Inspection on 04/05/05 for The Browning Care Home

This inspection was carried out on 4th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Browning Care Home 21/01/08

The Browning Care Home 13/04/06

The Browning Care Home 30/01/06

The Browning Care Home 09/02/05

The Browning Care Home 24/09/04

The Browning Care Home 09/12/03

The Browning Care Home 11/09/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Browning Care Home 19 Browning Road Banbury Oxfordshire OX16 9LA Lead Inspector Annette Miller Announced 04/05/05 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 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. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Browning Care Home Address 19 Browning Road Banbury Oxfordshire OX16 9LA 01295 261 496 01295 701 027 Telephone number Fax number Email 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 & Mrs Akrill Heather Akrill Care Home (PC) 4 Category(ies) of Dementia - over 65 years of age(DE(E)) 2 registration, with number Old age - not falling within any other category of places (OP) 4 Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09/02/05 Brief Description of the Service: Browning Care Home is the family home of Mr. and Mrs. Akrill and is registered to provide personal care for up to four residents aged 65 years and over. Mrs. Akrill is the registered owner and manager and is assisted by her husband in providing the residents care and dealing with the homes administration. The residents lounge, where there is small dining table is located on the ground floor. There is one residents bedroom on the ground floor and three on the first floor, with the bathroom and toilet facillities also being located on the first floor. En-suite facilities are not provided and there are no residents toilets on the ground floor. A stair lift is provided. Mr. and Mrs. Akrill have their own private accommodation in the house. The homes back garden can be used by residents and there are various clubs for older people in and around Banbury. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector over six hours. A tour of the building was undertaken and documents were inspected. Mrs. Akrill (the owner and manager) and her husband were the carers on duty and both took part in the inspection. The day-to-day life of the home was observed and a conversation was held with one resident, as well as with staff. What the service does well: What has improved since the last inspection? What they could do better: There are some inconsistencies in the home’s Terms and Conditions that should be removed. These relate to additional charges and the period of notice to be given when an increase in fee is planned. Individual care plans that set out in detail the action that needs to be taken are not currently being produced and the manager should develop this area of record keeping. Medicines should be stored in a suitably sized lockable cabinet that is secured to a wall, rather than in the freestanding lockable filing cabinet currently used. The medicine cabinet should also provide sufficient space to store products in an orderly way. Staff members responsible for administering medicines have not attended medication training and this should be arranged. The home is registered to provide dementia care and staff should attend training in this specialised area of care. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 6 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. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 standard(s) Written information about the home is provided in sufficient detail to help residents form a view before moving in. The home’s Terms and Conditions contain some inconsistencies regarding additional charges and the period of notice to be given before fees are increased. EVIDENCE: The home’s Terms and Conditions are detailed and specify the contract between the owner and the resident. However, there is inconsistency in the contract. For example, paragraph 1 of the contract refers to ‘no extra charges’, but paragraph 13 and 19 show that extra charges are made. Also, paragraph 1 refers to ‘three months’ written notice of increases in charges, whereas paragraph 10 refers to one month’s notice. The Statement of Purpose and Service User’s Guide provide information about the home and the services provided and these documents are made available to prospective residents. They were being reviewed at the time of inspection and were not seen by the inspector on this occasion. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 9 Mrs. Akrill confirmed that visits to the home before admission are welcomed. Owing to the advanced age of the most recently admitted resident, it was not felt appropriate to question her about her experience of admission, but it was clear that she was content in the home. The other three residents have been in the home for several years. Since the last inspection an assessment form has been produced to record the outcome of each pre-admission assessment. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 standard(s) Care needs are identified at the time of assessment, but individual care plans to deal with each separate care need are not kept. This could lead to some care needs being overlooked. Medication storage facilities currently provided do not meet the Royal Pharmaceutical Society’s guidelines and these facilities should, therefore, be reviewed. EVIDENCE: The care records of two service users were examined. In each set of records there was information about what the resident could and could not do and what help was needed, although care needs and the action required was not listed separately. A record of residents’ daily care was recorded and the standard of record keeping in this area was particularly good, as it provided a clear description of the care given and residents’ feelings. Appropriate risk assessments had been completed to identify any area of risk, and the action taken to reduce risk was recorded. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 11 Doctors and district nurses from a local surgery visit residents to provide health care. Five GPs returned comment cards directly to the Commission and the doctors were very satisfied with the standard of care provided. One GP wrote: “Excellent care and consideration to residents”. A relative praised the care given to her mother and wrote that the owner and her husband were “caring people and good at their job”. Staff administer residents’ medication, as none of the residents have chosen, or are able, to do this themselves. Each resident has a medication record sheet that staff sign when medication is given. Medicines should be stored in a suitably sized, lockable cabinet that is secured to a wall, rather than in the present freestanding, lockable filing cabinet. The medicine cabinet should also provide enough space to store medicines in an orderly way. It is recommended that a copy of the Pharmaceutical Society’s guidelines on the ‘Administration and Control of Medicines in Care Homes and Children’s Services’ is obtained. Members of staff have not attended medication training and this should be arranged. Medication policies are provided. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Individual choices are catered for. Staff and volunteers help residents who are mentally alert to keep in touch with the wider community. However, due to the mental frailty of some residents, the opportunity for residents to socialise with each other is limited. EVIDENCE: There is a TV, video and a radio in the lounge and video films and musical stories are regularly played. Newspapers, magazines and books are provided. One service user likes to listen to classical music and, in order not to disturb other residents, headphones are provided. A people carrier is available to take residents out, such as on shopping trips or to local places of interest, although trips out are infrequent at present due to the residents’ high dependency levels. A volunteer visits two afternoons a week and spends time talking to residents. Clubs for older people are available in the community. Visiting hours are not restricted. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 standard(s) Residents are informed on admission of the procedure for making a complaint. The training undertaken by the owner about the protection of vulnerable adults has provided her with a good understanding of what action is required if abuse is suspected. EVIDENCE: The complaint’s procedure includes the stages and timescales for the process of investigating complaints. Residents are informed that they can refer complaints directly to the Commission for Social Care Inspection at any time. The Commission has not received any complaints about this home. Mrs. Akrill has attended training in the protection of vulnerable adults and has obtained a copy of ‘The Oxfordshire Multi-Agency Codes of Practice for the Protection of All Vulnerable Adults from abuse, Exploitation and Mistreatment’. Mr. Akrill has not attended training, but was aware of the Codes of Practice. The member of staff who provides cover for Mr. and Mrs. Akrill when they are away, has a care qualification equivalent to level 3 NVQ. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 standard(s) The home is comfortable, homely and provides pleasant accommodation. Rooms are well decorated and furnished. The size of one bedroom is significantly below the size as outlined in the National Minimum Standards and when the room is vacated the owner has stated she intends reviewing its use. EVIDENCE: The home’s communal space consists of a lounge situated on the ground floor at the front of the house. This room is nicely decorated and furnished and looked comfortable and homely. There is a view across the small front garden to the road and a resident said she enjoyed seeing what went on outside. At the end of the room is a dining table large enough for two people, although only one resident eats her meals at the table. At mealtimes two residents stay sitting in their armchairs in the lounge and meals are placed on small tables in front of them, as they need assistance to eat. One resident has her meals served in her room. The home’s dining room was converted to a bedroom for a resident who was experiencing difficulty in using the stair lift. There are a further three residents’ bedrooms on the first floor, as well as the bedroom used by Mr. and Mrs. Akrill. One of the resident’s bedrooms is Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 15 significantly below the recommended room size of 10 sq metres and has limited space for personal possessions. The three other bedrooms contained residents’ personal