Care Home: Brown Edge House

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What the care home does well There is a satisfactory pre admission assessment process in place, helping to give the assurance that prospective service users` needs will be appropriately assessed before accommodation to the home is offered. There is a good awareness of peoples likes and dislikes and also of any specific dietary needs. We saw a certificate that had recently been issued by the local environmental health department, awarding the home 3 stars (good). We also received positive comments about the meals being provided at the home. The provider has been actively committed to addressing the issues that were raised at the last inspection visit on the 30/10/09. What has improved since the last inspection? The recently revised Statement of Purpose was observed to contain up to date and detailed information. The previous Inspection report recommended that the document needed to be brought up to date with accurate information. There is an improved atmosphere in the home, with people commenting on how much better it is now. The management of chiropody provision has improved. (see Health and Personal Care) The storage of continence aids is now done in a more dignified and sensitive manner. The previous use of communal toiletries, appears to have been stopped. The medication procedures have improved since the previous inspection. Peoples` medication is only administered during meals, if it prescribed to do so. The refurbishment of the car park was observed to be underway. It is apparent that this will be a major improvement. The previous report mentioned the need for redecoration in some of the bedrooms. We saw at this inspection that some bedrooms have been redecorated to a very good standard. We were informed that the redecoration programme is ongoing. (see environment section) There is now a much improved recruitment process in place at the home. This helps to show that the provider is committed to only employing people who have had the correct checks made. The health and safety inspection certificates were examined and they were all found to be up to date, including a Gas inspection certificate. The previous inspection discovered that an up to date Gas inspection certificate was not in place. One of the directors has recently completed training for Portable Appliance Testing (PAT). This helps to ensure that portable electrical appliances in the home are regularly checked, helping to maintain safety. The last report highlighted that some portable electrical items had not been tested for compliance. What the care home could do better: Service users` files would benefit from being audited. This would help ensure that up to date, relevant and appropriate assessment documentation is better organised. It is recommended that peoples` care plans contain more information regarding individual backgrounds and history. The food menu should be kept up to date, accessible to service users, with suitable alternatives offered. The management team need to be fully aware of the `safeguarding of Adults` process. There is limited understanding of the process for raising safeguarding alerts. There is a need to ensure that management and staff have a full understanding of this important procedure. The fixing of free standing wardrobes to walls is recommended to reduce the possibility of accidents. It is recommended that window restrictors should be used, in order to prevent any accidents occurring. All service users should have access to hot water. Regular checks need to be carried out to ensure that all rooms are receiving hot water. It was recommended that a more suitable, accessible location should be found to display and inform people about the complaints policy, activities, menu, newsletters etc. It is recommended that people have appropriate access to the complaints procedure and to be able to complain anonymously if needed. (see complaints section) It is recommended that complete, clear and auditable records of medicines handling (receipt, administration and disposal) need to be maintained. And, where people selfadminister medication or when medicines are needed whilst people are away from the home. Written assessments must be completed. There is a need to appoint an experienced and suitably qualified manager. This will help give assurance that the home is run and managed effectively. It is recommended that more detailed records of individuals` personal finances and receipts of purchases be maintained. There is a need for a quality assurance monitoring system, which would help ensure that people are given the opportunity to express their views about the care they are receiving. (see management section) The provider to carry out regular `Regulation 26` visits. There was no evidence that these monitoring visits have been carried out. This task is necessary to ascertain the views of service users and staff and to also regularly assess the day to day running of the home. (see management section). The acting manager and the director were informed of the issues that were identified at this inspection. An assurance was given by them that every effort will be made to continue with the improvements that have been achieved since the last inspection visit on the 30/10/09/. Key inspection report Care homes for older people Name: Address: Brown Edge House Nutgrove Road St. Helens Merseyside WA9 5JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Phil McConnell     Date: 1 2 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Brown Edge House Nutgrove Road St. Helens Merseyside WA9 5JR 01514264114 01514264114 brownedgehouse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Clarencare Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 20. 