CARE HOMES FOR OLDER PEOPLE
The Brambles Park Avenue New Longton Lancashire PR4 4AY Lead Inspector
Della Lovell Unannounced Inspection 15th May 2006 09:30 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 The Brambles DS0000005880.V296891.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. The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Brambles Address Park Avenue New Longton Lancashire PR4 4AY 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) 01772 614533 01772 614595 info@thebramblesresthome.co.uk Miss Karpal Kaur Mr Harbhajan Singh Mrs Kamal Jeet Kaur Virdee Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: The Brambles provides 24-hour personal care and accommodation for up to 24 older people. The Brambles is privately owned. The owners own the one home. The Brambles is a detached residence, situated in a residential area of New Longton, Preston. Local shops and other amenities are close by. The home is currently undergoing a major refurbishment and rebuild programme, once completed there will be 8 additional bedrooms and all the bedrooms will have ensuite facilities. The home has a passenger lift. Communal areas are all on the ground floor. The Brambles is set in one and a half acres of grounds, which are mainly grassed areas with woods to the rear and side of these garden areas. The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in May 2006. The inspection involved discussion with the people who lived and worked at the home, examination of records and a tour of the home. What the service does well: What has improved since the last inspection?
The new building and refurbishment programme was complete and work was underway on the grounds and gardens. This will ensure service users have a pleasant and safe outside area to use if they so wish. Since the last inspection the manager has undertaken risk assessments for all new service users and updated the policy and procedure for reporting and recording allegations of abuse. New staff had undergone the appropriate checks with regards to recruitment and there was evidence of this documented on their individual staff files. The staff rota had been amended to show all staff working in the home and the manager was considering applying for the Registered Managers Award. Since the last inspection the management team informed the inspector that the home does not hold monies for service users and any toiletries and
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 6 incontinence pads would be incorporated in the weekly charges. The registered person must ensure that this information is included in the homes documentation and a copy sent to the Commission for Social Care 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 Brambles DS0000005880.V296891.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 The Brambles DS0000005880.V296891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome group is – adequate The home does not provide sufficient information for new service users on what services and charges the home provides. The homes has a good assessment process, however all documentation should be completed fully to ensure that service users needs are assessed and met. EVIDENCE: Two new service users files were looked at. Both service users had a social services assessment and a commissioning document. The home had undertaken their own assessment and good information had been obtained with regards to service users background, hobbies, likes, dislikes and health needs. However there was no evidence that the service users or their representative had been involved in the process. There were weight charts and nutritional assessment forms in each of the files but these had not been completed. The home had undertaken a risk assessment and this was seen documented on the service users file, one service’s moving and handling risk assessment indicated a high risk, the home had recorded that two carers were required at all times to move this service user.
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 9 The inspector noted that both service users had a terms and condition in their personal files, however these had not been completed in relation to their stay, fees or room no. Both service users had a form for listing valuables and property brought into the home both forms were empty. The management team said that no property or valuables had been brought in. The inspector advised the management to complete the form and record that no property or valuables had been brought into the home. Service users in the home told the inspector that they like living at the home the staff were kind and felt their needs were attended to. The Brambles DS0000005880.V296891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome group is – adequate The home medication policy and procedure ensures the safety of service users. The homes care plans provide adequate information however further information is required in the way of instruction for staff to ensure that service users needs are fully met. Services users are treated in away that protects their rights and privacy. EVIDENCE: Each service user had an individual plan of care, care plans were viewed as part of the inspection process. One care plan stated that a service user had a catheter fitted, there was no instructions for the care staff on what care and attention was required for this need. The home should develop the care plans further to include detailed action that is needed by the care staff to meet their needs. Each service user had a daily record sheet, which recorded the care given and any significant events. Service users files contained information in relation to NHS entitlements such as dental, eyesight tests and hospital appointments. All service users spoken to felt their needs were being met and said that they were very happy with the care and attention provided by the staff at The Brambles. There was evidence that care plans are reviewed and updated however not all care plans are dated and signed and there is no evidence that
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 11 service users and their representatives are involved in the process. The storage of medication was in a dedicated room and all medicines were appropriately stored. The process for the administration of medication was observed by the inspector and discussed with the registered manager and it was evident from this discussion that good practises were carried out. The Brambles DS0000005880.V296891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15 Quality in this outcome group is – poor The homes social activities does not ensure that service users social and recreational interests needs are met. Service users are able to exercise a degree of choice and control over their lives, however the home needs to ensure that this is reflected in the homes policies, procedures and documentation. The dietary needs of the service users are well catered for with a balanced and varied selection of food available that ensures service users individual tastes and choices are catered for. EVIDENCE: The registered manager informed the inspector that an activity coordinator works at the home 2hrs a day, four days a week. There was no programme of activities available and no notice for service users or relatives. A record had been kept of what activities had taken place. The inspector noted that over a three week period two sessions a week had been provided and the activities were the same each week which consisted of “catch and through” or dominoes. On one session only 3 service users had taken part. Not all service users were aware of the activities and some said that they did not always enjoy the activities provided. One service user said that they don’t go out on trips and that they would like to go out occasionally.