possessions and looked comfortable and homely. The resident occupying the small room is totally dependent on staff for her care and either sits in the lounge during the day, or stays in bed. A ceiling hoist has been fitted over her bed to assist her getting into and out of bed. The residents’ bathroom is on the first floor and has a toilet, basin and bath with a hoist. None of the bedrooms have en-suite facilities and commodes are, therefore, used for residents unable to get to the toilet. There is a toilet and shower on the ground floor for the sole use of Mr. and Mrs. Akrill. There are no ground floor toilet facilities for residents. Radiators are not fitted with guaranteed low temperature surfaces or guards, although this work is planned for completion before the winter of 2005. Temperature control valves are not fitted to the basin, or bath, in the first floor bathroom and this work must be arranged before service users who are mobile are admitted. The risk of residents sustaining scalds at the present time is low as current residents are unable to run hot water without assistance. Cleanliness in the home was good and there were no unpleasant smells. Windows had been left ajar on the first floor and a resident indicated she felt slightly cold and could feel a draught. When the owner was informed of this the windows in the vicinity of the resident’s room were closed. Staff should ensure that if windows are open in bedrooms, this does not affect the comfort of other residents. Access to the back garden is through the owner’s private living room where a ramp to the garden is provided. The resident in the ground floor bedroom has direct access into the garden. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The present level of staffing is adequate for the needs of residents. Staff have not attended dementia care training and, as the home is registered to provided this type of care, this training should be arranged as soon as possible. EVIDENCE: Mrs. Akrill and her husband are the main carers and provide continuous care over 24-hours a day, seven days a week, for periods of ten weeks. They move out of the home for three weeks between each 10-week period and a permanent member of staff moves in to look after the residents in their absence. Mrs. Akrill has arranged for temporary ad-hoc help to assist the livein carer when she and her husband are away from the home. A cleaner is employed nine hours a week and a volunteer visits the home twice a week to talk to residents and to provide general help. Criminal record bureau disclosures at enhanced level were seen for all permanent and temporary staff working in the home, including the volunteer. Mrs. Akrill attended a first aid course in May 2004 and a basic food hygiene course in July 2003. A food hygiene update and handling and moving training are due to take place in May 2005. The home provides care for people with dementia, but neither Mrs. Akrill, nor her staff, has attended training in this area of care and this should be undertaken. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This four-bedded home is well managed and the need for Mrs. Akrill to have a management qualification equivalent to level 4 NVQ is not an issue at present, although standard 31 cannot be assessed as fully met until the qualification is obtained. EVIDENCE: Mrs. Akrill has been the owner and manager of Browning Care Home since the home was first registered in 2000. Previously she worked in the care sector providing care to people with learning disabilities, as well as caring for older people. Mrs. Akrill does not have formal care qualifications, but over many years of working as a carer has gained considerable experience in this field of work. She is considering undertaking level 3 NVQ training. Mr. Akrill is currently undertaking level 4 NVQ training (management) and takes responsibility for the home’s administration. Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 18 Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 x 15 x COMPLAINTS AND PROTECTION x 3 3 3 3 3 3 x STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x x x x Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 2 7 9 Good Practice Recommendations Review the Terms and Conditions to ensure there are no inconsistencies in the information provided. Each resident should have a written care plan that sets out in detail the action which needs to be taken by care staff to ensure that the residents care needs are met. Medicines should be stored in a suitably sized locked cabinet that is secured to the wall. The medicine cabinet should also provide sufficirnt space to store probucts in an orderly way. Members of staff involved in the administration of medicines should attend medication training. The manger should obtain a copy of the The Administration and Control of Medicines in Care Homes and Childrens Services published by the Royal Pharmaceutical Society of Great Britain. The manager should arrange for arrange for staff to attend dementia care training. 4. 5. 9 9 6. 30 Browning Care Home H57_H08_S13189_Browning Care Home_V215665_040505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Burgner House 4630, Kingsgate Oxford Business Park (South) Cowley, Oxford, OX4 2SU 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. 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