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 admissions to the home are within the following categories: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Brown Edge House is located in the Nutgrove area of St Helens Merseyside. The home is registered with Care Quality Commission to accommodate 20 people. The home is close to local amenities, with public transport networks close by. The home is built on two floors, with a passenger lift being available. The rear garden is very well maintained, with car parking provision at the front of the property. The present fees are £408 per week. Care Homes for Older People Page 4 of 31 Over 65 20 0 3 0 1 0 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Various information was gathered in order to be able to assess the National Minimum Standards for Care Homes for Older People, including: *The previous received Annual Quality Assurance Assessment, this is a document which the registered manager completes every year and it contains information about the service being provided. We use this information, in part to focus on our inspection activity. *The previous inspection report 30/10/09. *An unannounced Key Inspection, was carried out by three inspectors (2 Regulatory and a Pharmacist inspector) on the 12th April 2010 by the Care Quality Commission (CQC). Care Homes for Older People Page 5 of 31 *The acting manager and one of the company directors were present throughout the inspection visit. *There was the opportunity to observe and speak to some of the people who live at Brown Edge House and some discussions also took place with some of the staff team. *Peoples files were examined, with all relevant documentation being in place including, initial assessment documentation and care plans. However it was observed that the general organisation of the files needed a little attention. This was raised with the acting manager and the director. It was suggested to have a complete audit of the files. * A number of the staff files were examined and they also contained all of the necessary documentation needed for inspection purposes including, recruitment information and evidence of relevant training that has been provided. *Throughout the inspection visit there was the opportunity to observe the support and care that was being provided to individuals, which was done in a caring, appropriate and professional manner. *The organisations policies, procedures and the health and safety documentation were examined and they were found to be up to date and satisfactory. *A full tour of Brown Edge House was carried out and generally it was found to be of a good standard, with some improvements having been made since the last inspection visit. (see environment section). Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? The recently revised Statement of Purpose was observed to contain up to date and detailed information. The previous Inspection report recommended that the document needed to be brought up to date with accurate information. There is an improved atmosphere in the home, with people commenting on how much better it is now. The management of chiropody provision has improved. (see Health and Personal Care) The storage of continence aids is now done in a more dignified and sensitive manner. The previous use of communal toiletries, appears to have been stopped. The medication procedures have improved since the previous inspection. Peoples medication is only administered during meals, if it prescribed to do so. The refurbishment of the car park was observed to be underway. It is apparent that this will be a major improvement. The previous report mentioned the need for redecoration in some of the bedrooms. We saw at this inspection that some bedrooms have been redecorated to a very good standard. We were informed that the redecoration programme is ongoing. (see environment section) There is now a much improved recruitment process in place at the home. This helps to show that the provider is committed to only employing people who have had the correct checks made. The health and safety inspection certificates were examined and they were all found to be up to date, including a Gas inspection certificate. The previous inspection discovered that an up to date Gas inspection certificate was not in place. One of the directors has recently completed training for Portable Appliance Testing (PAT). This helps to ensure that portable electrical appliances in the home are regularly checked, helping to maintain safety. The last report highlighted that some portable electrical items had not been tested for compliance. Care Homes for Older People Page 7 of 31 What they could do better: Service users files would benefit from being audited. This would help ensure that up to date, relevant and appropriate assessment documentation is better organised. It is recommended that peoples care plans contain more information regarding individual backgrounds and history. The food menu should be kept up to date, accessible to service users, with suitable alternatives offered. The management team need to be fully aware of the safeguarding of Adults process. There is limited understanding of the process for raising safeguarding alerts. There is a need to ensure that management and staff have a full understanding of this important procedure. The fixing of free standing wardrobes to walls is recommended to reduce the possibility of accidents. It is recommended that window restrictors should be used, in order to prevent any accidents occurring. All service users should have access to hot water. Regular checks need to be carried out to ensure that all rooms are receiving hot water. It was recommended that a more suitable, accessible location should be found to display and inform people about the complaints policy, activities, menu, newsletters etc. It is recommended that people have appropriate access to the complaints procedure and to be able to complain anonymously if needed. (see