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 13 Although the homes assessment had recorded service users interests at the point of admission service users recreational interests and needs are not met by the current arrangements. This remains an outstanding matter from the last inspection. The registered person must review the homes recreational and social activities in accordance service users preferences, expectations and abilities. Service users told the inspector that their family and friends can visit when they want and service users were seen making choices with regards to their meals and the daily routine of the home. The cook in the home is very experienced and provides a varied and wholesome diet. The kitchen is stocked well and the cook was able to confirm that he orders both fresh and frozen product and that the provider never questions the quantity. On the day of the visit all service users enjoyed their lunch and some service user asked for an alternative, which was prepared by the cook. The menu board had not been completed and some service user were unsure of what the meal was when asked by the inspector. All the service users said that the food was very good. The cook had a sound knowledge of all the service users likes and dislikes and was aware of dietary needs with regards to health. The cook was able to confirm that he still had not received training in food hygiene, this remains an outstanding requirement with regards to training from the last inspection. The inspector reviewed the home’s procedures with regards service user rights and choices for purchasing personal products. Since the last inspection the business manager told the inspector that monies are not held on behalf of service users and that toiletries and incontinence pads would now be inclusive of the homes weekly fees and that service user have the right to purchase anything from outside the home. One service user told the inspector that her family manages her money the service user told the inspector that they had recently been invoiced for additional expenditure above the weekly charge. The registered provided must ensure that the Commission for Social Care Inspection are provided with an amended terms and condition, statement of purpose and service users guide in accordance with the home procedure on this matter. The Brambles DS0000005880.V296891.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome group is – adequate The home had a satisfactory complaints procedure, which ensures complaints would be investigated. Arrangements for the protection of service users are satisfactory which ensure the protection of service users, however further work is required to ensure that staff are trained in this important area. EVIDENCE: The home has a policy and procedure for reporting and recording complaints. There was one complaint at the time of the visit which was still under investigation. Service users spoken said that they had no complaints but knew who they could speak to if they had any concerns. The home had a policy and procedure for protecting service users this has been updated since the last inspection to include the correct reporting and notifying procedure. There was no evidence from the staff files that staff had received training on the protection of vulnerable adults, staff spoken to told the inspector that they would report concerns to the manager. On the day of the visit a number of staff file were observed by the inspector, all files contained information that appropriate checks had been undertaken to ensure they were fit to work with vulnerable adults. The Brambles DS0000005880.V296891.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome group is – good The home is clean and hygienic which provides a suitable and safe environment for service users that live there. EVIDENCE: The home has had a major refurbishment as well as a large extension, which will provide additional bedrooms and lounge space. On the day of the visit the inspector noted that the work was complete and a further visit by the Commission for Social Care will be made when the provider has all certificates in place. There is a new laundry, which is away from the communal and living areas of the home and the equipment provided ensures clothes can be washed at appropriate temperatures. The care staff attend to the laundry and were observed wearing protective clothing to protect against cross infection. A sluicing facility is provided in the laundry area. Service users spoken to were happy with the homes environment and a number of comments were made by service users about the nice decorations and rooms.
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 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 and 30 Quality in this outcome group is – adequate The procedure for the recruitment of staff ensures the safety of service users. The home does not ensure that the staff are trained and competent in the job they do. EVIDENCE: There was a duty rota available which included all the staff working in the home. On the day of the visit the inspector noted that a number of the service users required a high level of assistance and the care staff also undertake laundry duties as well as serving the evening meal. Staff spoken too said that they felt there was enough staff on duty both in the daytime and evenings to met the service users needs. A number of staff files were viewed as part of the inspection process. The registered person had undertaken the required checks for new staff prior to them starting work. The inspector was concerned to note that little progress had been made since the last inspection with regards to ensuring staff are provided with training to do their job competently. The inspector noted that the majority of staff required updates in moving and handling and basic food hygiene and the cook was still awaiting an update for food hygiene. This remains an outstanding requirement from the last inspection. There was no evidence that the new staff had received training or an induction. The registered person must address the training needs of staff in the home. .
