CARE HOMES FOR OLDER PEOPLE
The Briars 4 Station Road Thornton Cleveleys Lancashire FY5 5HY Lead Inspector
Mr Patrick Rooney Unannounced Inspection 10:00 23 March 2006
rd 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 Briars DS0000059597.V275087.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 Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Briars Address 4 Station Road Thornton Cleveleys Lancashire FY5 5HY 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) 01253 854722 Mrs Ellen Hewitson Mr Martin Paul Hewitson Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: The Briars is situated in Thornton Cleveleys near Blackpool, shops and amenities are nearby. It is a detached property offering residential care for 15 elderly persons. There are bedrooms on the ground and first floor, 15 are single rooms, two of which are ensuite. There is one double room on the ground floor. Bedrooms are pleasantly furnished, as are lounge and dining areas. A passenger lift facilitates access to the first floor. Communal space consists of a large main lounge and a sun lounge/dining area. A pleasant garden area is available for the use of residents. The home has achieved the Investors in People Award. The Briars DS0000059597.V275087.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 and took place over a four-hour period; the proprietor had completed a pre inspection questionnaire. The inspector consulted care records and spoke to most of the residents living at the home. Two residents were seen in their own rooms, their care was discussed their care with them. Comments received from residents were positive and were complementary about the care they receive. They include; “It is beautiful here staff are good to us and help us do things for ourselves”. “ They are very good here, I have my own things in my room”. Residents spoken to said they are offered a good variety of food which is home cooked and well presented. Records of food served showed there are a wide variety of meals offered with choices always available. Fresh fruit and vegetables are always available. The inspector toured the building, spoke to individual staff, had discussion with management and consulted records and policies and procedures. Questionnaires were issued for residents and relatives to complete. What the service does well: What has improved since the last inspection? The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 6 The proprietor of the home has ensured all new staff have acceptable references and that at least a POVA clearance has been received before a member of staff takes up post. New staff work supervised until a full CRB clearance is received. 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 Briars DS0000059597.V275087.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 Briars DS0000059597.V275087.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): All core Standards in this section were assessed at the last inspection. EVIDENCE: The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 9 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 and 9 Care plans should be a working document, which is accessible to staff and residents. Medication recording and storage requires attention in order to meet Standard 9 EVIDENCE: The residents care plan should set out in detail actions required to be taken by care staff to ensure all aspects of health, personal and social care needs are met. A the time of the inspection it was noted that care plans were stored in the office and were inaccessible to staff. The review system does not include input from residents or their representatives and is carried out by staff and recorded in the daily record notes. Care plans should be reviewed in conjunction with the daily records and should be kept together so that the reviewer has a full picture and can adjust the care plan when necessary. Reviews and care plans seen were not signed by residents or their representatives. The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 10 On asking for access to the medication cabinet, it was observed that the senior carer took the keys of a hook in the kitchen. To ensure safe storage of medication the key should be kept on the person responsible for giving out medication. Storage of medication is in a filing cabinet, which does not lend itself to providing ordered storage. An unmarked pot containing medication was seen in the drawer and the remnants of a capsule were seen at the bottom of the drawer. There was a container of eye drops which was opened, however the date of opening was not recorded anywhere. Eye drops should be discarded one month after opening. Medication record sheets had not been filled in correctly in relation to some residents in that one residents medication had been marked as being given, when in fact it had been refused. Another residents medication record had not been completed correctly to show when medication had been given. The Briars DS0000059597.V275087.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): 14 and 15 Residents are enabled by the home to exercise choice and control in their daily lives. Residents receive a varied appealing diet and have choices in what they eat. EVIDENCE: Residents are able to manage their own finances, however most have family doing this. Any personal allowances kept for residents by the home are kept securely and good records maintained of income and outgoings. Resident told the inspector they are happy with arrangements in place. Those who wish to contact local advocacy services are able to do so; information regarding these is available in the home. Residents said they are able to choose when they get up and go to bed and where they wish to sit during the day. Their own rooms are personalised and residents have their own possessions around them. Residents said, “It is beautiful here staff are good to us and help us do things for ourselves”. “ They are very good here, I have my own things in my room”.
