CARE HOMES FOR OLDER PEOPLE
The Brambles Park Avenue New Longton Lancashire PR4 4AY Lead Inspector
Della Lovell Unannounced Inspection 6th March 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.V285364.R01.S.doc Version 5.1 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.V285364.R01.S.doc Version 5.1 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.V285364.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2005 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.V285364.R01.S.doc Version 5.1 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 March 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? What they could do better:
Since the last inspection little progress has been made with regards to outstanding requirements and a number of immediate requirements were issued at this inspection to ensure that service users safety is protected. It was a requirement from the last inspection that staff are appropriately trained to ensure they can meet the service users needs. On the day of the inspection there was no evidence on new staff files of induction training. A number of staff required moving and handling updates and food hygiene The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 6 training and the cook did not hold a current food hygiene certificate. The provider must address the training needs of the staff with in the home. The following serious concerns must be dealt with immediately. These concerns were, although it was a requirement from the last inspection, staff had again been recruited and were working in the home without the appropriate checks in place. No staff must work at the home unless a POVA First Check has been obtained and all other documentation required by law in place. Not all service users had a copy of their terms and conditions. The home holds money for a number of service users. A number of service users were being charged for incontinence and bathing products. The homes system for recording and holding service users personal allowances does not ensure service users interests are protected. The terms and condition must be amended to ensure that it clearly states what may be charged for over and above those included in the fees. The home should keep all receipts. In addition, some service users did not have a care plan or risk assessment in place, which does not ensure the safety of service users and does not ensure that the home can meet the assessed needs prior to admission. The home must address all the serious concerns within 21 days from the date of the visit. 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.V285364.R01.S.doc Version 5.1 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.V285364.R01.S.doc Version 5.1 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 The home does not provide sufficient information for new service users on what services and charges the home makes. The homes assessment process does not demonstrate that the home can met the individual needs. EVIDENCE: Two new service users files were looked at. The home had completed an assessment for both service users. However there were no care plans or risk assessments in place to ensure that the home could meet the service users needs. One of the service users had been admitted to the home from hospital following a series of falls. The home had not undertaken a risk assessment and in the two weeks the service user had been at the home seven falls had been recorded. The inspector discussed this matter of concern with the manager. A thorough risk assessment must be undertaken and action to minimise any further falls put in to place. Another service users file did not provide clear instructions with regards to a specific health care need and how the home would meet this need. There had been no training provided for care staff with regards to this care. The
The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 9 registered manager informed the inspector that the service users daughter had instructed the staff on how to undertake the care task required and that a community-specialised nurse had been arranged to visit the home to talk to staff. The registered person must ensure that the home has the skills to meet the service users needs prior to any service user being admitted to the home. There was no evidence that both the service users had been involved in the assessment process and none of the new service users had been issued with a contract outlining the terms and conditions of residency. One service user spoken to said that they did not know if they had a contract or not. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 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 The homes care plans do not provide adequate information to ensure that service users needs are met by the care provided. EVIDENCE: On the day of the visit not all service users had a care plan in place. A number of care plans seen by the inspector were not dated or signed. One care plan did not provide care instructions for staff on how to meet a specific health care need. Discussion with the manager and staff suggested that these needs were being met even though there was a lack of information on the service users care plan. Care plans should be developed from the assessment and the care plan needs to provide written instructions for staff on how the needs are to be met by their actions. Service users said that they were happy with the level of service they received and said that the care staff were kind. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 The homes social activities need to be developed further to ensure that service users needs are met. The homes procedure with regards to personal shopping and allowances does not enable residents to exercise choice and control over their lives. Contact with family and friends are maintained. EVIDENCE: The registered manager informed the inspector that since the last inspection an activity coordinator had been appointed to provide 2hrs a day, four days a week. There was no programme or record of activities available and the activity coordinator had not been put on the staff duty rota. One service user spoken too was unable to confirm what the home provided in relation to activities. The homes assessment had recorded service users interests at the point of admission. However to ensure that service users recreational interests and needs are met the registered person is advised to record and inform service users what is available in the home. 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 home does hold monies on behalf of the service users. However the home does not obtain all receipts for monies spent on behalf of the service users.
