Care Home: Brierfield Residential Care Home

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What the care home does well People involved with Brierfield express a high level of satisfaction and feel that the home has a warm, friendly welcoming atmosphere. People feel they are listened to.Brierfield Residential Care HomeDS0000031867.V375857.R01.S.docVersion 5.2People have their needs assessed and the opportunity to spend time at the home before they move which improves the chance of successful admission. Access to health care is provided quickly and staff follow the instructions given by health professionals. Staff at Brierfield provides a good standard of personal care. People are supported in keeping their individuality and have opportunities to make choices about their daily life and activities. People feel that living in the home is a good experience and their needs are fully met. Comments included: `I like it here- they`re good and they help me with everything.` The environment of Brierfield allows service users to remain independent and provides spacious communal and private living space. The manager fosters good relationships with people, their relatives and professionals. She listens to what people say and is open and transparent. The manager understands the importance of continual training and is eager to continually improve the service provided. Staff recruitment is robust and so reduces the risk of employing unsuitable people. The care files are better organised and so it easier to monitor all the care and support that people have received in the home and how effective this is. What has improved since the last inspection? Since the previous inspection the manager has ensured that when relevant the psychological needs of people are considered assessed and staff comment on how contented people are. Since the previous inspection the manager has improved the management of medication in the home so that people receive the medication they need to Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 keep them keep well. This has included auditing medication in the home every week. Since the previous inspection a new medication cabinet has been purchased to make sure that medication is stored securely and in keeping with pharmaceutical guidelines. Since the previous inspection the manager has improved the staffs understanding and responsibilities in preventing and reducing the risk people developing pressure sores and wounds. Since the previous inspection the manager has reintroduce a varied activities programme that includes things to do in the home. Since the previous inspection the manager has made sure that all staff has received Protection of Vulnerable Training and understands and complies fully with the local adult protection policy and guidelines so that incidents are always investigated correctly. Since the previous inspection staff has been made aware of how they relate to people and the attention they give even if they are not completing a direct task. Since the previous inspection the registered person has started to visit the home and ask people about their opinion of the home, they have looked at complaints, accidents and incidents that have occurred and they have made a record of their visit. Comments about what has improved since the last inspection included: `People get a lot of choice about going out now.` What the care home could do better: The registered person should give to interested residents a rational about why a smoking shelter or room cannot be provided at Brierfield. The registered person should analyse complaints, incidents and accidents so that common themes can be identified and general risk reducing strategy put into place if necessary. The registered person should continue with the programme of cleaning and refurbishment so that all areas of the home look clean and are free from unsightly stains. Key inspection report CARE HOMES FOR OLDER PEOPLE Brierfield Residential Care Home Brierley Avenue Failsworth Oldham Lancashire M35 9HB Lead Inspector Michelle Haller Key Unannounced Inspection 29th May 2009 09:30 DS0000031867.V375857.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brierfield Residential Care Home Address Brierley Avenue Failsworth Oldham Lancashire M35 9HB 0161 681 5484 0161 682 7072 brierfieldshouse@masterpalm.co.uk 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) Masterpalm Properties Limited Nicole Thomas Care Home 37 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (37), Physical disability (37) of places Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability - Code PD The maximum number of service users who can be accommodated is: 37 Date of last inspection 31st May 2008 Brief Description of the Service: Brierfields is a purpose built, single storey care home for people aged 65 years and over. The owner is Masterpalm Properties who have three other homes in the area. The home is set on three wings, Acorn, Beech and Cedar. All service users are provided with single en-suite accommodation. Communal areas include one very large main lounge and dining room, a smaller lounge and quiet corners around the home, there is also a large enclosed porch that overlooks a quadrant garden. All bedrooms are single with en-suite toilet and washbasin. Most rooms have freestanding furniture, making it possible for service users to bring their own soft furnishings, accessories and other items. The fee charged by the home is £360-£375 each week. The Commission for Social Care Inspection report is on display at the entrance of the home and made readily available. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience GOOD quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visit we looked around the building, talked to residents, relatives and staff, including the manager and deputy manager. We observed the interactions between people living at Brierfield Residential Home and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last key inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information we have about how Brierfield Residential Home has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications’. We also received 12 Care Quality Commission (CQC) surveys that were returned to us by people using the service and from other people with an interest in the service such as staff. We have included comments made in these surveys throughout the report. What the service does well: People involved with Brierfield express a high level of satisfaction and feel that the home has a warm, friendly welcoming atmosphere. People feel they are listened to. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 6 People have their needs assessed and the opportunity to spend time at the home before they move which improves the chance of successful admission. Access to health care is provided quickly and staff follow the instructions given by health professionals. Staff at Brierfield provides a good standard of personal care. People are supported in keeping their individuality and have opportunities to make choices about their daily life and activities. People feel that living in the home is a good experience and their needs are fully met. Comments included: ‘I like it here- they’re good and they help me with everything.’ The environment of Brierfield allows service users to remain independent and provides spacious communal and private living space. The manager fosters good relationships with people, their relatives and professionals. She listens to what people say and is open and transparent. The manager understands the importance of continual training and is eager to continually improve the service provided. Staff recruitment is robust and so reduces the risk of employing unsuitable people. The care files are better organised and so it easier to monitor all the care and support that people have received in the home and how effective this is. What has improved since the last inspection? Since the previous inspection the manager has ensured that when relevant the psychological needs of people are considered assessed and staff comment on how contented people are. Since the previous inspection the manager has improved the management of medication in the home so that people receive the medication they need to Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 7 keep them keep well. This has included auditing medication in the home every week. Since the previous inspection a new medication cabinet has been purchased to make sure that medication is stored securely and in keeping with pharmaceutical guidelines. Since the previous inspection the manager has improved the staffs understanding and responsibilities in preventing and reducing the risk people developing pressure sores and wounds. Since the previous inspection the manager has reintroduce a varied activities programme that includes things to do in the home. Since the previous inspection the manager has made sure that all staff has received Protection of Vulnerable Training and understands and complies fully with the local adult protection policy and guidelines so that incidents are always investigated correctly. Since the previous inspection staff has been made aware of how they relate to people and the attention they give even if they are not completing a direct task. Since the previous inspection the registered person has started to visit the home and ask people about their opinion of the home, they have looked at complaints, accidents and incidents that have occurred and they have made a record of their visit. Comments about what has improved since the last inspection included: ‘People get a lot of choice about going out now.’ 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 on page 4. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 9 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 Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Brierfield residential home have their needs fully assessed before they move into the home so that they and the service can be confident that the appropriate life enhancing support will be offered. EVIDENCE: We looked at three care files, including those of people most recently admitted to Brierfield. We saw that each contained assessments completed by Social Services and additional pre-admission assessment undertaken by the manager. This information included a history of previous physical, social and psychological health needs. Risk assessments concerned with moving and handling, skin care and dietary needs had also been completed. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 11 We found that in the information she returned to us the manager confirmed that before moving into Brierfield ‘People are encouraged to spend the day at the home.’ We found that those who returned Care Quality Commission surveys all felt that they had received enough information about the home. People who were spoken to were satisfied with the process of moving into the home and confirmed that steps were taken for the manager to meet people before they moved. Comments about moving into Brierfield included: ‘We went around a number of homes- I liked this best because it is open plan and on one level. I came here for the day and had lunch- this was the best I could find. I can’t fault it.’ Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Brierfield Residential home have health and personal care in manner that promotes their physical and emotional wellbeing. EVIDENCE: We looked at three care files and each contained care plans. We found that each provided information about the general and specialist needs of people and how these needs must be met by staff. We found that care plans included information about how to meet physical health needs, such as promote continence, prevent pressure sores, weight loss, and specific information about personal preferences such as sleep pattern. We noted that there were times when care plan were not updated to reflect information in assessments. This did not impact on peoples care however as we found that people received the care and treatment they needed even when not highlighted in the care plan. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 13 We found that records, reports and other correspondence confirmed that people received input from health care professionals and were supported in attending outpatient appointments, general practitioner consultations, routine and specialist examinations including eye-tests, dental checks, podiatry, district nurse, continence advisory team and falls prevention. We noted that people wore hearing aids and prescription glasses which were clean and kept in good repair. We noted saw that it was clearly identified in assessments and daily records that people were supported in making an informed choice about their care. We found that staff who returned surveys all felt that they were always provided with enough information to meet people’s needs. They also stated that the communication in the home was good. Comments included: ‘We have care plans inn situ for everyone of our service users.’ And ‘We have handover between shifts.’ People who returned CQC surveys confirmed that they felt that they always received appropriate health care. We found that people were satisfied with the health care and attention provided. ‘He has improved since coming here, has regained his continence, is seen by the district nurse, podiatrist, opticians, they provide you with everything you need.’ We looked further at assessment information in conjunction with daily records and found that improvements had been made in relation staff dealing with psychological needs. We observed that staff follow basic instructions about communication and recorded in more detail issues that had affected people and how these had been dealt with. We observed the interaction between staff and people living at Brierfield throughout the day. And saw that people were approached in a quiet manner or in keeping with the mood of the moment. People were treated with dignity and respect. Daily records were in the main completed in enough depth to give a comprehensive picture of how a person had spent their day, the language used was kindly and the information showed that staff did work to the instructions in care plans. We found that there is effective monitoring because we could track the progress of people through the information recorded in weight charts, bath charts and incident summaries. This information confirmed that staff recognised, recorded and took action to deal with change. We observed that people are supported to achieve a good level of personal hygiene and grooming at Brierfield. During the inspection everyone was clean, Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 14 their hair was clean and neat, the men who wanted to shave had been supported in completing this task successfully. Ladies were fully dressed, wearing tights or stockings and men wore socks. People’s shoes and slippers were clean. We saw that signatures and amendments demonstrated that care plans were reviewed monthly and people or their relatives had signed care plans confirming their involvement in the planning process. At previous inspections there have been concerns about the number of pressure sores and leg ulcerations that have been acquired in the home. On the day of this inspection we discussed this matter. She informed us that there was one person receiving treatment for pressure wounds that had been acquired in hospital and one person receiving treatment for leg ulcers. We found through reading the pressure area risk assessments and records that staff now took a more proactive approach in trying to prevent pressure sores. We received six surveys from people living at Brierfield and each person confirmed that they always received the medical attention they needed. We observed the administration of the morning medicines for a short period on this inspection. Care was taken to ensure any special instructions such as ‘before food’ were followed, helping to ensure medicines work properly. The medicine round was nearing its end as the inspection commenced at about 09:30. We saw that medication records were generally up-to-date for each person and medicines received, administered and disposed of were recorded, enabling medicines handling to be ‘tracked’. Weekly audits (checks) are carried out to help make sure medicines are handled in accordance with procedures. We saw that controlled drugs (a class of medicine described in law) were adequately and safely managed. The records were accurate and a new storage cupboard purchased with guidance from a local chemist so that it met with current law. The previous inspection identified that the medicines policy could be usefully expanded to provide clearer guidance, for example, about supporting safe selfadministration; the manager said this was in progress. Brierfield Residential Care Home DS0000031867.V375857.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Brierfield are provided with recreational opportunities, supported to lead meaningful lifestyles and offered meals and nutrition which promote a sense of fulfilment and physical and emotional wellbeing. EVIDENCE: We found that the activities offered to people living at Brierfield have increased since the previous key inspection and a programme of activities has been reintroduced. Records confirmed that since the previous inspection activities had included making boxes in arts and crafts; floor and board games were offered. It was also evident that activities took place on a daily basis including weekends. An activities coordinator is in post and care staff also have the responsibility to organise events that help to keep people motivated. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 16 The manager ensures that people have the opportunity to participate in events that happen in the local community such as church events, shopping, theatre and outings. The training records and certificates confirmed that staff have received training in the importance of continued activities and hobbies for people in residential care homes. They have completed courses called ‘Yesterday, Today and Tomorrow’ and ‘Life Story’. These concentrate on the importance of social activities and events and help staff to recognise that people have varied pasts and that it is essential to consider, appreciate and respond to the wealth of life experience people in residential settings have had. The ‘Life story’ course also informs staff about the seeing people as individuals and the important of a person’s social history in making sure that people are regarded as individuals, an indication of their expectations and also help with ideas of what may be of interest to them in respect of developing a varied activities calendar. We saw that the life story and social histories for people had been completed and people were seen participating in activities they enjoyed such as reading, exercises and playing bingo. We noted that staff took the time to sit and talk to people. We noted that staff were attentive and friendly towards the residents. took time to stop and check that people were alright. Staff We saw that people are supported to develop good relationships as residents were happy speaking to each other and sharing information about what was happening in the home. On the day of inspection 10 residents went out to a local pub to celebrate a birthday. We found that people who returned surveys were content with the activities provided at Brierfield. Six people returned surveys and five felt that there was always something going on that they could enjoy and one person felt that this was usually the case. And person states that ‘Activities is something the home does well.’ We were told during the inspection that people were kept motivated and active through activities. Comments included: ‘People are kept very well entertained- they have activities and are always going to different places- they keep people occupied by doing all sorts of things.’ And ‘Activities are very good for the residents because they really enjoy it.’ Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 17 We observed that the routines in the home were flexible and that people could receive visitors when they wanted. During the inspection period relatives and friends came and went freely. They were made welcome and related very well to staff. People also made themselves or their relative’s drinks if they wanted. Family members felt that they were kept in touch with what was happening in relation to their relative. We were told that: ‘We are made welcome every time we come here, we are kept well informed, and some relatives even come at meal times because some people eat better if they are helped by their family.’ And ‘I like it here- they’re good and help me with everything.’ We observed that people enjoy the meals provided in the home. The breakfast choice ranges from cooked items such as eggs, bacon, sausages and beans, or cereal and toast. And breakfast time is unhurried and people came to breakfast at their own pace and ordered what they wanted, this was then freshly cooked. We saw that the lunchtime meal on the day of inspection was a choice of poached fish in parsley sauce or stewed steak, with potatoes and green beans. Both dishes looked very appetising and people said to one another that the meal was delicious. We looked at the menus which indicated that people were generally offered three cooked meals a day. We noted that the lunch and evening meals are varied and included traditional British dishes such as liver and onions, meat pies, and casseroles, meat roasts, corned beef hash and cottage pie fish and fish dishes. The menu states that either a baked potato with filling or sandwiches will be offered as an alternative to a cooked meal We were told by all the people who commented that they ‘always’ liked the food and people were very complimentary about the meals, drinks and snacks. People told us ‘There is a wide variety and choice of food- they get breakfast, lunch, tea and evening meals, plus snacks- they do very well.’ ‘It’s all very nice food that they put out.’ ‘The food is good she has put on weight since coming here.’ And, ‘The food is good for older people, plain and sufficient.’ We examined food and drink charts and nutritional assessments that had been completed with people. These provided detailed information about their Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 18 nutritional intake and indicated that people were well nourished and appropriate and effective steps were taken to ensure that people received the drink and food they needed. Certificates also confirmed that staff had received training in how to assess and improve the nutritional status of older people. Brierfield Residential Care Home DS0000031867.V375857.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People involved with Brierfield residential home have their complaints and concerns taken seriously and dealt with fairly and are protected by a robust adult protection policy which is understood by staff. EVIDENCE: We have not been involved in any investigations under the protection of vulnerable adults since the previous inspection. We have received four complaints, one anonymous and from family members and two from members of the public since the previous inspection. These were investigated by the manager and registered provider. They investigated the complaints and took steps to deal with the problems. We have not had any complaints about Brierfield since September 2008. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 20 We looked at the records kept by the home about the complaints investigated since the previous inspection. The information provided clear and detailed information about the complaints, what investigation had been carried out, the actions taken to deal with the matter and the opinion of the person raising the concern. We found that those who returned CQC surveys confirmed that they knew how to complain. Each service user file examined also held a copy of the home’s complaint procedure, and three out of the four had been signed as received by the person or their relative. The complaints procedure provided clear information about making a complaint and how these would be dealt with. We found that people felt comfortable and confident about making their concerns known. We found that communication was good and that people were listened to. People said: ‘I would talk to the manager to start off but then would approach social services- but we haven’t had cause.’ And ‘If you do have any problems or anything they do respond- I had spoken to the girls about something and when I’ve rung up, Nicole has known all about it and explained what she had done to resolve it.’ All staff who returned CQC surveys confirmed that they knew that they could raise concerns to organisations outside of the home, such as Social Services or CQC. We found that staff were knowledgeable about the protecting of vulnerable adults (POVA). The training record confirmed that since the previous inspection 23 care staff have received protection of vulnerable adult training. Discussion with staff confirmed that the ones spoken to had a better understanding of POVA issues. They also had a better understanding of the need to refer incidents between residents to Oldham Metropolitan Borough Adult Safeguarding team so that the agreed protocol is used to ensure that appropriate investigation takes place to identify the actions needed to prevent further harm. Brierfield Residential Care Home DS0000031867.V375857.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The facilities at Brierfield meets peoples various needs, and the fixtures and fittings are adequately maintained. EVIDENCE: We looked at all the communal areas and a number of bedrooms were entered. We saw comfortable seating placed in different alcoves and areas of the home so that people could sit and rest, read, or be on their own without having to return to their bedroom. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 22 We observed people making use of the different lounge and sitting areas throughout the home. Popular areas for people to sit included a small lounge over-looking the front of the home and an enclosed veranda style link-room overlooking the landscaped inner garden. We noted that the small lounge though pleasantly decorated still had broken glass on the outer side of the double glazed window. We noted that the carpet, in the main, dining area and lounge was clean and most of the furniture was clean. The hallway carpets were marked. We entered a number of bedrooms at random. These had been personalised and the bed bases that were looked at were clean, however, the carpets in a number were heavily stained and looked dirty. This was discussed with the manager. We found that the home was accessible and people were observed mobilising and using the facilities independently, with aids and adaptations such as hand rails, walking frames or walking sticks. Heightened toilet seats and bath chair lifts are also provided to assist in dealing with personal hygiene needs. We did not look at the laundry in the home we have found on previous inspections that this area has been clean and well organised and the equipment, fixtures and fittings had met the required hygiene standards because all the surfaces were washable and there was a washing machine with a sluice and disinfection-washing programme. We found that there was one negative comment about the home and this from a person who smokes. She felt that the home should provide a smoking shelter. The manager needs to look at the Smoke Free England guidelines concerning the rules for residential homes to see if a compromise can be reached. We were told that the home is always clean and that the level of hygiene was good. People’s comments included: ‘I have a lovely room.’ And ‘The rooms are clean- everywhere is clean and there’s never a smell.’ And ‘The rooms are very clean.’ Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Brierfield benefit from a well trained staff team who are supervised to provide effective support and who are employed using a robust recruitment process which results in the employment of suitable staff. EVIDENCE: On the day of this inspection we found that there were 33 people living at Brierfield residential home and the staff complement consisted of the manager and deputy manager, six care assistants, one domestic staff, one laundry staff, one cook and a kitchen assistant and an activities co-ordinator who works from 10:00 to 14:00. We observed staff interaction throughout the day and staff did not appear rushed and were evident in their work of supporting the residents and dealing with visitors to the home. We observed staff spending time talking to people and dealing with their requests and needs and staff also had a good rapport with relatives We found that staff who returned CQC surveys all felt that they received training appropriate to the work they do. The training record confirmed that since the previous inspection staff had attended course in manual handling; Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 24 fire safety; tissues viability; food safety; first aid; dysphasia; dementia; health and safety; control of substances hazardous to health (COSHH) infection control; fire marshalling and medication. The manager confirmed that staff receive training through the OMBC Training partnership. We believe that the majority of staff achieved a qualification in care because the manager informed us in the information she returned that 25 out of 27 staff have achieved National Vocational Qualification (NVQ) in social care at level 2 or above. Staff told us that they received training to help them to do their jobs. They said: ‘We are sent on courses such as induction, health and safety, first aidand put in for our NVQ- we get in-house training such as fire, Coshh, firetraining etc.’ And ‘The service gives you good training courses.’ Staff also confirmed that the manager talked to them about their work. They said: ‘We have appraisals every few months but we can approach both managers if we have any qualms.’ People who returned CQC surveys felt that there were usually staff readily available and people felt that staff did their jobs well. People said ‘The staff are considerate and helpful.’ We looked at the most recent recruitment records. We found that recruitment process is robust and protects against employing unsuitable people. Each file held references from two independent sources, both of which were traceable, and all other criminal record checks and additional proof of identity were in place. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Brierfield residential home is effectively managed and the needs of the people who live there are given a high priority. EVIDENCE: We found the management of the home is stable and Nicole Thomas continues to be the registered manager. Ms Thomas has completed National Vocational Qualification training level 4 in care, and has also gained the Registered Manager’s Award. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 26 We found that the roster confirmed that the manager is generally on duty for at least 37 hours each week; and people said that she was readily available. Comments about the manager throughout the day from staff, residents and visitors indicated that she is approachable and available. Staff said: ‘The managers are approachable.’ We found that all the people spoken to were positive about the way the home was run. Comments included: We get a lot of support and training we get one to one every couple of months or more if things crop up.’ We found that a quality assurance system which includes a questionnaire, meetings and suggestions box provides relatives and others with the opportunity to make suggestions and how the home is run. The notes from senior staff meetings, directors meetings and residents meetings were read through. We found that issues were discussed that would improve the running of the home and the experiences of the residence. This included staff deployment, records that needed to be kept and residents’ outings. We found that people’s money was safeguarded and fully accounted for. We looked at the accounts for seven people and the amounts tallied with the amount held on their behalf. A receipt book is used to record all expenditures and funds passed over to relatives are signed for. In the information she returned the manager confirmed that equipment such as electrical circuits, hoists, emergency lighting and other fire fighting equipment had been maintained or serviced in keeping with the recommendations of the manufacturer or regulating body. This was confirmed through checking the maintenance records and reports kept at the home. We found that staff have received training in health and safety and observation of moving and handling practices in the home appeared safe. Risk assessments are completed and it was observed that staff complied with moving and handling instructions that are detailed in individual care-plans. We looked at the accident records. We found that staff were good at reporting and recording accidents. We noted that there a lot of accidents were happening at night. We asked the manager to look into this matter to see what could be done reduce the number. This is the second occasion on which accidents in the home have been identified as a potential problem area and this needs to be addressed. This issue was discussed with manager. We saw in place risk assessment for all areas of the home and staff were seen using personal protection clothes, such as aprons, while they served meals. Staff have also received specialist infection control training. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 27 We found that the training calendar confirmed that staff continue to receive updated control of substances hazardous to health (Coshh) training and fire safety training. Fire check records indicated that emergency lighting and escape routes were checked regularly. We found that the registered providers now complete the Regulation 26 report. Copies of these were read through and confirmed that the provider recorded their view about the premises, record of events and complaints. The information also confirmed that they were satisfied that issues have been dealt with effectively and professionally. Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 28 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations The registered person should analyse complaints, incidents and accidents so that common themes can be identified and general risk reducing strategy put into place if necessary. The registered person should give a written reason about why a smoking shelter or room will not be provided at Brierfield. This is so people know that they have been listened to with respect to this issue. The registered person should continue with a programme of refurbishment and cleaning that will help to ensure that all areas of the home are hygienic, clean and pleasant to use. 2. OP19 3. OP26 Brierfield Residential Care Home DS0000031867.V375857.R01.S.doc Version 5.2 Page 30 Care Quality Commission North West Region Citygate Gallowgate Newcastle uponTyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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