Care Home: Brackens The

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What the care home does well People thinking about moving into the home are encouraged to visit to see if it is the right place for them. They are introduced to residents and may stay for a meal if they wish. The home supports residents in making sure their health care needs are met. Residents are treated with respect and their privacy is upheld. They are encouraged to make choices and maintain some independence. Staff members respond promptly to residents’ requests for assistance. The home supports residents to maintain contact with families and friends, where this is a resident’s choice. The home has a flexible approach to visiting and residents are welcome to have visitors at any reasonable time. Staff members are supported to complete NVQ awards in care. Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 What has improved since the last inspection? Following our recent enforcement action, the home has made sure it is now complying fully with requirements about medication administration. As we noted at our random inspection in August 2009, some improvements have been made to aspects of the home’s environment. The home had addressed our requirement to make improvements to the bathrooms and had met a previous requirement by installing a new wash hand-basin in the laundry room together with a pump to ensure the waste water goes up to ground level. Liquid soap and disposable paper towels were being provided. The temperature of hot water from the bath tap was within safe limits. Testing of portable appliance safety and testing for Legionella was up to date. Since our last key inspection, the home has been repainted. The staff rota now records accurately the staffing levels in the home. The menus have been reviewed and changed to improve the variety of meals provided to residents. What the care home could do better: They must always follow their recruitment procedures and not employ anyone in the care home without first having the required documents in place. These need to include two references relating to the applicant and they should carry out a Criminal Records Bureau check. It is important to make sure that current and future residents benefit from effective quality assurance and quality monitoring systems being in place. The home could be more proactive in identifying where improvements are needed rather than waiting to act on requirements from the commission, and strengthening its quality assurance systems would enable this. We were told our previous recommendation about summarising quality assurance surveys into reports that can be made available was being worked on. The home’s policy and procedures for medicine administration should be reviewed and amendments made where necessary. We have been assured by the provider that a competent person has been consulted about the arrangements for wedging fire doors open and has assessed them as being safe but this needs to be made clearly evident. The home needs to ensure it is evident that all staff members who are involved in food preparation have completed appropriate training. The opening dates of perishable foodstuffs should be recorded to minimise the risk of them being offered to residents after their expiry dates have passed.Brackens TheDS0000006913.V377861.R01.S.doc Version 5.2 They should ensure it is evident that all care staff receive regular supervision. Key inspection report CARE HOMES FOR OLDER PEOPLE Brackens The The Brackens 5 Elm Road Beckenham Kent BR3 4JB Lead Inspector David Lacey Key Unannounced Inspection 24th November 2009 10:30 DS0000006913.V377861.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brackens The Address The Brackens 5 Elm Road Beckenham Kent BR3 4JB 020 8658 6343 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 Serge Jhurry Mrs Prunjodee Jhurry Mr Serge Jhurry Care Home 9 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (7) Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 7) Dementia - Code DE (maximum number of places: 1) Mental Disorder, excluding learning disability or dementia - Code MD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 9 3rd March 2009 2. Date of last inspection Brief Description of the Service: The registered provider of services at The Brackens is also the registered manager. The home was first registered in 1997 to the current provider. The Brackens provides care and accommodation in a converted older style building, which is located in a residential area of Beckenham close to local shops and the town centre. The accommodation is arranged on three floors accessed by stairs only. This can make moving around the home difficult for people with restricted mobility. All bathing and toilet facilities are shared, as bedrooms do not have en-suite facilities. The provider/manager is on site five days a week working as part of the care team, and also provides on call cover when he is not on duty. Health care is provided through the local Primary Care Trust. The GP is in the same street and the visiting district nursing service is provided through the surgery. The fees for this care home were £400 per week. The provider/manager confirmed there had not been changes in the ownership, management or service registration details for The Brackens in the 12 months before our inspection in November 2009. Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star, which means that people using the service receive an adequate service. The unannounced site visit for this key inspection was completed over one day. All of the six residents living in the home at the time of this inspection were spoken with and the care of four of them was looked at in detail. Discussions were held with the home’s manager and three members of staff were interviewed. The site visit included a tour of the premises and sampling of documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures. As part of the inspection, we carried out a survey by questionnaire of residents, relatives and staff members. The two responses received by the time of writing this report have contributed to the evidence underpinning our judgements. These were from a resident and a relative; we had not received any responses from staff members. The inspection included a review of information received about this service. Following our last key inspection in March 2009, we carried out a random inspection in August 2009 to check compliance with the requirements we had issued. We have used findings from our random inspection in planning this key inspection. What the service does well: People thinking about moving into the home are encouraged to visit to see if it is the right place for them. They are introduced to residents and may stay for a meal if they wish. The home supports residents in making sure their health care needs are met. Residents are treated with respect and their privacy is upheld. They are encouraged to make choices and maintain some independence. Staff members respond promptly to residents’ requests for assistance. The home supports residents to maintain contact with families and friends, where this is a resident’s choice. The home has a flexible approach to visiting and residents are welcome to have visitors at any reasonable time. Staff members are supported to complete NVQ awards in care. Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: They must always follow their recruitment procedures and not employ anyone in the care home without first having the required documents in place. These need to include two references relating to the applicant and they should carry out a Criminal Records Bureau check. It is important to make sure that current and future residents benefit from effective quality assurance and quality monitoring systems being in place. The home could be more proactive in identifying where improvements are needed rather than waiting to act on requirements from the commission, and strengthening its quality assurance systems would enable this. We were told our previous recommendation about summarising quality assurance surveys into reports that can be made available was being worked on. The home’s policy and procedures for medicine administration should be reviewed and amendments made where necessary. We have been assured by the provider that a competent person has been consulted about the arrangements for wedging fire doors open and has assessed them as being safe but this needs to be made clearly evident. The home needs to ensure it is evident that all staff members who are involved in food preparation have completed appropriate training. The opening dates of perishable foodstuffs should be recorded to minimise the risk of them being offered to residents after their expiry dates have passed. Brackens The DS0000006913.V377861.R01.S.doc Version 5.2 Page 7 They should ensure it is evident that all care staff receive regular supervision. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 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 Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are assessed to ensure the home can meet their needs. People thinking about moving into the home are encouraged to visit to see if it is the right place for them. Residents receive contracts with terms and conditions for their placement. EVIDENCE: There had not been any new admissions to the home since our last inspection so it was only possible to see the assessments of people who had been living in the home for some time. The manager carries out pre-admission assessments to make sure the home can meet a potential resident’s needs. It was evident he had visited people either in their own home or in hospital to carry out an Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 10 assessment of their needs before deciding whether the home would be suitable for them. It was evident from discussion with the owner/manager that he understands clearly about the home’s registration categories and that they must be adhered to when deciding to admit any new residents. Needs assessments were seen in residents’ files. Residents whose placement had been arranged through a local authority had received care management assessments and the relevant local authorities had reviewed placements. People thinking about moving in are encouraged to come and visit the home to have a look around, and meet residents and staff. They may bring family members and stay for a meal if they wish. A person living in the home said a prospective resident had recently joined them for a meal. Relatives of a prospective resident were looking around the home during the inspection visit. The resident responding to our survey stated s/he did receive enough information to help decide if the home was the right one to move into. The relative who responded said they sometimes get enough information about the home to help make decisions. Contracts with terms and conditions were seen on all the residents’ files sampled for inspection. A resident said he could not recall seeing the contract but thinks it is held by relatives; a copy was seen on his file. The Brackens does not offer intermediate care thus standard 6 has not been assessed. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ health care needs are met and residents are satisfied with the care they receive. Care records are satisfactory. Residents are treated with respect and their privacy upheld. Medicine administration has improved, following compliance with our previous requirements. EVIDENCE: The care of four residents was looked at in detail through case tracking. Each had a care plan in place, which gave guidance to staff about meeting their needs. The plans seen had been reviewed and there was some evidence that either residents or their representatives had been consulted about their care. Residents who were able to give their views during the inspection were satisfied with the care they receive. All the current residents were seen during Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 12 the inspection visit and were well groomed and dressed appropriately for the time of year. All the people currently living in the home were independently mobile, with several using walking aids. The resident who responded to our survey stated they usually receive the care and support they need. The relative who responded to our survey stated the