CARE HOMES FOR OLDER PEOPLE
St Brendans 175 Ashburnham Road Luton LU1 1JW Lead Inspector
Katrina Derbyshire Unannounced Inspection 8th February 2007 09:55 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 St Brendans DS0000014959.V328862.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. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Brendans Address 175 Ashburnham Road Luton LU1 1JW 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) 01582 728737 01582 726022 Mr Jethra Kara Mrs Bhavna Kara Marian Oke Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th February 2006 Brief Description of the Service: St Brendans is a three storey period house in a residential area of Luton. It is on a bus route and within a short drive of nearby shops, post office, public houses and places of worship. Accommodation is provided on all three floors of the home, with 20 single bedrooms and 3 double bedrooms. Access to the upper floors is via stairs or a lift. There is a small lounge on the fist floor and two further lounges and dining room on the ground floor. The kitchen and laundry facilities are located on the ground floor. There is an attractive garden with an enclosed patio area at the rear of the home with raised flowerbeds and garden furniture. The fees for this home vary from £410.00 per week, to £450.00 per week, depending on the funding source. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of this visit was to undertake a key inspection. This unannounced visit took place on 5th February 2007. The Registered manager Mrs. Marian Oke and Mrs Bhavna Kara one of the owners of the home was present during the inspection. During the visit communal areas and private rooms in the home were visited and the inspector spent time with many of the residents’ in the main sitting area of the home and a dining room. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents were also received and their feedback has been used alongside information from the home to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit alongside their views. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
Residents feel that the staff at this home are very supportive and kind to them. Several residents commented that they had built up very good relationships with the team. They feel that staff respect them as individuals and find that they are considerate when providing care and support. One resident said “ l love living here, staff treat me as their equal”. This means residents believe that their privacy and dignity is maintained whilst living at this home. Staff at this home are also good at keeping residents families involved and updated in the care of the residents. When there has been a change in how the residents feel, staff will contact family members to let them know. Staff also get to know the relatives of residents and aim to build a trusting relationship with them. One resident for example needed the help and support of staff so that they could keep in contact with their family, staff assist them in using the telephone and offer encouragement and support to the resident to do this. Many of the residents at the home still feel that the standard of food is very good. The home offers residents a choice in their meals and residents also said that if they did not like any of the options on offer the cook would make them something else. One resident said, “ l like the food here very much, l always
St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 6 look forward to my meals”. Staff make sure that a balanced diet is available that includes fruit and vegetables. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 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 St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures the home had in place to ascertain if the home could admit prospective resident’s needs are adequate and puts residents at risk. EVIDENCE: Assessment documentation was noted to be in place within the care records of residents. The standard of information was sufficient and gave information on the physical, social, emotional and psychological needs of the resident’s. In addition assessments undertaken by the funding agencies were also seen in some of the care files examined. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 9 The homes registration categories were reviewed as one of the residents selected for case tracking at this visit was noted to have been admitted to the home whose needs were outside of the categories of registration held by the home. Three residents whose primary need related to their mental health diagnosis were living at the home. This placed the three residents and those remaining in the home at risk. An immediate requirement was not made as several staff including the senior staff at the home had undertaken training in this area, and the assessed outcomes for one of the residents selected for case tracking were noted to be good. An application however to vary the conditions of registration is to be submitted to the Commission for Social Care Inspection within seven days of this visit, this was agreed by the owner of the home. Intermediate care is not offered at this home. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems for the ordering, storage and administration of medication in this home are sufficient to ensure residents receive all prescribed medication and safe practice takes place. EVIDENCE: The standard of care planning examined at this visit was noted to be inconsistent. One residents’ plan of care was comprehensive and the guidance to staff in how they should support the resident was clear. However another resident’s only entry for their mental state/cognition was a medical diagnosis and that they had challenging behaviours. To ensure consistency in the care that resident’s receive all care plans must give sufficient guidance to staff and a plan must be in place for all assessed needs.