complaints section) It is recommended that complete, clear and auditable records of medicines handling (receipt, administration and disposal) need to be maintained. And, where people selfadminister medication or when medicines are needed whilst people are away from the home. Written assessments must be completed. There is a need to appoint an experienced and suitably qualified manager. This will help give assurance that the home is run and managed effectively. It is recommended that more detailed records of individuals personal finances and receipts of purchases be maintained. There is a need for a quality assurance monitoring system, which would help ensure that people are given the opportunity to express their views about the care they are receiving. (see management section) The provider to carry out regular Regulation 26 visits. There was no evidence that these monitoring visits have been carried out. This task is necessary to ascertain the views of service users and staff and to also regularly assess the day to day running of the home. (see management section). The acting manager and the director were informed of the issues that were identified at Care Homes for Older People Page 8 of 31 this inspection. An assurance was given by them that every effort will be made to continue with the improvements that have been achieved since the last inspection visit on the 30/10/09/. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a satisfactory pre admission assessment process in place, helping to give the assurance that prospective service users needs will be appropriately assessed before accommodation to the home is offered. Evidence: The homes admission policy and procedures were checked and they were observed to be up to date. Four service users files were examined, including the last person to go and live at Brown Edge House. The files contained evidence of admission assessments, which had been completed by Local Authority social workers. Completed pre admission assessments that had been completed by by Brown Edge House, were also available. The internal assessment was observed to be of a tick box format, which is acceptable, although more detailed information would be beneficial. Care Homes for Older People Page 11 of 31 Evidence: There was evidence to show that recent assessment reviews had been completed by the local Social Service Department. This helps to demonstrate that peoples assessed needs are being reassessed, in order to determine if the individuals needs are still being met or if they have changed. Although all of the files examined contained information and enough guidance to provide a service, it was apparent that some of the files lacked some information, particularly regarding peoples background and history. It is important that peoples history is recorded to enhance the provision of care. It was also apparent that files were a little overcrowded and disorganised. It was suggested to the acting manager, that it would be beneficial to carry out an audit of all documentation, in order to archive the out of date information. This would help ensure that the most recent and necessary information is more readily accessible. Copies of the Statement of Purpose and the Service Users Guide were available in the library, with the information being up to date. This previous requirement has been satisfactorily addressed by the provider. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are satisfactorily provided, helping to give the assurance that peoples wellbeing and care is actively promoted. Evidence: The care plans of four people were examined and they were found to be generally well maintained, detailed,with appropriate individualised information for each person. Although as previously mentioned, more background/history information for individuals is needed. This would be beneficial and help give the carers more insight into peoples past lives. There was a photograph of the person on the file, helping with identification, especially in the event of an emergency. It was also apparent that the care plans had been influenced by the initial admission assessments. Files contained evidence that peoples health care needs are being provided,with records of GP visits, hospital appointments and all other appointments and consultations with health professionals. The previous report highlighted the need for more regular chiropodist visits, either Care Homes for Older People Page 13 of 31 Evidence: from the NHS chiropody service or from a privately funded service. We were informed that generally people are prepared to wait for the NHS chiropodist. It had been recommended that disclaimer forms be drawn up, demonstrating that people are prepared to wait for the NHS chiropodist. There was documented evidence to show that the chiropodist is now attending on a 3 monthly basis. Signed disclaimer forms were observed at the inspection, in the event that the chiropody service is delayed for any reason. These stated that service users are willing to wait for the NHS chiropodist. However, some of the service users do access their own privately funded chiropody service. The feedback received from service users and relatives was positive about individuals health care needs. We looked at the medicines administration. Most medicines were administered by staff who had completed medication training, but people who wished to and were able were supported to manage their own medication. Similarly, consideration was given to peoples medication needs when on short stays away from the home. However, in both cases there was a lack of written assessments and information about how this is supported. The home has arrangements in place for the use of home remedies (non-prescribed medicines) so people can receive treatment for conditions such as minor pain without a prescription. We spoke with staff and found that