home sometimes meets the needs of their relative. The relative stated the home sometimes gives the care to their relative that they expected or agreed. When asked to consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation, the relative stated the home sometimes responds to the different needs of individual residents. The home makes sure that residents have access to specialist health care services as they need. One resident said he is able to manage his medical condition himself, with the support of a specialist nursing service. The Brackens uses the local Primary Care Trust’s visiting medical officer (VMO) service. The home is within walking distance of the surgery of the home’s GP. The GP visits the residents at the home regularly and will see people at other times as needed. Other health care services that residents had received included optical and dental services. Appointments and their outcomes are recorded. Staff confirmed they have to complete relevant training before they can give medication to residents. Two of the three staff members spoken with said they do not give medication as they have not completed the necessary training. Medication was being stored safely and is dispensed from dossette boxes prepared by the supplying pharmacist. The home has a controlled drug (CD) cabinet but no CDs were being stored at the time of the inspection. The home’s policy and procedures for medicine administration were readily available to staff. The manager was strongly recommended to review and make some amendments to these documents (see recommendations). The policy was not dated and referred to “nursing staff” in setting out its purpose. It is good practice to date policies to ensure they are kept under regular review and also The Brackens neither provides nursing care nor employs nursing staff. One section of the medication policy stated the home does not operate selfadministration of medicines whereas another section set out guidance for supporting residents to self-administer. This inconsistency should be addressed, bearing in mind that the national minimum standards expect care providers to support residents to be responsible for their own medication where appropriate. There were separate handwritten instructions for staff about administration of medicines, which should be considered for inclusion in the main typewritten document so that all staff guidance is in the same place. This should minimise the possibility of confusion for staff and make it easier to keep the content under review. Following our random inspection in August 2009, we took enforcement action to ensure compliance with regulations about medicine administration and Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 13 improve outcomes for people who use the service. At the present inspection, it was evident the home had made the required improvements. The medicine administration records (MAR) sampled for inspection were complete with no unexplained gaps. No handwritten changes were seen on the MARs inspected. Where appropriate, the MARs had been supplemented by information for staff that described clearly when ‘as required’ medicines may be given safely. The coding system for omission of medication was being used properly. Observations and discussions with residents and staff during the inspection visit showed that residents are treated with respect and that their rights to privacy are upheld. For example, staff interacting with residents called them by their preferred name and knocked on residents’ doors before entering their rooms. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to retain some choice and control over their lives. Contact with families and friends is supported and visitors are made welcome. Trips out from the home are encouraged. Residents have opportunities to take part in activities, although the range of these is limited. Residents are generally satisfied with the food offered and welcome recent improvements the home has made to menus. EVIDENCE: Residents were happy with the routine of being able to go to bed and get up when they like. Staff members interviewed during the inspection showed how they help residents to make choices and maintain as much independence as possible. The relative responding to our survey stated the home sometimes helps their relative to keep in touch with them and sometimes supports people to live the life they choose. The home has a flexible approach to visiting and Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 15 residents are welcome to have visitors at any reasonable time of the day. There was a relaxed atmosphere in the home on the day of inspection. There is no structured programme of daily activities but it was said residents decide how they spend their time each day. At our random inspection, the manager explained that he and the staff team make sure activities are tailored to meet people’s individual needs and preferences. Some residents take part in informal discussions or games but others choose not to do so. It was apparent from records and from discussions that external activities are limited and mainly organised by family members. One resident said he makes sure to go out from the home each day, such as going to the shops or to visit friends or family, as he is able to do this independently. Occasionally, staff may accompany residents who need support to go out from the home although it was understood this is rarely possible as it would leave insufficient numbers of staff in the home to care for residents there. Staff members cover domestic and cooking tasks when they are on duty as well as providing care to residents. This means the opportunities for staff to support other activities are limited. The garden offers a pleasant outdoor space for residents. A resident was seen enjoying a walk in the garden with the manager accompanying her. As we recommended at our last key inspection, the home had reviewed its menus to make sure they offer residents a more varied diet. A four-week rolling menu had been introduced. A resident said the variety of food had improved since new menus had been introduced. Some residents had been invited to contribute to the menu changes. The resident responding to our survey stated s/he usually likes the meals at the home though the relative responding to our survey commented that providing “better quality food” is something the home could improve. The lunch served on the day of inspection matched the choice on the menu and residents said it was tasty and had been cooked well. Alternatives to the menu were available on request. The staff were making sure they recorded what food had been provided to individual residents. It would be good to see fresh fruit openly available for people to help themselves. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures for complaints and for safeguarding adults. Residents know how to raise concerns, though as no complaints have been recorded as received it is difficult to make outcome judgements about how the home manages complaints. Training in adult protection has been made available and staff members have basic understanding about keeping residents safe from harm. EVIDENCE: The commission has not received any complaints or concerns about this home since our last inspection. The complaints log in the home did not show any complaints recorded and the provider/manager confirmed that none had been received. He said he has daily contact with residents and that, if people have any concerns or worries, these are dealt with straight away and are normally resolved without needing to go through formal procedures. The resident who responded to our survey stated there is someone to speak to informally if they are not happy and that s/he knew how to make a formal complaint. The manager said he has regular contact with those relatives who visit the home. The relative who returned our questionnaire stated s/he did not know how to Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 17 make a complaint about the care provided if they needed to. This relative stated the home sometimes responds appropriately if they raise any concerns. The home’s complaints procedure was on display in the entrance hall. The content was satisfactory, except for out of date contact details for the commission that need to be changed. It was understood the procedure had not been made available in any alternative formats. Since our last inspection, we have not been made aware of any safeguarding alerts in relation to people living at The Brackens and the provider/manager confirmed that none had been made. The provider/manager gives staff training in protecting residents from abuse, including at induction, and this issue is also addressed through staff members’ NVQ programmes. During our random inspection, the staff members on duty had been clear about their reporting responsibilities should they witness or suspect abuse of any residents. Staff spoken with on this occasion also showed basic understanding about keeping residents safe. It would be for the person in charge of the home to follow local procedures, including liaison with external agencies. The home has a policy and procedure for protecting residents from abuse, and also has a copy of the local authority procedures available. Given that staff members are sometimes in charge of shifts in the absence of the manager, we had raised an issue about this. A staff member who occasionally takes charge of the home said there is now a deputy manager to report any concerns to when the provider/manager is not on duty or is away on leave. Please see comment under standard 29 about staff recruitment practices, as this is relevant to protecting residents and keeping them safe. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is kept clean, with no unpleasant odour in communal areas. Residents are generally satisfied with their accommodation but further improvements in furnishings and facilities would provide them with a more comfortable environment in which to live. Following our previous requirements, the home has addressed some matters of repair or replacement to ensure residents’ safety. EVIDENCE: On the day of inspection, the home was clean and free from unpleasant odour. Communal areas were adequate, serviceable and generally comfortable but the Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 19 home is restricted for space. For example, there would not be enough room for all residents if they chose to sit in the lounge at the same time. Some residents would have to sit in the conservatory. The home has been repainted both inside and out since our last key inspection and now has an adequate standard of decoration. The home’s provision of bath and toilet facilities remained unchanged from the previous inspection. Residents normally have a daily wash in the sink in their bedrooms and a bath each week. There is a shower attachment to the bath taps, which is used only for hair washing while in the bath. Thus, the home lacks a proper shower facility that would offer residents an alternative to a bath. All toilets in the home are shared because the home does not have any en-suite facilities for its bedrooms. The home had addressed our previous requirement to make improvements to the bath on the ground floor. The worn areas of enamel in the bath had been painted over and this appeared to have resulted in a reasonable repair, though not a particularly good one from a cosmetic point of view. Improvements had been made to the bathroom on the upper floor following our previous requirement. The bath panel and the cracked tiling around the bath had been replaced, and staining removed. The temperature of the hot water from the tap in the bath on the ground floor was within safe limits, using the home’s thermometer, and comfortable to the inspector’s touch. As noted at our random inspection, the provider has met a previous requirement by installing a new wash hand-basin in the laundry room together with a pump to ensure the waste water goes up to ground level. Liquid soap and disposable paper towels were being provided. The dryer in the basement has not been working for some time, as we reported at our last inspection. We were told this makes the drying of clothes and bed linen difficult, particularly now that winter has come and it is not possible to use the washing line in the garden (see