Inspection on 25/09/06 for The Brambles

This inspection was carried out on 25th September 2006.

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

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

Other inspections for this house

The Brambles 05/06/07

The Brambles 08/01/07

The Brambles 18/11/05

The Brambles 24/05/05

The Brambles 22/11/04

The Brambles 02/06/04

The Brambles 05/08/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Brambles 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA Lead Inspector Mrs Cathy Moore Unannounced Inspection 25th September 2006 07:25 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 DS0000024978.V312680.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 DS0000024978.V312680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brambles Address 69a Vicarage Road Amblecote Stourbridge West Midlands DY8 4JA 01384 379034 01384 396892 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) Mr Boota Singh Khangoure Mrs Melanie Mansell Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 35 service users in the category of OP 14 can be PD(E). Date of last inspection 18/11/05 Brief Description of the Service: The Brambles is a residential home providing 24-hour care and support for 35 people over the age of 65 up to 14 of which can have a primary diagnosis of physical disability. It is located in a residential area of Amblecote opposite Corbett Outpatients Department and close to Stourbridge town centre. It is easily accessible by local public transport networks and there are a few parking spaces at the front. A major refurbishment and extension has been undertaken to improve the homes environment and increase the occupancy. This has increased communal space and enhanced bedrooms. The weekly fees for this home range from £300-£399. Additional charges are applicable for services from the hairdresser and private chiropody. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on one day between 07.25 and 18.25 hours. The inspection process assessed all of the key National Minimum Standards for older people. To aid the inspection process a ‘Quality Assurance Assessment’ questionnaire was forwarded to the home for completion. A proportion of the inspection was conducted in the living areas where care practices and staff/resident interaction could be observed. During the course of the inspection three residents’ files to include; assessment of need and care plan documents were assessed. Three staff files to include; recruitment documents and training were also assessed. The premises were part assessed to include; the lounges, the conservatory, dining room, six bedrooms, the laundry, kitchen, garden, bathrooms and toilets. Medication systems and the safe keeping of resident money were assessed. Both breakfast and main meal times were partly observed. Eight residents, three staff and three relatives were spoken to during the inspection. One senior and the owner were on site during the inspection process. What the service does well: Refurbishment and extension work has increased communal areas and enhanced the home considerably. The premises are of a good standard, well maintained, pleasant and homely. The home has a welcoming atmosphere. Staff work hard and are kind and caring. The registered owner spends time at the home most days- he is on site all day during the week. The assessment of need process concerning documentation is good. The home ensures that it receives information from the funding authority of each resident before they are admitted to enhance the assessment of need process further. At breakfast time there were a number of choices available including a full cooked breakfast for residents who wanted one. The home has good access via a ramp to the front of the home. Generally, staff have received most of the required mandatory training. The majority of staff employed have achieved N.V.Q level 2 or above in care. The home welcomes visitors and encourages residents to maintain contact with family and friends. Positive comments were received about the home and the staff which included; “The staff are excellent, polite and friendly like pals”. “ The home is very nice indeed”. “ The place is not too bad at all”. “The staff are o.k, nice ladies”. “ The The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 6 staff are very good to them from what I have seen”. “The staff are pleasant and polite, well cared for”.” She has settled in well”. What has improved since the last inspection? What they could do better: The home has received a high number of requirements following this inspection. Immediate requirements and a serious concern letter were issued regarding the staffing shortage which includes care, laundry and catering staff. The staffing shortage is potentially placing residents at risk. The situation is having a negative impact on the care delivered. One resident was heard saying; “ Wait, wait, wait that’s all we do”, when she was asked by a staff member to; “Wait a minute”. Immediate requirements and serious concern letters have been issued by the CSCI, the owner has been informed that if improvements are not made and sustained the CSCI will have to consider further or enforcement action. Poor recruitment practices were identified for example; one staff member has been re-employed by the home after a gap of a year without the required checks being undertaken. Unsafe medication practices were also identified examples being; Medication had run out for two residents so their medication could not be given to them. The medication fridge was broken and medication that required storage was not being refrigerated. These areas and others identified must all be improved upon within the timescales set or further action may have to be considered. The home has a number of residents who have a diagnosis of dementia. The home at the present time is not registered to provide care to people with this diagnosis. It was concerning that there was no care plan or instructions for staff to follow regarding one resident who has been admitted for respite care. A concern identified was that residents had to wait for a drink when they got up. Two residents asked for a glass of water. Further, drinks were not given between breakfast and lunch time. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 7 Infection control systems and processes need to be tightened to prevent transmission of infection. This is vital as there has been a recent outbreak of scabies at the home. 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 DS0000024978.V312680.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 The Brambles DS0000024978.V312680.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4. The overall outcome for this group of standards is judged to be adequate. Although it is positive each service user has a written contract/ statement of terms and conditions the information contained is not always correct and valid. No service user moves into the home without having their needs assessed. The home must only admit service users who have needs that are reflected in the homes registration certificate. EVIDENCE: It was positive that a contract/terms and conditions was available on the resident files that were viewed. However, some of the information contained within these documents was not always correct or valid. For example; one contract detailed the fee for the previous financial year not the current one. Reference was made to the NCSC which has not existed since April 2004 and contracts stated that the home is registered with Dudley MBC when in fact it is registered with the Commission for Social Care Inspection. Assessment of need documents were found to be good in that all of the main key areas were included and reported on. Additionally, it was positive that The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 10 information from the funding authority (where applicable) had been obtained for each resident and was held on their file. The home has at least six residents accommodated who have a diagnosis of dementia. Staff and the owner were not able to confirm if the dementia was their primary or secondary need. This needs to be dealt with and appropriate action taken by consulting with the Commission and providing accurate information for a variation to be considered as the home is not registered to accommodate residents who have a primary need of dementia. The Brambles DS0000024978.V312680.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The overall outcome for this group of standards is judged to be poor. Generally, most residents have their needs set out in a care plan. However, it was identified that there was no care plan for a new service user . Generally, the health and care needs of the service users are being met. However, further development is needed in respect of weight loss management. Medication systems were found to be poor and unsafe potentially placing service users at risk. EVIDENCE: The files of three residents were examined. A care plan of a good standard was in place for two. No care plan however, had been completed for the third resident who had been admitted for respite care. This was concerning as the staff had limited knowledge about this person who was a diabetic. It was noted positively that care plans are reviewed regularly and there was evidence of resident involvement in their production. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 12 Overall, there was evidence to demonstrate that the care needs of the residents are being met. Residents seen were well presented. One relative said;” She is always nice and clean”. Records were available to demonstrate that risk, tissue viability and nutritional assessments are undertaken. There was also evidence of monthly weight monitoring for each resident. One concern identified was that one resident had lost 2.9kg between the end of July 2006 and mid September 2006 which is a considerable loss yet, there was no evidence that this had been reported to the residents doctor as it should have been. There was evidence that a range of health care services such as the doctor and optician are accessed for the residents either as needed or on a fairly regular basis. Medication systems can only be described as being; ‘poor and concerning’ as follows. Although it is positive that the medication trolleys are secure they have been secured so that they cannot be taken from the medication room. Because of this the medication packs were left on the table in the medication room. The trolley unlocked whilst the senior gave medication to residents in the dining room giving an opportunity for residents to take medication from this room. Additionally, administration of medication is taking a long time because the staff member was having to go to and fro to collect and give medication. The staff member was observed signing the medication record before giving the medication to the resident which is not an approved practice as the resident may then refuse their medication and the medication record would not then be accurate. It was concerning that the medication fridge was not functioning. Although the owner had tried to