The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 12 The inspector noted that the home provides toiletries and personal products to services users, it was not clear whether or not the service user had agreed to this or whether they would prefer to purchase their own. The registered person must ensure that service users rights with regards to additional services and products that the home can provide are formally agreed with the service users and or their relative and choices are offered. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 13 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 home had a satisfactory complaints procedure, which ensures complaints would be investigated. Arrangements for the protection of service users are not satisfactory and do not ensure the protection of service users. EVIDENCE: Since the last inspection the home had developed a system for logging and monitoring complaints. The home had received one complaint since the last inspection, which was still under investigation by the home. The home had a policy and procedure for protecting service users however the procedure still required updating as recommended at the last inspection. The policy must ensure that The Commission for Social Care Inspection is notified within 24hrs of any allegation. There was no evidence from the staff files that staff had received training on the protection of vulnerable adults. On the day of the visit the inspector noted that new staff had commenced work prior to a POVA First and Criminal Record Bureau check being received by the home. The seriousness of this matter was discussed with a manager and an immediate requirement was issued to ensure that both new and existing staff members have the correct documentation required by law in place. The homes recording of service users money spent does not provide a clear indication of products and services purchased. The provider must address this matter in order to protect the rights and interests of service users. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 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 is nearly complete and a further visit by the Commission for Social Care will be made once fully completed. 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 one service user said, “ we have lovely new rooms and the staff always keep them my room nice and clean.” The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 15 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 The procedure for the recruitment of staff did not safeguard service users. Staff at the home are provided with some training, however further training is required to ensure that staff are competent in the job they do. EVIDENCE: There was a duty rota available, however the activity coordinator and the handy person were not included on the rota. The registered person should include 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. The registered person is advised to monitor and review the staffing levels in the home against the Residential Staffing Forum Model that calculates staffing levels in accordance to the dependency of the current service users. A number of staff files were viewed as part of the inspection process. There was no POVA or Criminal Bureau Check for two new staff working in the home and no evidence on existing staff files that checks had been undertaken. At the time of the visit there was one new overseas worker on the premises, who had recently arrived in the country. The home did not hold any documentation with regards to this person. This person was seen in the home in the presence of service users wearing an apron. The seriousness of this matter was discussed with the manager on duty and an immediate requirement was issued to ensure that the home undertook the appropriate checks on both the new and existing staff. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 16 Little progress had been made since the last inspection with regards ensuring staff are provided with training to ensure they can do the job. The cook had not received an update with regards to a basic food hygiene certificate and there was no evidence that the new staff had received training with regards moving and handling. A small number of staff were working towards an NVQ Level 2 in Care. One staff member said that she felt the course was very good and that the training helped them in the work they do. The registered person should ensure that 50 of care staff are trained to NVQ Level 2 in Care. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 17 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 and 35 The home is not being managed effectively, which does not ensure service users interests and welfare are protected. The home system for recording and holding service users personal allowances does not protect or safe guard service users monies. EVIDENCE: The registered manager has not received any training since the last inspection and does not intend to undertake the registered managers award. The inspector was informed that the home is considering appointing a new manager to the position. The home holds money for a number of service users. A written record is kept of moneys spent. However the home does not keep all receipts. The home charges service users for both toiletries and incontinence pads. The homes system for recording and holding service users personal allowances does not protect or safe guard service users financial interests. An immediate requirement was issued that the home reviews all service users personal allowances with regards to charges for incontinence pads and toiletries. All