The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 12 Residents spoken to said they are offered a good variety of food which is home cooked and well presented. Records of food served showed there are a wide variety of meals offered with choices always available. Fresh fruit and vegetables are always available. Residents are able to decide what meals they have and are consulted daily about what they want, food is also discussed in residents meetings. Hot and cold drinks are available throughout the day and a supper is offered in late evening. A cook is employed by the home and has competed a food hygiene course, staff are also provided with food hygiene training. The Briars DS0000059597.V275087.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): All core Standards in this section were assessed at the last inspection. EVIDENCE: The Briars DS0000059597.V275087.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): 25 Safety issues had not been adequately attended to due to the use of unsuitable heater EVIDENCE: The inspector noted a halogen heater in a resident’s room, which was positioned near to the resident’s chair. This was unguarded and is a risk to elderly persons, who are at risk from such heaters, the proprietor was asked to remove these heaters and if any secondary heating is required it must be suitably guarded. The proprieter complied with this request. The Briars DS0000059597.V275087.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 and 30 There are sufficient experienced staff on duty to ensure residents needs are met. Induction and basic training for new staff needs to be improved. EVIDENCE: Records showed that there are currently 60 of staff working at the home with at least NVQ 2 in care and two staff have NVQ 3. Rotas showed that there are always experienced staff on duty. A cleaner is employed for five days per week and a cook works four days. A new member of staff who had recently been appointed did not have an induction and training record. Training records seen for other staff showed that four staff were working without Moving and Handling training. All staff working with residents should have this training. It was suggested to the proprietor that one member of staff could be trained as a key mover; this would then allow them to be able to train other staff. The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 16 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): 33, 35 and 38 Residents are consulted regarding how the home operates and are able to make a contribution. None of the resident finances are dealt with by the home. More attention is required to ensure health and safety of residents and staff is promoted and protected. EVIDENCE: The Briars management conduct a regular survey in which they ask for feedback from service users and relatives regarding service offered by the home. A survey was carried out by the home in February 06 the results of this were available at the inspection and were pinned on the homes notice board. It contained positive feedback about care provide by the home. In addition the proprietor is available daily within the home and is available to talk to residents. There are residents meetings, which discuss issues arising in the home and food residents would like to receive. The home is accredited with the Investors In People Award.
The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 17 Al resident currently living at the home have their finances dealt with by families any personal allowances are made available from their families. The home has health and safety policies and procedures in place, however it was of concern that four staff are working with residents who have not had moving and handling training. Advice was given re this as stated in Standard 30 above. It was also of concern that a freestanding Halogen heater was observed to be placed near to a resident’s chair in their own room. The proprietor was told that it must be removed and any secondary heating must be suitable and guarded to protect residents. The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X 2 X STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 17(1)(a) (i) Requirement The registered provider must ensure that all medications given are accurately recorded in the Medication Administration Sheets. Refused medication must be recorded properly. The registered provider must ensure that all unsuitable heaters are removed from resident’s rooms and inform the CSCI in writing that this has been done. Timescale for action 23/03/06 2 OP25 13(4) 30/04/06 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. Refer to Standard OP7 OP7 Good Practice Recommendations Care plans should be available to staff working with them and should be drawn up with involvement of staff and residents. A care plan review format should be set up and reviews carried out with residents, and by consulting the daily records.
DS0000059597.V275087.R01.S.doc Version 5.1 Page 20 The Briars 3 4 5 6 7 OP9 OP9 OP9 OP30 OP30 All medication stored in the drug cabinet should be marked. Refused medication should be properly disposed of and a record kept of the disposal. Eye drop containers should have the date they are opened written on them. Keys to the medication cabinet should always be in the safe keeping of the senior member of staff responsible for. Medication administration All new staff should have a full induction in line with Skills to Care (formerly TOPPS) guidelines. All staff caring for residents should have moving and handling training. The Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 21 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
© 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 Briars DS0000059597.V275087.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
