Inspection on 15/05/07 for Le Brun House

This inspection was carried out on 15th May 2007.

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

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

Other inspections for this house

Le Brun House 11/03/09

Le Brun House 28/03/08

Le Brun House 28/06/06

Le Brun House 13/02/06

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 Jane Jewell Key Unannounced Inspection 12:30 15th May 2007 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.V337185.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. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 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 01323 438528 enquirieis@lebrunhouse.co.uk Mrs Ilona Austen Mira Adams Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty (20). Service users accommodated must be older people aged sixty-five (65) years or over on admission. Service users only with a dementia type illness to be accommodated. Date of last inspection 22nd November 2006 Brief Description of the Service: Le Brun House is a care home providing care and support to up to twenty people who have dementia. The home changed its registered in 2006 to accommodate people who have dementia prior to this it was care home for older people. The home is situated approximately one mile from Eastbourne town centre, with a main bus route within easy walking distance. The premises are a detached domestic house that has been extended over the years. Accommodation is provided on three floors with a passenger lift providing access to the first and second floor. Resident’s accommodation consist of twenty single bedrooms eighteen of which have their own toilet ensuite facilities with six bedrooms also having shower facilities. The communal facilities include a large combined lounge dining room, separate lounge leading into a conservatory and a small rear secure garden. The home literate states “that it aims to provide quality tailored care to meet the needs of elderly service users with dementia”. The fees for residential care are currently £400 to £650 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport, dry cleaning toiletries are additional costs. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over six and half hours and information gathered about the home. This includes: discussion with relatives and other stakeholders involved in resident’s care and health care professionals. The inspection was facilitated in the main by Mrs Mira Adams (Registered Manager). The inspection involved a tour of the premises, observation, examination of records and discussion with residents and staff. There were twenty residents living at the home at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there, this involved observing residents and their interactions with staff and examination of the homes facilities and documentation. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. The Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at the home will be referred to as residents in this report. What the service does well: What has improved since the last inspection? Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 6 Progress has been made towards meeting the majority of shortfalls in practices noted at the last inspection. Areas in which the home has fully met the previous shortfalls have improved the information available to residents to help them make informed decisions about whether to move to the home. Care planning has significantly improved providing better guidance for staff on the needs of residents. The home continues to undergo gradual redecoration, which maintains a nice environment for residents to live. A relative felt that the opportunities for occupation and stimulation are much better than they used to be. What they could do better: Where the shortfalls in practices identified at the last inspection have not yet been fully addressed positive steps must now be undertaken to fully address them and improve residents safety. This is in reference to the continuing shortfalls in medication practices and in staff supervision. Prospective residents and their representatives need to have up to date accurate information about the terms and conditions of residency in order that they are aware of their rights and responsibilities. Some daily routines at the home need to be reviewed in order that residents are able to exercises choice in their daily lives. Staff need to be appropriately supervised to ensure that residents needs are being met in a safe and dignified manner. A relative said “don’t always seem to understand Alzheimer’s”. Residents are not able to independently access their private accommodation or move freely around the building due to the installation of locks on corridor doors and bedroom doors. The manager was immediately required to seek fire safety advice on their installation and the effect that they had on evacuation practices in the event of a fire. In addition the manager has been asked to review the locks suitability for people with dementia in order that residents can enter and leave their bedrooms independently. The required recruitment documentation and checks must be undertaken prior to staff employment commencing in order to safeguard residents. A system needs to be established and maintained for monitoring the quality of the care provided, which includes a system for obtaining feedback from residents their representatives and other stakeholders on the services provided and the performance of the home. This is so the home can identify any areas of service shortfalls or areas for future development. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 7 Subsequent to the inspection the manager confirmed that all of the immediate requirements had been addressed within 48 hrs and provided written confirmation that the shortfalls in practices had been or were in the process of being addressed. 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. Le Brun House DS0000021154.V337185.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 Le Brun House DS0000021154.V337185.