St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 11 Documents seen within the individual care records of residents showed that residents had received a variety of healthcare support, including access to the local hospital; they had also benefited from prompt referrals to specialist medical staff when required. Documents were in place that should residents had, had access to breast screening and dietary advice from a dietician. Assessments had also been undertaken regarding tissue viability and nutrition. Residents spoken to confirmed that they were visited by their General Practitioner at the home and that the staff arranged for this to happen. In addition the manager of the home had challenged a recent incident concerning one resident and the treatment that they received from a healthcare service. In doing this the manager had ensured that the resident received the treatment that they required. All the residents spoken with at this visit felt that staff maintained their privacy. It was observed that staff knocked on resident’s doors before entering and used the form of address preferred by the resident. The interaction between staff and resident’s was seen to be relaxed, informal and supportive. Medication ordering, storage and administration was examined and noted to follow best practice guidance. Records were up to date and accurate and training in the administration of medicines had been provided for staff responsible for this area. A previous requirement regarding the recording of stock was seen to have been undertaken. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 12 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The dietary needs of residents continue to be well catered for with a balanced and varied selection of food that meets resident’s tastes and choices. EVIDENCE: Menus were on display within the home and written on a board within the main dining area of the home; these showed that a varied and balanced diet including all the main food groups was on offer. Observations of lunch showed resident’s had been given a choice in their main meal, staff were seen to assist those who required help to eat their meals. All residents spoke highly of the food available at the home. One resident spoken with stated that they were on a reducing diet, documents relating to this were seen within the individual care records. Residents through discussion confirmed that since moving into the home they had continued to be able to vote in elections, maintain close relationships and make daily choices for example the clothes that they wear and the food that they eat. Staff when questioned were very clear on the rights of the residents;
St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 13 during their induction to the home they had been advised via training and the policies of the home that residents must at all times be offered the opportunity to make decisions. Information provided by the home showed that a range of activities had taken place and are available for the residents, examples include entertainment, outings, games, reminiscence and bingo. The home had recently advertised for a part time activities co coordinator. Residents spoke of visiting religious representatives that would carry out services in the home. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place for residents to complain are good so residents feel enabled to raise concerns and feel that they will be listened to and their concerns acted upon. EVIDENCE: The home has a complaints procedure that makes clear how residents can complain and the timescale is given for the home to respond to them. All feedback received from residents said that they were aware of the complaints procedure and were happy to complain if they felt that they needed to. Staff through interviewing them were able to demonstrate a good understanding of the homes complaints procedure, and what they should do if they themselves were to receive a complaint. Training had been undertaken by staff in the protection of vulnerable adults. Staff through interviewing demonstrated that they had a sufficient level of knowledge of abuse and what they should do if they suspected any abuse of a resident. The manager also through discussion demonstrated a good understanding in this area and was aware of the local guidance in reporting procedures. The home did have a policy on abuse and a copy of the local protection of vulnerable adults policy. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the décor and carpeting in some areas of this home to ensure the environment is homely for the residents to live in. EVIDENCE: Residents rooms that were seen contained personal items for example photographs and pictures. Assisted bathrooms are in place and grab rails were also in place to assist residents with their mobility. The sitting areas in the home were clean and tidy and no odours were detected throughout the home. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 16 However some areas require redecoration for example the walls along the main corridor on the ground floor. In addition the carpet in the main ground floor lounge was worn and stained and needs to be renewed. However it is acknowledged that the owners have been making changes to the décor in the home and for example had recently purchased some new armchairs for one of the sitting areas. Cleaning schedules were seen to be in place alongside clinical and domestic type waste contracts. Protective clothing such as gloves and aprons were seen to be used by staff and hand washing facilities were situated throughout the home. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems in place for the recruitment of staff are not sufficient to protect residents and places them at risk. EVIDENCE: Staff files were examined and at the time of this visit contained application forms, evidence of identification and Criminal Records Bureau checks. However the most recently employed staff members had actually commenced their employment prior to the home receiving their POVA First check. Through discussion the manager confirmed that they believed this to be sufficient. This places the residents at risk and a requirement has been made relating to this. Several residents commented that they had built up very good relationships with the team. They feel that staff respect them as individuals and find that they are considerate when providing care and support. One resident said “ l love living here, staff treat me as their equal”. This means residents believe their privacy and dignity is maintained whilst living at this home.
St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 18 Records and staff confirmed that they had undertaken training in many areas including understanding dementia, fire safety and moving and handling. Several staff had also undertaken courses in understanding mental health, however in view of the home having admitted residents with needs in this area all remaining staff will also need to undertake this. Staff rotas are maintained and show all staff on duty. Residents spoken with felt that there were sufficient staff on duty at the home to meet their needs. One resident did state that they would like a member of staff with them at all times but understood that this was not possible, and they had been advised of this before moving into the home. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place for health and safety are sufficient to reduce the risk of accidents for the resident’s. EVIDENCE: St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 20 A letter was received by the Commission for Social Care Inspection in December 2006 to advise that the manager had been awarded a Foundation degree in Care Management. The Home Manager has many years experience, which is directly relevant to the role of manager in the home. The interaction as observed at the homes previous inspection between her and the residents and staff was supportive and caring. Staff again through interviews confirmed that the Home Manager was very supportive to them and provided sufficient and effective management. A previous requirement for the home to use the information received through resident and relative surveys to influence the running of the home was noted to have been met. The home has a policy on how residents monies managed on their behalf should be administered. Only senior staff have specific responsibility in this area and their practices were seen to follow the guidance within the home policy. All records, receipts and other information seen were of a good standard and provided a clear audit trail. All balances checked were noted to be correct and receipts of any expenditure are kept. The home has a Health and Safety policy. There was evidence within the training records that staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen within residents’ care files. Records evidencing that maintenance and checks were undertaken relating to fire prevention and electrical and gas equipment was seen. Staff were observed to follow safe practice in the following areas, moving and handling, risk assessment, first aid, food hygiene, infection control and COSHH. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 21 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 3 1 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP4 Regulation Requirement Timescale for action 28/02/07 2. OP7 10, 11, 12 No resident must be admitted & 13 to the home whose needs fall outside of the category of registration that the home holds. 12(1)(a) Care plans must contain & 15 sufficient guidance and instructions to staff on the support and care that they should provide for each assessed need. 23(2)(d) 30/04/07 3. OP19 4. OP29 12(1)(a) & 19 Redecoration must be 30/06/07 undertaken in areas such as the ground floor corridor and replacement of the sitting room carpet ensure residents have a pleasant environment in which to live. The home must not commence 28/02/07 the employment of staff prior to securing the relevant CRB check to protect the residents. St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 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. Refer to Standard Good Practice Recommendations St Brendans DS0000014959.V328862.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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
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