address the problem it had not been resolved. Medication that needed to be refrigerated was not. It was most concerning to identify that on two occasions recently medication had ‘ run out’ and was therefore not available to give to the resident. One of these medications was Warafrin- it is vital that this medication is given as prescribed without a gap. Medication records were also of a concern in that there were a high number of records not signed by staff to verify administration. Totals of Temezepam and Durogesic patches( both controlled drugs )did not tally. Staff on a number of occasions were heard using ‘pet names’ to address residents examples being; ‘sweetheart and darling’. Whilst staff may think they are being kind and friendly residents may not welcome being addressed in this manner. Staff observed were polite and caring. One resident went to take down her skirt the staff member near by reacted quickly and told the resident to; “Come with me to the toilet I will help you”. One relative said; “ The staff are polite”. This was confirmed by other residents. Toilet and bathroom doors were seen to be shut when in use to enhance privacy and dignity which is good practice. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 13 One resident said; “ Sometimes I like time on my own in private. I then go to my bedroom and watch a video”. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15 The overall outcome for this group of standards is judged to be adequate. Service users generally, are satisfied with the daily routines of the home. The home operates a flexible visiting policy. Residents are encouraged to maintain contact with family and friends. Service users generally, are helped to exercise choice and control over their lives. Menus and drink provision need further development and improvement. EVIDENCE: Residents spoken to were satisfied with their daily routines. One said; “I like to get up early. I hate staying in bed once I am awake”. It was positive to see that preferred daily routines had been determined for each resident and recorded on a ‘ Daily Routine’ document. Activity provision is lacking although staff do try. During the inspection a music session took place which residents clearly enjoyed and a high number participated in. In order to improve the activity provision shortfall from Monday 25 September a staff member has been allocated 2 hours each day, four days per week to provide activity provision within the home. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 15 Activity events were advertised an example being; a pending bonfire party on November 3rd 06. The vicar visits every two weeks and the mobile library every six weeks. The home has a flexible visiting policy. Residents are encouraged to maintain contact with family and friends. A number of people visited during the inspection. One relatives, friend said; “ I visit every week and am made to feel welcome”. A relative said; “ I feel welcomed by the home”. One resident said; “ My daughter comes to see me regularly”. The breakfast and main meal times were observed. Many positive aspects were noted. The dining room is pleasant. Furniture of a good standard and the tables were nicely laid. One resident had his food liquidised and a plate guard was provided to enable him to eat more independently. Staff availability at breakfast however, was limited due to staffing numbers so some residents had to wait a while for their food. The breakfast offered was varied with a range of cereals. Two residents’ however, asked for cornflakes and could not have these because they had run out. The owner said; “ This is a one off, an oversight, we have always got plenty of cornflakes. Food is one area that I take very seriously. I make sure we have plenty of everything”. Hot breakfast options were available. The majority of residents chose a hot option either a bacon sandwich or fried egg and bacon. One resident said cheerfully; “ They know what I like- a bacon sandwich every morning”. It was positive to note that both brown and white bread were available as were grapefruit and fruit juice. The main meal was well presented and plentiful. There was a choice of gammon or steak and kidney pie with boiled potatoes, carrots and cabbage. One resident said;” They ask you what you want for meals”. Drink provision was concerning. One resident before breakfast said; “ I am dying for a drink. I need one when I get up because I feel unsteady”. Another resident said; “ We have to wait for a drink”. It was noted that no drinks were offered between breakfast and lunch. This concern was raised with the senior. It was noted that one resident had lost a significant amount of weight in one month yet the home is not recording that person’s food and fluid intake. It was explained to both the senior on duty and the owner the importance of food/ fluid intake recording for residents who have lost weight, are nutritionally at risk or are unwell. Menus viewed were basic and did not detail any supper options. The tea menu for the day of the inspection was detailed as just ‘quiche’. Menus need to be re-written to contain more detail and supper must be added. The manager had carried out a survey of the meals with a questionnaire for the residents to complete. Results showed a dissatisfaction rate of 13 further exploration is needed to try and improve upon this. The Brambles DS0000024978.V312680.