Inspection on 13/02/06 for Le Brun House

This inspection was carried out on 13th February 2006.

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

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

Other inspections for this house

Le Brun House 11/03/09

Le Brun House 28/03/08

Le Brun House 15/05/07

Le Brun House 28/06/06

Le Brun House 10/05/05

Le Brun House 29/10/04

Le Brun House 01/06/04

Le Brun House 07/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Le Brun House 9 Prideaux Road Eastbourne East Sussex BN21 2NW Lead Inspector Angela Gunning Announced Inspection 13th February 2006 10:00 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 Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 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. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Le Brun House Address 9 Prideaux Road Eastbourne East Sussex BN21 2NW 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) 01323 734447 Mrs Ilona Austen Hellen Spicer Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is fifteen (15) That service users are aged sixty-five (65) years or over on admission. Date of last inspection 10th May 2005 Brief Description of the Service: Le Brun House is a care home registered to provide accomodation and care for fifteen (15) older people. The home is a detached house that has recently been extended to provide 5 additional single bedrooms with en-suite facilities and increase the communal facilities to include a conservatory and a large dining/lounge area. Currently registered with the CSCI there are 15 single bedrooms of which 2 are on the ground floor, 7 on the first floor and 6 on the second floor. 12 bedrooms have en-suite facilites of which 6 have shower facilites. The home is situated approxiamately one mile from Eastbourne town centre, with a main bus route within easy walking distance. There is a passenger lift to access the first and second floor accomodation. The home provides a lounge at the front of the house and a seperate dining room. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 8.5 hours on 13th February 2006 with one Inspector and one Regulation Manager. This is the second inspection of this year and therefore this report should be read in conjunction with the report from the inspection carried out on 10th May 2005. The purpose of this inspection was to assess compliance with the requirements of the previous inspection, to monitor care practices at the home and to assess the progress made to in relation to the application to vary the conditions of registration to increase the number of places to 20 and to care for service users with a dementia type illness. All parts of the environment were inspected, including the communal areas, the bedrooms and the kitchen. Three care plans and three staff records were examined. Several people were spoken to, including 6 out of the 12 residents accommodated, the Manager, the Provider, the cook and three care assistants. The Provider has applied to the CSCI for a change to the homes registration category to care for people with a dementia type illness and is working towards meeting the standards required to care for this group of people. What the service does well: What has improved since the last inspection? The extension at Le Brun House has improved the communal living space for service users. The home has a new emergency call bell system that is in working order and accessible to service users. The kitchen has been refurbished to improve facilities working conditions for food preparation. A Soap and towels have been provided provided in the laundry room for hand washing to meet infection control standards. In-house training has been provided to increase staff knowledge and understanding of Adult Protection issues and the Provider and Manager are fully aware of the East Sussex, Brighton and Hove Policy and Procedures for the Protection of Vulnerable Adults. This resulted in the management responding positively to two recent Adult Protection investigations. There have Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 6 been positive efforts made to ensure staff receive National Vocational Training in Care. 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. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The pre-admission assessment process does not obtain all necessary information to ensure that people’s health and welfare needs can be met. EVIDENCE: The Manager or the provider carry out a pre-admission and use a preadmission assessment form to obtain information about the care needs of service users. However, it was noted that the assessment information gathered was not in sufficient detail to ensure that their needs are adequately known so as to determine if the home can sufficiently meet their care needs. For example in one assessment there was reference to the individual requiring glasses but the assessment did not indicate why and how their needs would be meet. Also religious/spiritual needs were not documented. An Adult Protection investigation carried out also highlighted that there were issues around ensuring that all service users are assessed appropriately prior to being admitted to Le Burn House or re-admitted back to the home from hospital. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The care planning system lacks the information to assist staff in monitoring and meeting resident’s health and welfare needs. Residents are protected by the systems in place to manage medication safely. EVIDENCE: The home operates a key worker system and care plans are usually monitored and reviewed by key workers on a monthly basis. The Manager informed the Inspector that she ‘has lots of plans for improving the care plans and intends to involve service users in care planning where appropriate and provide key worker training to assist and support staff with care planning. However, due to staff shortage the care planning system has not been able to adequately record and monitor residents care needs. The information provided in each care plan does not give staff adequate information and guidelines to enable them to care for each person’s ongoing health and welfare needs. The care plans contain generic goals but are not specific and person centred. For example the care plan for one service user stated that she needs ‘adequate fluid daily’ but did not specify how much fluid was adequate and what action to take if it was inadequate. Also that the service user needed to be ‘assisted in bathing’ but did not give staff any guidance in how to achieve this. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 10 The Manager and Provider need to ensure that service users assessed needs are kept under review and to request an up to date social care/nursing assessment should this be required. However, 10 relatives who returned comment cards said they ‘are satisfied with the overall care provided’ and 7 service users who returned comment cards said they ‘feel well cared for’ at Le Brun House. Le Brun House uses a monitored dosage system for the administration of prescribed medicines and there is a policy in place with regard to the procedures for medication administration. Staff have received in-house training and external training from the pharmacist, who also carries out a monitoring visit to check that the administration, recording, storage and disposal of medicines is in line with current practice. However, it was noted that the pharmacist has not carried a monitoring visit since August 2005. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 The arrangements for leisure and social activities inside and outside of Le Brun House are being extended to ensure that the home provide opportunity for mental and physical stimulation. EVIDENCE: The activities programme of both in-house and external activities is being extended and at present offers music and movement sessions, aromatherapy and nail painting, poetry readings and games such as bingo and skittles. The home provides musical entertainers on a monthly basis. The Inspectors were informed that a new member of staff will have responsibility for organising and arranging activities. Staff were observed engaging with service users, either on an individual basis, playing dominos, reading and talking and a group activity of throw and catch. With the future plans to accommodate people with a dementia type illness there will need to be further planning, organisation and training of staff to provide sufficient and appropriate activities. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Although there are systems in place to deal with complaints, they need to be dealt with objectively and sensitively in order that service users will feel that there concerns are taken seriously and acted upon. The home has provided training to increase staff knowledge and understanding of Adult Protection issues to prevent residents being placed at possible risk of harm or abuse. EVIDENCE: The home’s complaints procedure is contained within the Service User Guide to the home, which all service users have in their bedrooms. The procedure is also displayed in the hallway of the home. 7 out of 10 relatives who returned comment cards said they ‘are aware of the complaints procedure’ and ‘have never had to make a complaint’ and 9 out of the 10 service users who returned comment cards said they ‘know who to speak to if they are unhappy about their care.’ However, it was evident following a recent investigation that further work needs to be undertaken in carrying out investigation and proving an appropriate response to the complainant. An Adult Protection alert was raised in November when an ex member of staff was reported to the police for financial abuse and the home followed correct POVA procedures. An Adult Protection Alert was made in October 2005 raising concerns in respect of alleged possible issues of neglect on admission to the hospital. The conclusion of this investigation is that the issues of neglect have not been substantiated. However, there were issues around ensuring that the home accommodate only people for whom it is registered to care for and that Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 13 service users are assessed appropriately, prior to being admitted or readmitted back to the home from hospital. All staff are given the homes’ policy on protection of vulnerable adults and prevention of abuse and they receive in-house training as part of their induction training. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22 Residents live in safe, spacious and comfortable surroundings that currently meets the needs of older people. EVIDENCE: The extension will provide 5 more bedrooms (which are currently not registered) and has increased the communal space to include a large dining/lounge area at the rear of the house and a conservatory at the front. Health and safety issues that were highlighted during the CSCI visit in November 2005 has been rectified. A fire safety officer visited and has assessed the premises to confirm that these are fit for purpose. A new call bell system has been fitted throughout the home and was in working order on the day of the inspection. With regards to the Providers plans to vary the registration to accommodate older people with dementia, further thought and consideration needs to e given in relation to the physical environment to include furniture and fittings, the use of colour, signs, symbols and lighting. The use of signs and symbols on toilet Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 15 and bedrooms doors was discussed to currently assist one service user who has been confused during the night whist attempting to use the toilet. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 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 Residents would be better protected if the turnover of staff was reduced and Staffing levels were increased. The procedures for recruitment, induction and training of all staff need to be more robust to protect the people living at the home. The home has made positive efforts to ensure staff receive National Vocational Training in Care to assist them in caring for older people. EVIDENCE: Although the Provider and Manager have been working towards creating and retaining a stable staff team, this has proved difficult to achieve and at times there has been insufficient staff on duty. Since the last inspection in February 2005 six carers have left employment at Le Burn. There were are 12 residents at the time of this inspection and the rota indicated there are usually two carers on duty during the day and 1 working a waking night duty. The Manager confirmed that the home ‘has been working towards having three members of staff on duty, but this has not been happening and that she has had to be included in the care work as they have been short staffed at times’. The Provider has also had to work shifts to cover the shortfall in staff. During a CSCI visit in November the Inspectors were concerned that only two carers would be working in the afternoon, with 13 residents, two of who required high support from staff. In addition care staff have to prepare the supper and carry out laundry tasks. The home has been using agency staff to cover the staff rota. The Manager confirmed that new staff are being recruited; one carer had Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 17 started the week of the inspection and three others were starting the following week. One member of staff said ‘she has been working on her own and that there has been lots of new staff coming and going’. Five out of the ten comment cards received back from resident’s relatives confirmed ‘that there are not sufficient numbers of staff on duty’. One relative considers ‘the constant turnover of staff is a problem’ and another is ‘aware of the ongoing problem but that it is being dealt with as far as is possible.’ Staffing arrangements are currently being reviewed and a plan of action is required for the proposed change of registration category to be accepted by the CSCI. Three staff files were examined and some lacked satisfactory recruitment information. One applicant had not completed all the application form and there were no interview notes to explain the reason for this. Confirmation follow up telephone calls to referees had not been made after receiving the written reference and not all had CVs included with the application. POVA First checks had been carried out and CRB checks were being undertaken. The home’s application form needs to allow applicants to record any relevant training obtained, to enable the Manager to assess competency and monitor training needs. Although the manager has developed an induction programme that meets the required standards and all new staff work through this over the first six weeks of employment, a longer off duty initial induction is needed to ensure that staff can care adequately for all residents. Since the last inspection some staff have received both external and in-house training, such as manual handling, managing violence and aggression, introduction to dementia, emergency first aid, bereavement, infection control, administration of medication, fire safety, keyworker, health and safety, adult abuse and needs of the service user. Four member of staff have achieved an National Vocational Qualification in Care (NVQ) Level 2 and three others are being encouraged and supported to achieve this qualification. Following a visit to the home in November 2005 as part of the application to vary the registration, it was acknowledged that a start had been made to ensure that the staff team have some understanding of Dementia. However, it is very important that all staff have this knowledge in order to adequately care for people with a Dementia type illness. Details of the content of these sessions and plans for the rest of the staff team, including the cook, to receive this training and details of future training was requested. Following discussions at this inspection the Provider has submitted proposed further staff training to take place in May/June 2006. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 38 There lines of accountability within the management team are not clear to ensure that the home is managed appropriately. The home has satisfactory systems in place to safeguard financial needs. There needs to be satisfactory fire safety arrangements to ensure service users are not put at risk. EVIDENCE: The Manager has been in post for 3 years and has been proactive in improving the service. She has achieved a National Qualification in Care and the Registered Managers Award. She has attended various training courses to assist her in this role, such as supervision, POVA, change management, care plans, health and safety, reducing staff turnover and recruitment. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 19 However, the Manager has not been able to fulfil her duties due to staff shortages and some conflict in management and lines of accountability with the Provider. This was confirmed by staff spoken with during the inspection who commented on ‘the tension between the Provider and the Manager’ and the ‘clash of authority’. Service users’ relatives or representatives receive itemised bills for services such as hairdressing, chiropody, newspapers and toiletries. The home maintains a written record of all extra amounts payable for these additional services and this is documented in service users’ terms and conditions of residency. The home provides lockable facilities and where money/cheque books are kept on behalf of a service user this is agreed and signed and a record is maintained of any money given out/spent and the remaining balance. Advice has been sought from a fire safety officer regarding wedging doors open and communal fire doors are now held open by electro-magnetic retainers. However, it was noted that some bedroom doors were being wedged open. Since the inspection the Provider has fitted hold open devises on these doors and should be fitted to all residents bedroom doors, where they request these to be left open at night time. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 20 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 X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X 2 X X X X STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X X 2 Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 21 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 2 Standard OP27 OP29 Regulation 18(1) 7, 9, 19 Requirement That there are adequate staff on duty at all times. That there are satisfactory recruitment procedures in place. (This was a requirement at the previous inspection.) That all service users are assessed appropriately prior to being admitted to Le Brun House or re-admitted back from hospital. That service users assessed needs are kept under review and to request a nursing assessment should this be required. That the information provided in each care plan gives staff adequate information and guidelines to enable them to care for each person’s ongoing health and welfare needs. That there is satisfactory planning, organising and training for staff to provide sufficient and appropriate social and leisure activities. Timescale for action 13/02/06 13/02/06 3 OP3 14 15/02/06 4 OP8 14(2) 15/02/06 5 OP7 15(2)(b) (c) 28/04/06 6 OP12 16(2)(n) 28/04/06 Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 22 7 8 11 OP38 OP30 OP16 23(4) 18(1) 22 12 OP30 13(4)(c) That doors are not wedged open. That all staff receive adequate training in caring for people with a dementia type illness. That all complaints are dealt with objectively and sensitively in order that service users will feel that there concerns are taken seriously and acted upon. A longer off duty initial induction is needed to ensure that staff can care adequately for all residents. (This was requirement of the previous inspection). 13/02/06 30/06/06 31/03/06 28/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP26 Good Practice Recommendations That a pharmacist carries out a monitoring visit to ensure that the correct procedures for the storage, recording and administration is being carried out. Additional staff are employed to assist with laundry tasks. Le Brun House DS0000021154.V249447.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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. 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