Care Home: Brentwood Care Centre

What the care home does well Following the last key inspection we received a number of Regulation 37 Notifications relating to alleged poor care practices and concerns about individual`s finances. Following discussion with the manager and from inspection of records, it was evident that appropriate measures had been taken to address the above and external agencies contacted. What the care home could do better: Whilst we recognise following the key inspection in November 2008, the management team of the home have focussed primarily on medication practices and procedures, enhancing staffing levels/deployment of staff within the home, arranging and providing training for staff and addressing concerns expressed by outside agencies/residents and relatives; issues and concerns as highlighted at the previous inspection pertaining to care planning/risk assessing and meeting individual`s healthcare needs remain outstanding. Not all the requirements about medication made on the last inspection have been met. There has, however, been an improvement in the management and recording of medicines and so where requirements have not been met in full, they have been given a new timescale for action. It should be noted that further non-compliance with requirements may result in enforcement action. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Brentwood Care Centre Larchwood Gardens Pilgrims Hatch Brentwood Essex CM15 9NG zero star poor service 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 assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. 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: Michelle Love Date: 1 9 0 2 2 0 0 9 Information about the care home Name of care home: Address: Brentwood Care Centre Larchwood Gardens Pilgrims Hatch Brentwood Essex CM15 9NG 01277375316 01277375473 brentwood@ranccare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ranc Care Homes Ltd care home 112 Number of places (if applicable): Under 65 Over 65 0 112 0 dementia old age, not falling within any other category physical disability Conditions of registration: 112 0 9 The registered person may provide the following category of service only: Care home with nursing - Code CRH N 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 into any other category who are over 60 years of age - Code OP (maximum number of places 112) Service users with dementia who are over 50 years of age - Code DE (Maximum number of places 112) Service users with a physical disability who are over 40 years of age - Code PD (Maximum number of places 9) The maximum number number of service users who can be accommodated is 112 Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home Brentwood Care Centre is a newly built care home situated on the outskirts of Brentwood Town. The home provides accommodation and nursing care for up to a maximum of one hundred and twelve people. Accommodation is provided over three floors. Residents have access to comfortable communal areas and all residents have single bedrooms with ensuite facilities. The costs for placement at the home at the time of this inspection ranged from 562.52 to 1,535.10 per week. Care Homes for Older People Page 3 of 13 What we found: As part of this site visit, the care files for 3 people were examined pertaining to specific areas (challenging/inappropriate behaviours, nutrition and refusal/non compliance of medication). Records show there is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these needs are to be met by both qualified nursing staff and care staff. It was of concern that not all areas of identified need were recorded within each persons care plan and there was limited and/or no information recorded as to how staff were to proactively manage the persons specific care needs. Records show that further development of the care planning and risk assessment process is required as shortfalls identified, place people at risk of not having all of their care needs met and provides staff with inaccurate and not up to date information about individual people who live at Brentwood Care Centre. Records of service users healthcare needs were not clearly being monitored, with potential complications and problems not identified and dealt with at an early stage by staff, including prompt referral to an appropriate healthcare professional or specialist. Additionally risk assessments were not devised for all areas of assessed risk. This has the potential of placing vulnerable people at increased risk, as the staff working within the care home do not have all of the information available, for them to identify risks and to provide proactive management strategies to minimise the risks. Records showed that physical and verbal aggression by some service users are not clearly understood or dealt with appropriaetly by staff. It was unclear from records which evidenced restraint had been used, that de-escalation methods had been tried, found to be unsuitable or failed. There was no evidence to support that restraint had been used as a last resort or as urgent action only to be used in exceptional circumstances. Additionally records showed failure by the management team of the home/senior team members to instigate appropriate measures so as to safeguard others who live at Brentwood Care Centre. On inspection of the staff training matrix, records showed that of 1 RGN and 5 members of health care staff on duty (Windsor), only one person had received training relating to dealing with challenging behaviour. We are aware that since November 2008, 10 members of staff have received this training so far. As a result of these concerns as detailed above, copies of documents were taken by inspectors under Code B of the Police and Criminal Evidence Act 1984. We are now considering further enforcement action. A pharmacist inspector examined practices and procedures for the safe handling, administration and recording of medication. The home has good clear written policy and procedures on the safe use of medicines to protect residents but some aspects of these procedures are not followed by staff. Secure storage is provide for medication to prevent unauthorised access but the key to the controlled drugs cabinet is stored within one of the other cupboards, not kept by Care Homes for Older People Page 4 of 13 the nurse in charge as required by the homes own policy. One of the medicine storage cupboards also contained money which is an inappropriate place to store money and again, not in line with the homes own policy for the secure storage of cash. The cupboards used to store controlled drugs are not fixed in a way which complies with the relevant regulations. Medication record forms and medication in use were examined for a number of residents. Records are kept of when medication is received into the home, when it is given to residents and when it is disposed of. These records were of a reasonable standard but a few discrepancies were found between the amount of medication that should be in stock if the records were correct and what was actually in stock. People