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The overall outcome for this group of standards is judged to be adequate. More action must be taken to resolve when complaints are received. Improvements are needed to ensure that service users are protected. EVIDENCE: The home has a written complaints procedure. No complaints have been received by the Commission. One concern however, was which suggested poor staffing in the home. Obviously this concern has been substantiated by evidence found during this inspection. One complaint has been received by the home in August 2006. It was disappointing that this complaint had been made about medication been given late due to staff shortage. The situation was summarised as a statement and the reason for the complaint the staffing shortage clearly has not been resolved to this day nearly two months later. Although a number of staff have received abuse awareness training it was surprising that staff asked had not seen Dudley MBC adult protection procedures which are the ones that must be activated if an allegation or incident of abuse were to occur. A quick reference flow chart for staff to follow if an allegation or incident of abuse were to occur was not available within the home. One must be produced giving names and contacts of agencies that must be contaced. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,25,26. The overall outcome for this group of standards is judged to be adequate. The home internally is safe and well maintained. It is well furnished, homely and comfortable. It offers a number of communal areas for residents and relatives to use. The garden area is of a generous size and is attractive with plants and shrubs. Service users live in safe, comfortable bedrooms. Although the home was clean with no offensive odour infection control processes/ facilities must be improved upon. EVIDENCE: As previously mentioned, the home over the last year has received considerable refurbishment and extension work which has improved the premises considerably. Effectively, apart from a few areas the home has been totally re-built. Similarly, over the same period most furniture and flooring throughout has been replaced and the home has had a new kitchen complete with stainless steel units. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 18 Communal areas include; one large room divided into two, a small lounge off the dining room, a dining room and conservatory. This allows residents a choice of where they want to spend their time and space for privacy if required. The garden is of a good size with attractive flowers and shrubs. Previous requirement were made about maintaining a planned refurbishment/ redecorating programme obviously since major work has been carried out work at the present time is up to date. Plans do however, need to be made for the future to ensure that redecorating/refurbishment work is maintained. The owner said;” I will be employing a handyperson in the near future”. At least six bedrooms were viewed. One resident accompanied the inspector to view her room which she was extremely proud of. This was the typical style of the new bedrooms; a good sized single room with en-suite facilities which was well furnished. One resident said; “ My bedroom is nice”. Another resident said;” I really like my bedroom, a lot of the furniture is mine”. Radiators throughout the home are of a low surface temperature type, the heating system is new, lighting seen was adequate and domestic in style which is all positive. The home was clean and no offensive odours were detected in areas viewed. The home has had an outbreak of scabies in recent weeks for which advice has been sought from the infection control nurse. Residents and staff alike have been treated. Infection control processes in the home need to be tightened. There was no liquid soap or paper towels in bathrooms and toilets just material towels and bar soap both of which are good vectors for infection transmission from resident to resident. Additionally, there were no hand wash signs displayed in bathrooms and toilets to remind/ encourage residents to wash their hands after using the toilet again to try and reduce bacteria or infection transmission. The laundry is provided with two washing machines and dryers. The flooring and decoration new. It was identified that there is only one sink in the laundry in which clothes were soaking therefore; there was no-where dedicated for staff hand washing purposes. Mop control needs attention in that mop heads were left wet in the bucket rather than them being allowed to dry in between use to prevent bacteria growth. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The overall outcome for this group of standards is judged to be poor. Staffing levels are poor placing service users at risk. The home has a very good attainment level for staff achieving N.V.Q level 2 or above in care. Recruitment processes are poor potentially placing service users at risk. Confirmation of induction processes is needed, the uptake of mandatory training is good. EVIDENCE: Staffing levels provided are very poor. On the day of the inspection three carers and one senior were on duty for thirty one residents. This ratio worse in the evenings when there are only three staff in total and only two staff at night (One of whom is regularly from the agency and not familiar with the residents or the home). The poor staffing situation is made worse by staff having to undertake laundry duties and at tea time one of the three carers are taken off the floor to do the tea as there is no afternoon cook. The senior when doing medication leaves only one carer on the floor. The home has increased its numbers from twenty to a possible thirty five but has not ensured that adequate