requirements). At our last key inspection, we noted residents do not have lockable facilities in their rooms and we recommended that residents are offered the choice to have such a facility in their bedrooms. At the present inspection, the provider/manager stated that keys are now available for residents if they request them. There is a flat at the top of the house, which at the time of this inspection was accommodating two people. The manager has explained previously that the two people living in this flat are provided with the accommodation in return for providing sleep-in cover at night. The only means of access to the flat is through the care home. We had previously made a requirement to ensure residents are not placed at risk by the terms of the home’s insurance being breached. The provider has subsequently supplied a letter from his insurers Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 20 confirming they are aware and that the insurance covers the arrangements regarding the upper floor flat. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably qualified and competent staff are employed to meet residents’ needs, and they respond to residents’ requests for assistance. Staff members are supported to undertake training that is relevant to their work, though more should be done in respect of food hygiene training. There are appropriate recruitment procedures in place but these have not always been carried out in full to ensure they support and protect residents. EVIDENCE: When the inspector arrived to carry out this unannounced visit, the provider/manager and a care worker were on duty to provide care and support to the six people in residence. Later in the morning another care worker came on duty. Staff said there are normally at least two people on duty for each day shift, and this was confirmed by further discussions and examination of staff rotas. The night staffing arrangement for this home is to have one waking staff member on duty and either one or two people sleeping in. In separate interviews, the provider/manager and a staff member stated the two people living in the upstairs flat provided sleep-in cover, and their names were on the Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 22 staff rotas seen during the inspection. The resident responding to our survey stated that staff members are usually available when needed and usually listen and act on what they say. The relative responding to our survey stated staff members usually have the right skills and experience to look after people properly. Making sure there are effective recruitment and selection practices is important for the support and protection of people living in the home. At our key inspection in March 2009, examination of a random sample of three staff files showed that all three staff members had started work on Criminal Records Bureau (CRB) disclosures obtained from previous employers rather than obtaining a new one through the home or a POVA First followed by a CRB check. This was raised with the provider/manager at that inspection visit so he could begin to take the action necessary to support and protect residents. At our random inspection in August 2009, three files of newly recruited staff members were examined. There were new CRB disclosures obtained through The Brackens for two of these staff but the third person only had a CRB disclosure dated May 2006 from a previous employer. The commission issued a warning letter because of our concern about how the service had not adhered completely to recruitment practices that would protect residents. At the present inspection, the files of six staff members were selected at random. There had not been any new staff recruited since our last inspection. Most of the required documentation was on file but the most current CRB disclosures for two of the staff were from previous employers. Both the staff members were on the current duty rota. The matter was raised with the provider/manager who confirmed CRBs through the home were not filed elsewhere and said he would ensure they are applied for immediately. An immediate requirement was issued to ensure there is no delay in making sure no staff member is employed at The Brackens before the required documentation has been obtained (see requirements). The manager has provided us with a written response that confirms the actions taken to address this immediate requirement. Two of the staff files seen during the inspection contained only one reference rather than the two references required by legislation (see requirements). Interviews with staff on duty showed they had training and experience in meeting the needs of the people living in the home. At the time of writing this report, we had not received any responses from staff members we surveyed. The home supports its staff to complete NVQ awards. Staff members interviewed during the inspection had either completed or were in the process of completing NVQ awards in care. Improvement to the provision of food hygiene training was needed, which is commented on under standard 38. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 23 Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s provider/manager is experienced and has skills to run the home. The home communicates well with residents and their representatives. An unmet requirement evident at this inspection did not reflect well on the running of the home. The home’s quality assurance and monitoring systems need development. Formal supervision of staff needs to be made evident. The health and safety of residents, staff and visitors is promoted though there are some specific matters needing attention. EVIDENCE: Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 25 The registered provider/manager is a qualified nurse who has owned and managed this home for many years, and has an open management style. The home has appointed a deputy manager to assist the provider in managing the home and take responsibility in his absence. The deputy was not on duty at the time of this inspection. Residents and staff members have occasional meetings, which are recorded in a ‘meetings book’. In 2009, only two such meetings had taken place in