receive their medicaiton taking into account any special instructions for use. There were also a few gaps in the records giving no indication whether medication had been administered to residents or not, and if not the reason why was not recorded. The homes management carry out regular audits of medication and medication records and this is good practice but it had not picked up these discrepancies. It is sometimes difficult to fully audit the medicines in use as the date the containers were started is not always recorded. This should be considered as good practice. Medicines are only administered to residents by staff who have been trained to do so. The level of training is satisfactory and staff are assessed that they are competent to adminster medicines. We saw a number of residents being given their medication in the lounge/dining areas of the home. The staff members were seen to administer medication to residents with regard to their dignity and personal choice and medication was kept secure during the process. The care plans for some people who regularly refuse medication were examined and it was disappointing that such occurences are not managed, assessed or reported to the prescriber. What the care home does well: What they could do better: Whilst we recognise following the key inspection in November 2008, the management team of the home have focussed primarily on medication practices and procedures, enhancing staffing levels/deployment of staff within the home, arranging and providing training for staff and addressing concerns expressed by outside agencies/residents and relatives; issues and concerns as highlighted at the previous inspection pertaining to care planning/risk assessing and meeting individuals healthcare needs remain outstanding. Not all the requirements about medication made on the last inspection have been met. There has, however, been an improvement in the management and recording of medicines and so where requirements have not been met in full, they have been given a new timescale for action. It should be noted that further non-compliance with Care Homes for Older People Page 5 of 13 requirements may result in enforcement action. 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 6 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and ensure these are regularly updated and reviewed to reflect the most up to date information. Previous timescale of 1/12/08 not met. This will ensure that staff have the most up to information and can provide appropriate care to meet their needs. 01/05/2009 2 7 13 Risk assessments must be 01/05/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps taken to reduce the risk. Previous timescale of 1/12/08 not met. This will ensure that risk areas are identified and staff are aware of the associated risks to residents health and wellbeing. 3 8 12 Ensure suitable 01/05/2009 Care Homes for Older People Page 7 of 13 arrangements are in place so as to ensure that residents health and welfare are promoted and any issues are promptly addressed and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. Previous timescale of 1/12/08 not fully met. This will ensure that the healthcare needs of residents are met. 4 9 17 Ensure that when medication 27/03/2009 is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. Previous timescale of 1/12/08 not fully met. This is to ensure a clear audit trail and to ensure peoples health and welfare. 5 9 13 Residents must be protected 27/03/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. Previous timescale of 1/12/08 not fully met. So as to ensure residents safety and wellbeing. 6 18 13 Ensure that all staff receive appropriate training relating to safeguarding and dealing 01/05/2009 Care Homes for Older People Page 8 of 13 with challenging behaviour. Previous timescale of 1/2/09 not fully met. This will ensure that staff, feel confident, have the skills to deal effectively with issues raised and residents are protected from harm. 7 27 18 Ensure there are sufficient staff, on duty at all times. Not inspected on this occasion. Previous timescale 1/12/08. So as to ensure the needs of residents are met according to their specific needs and dependency. 8 29 19 Ensure that robust recruitment procedures are adopted at all times and all records as required by regulation are sought. Not inspected on this occasion. Previous timescale 1/12/08. This will ensure that residents and others feel assurred that they are safeguarded by the homes procedures. 9 30 18 All staff newly employed to the care home receive, a structured induction. Not inspected on this occasion. Previous timescale 1/12/08. This will ensure that staff, feel supported and able to carry out their role. 01/04/2009 27/03/2009 01/04/2009 Care Homes for Older People Page 9 of 13 10 30 18 Staff receive appropriate training to the work they perform. This refers specifically to core subject areas and those conditions associated with the needs of older people. Not fully inspected on this occasion. Previous timescale 2/3/09. This will ensure that staff, have the competence, confidence and ability to meet residents care needs and people living at the care home will feel reassured that their care needs will be met by suitably trained staff. 01/06/2009 11 31 10 The home is managed appropriately with skill and competence. Not inspected on this occasion. Previous timescale 1/12/08. To ensure that the care home is run in the best interests of the people who live at Brentwood Care Centre. 27/03/2009 12 36 18 Ensure that staff, receive regular supervision. Not inspected on this occasion. Previous timescale 1/12/08. So that staff feel supported and residents know that staff are appropriately managed. 01/04/2009 Care Homes for Older People Page 10 of 13 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, Care Homes 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 8 17 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and appropriate action taken. So as to ensure peoples safety and wellbeing. 01/05/2009 2 9 13 Ensure that when medication 27/03/2009 is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. So as to ensure peoples safety and wellbeing. 3 9 13 Medication, including controlled drugs, must be stored securely in line with relevant legislation. This will prevent unauthorised access to medicines and protect residents from harm. 27/03/2009 4 18 13 Physical and/or verbal aggression by residents is understood and dealt with appropriately. Physical 27/03/2009 Care Homes for Older People Page 11 of 13 intervention is used only as a last resort and in accordance with policies and practices of the home and other legislation. So as to ensure peoples safety and wellbeing. 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 1 9 The date of opening should be recorded on containers for medicines to ensure an audit trail of medicines is possible. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI 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: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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