staff are employed to match the increased demand. It must be acknowledged that the owner has taken some action to address the poor staffing levels by placing a vacancy sign outside of the home and The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 20 advertising but has not managed the situation in the interim which is having a negative impact on the residents and is potentially placing them at risk. One resident was heard saying; “ Wait, wait, wait that’s all we do”, when asked by a staff member to; “Wait a minute”. It was more concerning to read an entry made in the complaints book dated 6 August 2006 as follows; “ At 10 am … had still not had her medication. As I could see this was due to a staff shortage with 4 staff one of whom was cooking. I would think that 3 staff for 24 residents is not enough and is not fair on the staff or residents. Outcome Before complaint was made already .. staff ratio ( due to increase in resis, require more staff.” Staffing levels have not improved since this entry was made. Immediate requirements and serious concern letters have been issued by the CSCI, the owner informed that if improvements not made/sustained then the CSCI will have to consider enforcement action. Staff observed during the inspection were hard working, pleasant, friendly and cheerful. Positive comments were received from relatives and residents about the staff which included the following; “The staff are excellent, polite and friendly like pals”. “ The home is very nice indeed”. “ The place is not too bad at all”. “The staff are o.k, nice ladies”. “ The staff are very good to them from what I have seen”. “The staff are pleasant and polite, well cared for”.” She has settled in well”. The home must be congratulated on its high attainment level for N.V.Q. Eighty one of the staff team have achieved N.V.Q level 2 or above. Poor recruitment practices were identified for example; one staff member has been re-employed by the home after a gap of a year without the required checks being undertaken. This staff member was to be senior in charge of the home on the afternoon of the inspection, the owner assuring the inspector that she was suitable to be in charge of the home. When this staff members file was assessed and the shortfalls identified another senior had to be brought in. There are no routine checks carried out by the home for agency staff. It is the managers and owners responsibility to ensure agency staff working in the home have received all of the required checks and training. There was no evidence of induction processes for the two staff re-employed and none on file for other staff. Whether or not induction documents were elsewhere the owner did not know. Evidence to confirm induction processes one way or another must be provided to the CSCI. On a positive note by and large existing staff have all mostly received the required mandatory training. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. The overall outcome for this group of standards is judged to be adequate. Management systems, processes and responsibilities must be improved upon to prevent major shortfalls like those identified in this report . Improvements are needed to ensure that the home is run in the best interests of the residents. Development is needed concerning the management and monitoring of residents money. Improvement is needed in terms of staff supervision. A number of areas concerning health and safety require attention. EVIDENCE: The manager is registered by the Commission. It is positive that she has achieved the Registered Managers Award. As detailed throughout this report a number of serious concerns have been identified thus questioning the effectiveness’ of management systems and The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 22 responsibilities in the home. The manager and registered person both have responsibility to ensure that the residents are safe and well looked after and the home is complying with the Care Home Regulations 2001. Quality assurance systems are in place within the home but need development. For example a recent satisfaction survey undertaken revealed significant satisfaction but areas of non-satisfaction examples being; management and food. Therefore processes must be put in place to further explore dissatisfaction and rectify. The owner confirmed at the present time the home does not have in place an annual development/business plan and there was no evidence of overall monitoring of compliance across the National Minimum Standards for Older People. The home holds in safe keeping money for a number of residents which is stored in a safe. Three monies were checked against balances. Two were correct, one however, showed a deficit which was due to the residents representative not providing their personal allowance. On further examination it was identified that this was not a one off. Cases such as this must be referred at least to the residents social worker or where concerns persist through vulnerable adult procedures to involve Dudley MBC. It was identified from records that there are not always two staff present to verify transaction as only one signature was seen. Some staff are receiving one to one supervision but not all. Supervision frequency at the present time does not equate to six per year. Staff supervision therefore requires attention and improvement. Records to evidence servicing of fire fighting and other equipment were not available during the inspection. A requirement has been made for a random selection to be provided to the CSCI for perusal. A few shortfalls were identified concerning health and safety in that there was a lot of bricks, rubble and other items not secured in the garden which could have risk implications to residents. Footrests were seen being used without footrests and one wardrobe was not secured. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 23 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 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 x x x 3 3 1 STAFFING Standard No Score 27 1 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 2 x 2 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement The Statement of Purpose and service user guide need updating and must contain all the information required under this standard. Consideration must also be given to making copies available for prospective and all existing service users in a format they can read i.e. large print. This is an outstanding requirement from 22nd November 2004. A copy must be forwarded to the CSCI by timescale set. 2 OP2 5(1)(a)(b) The registered person and manager must amend the resident terms and conditions documents to ensure the following; That the correct fee for any given financial year is correct. That the section which states that the home is registered by Dudley MBC be changed as it is registered by the CSCI. The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 25 Timescale for action 01/12/06 30/11/06 That any reference to NCSC is changed to CSCI. That all contracts/ terms and conditions meet the requirements of the amended Care Home Regulations 2006 concerning terms and conditions and fees. 3 OP3 13(4)(c) 18(1)(a) The registered person must 02/10/06 confirm in writing to the CSCI his decision not to admit any further residents ( even for respite) until he can demonstrate that staffing levels are satisfactory and adequate). The registered person and 25/09/06 manager must not admit any other resident who has a diagnosis of dementia (or other needs not reflected in the home’s certificate of registration). The registered person and 25/10/06 manager must provide to the CSCI a comprehensive list (including names) of all residents accommodated who have a primary diagnosis of dementia. The registered person and manager must ensure that a care plan is produced for each resident (including those for respite) on admission. Staff must ensure medication is taken by the resident before signing the medication record sheet. Timescale of 18/11/05 not met. 10/10/06 4 OP3 14(1)(d) 5 OP4 14(1)(a) 6 OP7 15(1) 7 OP9 13(2) 05/10/06 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 26 8 OP9 13(2) The registered person and manager must ensure; That all medication records are initialled by staff immediately after medication has been administered or an appropriate code used for nonadministration. 10/10/06 9 OP9 13(2) That precise records are made of all medication administered to include Durogesic patches. The registered persons must 15/10/06 ensure that one suitably qualified and competent staff member is given the responsibility to oversee medication in the home. An immediate requirement followed by a serious concern letter was issued by the Commission in which this requirement was included. 10 OP9 13(2) The registered person and manager must ensure that the manager undertakes regular weekly documented audits of the medication systems. An immediate requirement followed by a serious concern letter was issued by the Commission in which this requirement was included. This to improve medication systems/safety and to ensure that all tablets/medication held tallies with running totals. 15/10/06 11 OP9 13(2) The registered person and manager must ensure that urgent action is taken to address and meet requirements made ( concerning medications) in the DS0000024978.V312680.R01.S.doc 10/10/06 The Brambles Version 5.2 Page 27 12 OP9 13(2) CSCI report dated 25 September 2006 as soon as it is received. The registered person and manager must take action to ensure that the person administering medication is able to undertake this task without being disturbed ( for example answering the telephone). The registered person and manager must ensure at all times that medication is not left unattended or the medication trolley unlocked when not being supervised. The registered persons and manager must ensure that medication where prescribed for residents is available within the home for administration at all times. (Medication that had ‘run’ out included Warfrin for one resident). The registered person and manager must ensure that all incoming medications ( even those brought into the home by residents) are counted and recorded. The registered person and manager must continue to communicate with the engineer to ensure that the medication fridge is mended. In the interim use a locked box in the kitchen fridge to store medication that needs refrigeration ( if possible on a separate shelf to food). The registered person and manager must ensure that a suitable medication trolley (approved, lockable and safe) is DS0000024978.V312680.R01.S.doc 10/10/06 13 OP9 13(2) 10/10/06 14 OP9 13(2) 08/10/06 15 OP9 13(2) 08/10/06 16 OP9 13(2) 08/10/06 17 OP9 13(2) 08/10/06 The Brambles Version 5.2 Page 28 used to take around the home for the purpose of medication administration. This must then be secured when not in use. 18 OP9 13(2) The registered person and manager must ensure that a photo is taken and attached to each residents medication record on the day of their admission. The registered person and manager must ensure that where medication records are handwritten; Two staff check and sign to confirm that the