CARE HOMES FOR OLDER PEOPLE
Colebrook Respite Unit 291 Bosworth Drive Chelmsley Wood Solihull West Midlands B37 5DP Lead Inspector
Jill Brown Unannounced Inspection 14th February 2006 09:50 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 Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Colebrook Respite Unit Address 291 Bosworth Drive Chelmsley Wood Solihull West Midlands B37 5DP 0121 770 6133 0121 770 6144 colebrookdayunit@btconnect.com 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) Family Care Trust (Solihull) Mrs Anne-Marie Yardley Care Home 7 Category(ies) of Dementia - over 65 years of age (7) registration, with number of places Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That the home can accommodate up to 7 older people who also have dementia, on a respite basis. One person of the 7 accommodated at any one time may be between the ages of 55 and 65 years. 31st August 2005 Date of last inspection Brief Description of the Service: Colebrook Respite Centre is part of the Family Care Trust Organisation. They provide a respite service for people with dementia. Respite is usually offered for up to six weeks a year but can be extended depending on circumstances. Most residents are admitted after a planned admission programme however the centre can after consideration provide emergency placements. Six of the beds provided are funded by Solihull Social Services on a block contract and one bed is available for privately funded people. Residents are aged over 65 years and over and have to be mobile independently or walk with a walking aid. All the centres accommodation is at ground floor level and accessible by people with disabilities. Two of the bedrooms have en suite facilities. The centre has an assisted bathing and a separate assisted shower facility. The centre has several communal areas that are shared with the day centre. One of these is a quiet lounge. A day centre facility is also run from the same premises. The company has a minibus, which it uses to and from the day centre and for trips for residents. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a day in February. There were five residents in the respite unit at the time of the inspection and the inspector spoke to three of these residents. Three resident records and three staff records were looked at. Two staff were spoken to as well as the registered manager. A tour of some areas of the building was undertaken. Medication records were looked at. What the service does well:
Staff at the centre showed a good understanding of the needs of residents with dementia and were able to describe in detail the care of a resident chosen at random by the inspector. The Registered Manager was able to describe issues arising from the care of residents whose first language is not English. Daily records held about individual resident’s days were clear, detailed and passed on good information to the next person that had to care for the resident. Residents spend the day with day centre attendees and for the most part showed signs of being well and content. Residents’ personal care needs were attended to. Where residents due to their health needs were agitated there was a determination from staff to understand the concerns of the resident despite the resident’s communication difficulties. Residents were treated with respect and sensitivity. The centre had clearly spent some time planning Valentine’s Day and it was good to see that this went well, with residents dancing, singing love songs and with each resident being given a rose. The centre was clean and fresh and provided a good environment for residents and day centre attendees that like to walk around. The staffing levels in the centre were satisfactory and half of the staff that provided the residential care and support have achieved the NVQ2 in care. It was clear that the in the recruiting of staff the organisation explored gaps in employment and this is good practice as it safe guards residents. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The centre has detailed information for relatives and representatives of residents in its statement of purpose. This information had not been updated to include the changes in the number and size of rooms available for respite, the people that the centre can take and information about the staff. Whilst the assessment and care planning process had improved further detail on moving and handling and the managing of residents’ behaviour would safeguard residents further. The centre needs to include more detail on what help residents need to maintain their personal hygiene so that independence can be maintained. The home needed to record the amount of food residents eat to ensure that residents were kept well. As the records showed that residents were rarely choosing the alternative meal these alternatives needed reviewing. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 7 The home details health concerns in residents files but on some occasions does not record the outcome of these concerns in the same place. The procedures for adult protection and complaints for residents did not include the contact details for the Commission. The Commission must be advised of any event that adversely affects a resident of the centre. A number of minor issues of refurbishment remained outstanding and a lock on an outside shed was needed to safeguard residents. The centre was not able to produce its quality assurance system for the inspector. The Commission had not received the reports of the monthly visits by the organisation’s representative to the residential part of the centre and this requirement remained outstanding. The staff records were not complete; some information on staff was kept at the organisation’s central office. The organisation needs to advise the Commission of arrangements to see these records. Not all residential care staff received regular recorded supervision and this important to safeguard residents. 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. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 Information provided needed improvement to reflect the service offered. The information collected had improved, further improvement on the detail of moving and handling assessments and behaviour was needed to ensure the safety of residents. EVIDENCE: The centre provided the Commission with a statement of purpose subsequent to the inspection this had not been updated as required by the inspection in August. The changes in the number of residents of the centre could accommodate, the changes of accommodation and the age range of residents did not reflect the centre’s registration. The statement of purpose had some gaps in the section on staffing and would benefit from being numbered in line with the index. The complaint procedure must be changed in line with comments made in standard 16. The centre was collecting good information on potential residents and this information should provide good information to set up care plans. Assessments of residents were appropriate to the current needs of the residents. The centre were undertaking assessments of risk in moving and handling of residents and
Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 10 keeping residents’ skin healthy. More detail on the moving and handling assessment including aids and how residents are to be assisted by carers would ensure the safety of residents. Information on resident’s past life was being recorded and this will assist staff in providing a good experience for individual residents. Staff interviewed was able to explain the individual needs of a named resident and demonstrated knowledge of how to respect their privacy and dignity. The manager showed an understanding of the cultural needs of a number of residents and explained the centre’s planning for residents whose first language is not English. All of the residents were within the centre category of registration. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The arrangements for care planning had improved, further detail would ensure that residents’ care needs are consistently met. Arrangements for health care and medication needs were good and this ensures the wellbeing of residents. EVIDENCE: Respite residents had care plans these had improved substantially since the last inspection. Descriptions of how carers are to assist residents with personal hygiene and manage behaviour could be improved. Daily records of residents care were good. These included positive comments about residents, details of activities undertaken, as well as passing on important information to the next member of staff caring for the resident. Health issues and concerns expressed by residents were recorded. For the most part the follow up of these concerns were recorded on the resident’s file and it is recommended that this be done in all situations. Residents were weighed at the beginning and at the end of their stay and it was expected a monthly weight be taken if they stayed longer and this was an improvement on the previous inspection.
Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 12 Residents were showing signs of wellbeing for the most part and their personal care needs were met. Where residents were agitated they were spoken to kindly and patiently with an effort being made to understand the resident’s concern. The system for medication had improved since the last inspection. The centre now ensured that the GP was contacted prior to admission to verify that medication was correct. The amount of medication was recorded on the Medication Administration Record (MAR) and audits were being undertaken of staff competency in administering drugs. Although medication was being accepted in secondary dispenser these now had the names and strengths of the medication. The medication procedure and medicinal cream management were not viewed on this inspection and these requirements were brought forward. Whilst a temperature of the medicinal fridge were recorded a minimum, current and maximum temperature was needed to ensure that medication remained within its product licence. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 The arrangement for activities was good and for meals was satisfactory and this enhances residents’ lives. EVIDENCE: The centre has a programme of activities usually one activity in a morning and one in the afternoon. Both residents and attendees of the day centre can attend. As the day of the inspection fell on St Valentine’s Day the inspector found the centre in midst of celebrations. There was a themed approach to the day with dancing and music. Each resident was given a rose. The centre had photographs of outings and other celebrations displayed on the wall. Residents have a choice of a hot meal and an alternative however the records of choices suggest that residents are not choosing the alternatives and these alternatives should be reviewed to ensure that these represent realistic choices. The amount residents eat should also be recorded so that the nutritional welfare of residents can be monitored. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The arrangements for protecting of residents were good. The complaint procedure needed some adjustment to ensure that complainants find the process easy to use. EVIDENCE: The centre had an adult protection procedure that ensured the safety of residents a sentence about contacting the Commission if an allegation is made is needed. The centre has reclining chairs for residents and people at the day centre that need time with their legs elevated but residents are free to walk when they wish and are assisted to do this in safety. The staffs use a breakaway technique in managing residents that become aggressive and this reflects the frailty of residents. The centre ensures that there is an inventory of resident’s belongings on admission. The centre’s complaint procedure was sent to the Commission subsequent to the inspection. It provided a full explanation of the organisations process for managing complaints however it needs to be in a more accessible form for relatives. The complaint process needs explain that at any stage the complainant can contact the Commission and the Commission’s contact details should be included. Complaints are investigated when needed. A recent complaint from a relative was about the Commission requiring extra safeguards on medication administration.
Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The arrangements for the centre’s environment were good and this ensures residents have comfortable place to stay. EVIDENCE: The residential part of the centre was for the most part clean and fresh. Bedrooms are well decorated but in a minimal style as residents spend generally a few weeks within the centre. Residents are allowed to bring personal items to the centre however in practice this does not always happen and consequently the rooms can look a bit stark. The centre had good facilities with lounges, activity and quiet areas. The number of toileting and assisted bathing facilities were good. Carpets in the centre had improved in cleanliness although in a number of areas problems still remained. A lock on an outside shed was needed to safeguard residents... Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The arrangements for employing, the levels of staff on duty and training of staff appeared satisfactory but clearer records need to be kept to ensure that safety of residents is assured. EVIDENCE: The number of staff on duty was appropriate at the time of the inspection. Staffing level fluctuates with the number of residents having respite at any time. The centre has begun to include the residents in the assessment of dependency for the centre and this is important when determining staffing levels. Half of the staff that work on the residential section of the centre have achieved the NVQ level 2 in care. Staff files were not complete as some information is kept centrally by the organisation. The organisation must advise the Commission of how these are to be made available for inspection. It was clear that appropriate checks but full outcomes of these checks were not available. It was clear that interviews of potential staff included exploration of any gaps in employment and this is good practice. It was clear that staff had undertaken training and this was not reflected in staff files as required and therefore was difficult to audit. A matrix of residential staff training and copies of qualifications was required.
Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 The arrangements for the management of health and safety and residents money were good. However further improvements were required in auditing and staff supervision to ensure a consistent and safe service for residents. EVIDENCE: The registered manager of the respite unit has a NVQ level 2 in care and has achieved the Registered Managers Award. In addition has a Diploma in welfare studies. The manager stated that it is intended to enrol her into the NVQ level 4 in care. The manager has had long experience as an auxiliary nurse and a support worker. The manager has had training both with the organisation and externally in the care of people with dementia. The centre stated that they had audit trails as part of its quality assurance but were unable to produce this at the inspection. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 18 The centre does not manage residents’ money as residents are only in the centre for respite. The records of supervision of staff were poor with several staff not having supervision frequently. Staff records did not show how concerns about staff performance was managed. Subsequent to the inspection the Registered Manager provided dates of intended supervision for all residential care staff. Records had improved since the last inspection. Tippex was not being used on records. The missing person procedure had been altered to include a well person check on return as required. However the record of the representative of the organisations monthly visit to the centre had not been sent to the Commission as required. The centre had looked at the areas of health and safety since the last inspection. The hot lockers are no longer stored in the corridor of the residential area of the centre. Bath temperatures were being recorded prior to residents being given a bath. Fire doors were not wedged open and processes had changed to prevent the need for this. The home had been inspected by the Food Safety Department recently and had received an excellent report. Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 3 3 Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1) Requirement Timescale for action 30/04/06 2 OP3 13(5) 3 OP3 14(2) 4 OP7 15(1&2) 12(2&3) The Centres statement of purpose must be reviewed and revised in line with the appropriate variations. (This remained outstanding since 31/10/05) Moving and handling 30/04/06 assessments must contain clear details of how residents are to be assisted. Information collected on 30/04/06 residents’ behaviour must be in enough detail to assist the risk assessment and care planning. The registered manager must 30/04/06 ensure: Care plans reflect the current needs of residents and clearly inform the care staff on care to be given or action to be taken especially about resident’s behaviour and personal hygiene assistance needed. (This aspect of the requirement remained outstanding since 31/10/05.) All medicinal creams must have recorded details how, where and
DS0000004527.V284823.R01.S.doc 5 OP9 13(2) 30/04/06 Colebrook Respite Unit Version 5.1 Page 21 when it must be applied. (This was not inspected and this requirement was brought forward.) The centre must devise a procedure that reflects good practice and ensure its implementation. (This was not inspected and this requirement was brought forward.) A record of the food eaten by individual residents including amount must be kept for all meals. (This requirement remained outstanding 30/09/05) The centre’s complaint procedure must include information about contacting the Commission and a more accessible version must be produced. The centre’s adult protection procedure must include detail about contacting the Commission. An audit of carpets must be undertaken and action taken to remove staining. The garden shed must have a lock. (These remain outstanding since 31/10/05) The registered manager must produce a protocol to ensure that good infection control procedures are maintained with external laundry. (This was not assessed and was brought forward) The registered provider must supply the Commission with details of how staff records including CRBs can be viewed by inspectors. Staff records must include a
DS0000004527.V284823.R01.S.doc 6 OP15 16(2)(i) 30/04/05 7 OP16 22 30/04/06 8 OP18 37 30/04/06 9 OP19 23(2)(d) 30/06/06 10 OP26 13(3) 30/04/06 11 OP29 Sch 2 30/04/06 12 OP29 Sch 2(4) 31/05/06
Page 22 Colebrook Respite Unit Version 5.1 13 OP30 18(1)(a) 14 15 16 17 OP33 OP36 OP36 OP37 24 18(2) 12(5) 18(1)(a) 37 18 OP37 17(1a,3b) S4(16)26 detailed record of training undertaken and copies of certificates. A matrix of the training residential staff have attended must be sent to the Commission by 07 March 2006. A quality assurance system must be available in the residential part of the centre. All residential care staff must have recorded supervision six times a year. Staff files must be kept that assist the process of performance management. A Copy of the report of the monthly visits by the responsible individual must be sent to the Commission. (This remained outstanding since 31/10/05) The centre must ensure that all records are available for inspection in the manager’s absence. (This was not assessed on this occasion and was brought forward) 07/03/06 31/05/06 30/06/06 14/03/06 31/03/06 31/03/06 Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 23 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 1. 2. Refer to Standard OP9 OP12 OP15 OP21 Good Practice Recommendations Records of the current, maximum and minimum temperature of the fridge must be maintained to ensure medication is stored within its product licence. It is recommended the menus must be reviewed to ensure that choices offered are choices that appeal to residents. It is recommended that the centre develop strategies to assist residents with sight loss at meal times. (This was not assessed on this occasion) It is recommended that the centre consider increase the tiled area around wash hand basins in communal toilets to improve the ease of cleaning. (This remained outstanding) It is recommended that the registered provider consider colour-coding doors to toilets bathrooms and en suites to assist residents. (This remained outstanding) 3. OP22 Colebrook Respite Unit DS0000004527.V284823.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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