The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 18 service users must be provided with a terms and condition which clearly states what may be charged for over and above those included in the fees. Service user care plans must identify an assessment for the need of incontinent products. The home must not provide communal toiletries and ensure that service user have their own personal toiletries of their own choice. The home is not currently holding valuables. The inspector informed the manager that the home should obtain a register and must record expensive items such as televisions brought in to the home by services users. On the day of the visit the home was issued with an immediate requirement to review and amend the homes procedure for recording service users personal allowances, which ensures that all moneys spent can be accounted for. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 19 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 1 1 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 X X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X X x The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 Page 20 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 Requirement 5(2) Timescale for action The registered person must 31/03/06 ensure that each service user is provided with a service user guide. The registered person must 27/03/06 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. The registered person must 27/03/06 ensure that a thorough risk assessment is carried out for all service users with regards to the risk of falls and action taken to reduce any identified risk. The registered person must not 31/03/06 accommodate a service user unless the needs of the service users can be met. The registered person must 30/04/06 ensure that staff are appropriately trained to the work they are to perform. The registered person must 31/03/06
DS0000005880.V285364.R01.S.doc Version 5.1 Page 21 2 OP2 5(1)(b) Schedule 4 8. 3 OP3 13(4)(a) (b)(c) 4 OP3 14(1) 5 OP3 18(c)(i) 6 OP7 15(1) The Brambles 7 OP7 15(1) 8 OP8OP7 15(1) 9. OP12 16(2)(m)( n) 10 OP14 12(2) 11 OP18 13(6) 12 OP18 37(1) (e) 13 OP28 18 (c) 14 OP18OP29 19(1) 4(b) Sch 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. The registered person must ensure that each service user has a written care plan in place as to how the service users needs are to be met. The registered person must ensure that the care plan provides written instructions on how the assessed needs are to be 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 not met The registered person must ensure that service users rights and choices are respected with regards to purchasing personal products. The registered person must ensure that all care staff are provided with training on the protection of Vulnerable adults. The registered person must ensure that the homes policy and procedure for reporting allegations of abuse includes notifying the Commission for Social Care Inspection. The registered person must ensure that all staff are kept up to date with relevant training. (Timescale of 30/11/05 not met) The registered person must ensure that information and documentation listed in Schedule 2 of the Care Homes Regulation 2001 in respect of persons working in the home are obtained. (Timescale of
DS0000005880.V285364.R01.S.doc 31/03/06 31/03/06 31/03/06 27/03/06 30/04/06 31/03/06 31/04/06 07/03/06 The Brambles Version 5.1 Page 22 15 OP27 Schedule 4 (7) 19(1) Schedule 2 18 ( c) 16 OP29 17 OP30 18 OP31 9(b)(i) 19 OP35 12(1)(a) 20 OP35 Schedule 4 30/11/05 not met) The registered person must ensure that the staff rota shows all staff working in the care home. The registered person must ensure that all staff have a satisfactory check with the Criminal Record Bureau. The registered person must ensure that a record of induction training is kept for all new staff. (Timescale of 30/11/05 not met) The registered person must ensure that the registered manager has the qualifications, skills to manage the care home. (Timescale of 31/12/05 not met) The registered person must ensure that the homes accounting procedure for holding service users personal allowance is reviewed and measures are put in place to safe guard service users monies. 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. 31/03/06 07/03/06 30/04/06 30/04/06 27/03/06 31/03/06 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. Refer to Standard OP12 Good Practice Recommendations The registered person should develop a programme of activities for service users.
DS0000005880.V285364.R01.S.doc Version 5.1 Page 23 The Brambles 2. OP18 3. 4. 5. OP27 OP28 OP35 The registered person should ensure that the homes policy for the protection of vulnerable abuse is revised to provide clarity for staff of the action they should take should an allegation of abuse be made. It is recommended that staff are provided at the home in accordance with the dependancy needs of service users. The registered person should ensure that 50 of the staff team is trained to NVQ Level 2 in Care. The registered person should retain all receipts of monies spent on behalf of service users. The Brambles DS0000005880.V285364.R01.S.doc Version 5.1 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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