Care Home: Brandon House

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What the care home does well Staff are approachable and demonstrate a caring and patient attitude towards the peoplethey care for. The food is of a good standard and people enjoy it. Visitors are welcomed at the home at any time. What the care home could do better: There is a clear need for strong leadership at the home to provide direction for staff and to effectively monitor the care provided to the people who live there. We have been informed that there are a number of new staff apointments. It is essential that there are enough staff employed at the home who know and understand the needs of the people living at the home. People should expect consistency of care. Staff need to be properly trained to effectively carry out their role. Training must be given by people who are trained to train and with up to date knowledge. This is so that staff are equipped with the knowledge they need and know how to look after people properly. Medication must be adminsitored correctly as they are prescribed so they are properly effective. The records of medicines at the home must be clear accurate and complete so that they are fully accounted for. Medicines must be stored at the right temperature so that they are not spoilt. Care plans and the supporting paperwork should have detailed information about how all medications should be handled. This will make sure that medicines are handled and administered safely. Requirements and recommendations appear at the end of the report. Random inspection report Care homes for older people Name: Address: Brandon House Tongue Lane Meanwood Leeds Yorkshire LS6 4QD one star adequate service 11/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Catherine Paling Date: 0 2 0 9 2 0 1 0 Information about the care home Name of care home: Address: Brandon House Tongue Lane Meanwood Leeds Yorkshire LS6 4QD 01132787103 01132306279 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Dawn Elaine Andrews Type of registration: Number of places registered: Conditions of registration: Category(ies) : Esteem Care Limited care home 42 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Conditions of registration: 8 0 The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old Age, not falling within any other category, Code OP - maximum number of places 34 Service users with Dementia - Code DE (maximum number of places: 8). Date of last inspection 1 2 0 4 2 0 1 0 Care Homes for Older People Page 2 of 12 Brief description of the care home Brandon House is in the Meanwood area of Leeds. The home is set in an acre of land with parking facilities, gardens and patio areas. There are public transport links near to the home, which is situated close to a range of local amenities. The home is registered to provide nursing care for up to forty two older people with eight of those places for people with dementia. There are forty bedrooms, the majority of which are single en-suite. There are two shared rooms available. There are communal lounge and dining areas on the ground floor. There are a number of communal bathroom and toilets. Information is available about the home in the form of a statement of purpose and a brochure is also available. These documents together reflect the services and facilities at the home. The fees are reviewed annually in April of each year. The service should be contacted directly for up to date information about charges. Additional charges are made for chiropody, hairdressing and newspapers. Care Homes for Older People Page 3 of 12 What we found: This was an unannounced visit to the service on 2nd September 2010 carried out by one inspector who was at the home from 08:50 until 13:30. As part of this inspection a specialist pharmacist inspector also made an unannounced visit on 9th September 2010 to look at how medicines were being handled. The visit was as a result of safeguarding alerts made to the local authority which resulted in an investigation into the home by the multi disciplinary safeguarding team. As a result of findings the local authority have suspended placements at the service and an action plan is being implemented and closely monitored. Everyone living at the home has had their care reviewed as part of the safeguarding investigation. On 2nd September 2010, we looked closely at the care of two people; we spoke with people living at the home and their relatives; we also spoke with staff and observed practice. We spoke with the regional manager on the telephone during the course of the visit. On arrival at the home there was one nurse on duty who was also in charge. This person works for the provider on a casual basis and although he was familiar with the home he was not fully up to date on the detail of peoples needs. He was the only nurse on shift. The registered manager has been absent from the service since early July. On arrival there was one nurse on shift supported by four carers. There was ancillary support from a housekeeper, two domestic staff and laundry worker. In addition, there was a senior chef on duty with a kitchen assistant. The nurse was not a regular member of the staff team. This person is employed on an ad hoc basis by the company. They have worked at Brandon House before and told us that although they felt they knew the home they were not fully familiar with individuals. The nurse in charge told us that there were usually five carers, the duty rotas supported this, and he did not know why there were just four on this occasion. There were four people living on the small dementia unit. On the day of our visit they were being looked after by one carer. One person had finished their breakfast and was sleeping. The carer was taking another person into the lounge/dining area at 09:15. This person said they were ready for their breakfast. They told us that they were well looked after and that you couldnt get better. The carer had to leave the unit unattended to get this persons breakfast, returning after several minutes with a tray of grapefruit, cereal, toast and tea. The carer put one course in front of the person and left to start getting the next person up. The carer was working alone and at 09:30 still had two people to get up from bed for their breakfast. At 10:35 the fourth person on this unit had still not had their breakfast and as the carer was working with this person the lounge area was unsupervised with one person becoimg agitated and another very restless. The management of the breakfast period was