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 17 A small number of staff were working towards an NVQ Level 2 in Care. One staff member said that she enjoying doing the course. The registered person should ensure that 50 of care staff are trained to NVQ Level 2 in Care. The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 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): 31,33,35 and 38 Quality in this outcome group is –adequate The management in the home is adequate, which ensures service users interests and welfare are supported however further consideration is need with regards formal training for the manager. The home system for recording and holding service users personal allowances is satisfactory and ensures the protection of service users monies. EVIDENCE: The registered manager holds a NEBBS introduction to management but is expected to have a formal qualification by 2007. At the time of the visit consideration was being given by the manager to enrol for the Registered Managers Award. The management team informed the inspector that since the last inspection the home does not hold any service users money and had recently reviewed the homes charges. The inspector was informed that the homes charges include both toiletries and incontinence pads. A copy of the terms and
The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 19 condition, Statement of Purpose and Service User Guide should be sent to the Commission for Social Care Inspection. The home is not currently holding valuables. A proforma is available to record any valuables coming into the home from service users. The inspector advised the management to obtain a register, which would provide prompts on information to record. The home appropriately records all accidents and there is a fire and environmental risk assessment in place. Infection control measures are in place and all staff are provided with protective clothing when undertaken specific tasks. General maintenance certificates where in place and up to date. A number of staff required training in moving and handling. The registered person must ensure that staff are trained to ensure the safety of service users wellbeing. The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 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 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 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 Standard OP1 Regulation 5(2) Requirement The registered person must ensure that each service user is provided with a service user guide.(time scale of 31/3/06 not met) The registered person must ensure that each service user is provided with a copy of their terms and conditions of residency which includes the charges to the service user including any extra amounts payable for additional services not covered in the general charge. (Timescale of 27/3/06 not met) The registered provider must provide a copy of the homes Service Users Guide, Statement of Purpose and Terms and Condition to the Commission for Social Care Inspection. The registered person must ensure that full assessment of needs is undertaken for all new service users. The registered person must
DS0000005880.V296891.R01.S.doc Timescale for action 31/08/06 2 OP2 5(1)(b)Sc hedule 4 8. 31/08/06 3 OP1 OP2 4(2)5(2) 31/08/06 4 OP3 14(1)(a) 31/08/06 5 OP7 15(1) 31/08/06
Page 22 The Brambles Version 5.2 ensure that all service users and or their relative are provided with the opportunity to be involved in the care planning and reviewing process.(Timescale of 31/3/06 not met) 6 OP8 OP7 15(1) The registered person must ensure that the care plan provides written instructions on how the assessed needs are to be met.(Timescale 31/3/06 not met) Following consultation with the service users the registered person must ensure that service users social, and recreational interests are met.(Timescale of 31/12/05 & 31/3/06 not met) The registered person must ensure that the cook is kept up to date with basic food hygiene certificate. The registered person must ensure that all care staff are provided with training on the protection of Vulnerable adults.(Timescale of 30/4/06 not met) The registered person must ensure that all staff are kept up to date with mandatory training including moving and handling and food hygiene. (Timescale of 30/11/05 & 6/4/06 not met) The registered person must ensure that a record of induction training is kept for all new staff. (Timescale of 30/11/05 & 30/4/06 not met) The registered person must
DS0000005880.V296891.R01.S.doc 31/08/06 7 OP12 16(2)(m)( n) 31/08/06 8 OP15 18(1) (C)(i) 13(6) 31/08/06 9 OP18 31/08/06 10 OP28 18 (c) 31/08/06 11 OP30 18 ( c) 31/08/06 12 OP31 9(b)(i) 31/08/06
Version 5.2 Page 23 The Brambles ensure that the registered manager has the qualifications, skills to manage the care home. (Timescale of 31/12/05 & 30/4/06 not met) 13 OP35 Schedule 4 The registered person must ensure that a record is kept of furniture and valuables brought into the home by the service user and a written acknowledgement of the return of valuables. 31/08/06 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 3. 4. 5. Refer to Standard OP12 OP15 OP28 OP35 OP35 Good Practice Recommendations The registered person should develop a programme of activities for service users. The registered person should display the daily menu in the home. The registered person should ensure that 50 of the staff team is trained to NVQ Level 2 in Care. The registered person is advised to obtain a formal register to record valuables and furniture brought in to the by service users. The registered person should ensure that the record for recording service users belongings/ valuables and furniture brought in to the home is completed. The Brambles DS0000005880.V296891.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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