Care Home: Briarwood Rest Home

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What the care home does well Briarwood Care Home has a good group of staff that know the needs of people living at the home very well. The home provides a relaxed atmosphere and the quality of care is good. Residents are comfortable living at the home and get on well with the staff team. One resident said, "I am so pleased with the place, and I am without complaint. Staff are exemplary". People living at Briarwood Care Home were generally very pleased with the care provided and the staff group with one person saying on a comment card, "If I want them they are there". Relatives said, "The residents are treated with respect. The carers are very friendly" and "It would be very hard for me to say how the care home could improve, as I think they are doing a wonderful job". There are good systems in place to make sure that staff understand the needs and requirements of people before they live at the home. This is to make sure that people are only admitted to the home if their needs, wants and wishes can be met. The manager makes sure that staff are well trained so that people`s needs and requirements are well met by a competent staff team. Care plans, that tell staff what the individual resident can do independently, or what help may be required are detailed and comprehensive. This helps to ensure continuity of care. What has improved since the last inspection? Since the last inspection, the vast majority of care staff have undertaken a variety of mandatory health and safety training or retraining. This has helped to make sure that the staff team are adequately trained. Staff that have yet to complete some elements of this training, will do so in the near future. Staff have also undertaken adult abuse training, this helps to protect residents. At the last inspection, one of the bathrooms was not in use. At that time it was understood that an assisted bath was to be provided. However a new hoist has been fitted in this bathroom to enable resident`s ease of use when using the bath. Staff spoken with felt this had made a big difference for residents and was adequate for this present time. What the care home could do better: Usually the recruitment of new staff at Briarwood Care Home is very thorough. However on one occasion, not all the required clearances had been obtained and deemed to be satisfactory before a new member of staff started working at the home. The outstanding clearance was provided within a few days of theemployment starting, but all clearances should have been obtained before the newly appointed member of staff started working at the home. All staff are informally supervised on a day-to-day basis by the management team to make sure that they are doing their job right. However care staff should also receive formal one to one supervision at least six times a year. Although staff do receive formal supervision that is well recorded, this is not as frequently as it should be. All radiators in bedroom accommodation and some radiators in communal areas of the home have been guarded to prevent residents being accidentally injured. However all radiators in resident accommodation should be guarded. The homeowner said that a Fireguard company had previously said that radiator guards were not required in these areas. This is not the case. The homeowner said that if radiator guards were required in these areas they would be provided. CARE HOMES FOR OLDER PEOPLE Briarwood Rest Home 1-3 Todd Lane South Lostock Hall Preston Lancashire PR5 5XD Lead Inspector Denise Upton Unannounced Inspection 4th December 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Briarwood Rest Home Address 1-3 Todd Lane South Lostock Hall Preston Lancashire PR5 5XD 01772 626177 01772 312130 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) Briarwood Rest Home Ltd Mrs Indrannee Pumbien Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 24 service users to include up to 24 service users in the category OP (Old Age not falling within any other category). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 7th November 2006 2. Date of last inspection Brief Description of the Service: Briarwood Rest Home is currently registered to accommodate up to 24 older people who do not require nursing care. The home is located in a quiet residential area but in close proximity to the main shopping area of Lostock Hall and community facilities and resources. The accommodation is arranged over two floors. All current residents are accommodated in single bedroom accommodation, however shared rooms are available if required. Communal areas of the home consist of a main lounge area, a dining room that leads onto a conservatory and a smaller lounge that is the designated smoking area. Although bedroom accommodation does not provide an en-suite facility, bathing and toilet facilities are sufficient in number, conveniently situated and provided with appropriate aids to promote independence. A passenger lift and stair lift are provided. The grounds to the house are limited in size but carefully laid out and provided with tables and seating for people living at the home to enjoy. At the time of the site visit the cost of residential care at Briarwood Care Home ranged from £319:00 - £361:00 per week. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place over a mid weekday and in total spanned a period of approximately seven hours. For part of the day an expert by experience also visited the home and spoke with a number of residents to order to gain their thoughts and feelings about living at the home. An expert by experience is a person who because of their experience of using or visiting a care home(s) visits a service with an inspector to help them get a picture of what it is like to live in the home. During the course of the day the inspector also spoke with the homeowner/ manager, the homeowner’s husband, the deputy manager, the cook and a senior carer. In addition, discussion also took place with the relative of a resident who was visiting and brief general discussion also took place with several other residents who were ‘at home’. A number of records were examined and a tour of the building took place that included communal areas of the home, the laundry, kitchen and some bedroom accommodation. Six, Commission for Social Care Inspection resident surveys were completed and returned along with four relative surveys and four staff surveys. This information also helped