not satisfactory. The result of the carer working alone on this unit was a delay in people having their breakfast. There was lack of supervision of the lounge area for long periods of time and people had no stimulation or occupation. Care Homes for Older People Page 4 of 12 The nurse in charge agreed that this was not satisfactory. We spoke with the regional manager on the telephone who explained that a new member of staff had been unable to work and had not been replaced leaving the staff group short. Rotas did indicate that this was not the usual staffing level. Systems should be in place to ensure that staffing levels are maintained so that people can be sure that they will get the care they need in a timely way. The provider should make sure that there is a consistency of staff so that people can be sure that staff looking after them know and understand their needs. Staff working on the dementia unit have not had specific training. The nurse in charge on the day of the visit told us that he is a Registered Mental Nurse and that he will be providing training to staff although he did not know when this would be as after his current five day period of working at the home he was not due to return until November. He told us that he is not a trained trainer and was not able to tell us when he last had any update in dementia care. Training should be provided by people who are trained to train and who have up to date knowledge. We spent time on the older persons unit observing staff practice and talking to a number of people who live at the home and two relatives who are regular visitors to the home. It was clear from talking to people that there have been issues at the home. A meeting had been held in August with the regional manager and a representative from Leeds City Council to explain that there was a safeguarding enquiry underway at the service. The notes of this meeting are displayed in the entrance area of the home. One relative told us that they felt that the regional manager had been honest about the issues at this meeting. This relative told us that over the short time her mother had been at the home she had raised concerns about care with the manager and action had been taken. This relative said that she could see improvements and referred to decorating and cleaning. There had been a very strong unpleasant smell and this has improved greatly. On the day of our visit there was no smell on entering the home. Another relative said that her mother is happy at the home and tells her that the staff are nice to her and so she has to be satisfied. However, she also said that she could clearly see that there was a need for improvement - in particular the need for strong and clear management and guidance for staff. This relative also said that there was a need for better supervision of people in the lounge areas and a need for more drinks to be available and given to people. People said: have seen an improvements and can see the difference each day a hell of a lot more to do We also spoke to some of the people who live at the home. People told us that they sometimes had to wait for staff to take them to the toilet and that if they woke in the night staff did not always offer them a cup of tea. One person said that some of the night staff were brilliant but that others could sometimes be niggly and they did not always get an early morning drink. Several said that they felt there could be better attention to cleaning - with particular reference to cleaning wheelchairs. Wheelchairs were grubby with food debris and dust. People told us that the food is good with one person commenting in particular on how much they enjoyed the homemade soup. We looked closely at two sets of records and overall staff have access to the information they need to know how to look after people properly. We saw that some care plans had Care Homes for Older People Page 5 of 12 been written in June 2009 and could benefit from being rewritten to make sure that staff have easy access to the most up to date information. There was evidence that updates and any changes to care were being recorded in the evaluation section of the plan. For example, a change to treatment for swollen legs had been written in the evaluation section but the actual care plan had not been updated to reflect this change. Staff were aware and were following the new instructions but there is a risk that changes to care could be overlooked if staff do not have easy access to the most up to date information. We saw that staff were completing evaluation of care plans but that this was not always happening every month. The evaluation of care plans needs to be developed to make sure that it is a proper review of the effectiveness of the plan for the previous month and not just care plan effective. We saw that there was a range of risk assessments being completed for people and where risk is identified there was a care plan in place to reduce and/or manage the risk. Turn charts were in use for people identified as being at risk of skin damage and food and drink records for those at nutritional risk. These charts were kept in the office rather than with the individuals concerned. When we asked staff about updating these records they told us that they kept their own records and added them to the charts later in the day. This means that the charts are not always up to date and there is a risk that recordings might be overlooked. The most recent entries on the charts we saw had been made by the night staff around 06:30 that morning. One person was demonstrating particularly challenging behaviour. We saw clear evidence in their records of the involvement of other healthcare professionals who were being consulted to help the staff understand and manage the behaviour and to re-assess their care needs. We saw some good interaction between staff and the people they care for although there are sometimes communication issues between overseas staff and people who themselves have communication problems because of their health problems. Care staff were patient with people. We saw two staff gently wake one person before transferring them to a wheelchair to be taken for their lunch. This person, who could not properly weight bear, was transferred by means of an underarm lift. This is not good practice. This persons risk assessment did state that two people were needed to transfer and that they were immobile and that there could be partial resistence to intervention. There was no indication that any specialist equipment should be