure staff competence. Quite a number of the people living in the home were self administering some of their medication however there was no evidence that risk assessments had been undertaken to ensure they were able to do this safely. No evidence was seen of any compliance checks being undertaken for those people self administering. There was some controlled medication being administered in the home. The records for this were appropriate. The controlled drug register was being used and two staff were signing this. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 14 We 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 privacy not being upheld. All the bedrooms in the home were of single occupancy and all the people living there 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. Staff did need to be more vigilant about their terminology when recording about the people living in the home, for example, ‘she behaved very well at suppertime at the table’ this sounds very much as if they are referring to a child. Bryony House DS0000016895.V363844.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 adequate. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home. There were activities on offer for the people living in the home if they wished to take part but it was not clear if these met the expectations of all. The people living in the home were able to exercise choice and control over their lives. The meals served in the home generally met with the needs of the people living there. EVIDENCE: No rigid rules or routines were seen during the course of the inspection. People in the home were seen to wander around freely, sit out in the garden, spend time quietly in their rooms, sitting in the lounges and meeting with visitors. There was an activities programme on the notice board and this was also issued to the people living in the home in a monthly newsletter. Regular activities included keep fit, hairdresser visits and exercises. Activities throughout the month included film quiz, animal man, spring fayre, bingo and outside entertainers. Despite this the people living in the home that we spoke with stated there was little going on and they did get bored. It was recommended that the variety and frequency of activities is discussed with the Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 16 people living in the home to ensure people’s social needs are being met. The newsletter also gave the people living in the home updated information about staff and people living there and all birthdays were acknowledged. Care plans included some information about the preferred hobbies of the people living in the home but there was little evidence that staff enabled these. For example, the assessment for one of the people living in the home stated enjoys ‘gardening, reading daily newspapers, listening to radio’. The care plan stated ‘likes to read newspapers on a daily basis, joins in keep fit class and quiz days. Likes to talk about motor bikes.’ There was evidence that the individual had the newspapers on a daily basis but no evidence that he had joined in activities or been in the garden. As at the last inspection staff were not recording all the activities that people were taking part in or being offered. Not all of the people who were living in the home would have been able to take part in the organised activities and some chose to spend a significant amount of time in their bedrooms. There needed to be some evidence of how they were offered some stimulation and of them having some one to one staff time. Many of the daily recordings made by staff stated such things as ‘has been fine’ or ‘no problems’. Daily records needed to give an overview of the individuals’ well being and how they were spending their time to evidence their needs were being met. Visitors were seen to come and go from the home during the course of the inspection. Staff were seen to contact relatives when the health of the people living in the home was causing concern. Daily records showed that visitors were in the home at various times throughout the day and evening. There were no restrictions on individuals going out with families and friends. Some concerns had been raised by a social worker prior to the inspection as she had been told that staff never took any of the people living in the home out. This was discussed with the manager and she stated that if people wished to go out for a walk or to the local shops staff would be made available to escort them. Observations made throughout the day and discussions with the people living in the home showed that they were able to exercise some choice and control over their lives. Care plans gave some details of where individuals were able to make choices. They were able to take part in the organised activities if they wished. They could stay in their rooms and have their meals taken to them. One person declined to have a bath when asked by staff this was respected by them and no pressure was put on her to comply. Some of the people living in the home continued to manage some of their own finances. The bedrooms seen had been personalised to the occupants’ choosing and many had had their own telephones installed. Only one of the people living in the home that was spoken with raised any issues about the quality of the food. This is ongoing with this person and staff do try and address the issues. Other people spoken with described the food as ‘very good’ and ‘o.k.’ The menus did not include specific choices but there was Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 17 a good selection of alternatives available at all meals for the people living in the home. The food records showed that the people living in the home often had an alternative to the meal on the menu. The care plans for the people living in the home generally included any dietary needs, for example, soft diets, small meals, eats little meat. Food records showed that these diets were being catered for. As stated previously the people living in the home could eat in their rooms if they wished and trays were seen being taken around at meal times. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 18 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): 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. Staff were not fully aware of safeguarding issues and this could put the people living in the home at risk. EVIDENCE: The people living in the home were all issued with a service user guide which included the complaints procedure for the home. This needed to have the address and telephone number of the Commission changed to the current ones. The people living in the home that were spoken with during the course of the inspection stated they would go to the staff if they had any issues to raise and that they would sort them out. Issues raised by the people living in the home were generally recorded on daily records. As at the last inspection it was strongly recommended that the home logged all minor concerns or 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. The home had not had any formal complaints since the last inspection and none had been lodged with us. Some concerns were raised with us prior to the inspection in relation to how the people living in the home were spoken to and that they were never taken out by staff. There was some evidence seen that staff could address the people living in the home in a child like way and this Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 19 was brought to the attention of the manager. Staff took out the people living in the home if this was requested. Part of this inspection spent gathering information into issues around safeguarding. This involved us looking at specific policies, procedures and records and asking the manager, three staff and some of the people living in the home set questions. There were appropriate policies and procedures on site in relation to safeguarding and whistle blowing. The home had a copy of the multi agency guidelines for adult protection on site and this detailed all the necessary contact numbers if there was a suspicion or allegation of abuse. The people living in the home that were spoken with appeared comfortable with the staff team and told us they felt able to raise any concerns they had with staff. Staff spoken with did not understand the term safeguarding but did understand what adult protection meant. They told us that if they suspected or saw any incidents that may constitute abuse they would report this to the manager. They were not fully aware of what the whistle blowing policy was or what other points of contact they had for reporting any issues. The training matrix for the home indicated the staff had received training in safeguarding/adult protection. One of those spoken with could not recall the training. Only one of those spoken with was sure the home had policies and procedures in place for safeguarding/adult protection. One stated they had had a questionnaire in relation to whistle blowing but would need this refreshed. The manager needed to ensure that staff were fully aware of the policies and procedures in relation to safeguarding/adult protection and that they are clear about the whistle blowing policy. The training matrix for the home indicated that some of the ancillary staff had undertaken training in prevention of abuse it was strongly recommended that this was extended to all ancillary staff. The manager of the home was fully aware of her responsibilities in relation to safeguarding. When asked how she ensured the procedures were followed she stated by monitoring staff practice, via staff supervision and information from surveys conducted with the people living in the home. The recruitment procedures in the home were robust and safeguarded the people living there. Staff spoken with were aware that a police check had been undertaken on them prior to them commencing work at the home and that references had been obtained. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 20 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, 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 undertaken. It was found to be safe, well maintained and very comfortable. The home had ample communal space with two large lounges, a conservatory and a smaller lounge on the first floor. Dining space was adequate. The conservatory had been virtually rebuilt since the last inspection. It now has UPVC window frames and new furniture and flooring had been purchased. All the other communal areas were well furnished and nicely decorated. There were extensive grounds to the rear of the home that were very well maintained Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 21 and accessible to the people living in the home. Some of the people living in the home were sitting out in the garden on the day of the inspection. There were numerous toilets, bathing and showering facilities throughout the home. All bathrooms and 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 that had been redesigned and refurbished since the last inspection. These now allowed better access for people with walking aids and allowed for staff assistance. They were also much better for ensuring the privacy of the people living in the home. All bedrooms had en-suite facilities of toilet and wash hand basin and some had floor level showers fitted. 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 hygienic on the day of the inspection. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 22 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 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 but they still maintained a core group of staff that had worked there for a considerable amount of time. The rotas showed that there were always four care staff on duty throughout the waking day and a care officer. There were three staff on every night one of whom was a senior. The manager’s hours were supernumery to the care rota. At times staffing levels would be increased, for example, when any of the people living in the home were really ill and needed more staff time. The home also employed laundry, domestic, catering administrative and maintenance staff. Relationships between the people living in the home and the staff were good. People living in the home described staff as ‘good’ and ‘very good’. Staff spoken with stated that team working in the home was good, manager’s were approachable and would help out when needed. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 23 The recruitment files for three staff recruited to the home since the last key inspection were sampled. These showed that all the required checks had been undertaken prior to the staff commencing work at the home including, two written references, POVA first checks and CRBs. Prior to recruitment prospective employees were asked to complete a skills scan. This gave the manager a good overview of what skills and knowledge applicants had and any shortfalls that needed to be addressed. All new staff undertook induction training in line with the specifications laid down by Skills for Care and evidence of this was seen on their files. An outside organisation had undertaken a training needs analysis for the home which identified staff as needing training in dementia care, manual handling, and basic food hygiene. The manager had scheduled these courses to be undertaken throughout the year. It was noted on the training matrix for the home that several staff had not undertaken infection control training and it was recommended that this be included in the training schedule. As mentioned previously although staff had undertaken training in safeguarding issues the manager needed to ensure that staff were fully aware of the policies and procedures in relation to safeguarding/adult protection and that they were clear about the whistle blowing policy. It was also recommended that all ancillary staff undertake training in safeguarding issues as they all have contact with the people living in the home. The AQAA and the training matrix showed that fifteen of the seventeen staff employed at the home had NVQ level 2 and some also had NVQ level 3. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 24 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 manager of the home had many years experience of caring for older people, was a registered nurse and also had the Registered Manger’s Award. Throughout the inspection she demonstrated a good knowledge of the needs of the people living in the home. She was very receptive to the findings of the inspection and committed to meeting any requirements made. The main issues raised at this inspection were the need for more robust risk assessments and Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 25 for care plans to be updated as the needs of the people living in the home changed. As at the last inspection there was a quality assurance system in place at the home. Audits of the service were undertaken against the National Minimum Standards and surveys were sent out to the people living in the home and their relatives covering topics such as food and activities. The quality of the food was audited after every meal and the comments made by the people living in the home recorded. There was no system in place to analyse the information gathered from the audits and surveys so that a development plan for the home could be drawn up. The manager was looking into this at the time of the inspection. The home continued to manage some money on behalf of some of the people living in the home. The records for this were sampled and were found to be appropriate. Money was kept in the safe in the main office and was not accessible when the administrative staff had gone home. The manager stated there was a system in place to ensure people had access to money out of office hours. The manager told us that she audits the system with the administrator on a regular basis. Health and safety in the home was well managed. Staff received training in safe working practices and the home was well maintained and safe. The AQAA showed that the equipment used in the home was regularly serviced. The records for the in house checks on the fire system were all up to date and fire drills were carried out as required. The home were notifying the Commission of accidents in the home however it was noted in the daily records that there had been some incidents of challenging behaviour which also needed to be notified. This will assure the Commission that situations are being managed appropriately. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 26 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X 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 X 2 X 3 X X 2 Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 27 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(2)(c) Requirement Care plans must be updated as the needs of the people living in the home change. This will ensure people receive person centred care. There must be management plans in place for staff to follow for any challenging behaviours. This will ensure the people living in the home and the staff are not exposed to any necessary risks. 3. OP7 13(5) Where the use of a hoist is indicated on a manual handling risk assessment the type of hoist and sling size must be detailed. (Time scale of 30/07/07 not met.) This will ensure staff use the correct equipment when moving the people in the home. 4. OP8 12(1)(a) Tissue viability assessments must be completed correctly and management plans put in place where people are deemed to be DS0000016895.V363844.R01.S.doc Timescale for action 30/06/08 2. OP7 13(4)(b) (c) 30/06/08 30/06/08 30/06/08 Bryony House Version 5.2 Page 28 at risk. The plans in place for meeting people’s nutritional needs must be correct and staff must ensure they follow them. 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. (Previous time scale of 16/07/07 not met.) 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. (Previous time scale of 16/07/07 not met) There must be records of compliance checks being undertaken for those people who are self administering their medication. This will ensure individuals are able to administer their medication safely. Medication must be signed for as it is administered. When medication is not administered the appropriate code must be entered on the MAR chart. Any discrepancies noted in the amounts of the tablets remaining in the home when checked against what has been received and administered must be fully Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 29 5. OP8 12(1)(a) 30/06/08 6. OP9 13(2) 30/06/08 7. OP9 13(2) 30/06/08 investigated. This will ensure the people living in the home receive their medication as prescribed. 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 OP3 Good Practice Recommendations Pre admission assessments should include 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. Care plans should include evidence that the people living in the home have been consulted about them. This will ensure that their care is delivered in a way that suits them. 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 sample of staff signatures with the MAR charts so that it can be determined who has administered the medication. The manager should ensure staff drug audits are undertaken before and after drug rounds to ensure staff competence. This will ensure medication is administered safely. 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 range and frequency of the activities available in the DS0000016895.V363844.R01.S.doc Version 5.2 Page 30 2. OP5 3. OP7 4. OP8 5. 6. OP9 OP9 7. 8. 9. OP12 OP12 OP12 Bryony House 10. OP16 11. OP18 12. OP33 13. OP38 home should be discussed with the people living there to ensure they meet their social needs. It is strongly recommended that the home logs all concerns and 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 registered manager should ensure all staff are fully aware of the policies and procedures in relation to safeguarding/adult protection and that they have a clear understanding of the whistle blowing policy. This will ensure the people living in the home are safe guarded. The home should have a development plan in place based on the quality audits that details how the service is to be improved. This will ensure the service offered to the people living in the home is continuously improved. The Commission should be notified of any incidents in the home that affect the well being of the people there. This will assure the Commission that incidents are managed in the best interests of the people living in the home. Bryony House DS0000016895.V363844.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V363844.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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