to form an opinion as to whether the Briarwood Care Home was meeting the needs and expectation of the people who live there. The vast majority of responses provided on the survey forms were very positive about the level of care and support provided and the staff group. However the opinions were more mixed from the people who spoke with the Expert by Experience. This site visit was unannounced however prior to the visit, the registered manager completed an Annual Quality Assurance Assessment (AQAA) that provided further important information. All of the core standards identified in the National Minimum Standards, Care Homes for Older People were assessed during the course of the visit, along with the one requirement and three recommendation made after the last inspection. What the service does well: Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 6 Briarwood Care Home has a good group of staff that know the needs of people living at the home very well. The home provides a relaxed atmosphere and the quality of care is good. Residents are comfortable living at the home and get on well with the staff team. One resident said, “I am so pleased with the place, and I am without complaint. Staff are exemplary”. People living at Briarwood Care Home were generally very pleased with the care provided and the staff group with one person saying on a comment card, “If I want them they are there”. Relatives said, “The residents are treated with respect. The carers are very friendly” and “It would be very hard for me to say how the care home could improve, as I think they are doing a wonderful job”. There are good systems in place to make sure that staff understand the needs and requirements of people before they live at the home. This is to make sure that people are only admitted to the home if their needs, wants and wishes can be met. The manager makes sure that staff are well trained so that people’s needs and requirements are well met by a competent staff team. Care plans, that tell staff what the individual resident can do independently, or what help may be required are detailed and comprehensive. This helps to ensure continuity of care. What has improved since the last inspection? What they could do better: Usually the recruitment of new staff at Briarwood Care Home is very thorough. However on one occasion, not all the required clearances had been obtained and deemed to be satisfactory before a new member of staff started working at the home. The outstanding clearance was provided within a few days of the Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 7 employment starting, but all clearances should have been obtained before the newly appointed member of staff started working at the home. All staff are informally supervised on a day-to-day basis by the management team to make sure that they are doing their job right. However care staff should also receive formal one to one supervision at least six times a year. Although staff do receive formal supervision that is well recorded, this is not as frequently as it should be. All radiators in bedroom accommodation and some radiators in communal areas of the home have been guarded to prevent residents being accidentally injured. However all radiators in resident accommodation should be guarded. The homeowner said that a Fireguard company had previously said that radiator guards were not required in these areas. This is not the case. The homeowner said that if radiator guards were required in these areas they would be provided. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 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 Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. The needs of those wishing to live at the home had been thoroughly assessed prior to admission so that the home was confident that the staff team could meet individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records of three people living at Briarwood Care Home were examined during the course of the visit to the service. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 10 The procedures in place showed that a comprehensive preadmission process had been adopted by the home to ensure that the needs of individuals admitted were known and could be adequately met. The detailed preadmission assessment involved the registered manager discussing needs and requirements with the prospective resident and their representative prior to admission. This was to make sure that staff would be provided with sufficient information of what each new resident’s needs were before they entered the home. A copy of the Care Management assessment had been obtained for those funded by the local authority. For those who were assisted with meeting the cost of residential care at Briarwood Care Home and for individuals who were self-funding, the home had carried out an independent assessment to ensure that individual assessed needs could be adequately met by the staff team. The six completed resident comment cards that had been received before the site visit to the home, all confirmed that each resident had been provided with a contract of residency that included the Terms and Conditions of residence. A relative spoken with during the course of the visit also confirmed that they had been issued with the terms and conditions of residence in respect of their relative so that they were aware of the cost of the residential care provided and the services and facilities made available. The relative of one recently admitted resident confirmed that the manager of the home had been to conduct an assessment before her father was admitted to Briarwood and that sufficient written and verbal information had been given about the home to make an informed choice about “bringing my father to live here”. Standard six was not assessed as Briarwood Care Home does not provided intermediate care. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is good. The assessed health, personal and social care needs of those living at the home was being met and their rights to privacy and dignity were being upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three of the residents files examined contained a person centred care plan. The plans contained good detailed information in order to guide staff and to ensure the support needs of the individual resident was met. The care plan had been generated from the pre-admission information obtained before the resident had been admitted to the home and from the ongoing continuing assessment following admission. The plans of care seen were well written Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 12 documents, easy to understand and considered all areas of the individuals life including health personal and social care needs. A number of risk assessments are routinely undertaken when a new resident is admitted to the home. This is to make sure that the most common areas of risk are assessed and where necessary minimised. The process of the risk assessment is also used as a training item for staff to make sure they are confident and competent in identifying risks and how to minimise risks. There was good evidence of routine monthly reviews of care plans with detailed written information of any amendments to the care plan. In one instance a resident had displayed a recent change in behaviour. This was well documented, the care plan had been amended and additional risk assessments had been undertaken both in relation to the resident and her environment. Staff had the skills and ability to support and encourage residents’ and/or when appropriate their relatives in the development of the initial, individual care plan and the outcome of the monthly review. All care plans observed, had been signed by the resident or their relative as acknowledgement and understanding of the content of the care plan. One relative spoken with confirmed that she had seen and approve her father’s care plan and that the detail in the care plan had been discussed with her. Care plans at Briarwood Care Home are usually very personalised and detailed. However recently some new pre printed care plans and risk assessments have been introduced. Whilst still providing good information, these newer documents are not as personalised to the individual as the previous ones. From discussion with the homeowner, it is understood that consideration is being given to returning to the original hand written care plan to ensure that they contain the detailed and very personalised information to guide and instruct staff. Three of the six residents who completed the Commission for Social Care Inspection survey’s stated that they always received the care and support they needed and the remaining three residents had ticked that they usually received the care and support they needed. Nobody had stated that they only sometimes or never received the attention they required. One person said “They (the staff) are beyond question, the staff are exemplary, although busy, they always deal with me as soon as they can”. Another resident had written, “If I want them they are always there”. Residents’ health care needs were being well met by the additional input of a variety of other professionals involved in the overall care of people living at the home. This was confirmed by the examination of the medical records that recorded why a medical assessment had been sought, what the outcome was and any following changes to medication. The relevant information was then Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 13 included in the plan of care. Individual daily record/evaluation sheets were informative and were each completed following the early shift, late shift and nighttime period. All residents spoken with or who completed a survey, commented that they always received medical support when they needed it, with on resident saying, “Doctor is always called if I need one, staff are good at that and very efficient”. Relatives who completed the Commission for Social Care Inspection relative surveys confirmed that they were always kept informed about important issues including health issues and one person wrote, “ The care home is usually very good at keeping one up to date with important issues affecting my father”. Although all resident spoken with or who completed the Commission for Social Care Inspection were satisfied with the health care arrangements, one lady did comment that if she asked to see her Doctor this was never in private and the care manager was always in on her appointment. Later discussion with the homeowner did not confirm this. Residents are sometimes escorted to their G.P. surgery but unless the resident wished for the member of staff to see the G.P. with them, the carer waits outside for the consultation to be completed. It is important that every resident who wishes to do so, is enable to have a private consultation with their G.P. Wherever possible, residents should be always asked if they would like to see their G.P. in private and their decision respected. If staff at the home wish to talk with the G.P., this should be arranged either before or after the consultation. Likewise if the G.P. feels that staff need to be made aware of some information this should be provided after the consultation. The handling of medications was well managed. Clear procedures were in place to ensure that the home had a good record of compliance with the administration, safekeeping, and disposal of medications. Senior staff with responsibility for the administration of medication had received appropriate medication training that included the completion of a workbook that helped to ensure competence and understanding. The homeowner/manager is a registered mental health nurse who is very aware of medication issues and provides good guidance to the staff team. Although senior staff have completed medication training, the pharmacist who supplies the home with medication provides further on-going training. It is also understood that arrangements are to be made for all remaining care staff to receive basic medication training. This would help to ensure that all care staff have some understanding of why the medication practices are adopted in the home and have some understanding of common side effects of certain medications. Staff were observed to speak appropriately to residents and treat them with respect. Residents spoken with by the expert by experience all confirmed that Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 14 they felt that their privacy and dignity was well respected by staff. A relative had written, “The residents are treated with respect and the carers are very friendly”. Another relative wrote, “The standard of care is very high, I cannot find fault with anything”. All staff receive training in respect of maintaining privacy and dignity during induction training, National Vocational Qualification (NVQ) training and through regular supervision. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. The routines of daily living are kept flexible to enable people living at the home to enjoy the lifestyle of their choice. Dietary needs of residents are well catered for with a balanced and varied selection of food available however some residents stated that there was no choice offered at mealtimes. This judgement has been made using available evidence including a visit to this service. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 16 EVIDENCE: Information recorded on each resident’s file includes their preferences, interests, social, religious and cultural needs, that is used to ensure individual needs are identified and met as far as possible. The views regarding the range of activities made available for resident’s to enjoy was mixed. There was clear, recorded evidence of activities that had taken place during morning and afternoon periods of each week that identified the residents that had taken part and the member of staff who had organised/participated in the activity. During the afternoon of the site visit a number of residents were enjoying a game of card bingo in the conservatory. Other activities recorded as having taken place included musical movement, quizzes, manicures, passive exercises, dominoes and reminiscence therapy. The homeowner/manager stated that staff take some residents out for walks or to the local shops. The library service provided large print book that are changed periodically. A local vicar visits the home every Sunday and mass is conducted in the home once a fortnight. The Annual Quality Assurance Assessment (AQAA) completed by the homeowner/manager prior to the site visit stated that trips to Southport and Blackpool illuminations had taken place and relatives and residents had enjoyed a summer fete and bonfire party. A Christmas party has been arranged. Birthdays are celebrated when family and friends are invited to the party. A member of staff spoken with said that activities are kept flexible and residents are asked each day what sort of activity they would like to undertake during the morning and afternoon period. The same member of staff also said that it was quite possible that two or even three activities could be taking place at the same time organised by a different member of staff if this is what residents wanted. The homeowner also commented on the AQAA that the home are consistently reviewing any areas that require improvement but that they had had no suggestions from resident’s, their representatives or staff on what alternative activities residents would like to be provided. A relative who was spoken with that visits the home regularly confirmed the outings and activities on offer and all but one of the residents who completed the Commission for Social Care Inspection survey form stated that activities were either always or usually arranged by the home that the resident could take part in. One resident went on to say with regard to activities, “I couldn’t improve on it, but I don’t wish to participate although I am always asked”. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 17 However, the four residents that the Expert by Experience spoke with, all said that activities, entertainment and outings were very limited or none existent except for the television with little or no opportunity to go personal shopping or to outside entertainment such as a theatre or pantomime trip. Later discussion with the homeowner confirmed that a number of residents do have short-term memory loss. It is unknown if some or all of the residents the Expert by Experience spoke with have short-term memory loss. This may however explain why residents views were so different. Given that the views of some people living at the home are so different regarding activities, it is suggested that each resident is informally spoken with about what sort of activities/interest/outings they would like to be provided. Any new information should be recorded on the individual care file. If a resident does not wish to participate in any activities at this present time this should also be recorded, with their decision regularly reviewed. It is especially important that suitable activities are provided for people with cognitive impairment who may not be able to participate in some of the activities arranged. Visitors were able to visit the home at any reasonable time and could visit their friend/relative in the privacy of their own room. One visitor spoken with on the day of the visit to the home said she felt very comfortable visiting the home and that staff were “approachable, helpful and very kind”. All residents at Briarwood Care Home are encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so. However in reality, a member of their family assists the majority of resident’s in this task. Details of advocacy services are made available for people living at the home and their family to access if and when they choose. Meals and mealtimes continue to be given high priority with a wide range of foods provided. The AQAA completed by the homeowner/manager stated that “There is always a choice of menu and alternatives are readily available. Snacks and drinks are available at all times. In addition to specific preferences, food is always nutritious, balanced, appealing and well presented” The menu of the day was displayed on a board in the dining room showing a choice of midday and evening meal. Only one baked pudding was highlighted for the midday meal but the cook explained that cheese and biscuits, ice cream and yoghurt are all readily available or a resident could choose an alternative of their choice. It is understood that residents often ask what the menu for the day is during breakfast in the morning. The cook also explained that there is a four weekly rotating menu but this is kept flexible. Residents are sometimes asked what they would like to eat and individual food is sometimes made for two residents, one of whom is Caribbean Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 18 and enjoys curry’s and a Polish gentleman has been provided with Polish meals as his daughter had provided a Polish recipe book for the cook to follow. Fresh fruit and vegetables are served daily and a joint of various meats is served several times a week, as residents appear to enjoy these meals. Breakfast is a free choice that includes a cooked breakfast. Menus are changed periodically and staff pick up on what residents say they would like to be included on the menu. Residents who completed the survey forms all stated that they always or usually liked the meals at the home. One resident said “no complaints what so ever”. Another resident stated in answer to the question ‘Do you like the meals at the home’, said that they were “Very satisfied with the meals. Often been fussy in the past but enjoy every meal”. Whilst residents who spoke with the Expert by Experience appeared to enjoy the actual meals served, there was some concern as they felt that no choices were made available. One resident did emphasis that there was no choice at all at mealtimes “you ate what was given to you”. In order to address this problem it is suggested that every morning each resident is individually informed of the choices for the day and asked to select their individual choice from the day’s menu. This should be recorded. By adopting this approach, residents would have a clear understanding of the menu choices available and be in a position to select an alternative of their choice should this be required. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Any complaint received by the home would be well managed and robust procedures were in place to ensure that the people living at Briarwood Care Home are adequately safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a comprehensive complaints policy in place, which included all of the required detail and outlined the steps that could be taken if a resident or other person were unhappy with the service provided. The policy/procedure is made available to residents and their relatives in the written information provided. Since the last inspection no complaint has been received either directly to the home or to the Commission for Social Care Inspection. Residents who completed surveys confirmed that they knew how to make a complaint however one resident had written, “ I have no complaints what so ever”. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 20 A written policy was in place at the home in relation to the protection of vulnerable adults, which provided clear guidance on the procedure to be followed in the event of any allegations of abuse being received. A copy of the guidance ‘No Secrets in Lancashire’, identifying local procedures to be followed was available for staff reference to ensure that correct procedures would be followed. A whistle blowing policy was also in place so that staff were aware of their responsibilities in relation to the reporting of any concerns, which may affect people living at Briarwood Care Home. All staff had been provided with adult protection training in 2006 and an adult protection training pack is available in the home. This not only clearly advises staff what they should do in the event of any allegation of abuse but also what they must not do. From discussion with the homeowner/manager it was also confirmed that adult protection is frequently discussed during individual supervision. Adult protection is also a mandatory topic during induction training and National Vocational Qualification (NVQ) training. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The environment and building is safe, clean and well maintained providing comfortable surrounding for residents to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As identified at previous inspections, residents at Briarwood Care Home live in well-maintained accommodation that is comfortable and homely and designed to suit the needs of the people who live there. The home is situated in the village of Lostock Hall with local shops and community facilities close by. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 22 There is a large lawned area to the front of the home and a landscaped patio area with tables and seating to the rear of the building that resident’s can enjoy in the summer months. The layout of the home gives residents opportunity to move freely round the building and access all areas with ease. The home is well maintained, tastefully decorated and offers alternative lounges including a conservatory to the rear of the building and designated smoking lounge. There is a passenger lift for ease of access throughout the building and a new stair lift has recently been provided. Bedrooms continue to be light and airy and comfortably furnished to suit the needs and requirements of the individual occupant. Residents were able to personalise their rooms with their own belongings helping them to feel comfortable and settled in the home. At the last inspection one of the bathrooms was not in use. There were plans to provide an assisted bath however there was a change of plan and a new bath hoist has now been fitted. This bathroom, another bathroom and two toilets have also been provided with new flooring. Staff spoken with felt that the new hoist was sufficient to meet current needs. During the course of the site visit, the Expert by Experience observed one of the bathrooms and felt this to be below standard. Later in the day this bathroom was observed again. On this occasion the bathroom, although not of more modern design was clean, warm and tidy. Residents who completed a survey in answer to the question ‘Is the home fresh and clean’ all considered that this was always the case. One resident wrote, “Always very clean with no smell”. A relative stated, “The care home is always clean and smells fresh”. The registered manager confirmed that all bedroom accommodation is provided with a lock to the door and a lockable facility for the safe storage of items of a personal nature. However it was noted that during the afternoon period, a number of bedroom doors had been left wide open when the occupant was in another area of the home. In order to ensure privacy and maintain dignity, it is recommended that bedroom doors be kept closed at all times with the occupant retaining the key to their bedroom unless the individual risk assessment suggests otherwise. This was of particular concern to one female resident who told the Expert by Experience that privacy and dignity was paramount to her but she did complain about a male resident who wandered into her bedroom uninvited. He did leave when told, but this situation could have been avoided had the bedroom door been kept closed. All radiators in individual bedroom accommodation are guarded to protect residents and thermostatic devises fitted to hand washbasins and baths/showers in resident accommodation to prevent accidental scalding. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 23 However radiators in some communal accommodation are not guarded including the smoking room, a corridor and the conservatory. The homeowner explained that she had been advised, by a fireguard company that radiator guards in these areas were not required. This is not the case. All radiators in resident accommodation should be guarded even when furniture is placed in front of the radiator as the furniture could be moved and residents be put at risk. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Staff are provided with protective clothing. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. The number and skill mix of staff on duty were sufficient to ensure that the assessed needs of residents were met. Staff had received a wide range of training to ensure that they were competent to do their job. The recruitment procedures are normally adequately protected those living at the home. However on one occasion this was not fully complied with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been little change in the staff team since the previous inspection with only one new member of staff appointed. The record of this member of staff was looked at in detail and was found to contain all but one document to confirm that the correct recruitment procedures had taken place to ensure that residents were protected. This member of staff is currently employed in a none Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 25 care capacity and began working at the home before a Criminal Records Bureau (CRB) certificate that was requested by Briarwood Care Home had been obtained and deemed to be satisfactory. The person in question had a current CRB certificate dated several days prior to commencement of employment at Briarwood Care Home from an alternative employer. However the Commission for Social Care Inspection is led to understand that this was not portable. This member of staff now has a full CRB certificate. Never the less, except where a member of staff is secured from a registered recruitment agency on a temporary basis, all newly appointed members of staff must have a CRB, and in respect of care staff a POVA clearance, that had been requested by the home before the new employee actually takes up post. Other staff members spoken with confirmed that the full recruitment had been undertaken before they had commenced employment at the home. One member of staff had written on a survey form, “I was unable to start work until the manager had received my references and CRB”. Another person wrote, “I was unable to start work until my references were checked and I had my Police clearance”. Staff training is seen as priority and currently 66 of the care staff team have achieved a nationally recognised qualification in care at various levels, providing them with a good range of skills and experience. One member of staff wrote on a survey form, “I have attended plenty of training courses all of which I find useful and relevant to the job. I feel I am always up to date with new ways of working and feel comfortable within my role”. Staff individually spoken with was able to demonstrate their commitment to provide the residents with a quality service that met their individual needs. Staff said that they were clear about their role and worked well as a team to ensure the individual and collective needs of the residents were met. Examination of staffing rotas showed staffing levels were sufficient for the number of residents living at the home and on duty at the time of the inspection. This was also confirmed by staff individually spoken with who felt that sufficient staff were on duty at all times to ensure that the needs of residents were met. Additional staff are on duty at peak times of activity and all night staff have ‘waking watch’ responsibility. There was sufficient ancillary staff employed to ensure standards in respect of domestic and catering arrangements are maintained. Nationally recognised induction training is available and provided to all newly appointed care staff. One person said, “After my induction was complete I felt confident enough to do my job well. If there was anything I was unsure of I was always able to ask someone”. The deputy manager wrote, “Inductions are always carried out for new staff. It is vital for new staff to deliver high standards of care. As deputy manager I make sure that this takes place”. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 26 A relative commented, “I am confident with the skills and experience of the staff in the care home.” It is understood that the most recent employee is interested in becoming a member of the care staff team. In order to achieve this, the person in question has recently started nationally recognised induction training for care staff that consists of an ‘in-depth’ workbook supplied by an external training provider. Comments received about the staff group were very positive. One relative stated that she was “completely happy” and that her relative, resident at the home was “very happy in their care and we are assured that he is well looked after. We have had no issues/concerns in the five years he has been there” Another relative wrote, “the standard of care in this home is very high. I can’t find fault with it” .A relative individually spoken with commented that, “I didn’t know people cared so much. I have peace of mind knowing dad is safe and secure and looked after to the highest standard”. Staff also felt that a very good standard of care was provided. In answer to the question ‘What does the service do well?’ one member of staff wrote, “Provides a good standard of care and a happy home environment”. Another member of staff said, “I feel that our service users are very well looked after. I feel that all their individual needs are met well by the managers and my fellow colleagues. I am proud to work at this home and there is nothing I can fault from the basics of cleaning to the high level of care our service users receive”. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. The home is well managed and run in the best interests of the people living there. The health, safety and welfare of both residents and staff was promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 28 The homeowner/manager is a qualified mental health nurse who is very experienced in the care of the elderly and who works along side the deputy manager to provide a professional management team. The homeowner has also achieved the Registered Managers Award and has undertaken further recent training to update her skills and knowledge. There were clear lines of accountability within the home and the staff felt well supported. The home had a number of quality assurance monitoring systems in place to gather the views of residents and visitors. These were designed to ensure that residents received the support that they needed. These included annual resident questionnaires the last one being completed in May 2007, and also relative questionnaires. Residents and relatives are informed of the outcome of the questionnaires by individual verbal discussion. However one resident in discussion with the Expert by Experience said that he did not feel that any concerns or suggestions he had made had any impact. Whilst it is not known in what context this was said, it is suggested that all residents are reminded, individually if necessary, that their comments and views are important. It is also suggested that any comments made are recorded, analysed and the resident provided with further information or informed of any action to be taken as a result of their concern/suggestion. Although there are currently no surveys specifically designed for staff to complete, surveys are available for other stakeholders such as Social Workers, District Nurses and General Practitioners (G.P). In addition, resident meetings take place approximately two months and formal staff meetings take place on a less frequent basis. Staff confirmed that they are listened to and action taken if and when required. The home had achieved the Investors in People Award which is a quality assurance award awarded by an outside body. Policies and procedures were reviewed and updated as necessary to ensure that staff were aware of their responsibilities. The home safeguarded the resident’s financial interests as far as it was able. Small amounts of money were held for some residents accommodated. These were maintained individually and receipts were kept for any purchases made. Clear records were maintained in relation to residents’ personal allowances and any monies retained by the home for safekeeping. Policies and procedures were in place in relation to the handling and protection of residents’ finances so that appropriate safe guards were put in place. The home also maintained an inventory of the possessions of people living at the home and would give receipts for any valuables held on behalf of a Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 29 resident. Secure facilities are provided for the safe keeping of personal monies and a weekly audit of monies held in safekeeping is routinely undertaken. There was clear evidence of well-recorded, one to one supervision records being maintained. However, although the homeowner/manager stated that all staff received formal one to one individual supervision every two months this was not confirmed by the records maintained. Formal, recorded, one to one staff supervision was taking place less frequently with one staff file showing that formal supervision had taken place in March 2007 and not again until August 2007. The homeowner/manager explained that formal supervision is not always recorded. As identified in Standard 36.2 all care staff should receive formal, recorded supervision at least six times a year. Supervision at minimum should cover all aspects of practice, philosophy of care in the home and career development needs. It is understood that career development needs are discussed and recorded during the annual appraisal. However training and development needs and requirements could change during the period of a year and this topic should be discussed during formal supervision and the staff training plan amended as a result of any changes. The homeowner/manager ensures as far as is reasonable practicable the health, safety and welfare of residents, staff and visitors. Since the last inspection staff have undertaken a variety of health and safety training or retraining. This has been achieved by arranging two separate training days covering the same topic to enable staff to make a choice of which day to attend. Training has included, manual handling, first aid, food safety, fire safety adult protection and infection control training. It is understood that the small number of staff who have not completed this training will be expected to attend in the near future. Equipment in the home is inspected and serviced on a regular basis and measures are in place in respect of Legionella. Water temperatures are tested every four weeks to ensure the maximum temperature delivered from hot water outlets remains constant. A policy is in place that deals with issues of safe working practices and environmental risk assessments were in place. Health and safety issues are also addressed through the induction training standards and NVQ training. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement All newly appointed staff must have a new CRB clearance before commencing employment at the home. Timescale for action 31/12/07 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 4 5 6 Refer to Standard OP8 OP12 OP15 OP19 OP25 OP33 Good Practice Recommendations Residents should always be enabled to have a private consultation with their G.P. It is recommended that each resident be asked what activities/outings/entertainment they would like to take place that is recorded. This should be regularly reviewed. It is recommended that residents be asked each morning their choice from the menu of the day that is recorded. In order to ensure privacy it is recommended that all bedroom doors be kept closed with the resident retaining the key unless their risk assessment suggests otherwise. All radiators in resident accommodation should be guarded or have guaranteed low temperature surfaces. It is recommended that residents are reminded that their DS0000063007.V351926.R01.S.doc Version 5.2 Page 32 Briarwood Rest Home 7 8 OP36 OP38 views are important and that information is provided in relation to any suggestion received. Formal, recorded one to one staff supervision should take place at least six times a year. The small number of staff that have missed some arranged health and safety training for various reasons should undertake this training as soon as possible. Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 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 © 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 Briarwood Rest Home DS0000063007.V351926.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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