used. On 9th September 2010 the newly appointed deputy manager assisted the pharmacy inspector. Medication arrangements: We spoke with three carers and one person who lived in the home and checked samples of medicines records and stocks. We gave detailed feedback to the deputy manager at the end of our visit. Overall we found some medicines were not being given to people correctly, which places their health and wellbeing at unnecessary risk. We found medicines stock difficult to account for because records of medicines received into the home and carried forward to a new month were not always completed properly. We carried out some detailed checks on the current stocks and records and found regularly prescribed medicines that were kept in the specially dispensed system provided by the pharmacy were usually being given correctly. However, medicines that were Care Homes for Older People Page 6 of 12 supplied in traditional packets and bottles did not always add up showing they had sometimes been missed. The new deputy manager was aware that there were problems accounting for stock and he said that the new medicines supply to be started in the next few days would be properly recorded and carried forward so that all medicines could be easily accounted for. Our checks showed that one person missed several of their medicines over the last month including a medicine used to prevent stomach acid on seven occasions and a calcium supplement on fifteen occasions. This person also went without their prescribed iron tablets and a cholesterol lowering medicine for over a week because stock had not been obtained. Another two people missed weekly medicines because staff had forgotten to give them, one of these was a strong pain relief patch and the other a medicine used to prevent osteoporosis. We also looked at the times medicines were given to people and found some were wrongly given with food instead of before because the medicines rounds had not been properly organised. Giving people their medicines at the wrong time, wrong dose or not at all is poor practice because it can seriously affect their health and wellbeing. We checked a sample of care plans and supporting paperwork for information about medicines such as those prescribed as when required and for detailed information about specific medicines and the health issues they were prescribed for. New plans had been written for when required medicines but these were the same for all people who lived in the home and did not contain any detailed information about how to give them and what they were prescribed for. The deputy manager agreed that these plans lacked detail and were not person centred. We found another care plan lacked enough information about how to manage a person who suffered epileptic seizures. On one occasion they were given their rescue medicine unnecessarily and on another it was unclear if it should have been given because the care plan lacked clear instructions about how and when it should be used. We found external medicines such as creams were not well recorded. Nurses ticked the medicines records during the medicines rounds but the deputy manager and a carer confirmed that care staff applied most of the creams and these were usually kept in the bedrooms. The deputy manager said he was planning to introduce creams charts to be kept in the bedrooms, he said these would be signed by the care staff that applied the creams to help make the records accurate and genuine. We checked how medicines liable to misuse, called controlled drugs, were handled. We found they were securely stored in suitable cupboards and when we checked the current stocks we found these were correct and all records were properly witnessed. Having secure storage and witnessed records helps prevent the mishandling and misuse of controlled drugs. We checked how medicines were stored and found them to be securely kept in a clean and tidy room. However, the temperature of the medicines storage fridge had been too high for the last week and no action had been taken to put it right. Storing medicines at the wrong temperature can spoil them and stop them working properly. What the care home does well: Staff are approachable and demonstrate a caring and patient attitude towards the people Care Homes for Older People Page 7 of 12 they care for. The food is of a good standard and people enjoy it. Visitors are welcomed at the home at any time. What they could do better: 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 set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Records of medicines 30/09/2010 received into the home and administered to people must be clear, accurate and complete. This is important so that all medicines can be fully accounted for. 2 9 13 Medicines requiring cold storage must be kept at the right temperature. This will help prevent them being spoilt. 30/09/2010 3 9 13 Medicines must be administered to people correctly as prescribed. This is important because receiving medicines at the wrong time, wrong dose or not at all can seriously affect a persons health and wellbeing. 30/09/2010 4 27 18 The provider must show that 30/09/2010 as far as possible there are enough staff who know the Page 10 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action needs of people using the service. This is so that people who use the service can expect consistency of care. 5 27 18 Training about the care of people with dementia must be provided to all staff. This must be delivered by someone who is qualified to teach and has up to date knowledge of the subject matter. This will help to make sure that peoples needs are understood and are met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/09/2010 1 8 Risk assessments for manual handling and moving should be reveiwed and information for staff about how to safely move people should be fully detailed in care plans. This will mean that staff will have the information they need to make sure that people are moved safely. Care plans and supporting paperwork should have detailed information about how medicines should be handled including when required medicines. This will help make sure they are handled and administered safely. A detailed training programme should be produced for staff. Training should be provided by people who are trained to train and knowledgable. This will make sure that staff have the knowledge they need to look after people properly. 2 9 3 27 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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