information transferred from medication packets and bottles is correct. That the information detailed on medication records contains all required information (as detailed at the head of the medication record) doctor, allergies etc. 20 OP9 13(2) The registered person and manager must ensure that the doctor is made aware of the homely remedies being given to resident (ET) who takes Bache remedy and other preparations and that he/she approves these before further administration. The registered person and manager must ensure that the medication policy is amended to ensure that; It states that all homely remedies brought into the home by residents must be ratified in writing by their doctor. Any medication errors must be reported to the CSCI in The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 29 10/10/06 19 OP9 13(2) 10/10/06 08/10/06 21 OP9 13(2) 25/10/06 accordance with Regulation 37. It contains a section on managing covert medication administration (in case the need ever arises). 22 OP9 13(2) The registered person and manager must ensure that an approved pharmaceutical guide no older than 12 months is available within the home at all times. The registered person and manager should discourage staff using pet names for example ‘sweetheart’, ‘Darling’ etc unless it is the wish of the resident to be addressed as such and a record of this made in their care plan. The registered person and manager must ensure that a range of drinks are available and are offered regularly to the residents. This to include as soon as they wake up, whilst waiting for breakfast and between meals. The registered person and manager must ensure that menus and menu boards are expanded to detail at least four meals per day are being offered as follows; breakfast, lunch, tea and supper. Menus must be expanded upon to give the full range of foods offered and options for example tea on 25 September was detailed as quiche. The registered person and manager must ensure that food/fluid intake charts are produced and put into operation for any resident who has lost DS0000024978.V312680.R01.S.doc 25/10/06 23 OP10 12(4)(a) 10/10/06 24 OP15 16(2)(i) 16(4) 09/10/06 25 OP15 Sched 4 (13) 20/10/06 26 OP15 16(2(i) (4) Sch4/13 08/10/06 The Brambles Version 5.2 Page 30 weight, is nutritionally at risk or has a poor appetite. These must be completed over a 24 hour period every day. 27 OP15 12(1)(a) The registered person and manager must at all times encourage healthy eating by encouraging residents to have grilled foods instead of fried and poached eggs instead of fried eggs. 20/10/06 28 OP16 22(4) The registered person and 10/10/06 manager must ensure that complaints are fully dealt with and the cause is rectified and not repeated. The registered person must ensure that; A quick reference flow chart is produced (one is included in Dudley MBC procedures Safeguard and Protect that can be added to) to give names and contact telephone numbers of agencies that must be contacted if there is an allegation or incident of abuse. This to include Dudley MBC adult protection coordinator and the CSCI. All staff read, sign and date Dudley MBC adult protection procedures titled’ Safeguard and Protect’. 01/11/06 29 OP18 13(6) 30 OP18 13(6) 31 OP19 23 The registered person and manager must ensure that all staff who have not to date receive abuse awareness traning. The registered person and DS0000024978.V312680.R01.S.doc 01/12/06 01/11/06 Page 31 The Brambles Version 5.2 manager must establish and implement a planned (with predicted future dates) redecoration and renewal of fabric programme. 32 OP26 13(3) The registered person and manager must ensure the following; That bar soap is not used for communal purposes. That material towels are not used for communal purposes. That liquid soap and paper towels are made available in all high risk areas examples being; toilets, bathrooms and the laundry. 10/10/06 33 OP26 13(3) The registered person and manager must ensure; That mop control is implemented. Mop heads and buckets to be cleaned daily (mop heads to disinfectant temperatures) and left to dry in between use. Records must be made of cleaning of mop heads and the changing of. That specialist disposable bags are purchased to reduce the need for handling soiled or contaminated clothing/laundry. The registered person and manager must ensure that infection control procedures are produced and displayed in the laundry to ensure segregation of clean and soiled washing and prevent infection transmission. That an additional sink for staff hand washing purposes only is installed in the laundry. DS0000024978.V312680.R01.S.doc 20/10/06 34 OP26 13(3) 25/10/06 35 OP26 13(3) 01/11/06 The Brambles Version 5.2 Page 32 36 OP27 18(1)(a) The registered person and manager must ensure that;; Recruitment is continued . Staffing is provided as (by using agency staff or other who meet requirements both in Regulation 18(1)(a) and 19(1)-(7) follows; Am five care staff plus a senior. Pm Four care staff plus a senior . Nights two care staff plus a senior. These staffing levels must not include the managers hours. An immediate requirement followed by a serious concern letter were issued by the Commission in which these requirements were included. 29/09/06 37 OP27 18(1)(a) The registered person and manager must ensure that staff rotas are provided to the CSCI every Monday commencing 2 October 2006 to confirm that staffing levels as detailed above are being adhered to. An immediate requirement followed by a serious concern letter were issued by the Commission in which this requirement was included. 