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): 1 2 3 4 and 6 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have access to information about the home to help them make informed choices about whether to live at the home, however residents and their representatives need to be provided with terms and conditions of residency. Residents move into the home following an assessment of their needs. Although most needs of residents are able to be met, practices need to be reviewed in order to ensure that residents needs are being met in a safe and dignified manner. EVIDENCE: There is literature available about the home, which includes a statement of purpose and service users guide. In line with previous requirement these have Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 10 been updated and made available to perspective residents, their representatives and interested parties. It was identified that further work could be undertaken to the service users guide to make it accessible to people who have dementia in order to help make informed decisions about moving to the home. Although a copy of the terms and conditions of residency is available within the homes literature, not all residents had been provided with a written statement of their terms and conditions of residency with the home. This has been required in order to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Residents representatives consulted with spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. The manager gave examples of the different types of visits that prospective residents have undertaken, depending upon the individual needs of prospective residents. The manager ensures that prospective residents are accommodated following an assessment of their needs by the home or Social Services. The manager demonstrated an understanding of the needs that could be accommodated at the home and when needs go beyond that which the home can meet safely. There is a range of needs being accommodated at the home this includes residents who do not have dementia and residents who have complex needs including physical needs. The home is able to evidence that most needs of residents can be met however further work must be undertaken to ensure that residents needs are being met in a safe and dignified manner. This is further discussed throughout the report. A sample of comments made by resident’s representatives regarding the home include: “standard of care seems fine”; “couldn’t have wished for a better home”; “Very happy, great care clean and tidy” “I liked the feeling when I walked into the home” and “don’t always seem to understand Alzheimer’s”. The first six weeks of occupancy is looked upon as trail occupancy. Where social services are the placement authority it is usual practice that within this period a review be undertaken to determine whether the residents wishes to stay permanently at the home. Intermediate care is not offered at the home therefore this standard is not assessed. Le Brun House DS0000021154.V337185.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 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The arrangement for care planning is generally good ensuring that resident’s needs are being identified, however staff need to be fully familiar with care plans to ensure support is provided in a consistent way. Some of the homes practices did not promote resident’s privacy and dignity. The health needs of residents are being addressed with evidence of regular input from health care professional however medication practices have not improved sufficiently in order to safeguard residents which remains of particular concern. EVIDENCE: Information is gathered about each resident and compiled into a care plan. In order to address the previous requirements the manager reported that they have gradually been introducing new care planning documentation. This new documentation is well organised and has improved the standard of information being recorded about each residents needs and provides staff with the Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 12 necessary guidance to work safely with residents ensuring that their individual preferences are identified. Care staff are responsible for recording in the daily notes, but currently it is mainly the manager who has been involved in writing and implementing the new care planning documentation. Staffs knowledge of the contents of care plans was limited and their greater involvement in care planning is needed to ensure that care and support is being provided in a consistent way. It was previously required that residents be involved in compiling their care plan. The manager reported they have recently introduced care plans reviews for some residents and their families in order to encourage their greater involvement. The risks faced and posed by residents are assessed, recorded and any actions identified in order to reduce or manage the risk are included in the residents care plan. Records of medical intervention showed that the home works closely with health care professionals including GP’s, district and specialist nurses to ensure residents receive a range of health care intervention. Health care professionals consultants with felt that staff were prompt to seek medical support and advice and that there instructions were followed by staff. The system for the administration of medication did not provide for a clear audit trail of medication, therefore it was not always possible to ensure that medication was being accurately administered or accounted for. The follow areas of shortfalls were noted, which the manager agreed to address as a matter of priority in order to ensure residents safety. • Medication administration instructions not being written in full on medication administration records. • Not all medication was being recorded as having been administered. • Not all “as prescribed” medication having specific individual instructions for their use. It is of particular concern that medication administration standards have not improved despite the home being required to address shortfalls in practices at the last inspection. Continuing failure to address these shortfalls may now result in enforcement action being undertaken. A relative said that their relative always looks smart. Staff were observed knocking on bedroom doors prior to entering, however not all of the home practices observed by the inspector promoted residents dignity. This is with particular reference to poor standard of laundering clothes, personal care information displayed in communal areas and the conduct of staff when talking about residents in their company. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s lives are enhanced by links with families and friends being supported and encouraged by the home and by a range of opportunities for occupation being gradually provided. Dietary needs of residents are catered for with a balanced and varied selection of food available that meets resident’s tastes and preferences. Residents currently have little control or choice over some routines of daily living. EVIDENCE: On the afternoon day of the inspection there was a motivation class being undertaken which residents were clearly enjoying along with the staff on duty. This class was being run by an external organisation who specialise in these classes for people who have dementia. The people involved in running the class spoke of this being the first time they had visited the home and how nice it was to have staff join in with residents. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 14 Staff spoke of the range of activities that they undertaken with residents during the afternoon this included arts, crafts, tea dances, ball and card games. A staff member said that all residents are provided with the opportunity of going out for walks. Relatives comments included: “Not sure that they do as much activities as they say they do” and “feels that they are now doing more activities with them”. It is the homes practice to record what activities residents have undertaken, however this had not been completed for a considerable amount of time. A newly appointed staff member spoke of their role being to develop more opportunities for activities and occupation for residents. Visitors commented upon how welcomed they are made to feel during their stay. A sample of comments made include: “Pops in any time always made to feel welcome”; “I can stop and have my lunch there”; “can go anytime always very relaxed”; “usually offered refreshments depending upon how busy they are” and “always take the time to talk to me”. A relative spoke of a wedding anniversary party that the home held for a resident and their spouse. A friend of a relative spoke of the importance for them to have their own phone, which enabled them to keep in regular contact with each other and that it was important to the resident to have the privacy that their own telephone afforded them. Through discussion with staff and examination of records it was evident that some of the routines of daily living were not determined by the needs and preferences of residents but by the homes policies and staff deployment. This is in reference to times for rising and going to bed. This is of particular concern and the manager has been required to address this to ensure that residents are provided with choice and their individual preferences observed where possible. Some examples of good practices were observed in the techniques a staff member was using when offering choices to people who have dementia. A staff member said that sometimes she had to made choices for residents based on her past knowledge of them. Bedroom doors and corridors doors are fitted with locks that require considerable dexterity or a key to open. This therefore prevented residents being able to move around the home independently. This is further discussed under standard 19 and 38. A resident spoke of the monthly Christian Parche service that is held at the home and how important this was to them to be able to attend. They commented to their relative that the service had been occurring at the home for several months before they had been made aware of it, this they felt disappointed in, as their faith was clearly very important to them. A sample of feedback received regarding the foods include: “Food looks absolutely delicious and “really good cook proper home cooking”. Records of Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 15 meals provided showed that a varied menu is provided with resident’s individual preferences and specialists diets being catered for. The majority of residents eat their meals in the pleasantly decorated dining room. The meal served at inspection looked appetising and was presented well. The manager reported that Environmental health had recently visited and inspection the food preparation areas and no recommendations had been made. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience an Poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a complaints system in place with relatives feeling able to raise any concerns that they may have. Not all of the homes practices currently safeguard residents. EVIDENCE: There is a complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Relatives consulted with said that they felt able to share any concerns they had with the provider and staff and said that where they have done so the issue has been dealt with promptly. A relative said that the only concern they had was that on a few occasions’ clothes would go missing. The manager stated that they are in the process of dealing with a complaint, which was being undertaken in accordance with the homes policy and timescales. There have been several safeguarding adults referrals to social services regarding the home since the previous inspection, this includes a self-referral from the home. These have resulted in safeguarding adult’s investigation being undertaken by social services of which the outcome was pending at the time of compiling this report. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 17 During discussions with the manager prior to the inspection it was identified that the manager was not fully aware of their roles and responsibilities under safeguarding adults guidance and they were advised to undertaken training in this area. They reported that this had been arranged for the near future. Staff consulted with said that they had undertaken training in safeguarding adults either in previous employment or at the home and showed a good level of understanding of how to report suspected abuse. However not all staff demonstrated an understanding of what is poor or degrading or abusive practices. This is in reference to the daily routines and in the conduct of staff previously noted. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 24 25 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean, well maintained and comfortable environment however residents are not able to freely move around the building and some are at risk of being trapped in their bedrooms. EVIDENCE: The home is located on the outskirts of Eastbourne town centre. Accommodation is provided across three floors with a passenger lift providing access the first and second floor accommodation. The overall standard of maintenance and decoration was good, the manager reported that several bedrooms have recently been decorated, these were noted to have been done to a high standard. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 19 Resident’s accommodation is for single occupancy with the majority of bedrooms having toilet ensuite facilities with six bedrooms also having shower facilities. Bedrooms had been personalised with resident’s personal effects. All bedroom doors are fitted with Yale locks, which require a key to open the door when shut, or from the inside to twist a small knob. Staff hold the keys to the bedroom doors with only a few residents described as able to hold their own keys. It is of particular concern that residents are not able to freely and independently access their personal accommodation. Concern was also noted that once bedroom doors were shut not all residents would be able to open the doors independently from the inside. A relative also expressed this concern saying that their relative was “virtually a prisoner” when in their bedroom. There was no evidence that these types of locks have been requested by residents or assessed as needed and the manager was required to review them as a matter of priority to ensure residents safety and wellbeing. The communal facilities include a large combined lounge dining room, separate lounge leading into a conservatory and a small rear secure garden. Much effort has been made to create a homely feel to the environment. The manager spoke of their plans to make the garden more accessible and attractive for residents to be able to enjoy. Corridors doors have recently had an additional handle installed, requiring considerable dexterity in order to open the door. The manager said that these were fitted to prevent residents from falling down the stairs. The manager could not provide any evidence that the decision to install them had been based on an assessment of risks to residents. Concern was expressed that their instalment therefore restricted resident’s free movement around the home, which included being able to evacuate in the event of a fire. In order to ensure residents safety the manager was immediately required to consult with a fire safety expert regarding the fire safety precautions and evacuations procedures at the home. The manager subsequently reported that they had sought advice and were in the process of undertaking the necessary works as advised by the fire safety officer to ensure residents safety. There are sufficient number of assisted baths and showers, this includes the installation of a new wet room. There was a range of individual aids and adaptations to assist resident’s mobility and independence, including raised toilet seats, walking aids, hoist ramps and grab rails. Bedrooms have a call point fitted that enables assistance to be summoned. The inspector observed that a wheelchair was not being used in accordance with good safety practices and the manager addressed this immediately. A staff member said that there was only one pool wheelchair for all residents to use, which they felt was not enough. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 20 Parts of the home visited were observed to be clean with any melodious odours confined to a few areas. A relative described the home as: “Very clean”. Laundry faculties are available on site and as previously noted the standard of laundering was varied, which did not help to promote residents dignity. It was previously recommended that a laundry assistant be employed, this had not been acted upon. The manager agreed to look at ways of ensuring a consistent good standard of laundering was attained. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sufficient number of staff on duty to be able to meet resident’s needs, however staff need to be deployment and have the competencies and understanding of dementia to meet residents needs in a dignified professional and safe manner. The procedures for the recruitment of staff are not sufficiently robust to safeguard residents. EVIDENCE: At the time of inspection there were three care staff and the manager on duty. Staff confirmed that this is a normal staffing level during the morning period. All staff consulted with felt that staffing levels were sufficient to be able to meet the needs of residents in a timely manner. However the practices of residents being assisted to get up by night staff in readiness for breakfast to be served at 8am meant that residents were being assisted to get up in the early hours. It was discussed with the manager that this practice needs to be reviewed along with staff deployment to ensure that resident’s are able to have choices over their daily routines. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 22 A number of staff consulted with said they were relatively new to care work. A staff member said that the manager tries to ensure that there is a mixture of ages and experiences of staff on each shift. Variable comments were received regarding staff from relatives and health care professionals, a sample of their comments include: “majority quite helpful”; “cheerful”; “don’t always seem to understand Alzheimer’s”; “Staff seem fine very caring towards mum” and “they are wonderful”. A staff member said that they really liked to work at the home and “Lovely as everyone puts residents first”. The inspector observed some conduct by a staff member that did not promote residents dignity or good practices in the care of people who have dementia. This was fedback to the manager who subsequent to the inspection reported that this matter had been dealt with through the homes disciplinary procedures. The personal files of newly appointed staff were inspected and these showed that a recruitment process is followed, which included the use of an application form, interviews and CRB checks. However written references were not obtained prior to employment commencing. It has been required that all of the required recruitment checks need to be undertaken in order to safeguard residents. The home has sufficient staff on NVQ training courses to assist the eventual meeting of the Government target of at least 50 of carers reaching the basic standard of training. The home has recently bought a training package, complete with videos, certificates and competency tests. This enables the mandatory training subjects, that equip staff to be able to work safely with residents to be undertaken at the home. Although not all staff have the necessary mandatory training the manager was aware of this and reported that they are in the process of developing a training and development plan to identify what training is needed. In accordance with the previous made requirements the manager reported that staff induction follows the skills for care guidance and standards. The manager reported that the majority of staff had undertaken a three-day course in dementia care. Concern was noted by the inspector that this training had not been translated into good care practices or understanding of people who have dementia. In light of the concerns raised from the inspection further dementia training is recommended, in order that staff are kept updated on changes in legislation and good practices in the care of people who have dementia. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 36 and 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although all persons consulted spoke positively about the manager they are not effectively managing the home in ensuring that residents are safe and their wellbeing is protected, as born out by the number of concerns noted at inspection. Serious concern was noted regarding fire safety in being able to evacuate the building in the event of a fire. EVIDENCE: The manager said that they had just completed the Registered Managers Award qualification. They have been the registered manager of the home for Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 24 approx 12 months. It was previously required that the manager has a clear and specific job descriptions to enable her to competently take responsibility for fulfilling her duties at le Brun House. They reported that they now have a job description. A sample of comments made regarding the manager includes: “funny nice lady”; “really good”; “find no problems, approachable” and “always bright cheerful and gives us any information”. Staff spoke of the positive changes the manager has had on the home through changes in practices since she has been in post. However as noted throughout this inspection report there are a number of concerns highlighted which indicate that the there must be a clearer sense of leadership and direction provided in order to effectively implement and maintain the practice changes necessary in order to safeguard residents and improve their quality of life. Staff said that they do not have regular formal supervision. A newly appointed member of staff has recently started to undertake recorded observed supervision of some staff’s practices. However it was noted that this did not highlight any areas for staff to improve upon in their practices as was noted and observed by the inspector. It was discussed with the manager that there is a need to ensure that staff involved in the supervision of others have the experiences and skills to undertake supervision in an effective manner and which covers all aspects of practice and philosophy of care. It was not always clear who was in charge in the managers absence and therefore responsible for the supervision and conduct of staff. It has been required for some time that the manager receives training and support to carry out regular supervision with care staff. It is therefore of concern that standards of supervision had not yet been fully addressed and must be as a matter of priority to ensure consistent good standards of care. A system for the self auditing and quality assessment of the homes services and facilities is not yet in place. The manager said that they were currently developing feedback questionnaires in order to obtain feedback from residents, relatives and other stakeholders on their experiences at the home. It has been required that there is an effective system for reviewing and self-monitoring the services and facilities provided at the home. This is to ensure that any shortfalls in practices can be promptly identified and to help inform future service development Written guidance is available for staff on issues related to health and safety issues. Some systems were in place to support fire safety, which included: regular fire alarms and emergency lighting checks and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been undertaken during 2006 which records the actions being undertaken and reviewed to ensure adequate fire safety precaution in the home. However this had not been reviewed following the instillation of bedroom door locks and additional handles on corridor doors. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 25 Because of the serious risk to residents, in the event of a fire due to installation of these additional locks the manager was immediately required to seek guidance from a fire safety expert. The manager reported subsequently to the inspection that they had done this and were following the advice provided by the fire authority. It was previously required that the provider carries out the required monthly unannounced visit to the home and produces a report on the conduct of the home. The manager said that this is now being undertaken. Le Brun House DS0000021154.V337185.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 3 2 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 1 3 2 X 1 3 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 1 Le Brun House DS0000021154.V337185.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 OP1 Regulation 5(1)(b) Requirement That service users or their representatives are provided with a copy of the terms and conditions of residency, in order that they are aware of their rights and responsibilities whilst residing at the home. Medication systems need to be tightened up and staff are to be reminded of their legal responsibility for administering and recording medication accurately. (Timescales of the 30/12/06, 30/12/06 not met) That there are arrangements in place for the adequate recording, handling, safekeeping, safe administration and disposal of medicines at the home to ensure that service users receive medication in accordance with their prescribed instructions. That as far as is possible service users are able to make their own decisions with regard to their routines of daily living, and which are respected by staff. That bedroom doors have DS0000021154.V337185.R01.S.doc Timescale for action 30/08/07 2 OP9 13(2) 30/08/07 3 OP9 13(2) 30/07/07 4 OP14 12(2) 30/07/07 5 OP14 13(4)(c) 30/07/07 Page 28 Le Brun House Version 5.2 6 OP29 19(1)(b) (i) Sch 2 (14) 24(1) appropriate locks fitted which protects service users privacy and ensures their safety by being able to enter and leave their bedrooms independently. That the required recruitment documentation and checks are undertaken prior to employment commencing to help safeguard residents. 30/07/07 7 OP33 8 OP36 9 OP38 That a system be established and maintained for monitoring the quality of the care provided, which includes a system for obtaining feedback from service users their representatives and other stakeholders on the services provided and the performance of the home. 18(1)(c) The manager receives training & and support to carry out regular supervision with care staff. (Timescales of the 30/09/06, 30/03/07 Not met ) That all persons working at the home are appropriately supervised at all times to ensure that residents are safe and their wellbeing is promoted. 23(4)(c)(ii That with immediate effect the i) registered provider must consult with a fire safety expert regarding the fire safety precautions and evacuations procedures at the home following the installation of additional door handles on fire doors leading onto stairways 30/09/07 30/09/07 15/05/07 ` RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 29 No. 1 Refer to Standard OP30 Good Practice Recommendations That further dementia care training be undertaken for all staff in order to keep staff updated on changes in legislation and good practices in the care of people who have dementia. Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Le Brun House DS0000021154.V337185.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!