January and in September. The relative responding to our survey stated s/he is usually kept up to date with important issues affecting their relative. We have recommended previously that the findings from quality assurance surveys are summarised into reports that can be made available to residents, their representatives and other interested parties. There was no evidence of quality assurance activity at the present inspection although the manager stated this was being worked on. An unmet requirement to improve recruitment practices that had already been repeated at our last inspection did not reflect well on the running of the home and it is important to make sure that current and future residents benefit from effective quality assurance and quality monitoring systems being in place (see requirements). We have continued to encourage the provider/owner’s initiative to become competent in the use of information technology, as it has the potential to benefit residents. For example, the provider and his staff team would be more easily able to keep updated about matters such as the changes to the legal framework for the regulation of adult social care from April 2010 and how the home can demonstrate compliance. The home’s procedures are designed to protect residents’ financial interests. The manager explained the home does not manage any resident’s finances, as residents either look after their money or their families assist them with their financial affairs. Three residents were paying extra for hairdressing services. The home will keep a small amount of money on request to cover a resident’s day-to-day expenses such as this, which is topped up as needed by residents’ relatives or other representatives. Staff members have regular contact with the manager and deputy manager but there was no documentary evidence of formal supervision. It is important that people using the service can be assured that their carers are being supervised regularly and it is important for care staff that they receive regular supervision and support (see recommendations). During the visit, the inspector sampled the home’s documentation relating to health and safety, finding items to be up to date and within the appropriate timeframes. We found at our visit in August 2009 that the health and safety matters that we had raised at our last key inspection had been addressed. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 26 The home’s care workers do the cooking and most have completed food hygiene training. One staff member spoken with had not yet undertaken this training but was seen to be involved in food preparation. The home needs to ensure it is evident that all staff members who are involved in food preparation have completed appropriate training (see requirements). There were some perishable foodstuffs, such as salad creams and sauces, in both of the kitchen fridges that had been opened but not had the opening dates recorded. Recording the opening dates, preferably on the container’s label, helps to ensure such foodstuffs are not used beyond the timescales recommended by the manufacturers (see recommendations). Some fire doors to bedrooms were seen to be wedged open and this was raised with the registered provider/manager. He stated that this is the individual resident’s choice, that this is documented and that the fire service and residents’ next of kin are aware. He said that fire doors are shut when a resident is not in their bedroom and at night, with the exception of one resident who wishes to have his door open at night. Particularly in view of the protected staircase, it must be evident that a competent person has been consulted about these arrangements and has assessed them as being safe (see requirements). The provider/manager stated during the inspection that there were no residents in the home who are subject to deprivation of liberty authorisations. Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 27 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 28 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 OP26 Regulation 16 Requirement The registered person must ensure the dryer in the basement is repaired or replaced, so that residents’ clothes and bed linen can be dried effectively. The registered person must not employ anyone in the care home without having the required documents in place, specifically, a CRB disclosure undertaken by the provider. The registered person must not employ anyone in the care home without having the required documents in place, specifically, two references relating to the person. Timescale for action 31/01/10 2 OP29 19 (Sch2) 27/11/09 3 OP29 19 (Sch2) 31/01/10 4 OP33 24 The registered person must 28/02/10 ensure that effective quality assurance and quality monitoring systems are in place. The registered person must ensure it is evident that a competent person has been DS0000006913.V377861.R01.S.doc 5 OP38 23 31/01/10 Brackens The Version 5.3 Page 29 consulted about the arrangements for wedging fire doors open and has assessed them as being safe. 6 OP38 13 The registered person must ensure it is evident that all staff members who are involved in food preparation have completed appropriate food hygiene training. 28/02/10 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 OP9 OP9 Good Practice Recommendations The registered person should review and amend the home’s policy and procedures for medicine administration. The registered person should ensure that there are photographs, preferably dated, for all residents on their medicine charts. The registered person should ensure the findings from quality assurance surveys are summarised into reports that can be made available to residents, their representatives and other interested parties. The registered person should ensure it is evident that all care staff members receive regular, recorded supervision, so that residents may benefit from knowing they have carers who are supervised. The registered person should ensure the opening dates of perishable foodstuffs are recorded. 3 OP33 4 OP36 5 OP38 Brackens The DS0000006913.V377861.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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