02/10/06 38 OP27 18(1)(a) The registered person and manager must ensure that the recruitment of laundry and kitchen staff (for tea times) be continued. An immediate requirement followed by a serious concern letter were issued by the Commission in which this 25/10/06 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 33 requirement was included. 39 OP27 18(1)(a) The registered person and manager must ensure that a tea time cook is secured from an agency ( who meets requirements both in Regulation 18(1)(a) and 19(1)-(7). Written evidence that this has been done and the name of the cook each day must be forwarded to the CSCI each Monday morning commencing 2 October 2006. An immediate requirement followed by a serious concern letter were issued by the Commission in which these requirements were included. 40 OP29 19(1)19(7) The registered person and manager must ensure that no staff are employed ( reemployed) without firstly undertaking all of the required checks and obtaining documents as described in Regulations 19(1)-19(7). An immediate requirement followed by a serious concern letter were issued by the Commission in which this requirement was included. 41 OP29 19(1)19(7) The registered person and manager must ensure that processes are put in place to ensure that all requirements in Regulation 19(1)-19(7) are met for staff members (JH) and (JH). An immediate requirement followed by a serious concern letter were issued by the The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 34 02/10/06 25/09/06 26/09/06 Commission in which this requirement was included. 42 OP29 19(1) 19(7) The registered person and manager must ensure that both staff (JH) and (JH) sign a declaration confirming their status with regards to any criminal convictions, cautions or pending cases. That both staff (JH) and (JH) are fully supervised on each shift that they work by a named supervisor ( Whose name(s) must be detailed on the rota). That a POVA first check application is made for both (JH) and (JH). An immediate requirement followed by a serious concern letter were issued by the Commission in which these requirements were included. 43 OP29 19(1) 19(7) The registered person and 26/09/06 manager must ensure that a checking process for each agency staff member is undertaken before they are allowed to commence duties in the home. This to include sight of a clear CRB/POVA list check and required mandatory training. An immediate requirement followed by a serious concern letter were issued by the Commission in which these requirements were included. 44 OP30 18&19 Induction and foundation training to NTO specifications must be introduced. ( Now skills for Care induction standards) DS0000024978.V312680.R01.S.doc 26/09/06 01/11/06 The Brambles Version 5.2 Page 35 This is an outstanding requirement from 22nd November 2004. 45 OP33 24 The registered person and manager are required to implement a quality assurance system, published annually, with an action plan to improve standards. This also to include a monitoring system to audit all policies and procedures and compliance with the National Minimum Standards for older people to identify and rectify non-compliance and apply corrective actions. This must also include a process for re-visting and rectifying area where resident satisfaction surveys have highlighted ‘ non satisfaction’ an example being meals and management 46 OP33 26 The proprietor must complete monthly Regulation 26 reports and forward copied to the CSCI. This is an outstanding requirement from 22nd November 2004. The registered person and manager must ensure that two signatures verify all transactions of resident money. The registered person and manager must ensure; That an inventory of personal belongings is produced for all residents ( including those accessing respite services) as soon as they are admitted. This to include furniture/ tv’s etc brought into the home 01/11/06 01/12/06 47 OP35 13(6) Sch 4 (9) 13(6) Sch 4 (9/10) 01/10/06 48 OP35 25/10/06 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 36 .49 OP38 12&13 That residents relatives provide sufficient personal allowance money to avoid a deficit balance occurring. If residents to not cooperate then the residents social worker or local social work office (or where assessed as needed adult protection co-ordinator) should be notified. Policies and procedures reflecting 01/11/06 current practices must be developed, implemented and reviewed. They must be signed and dated by the manager then signed and dated by staff as being read and understood This is an outstanding requirement from 22nd November 2004. 50 OP38 13(4)(c) 51 OP38 13(4)(c) 52 OP38 23(2)(c) 53 OP38 23(2)(c) 23(4) The registered person and manager must ensure that all wardrobes are suitably and safely secured. The registered person and manager must ensure that areas inn the garden where work is being carried out are risk assessed and that they are made safe at all times. The registered person and manager must ensure that footrests are used on wheelchairs at all times. The registered person and manager must forward to the CSCI official evidence of the following; Staff fire drills. Lift service. Hoist services. Gas landlords safety certificate. 05/10/06 05/10/06 05/10/06 15/10/06 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 37 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 The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Brambles DS0000024978.V312680.R01.S.doc Version 5.2 Page 39 - 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. 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