although staff knew some medicines had special label instructions e.g. before food arrangements were not in place to ensure this always happened. It is important that these instructions are followed to help ensure people get the most benefit from their medicines. Records showing the administration of medication were generally up-to-date but there were some areas that could be improved to ensure the completeness and clarity of these records: Where quantities of medication were brought forward from a previous months delivery the quantity was not recorded and on occasion records of the quantities of medication received into the home were missed. This was particularly evident for prescribed nutritional supplements and meant it was not always possible to account for (track) the safe handling of medicines at the home. On the visit day a different nutritional supplement was in stock from that listed on the medication administration record for one person. Although staff said the supplement had been supplied for that person, this was not supported by accurate record keeping. Most administration records were pre-printed by the pharmacist but where handwritten entries were made these were not always signed and countersigned. This is recommended to help reduce the risk of errors. The management does not currently carry out written medication audits. This is recommended to help ensure that should Care Homes for Older People Page 14 of 31 Evidence: any weaknesses arise, they can be promptly identified and addressed. We found that medicines including controlled drugs were stored securely. This helps to ensure that they are not misused or mishandled. But, the controlled drugs cupboard was not of the standard type. The management needs to confirm that it meets with the requirements of current law. The previous report also stated that continence aids were indiscreetly stored throughout the home. During this visit we observed that all incontinence aids were appropriately and discreetly stored. This helps to demonstrate that with regards to this issue, peoples dignity and respect is promoted. Throughout the visit we observed that service users were being treated with dignity and respect. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improved provision of activities, helps to give assurance that people are satisfactorily stimulated and motivated. Evidence: We spoke to the member of staff who had recently been given the role of activities coordinator in addition to her care worker role. She told us that activities were scheduled for Monday, Wednesday and Friday afternoons, that a hairdresser visits during the week and that they do pamper sessions with the service users on a Saturday morning. She told us that they had recently started to record activities that had taken place. We saw that recent activities included card making, Easter Tea Party, Grand National Sweepstake, flower arranging, watching films, colouring pictures, bingo and a quiz. We were informed that they planned to celebrate St Georges day, with fish and chips. They also plan to visit a local wildflower centre and hold a garden party in the summer. The activities coordinator told us that she was looking for ideas to develop the activities programme and she was very enthusiastic about this. The system for providing activities and for the recording of who has attended, has improved since the previous inspection. This helps to show that people are given the opportunity to be better stimulated and motivated than they were previously. Care Homes for Older People Page 16 of 31 Evidence: Staff told us that people were visited by representatives from local churches to help people maintain their faith, however, staff were not aware of what denomination the churches were. All of the information including, news letters, menus, ID pictures of the staff team and the complaints procedure were all located in the front entrance porch. A place where very few service users would visit, unless they were leaving or entering the building. It was recommended that a more suitable, accessible location should be found to display and inform people about the complaints policy, activities, menu, newsletters etc. Brown Edge House has an open house policy, with the AQAA stating, we do not advertise visiting times, preferring always for visitors to visit when they want. In the feedback received it was clear that visitors are made welcome to the home and during the inspection visit it was evident that there was an happy atmosphere in the home, with people coming and going. During the inspection visit, staff were observed supporting service users in a calm, relaxed atmosphere, with sensitivity. As previously mentioned, the menu for meals was displayed in the front entrance of the home, which was also out of date. The homes cook had the only copy of an up to date menu. We were informed by the cook, that the menu had recently been revised. It is important that the food menu is readily available to service users. This would inform people of what is available and help them to make a choice. It was also observed that the menu failed to offer an alternative. We were informed that although it is not written down, people are able to choose an alternative meal. It was recommended that alternatives should be displayed on the menu, enabling people to make an informed choice. The cook had a good awareness of peoples likes and dislikes and also of any specific dietary need. We saw a certificate that had been recently issued by the local environmental health, awarding the home 3 stars (good). Comments regarding the meals being provided were all positive. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is limted understanding of the process for raising safeguarding alerts. There is a need to ensure that management and staff have a full understanding of this importnt procedure. Evidence: Brown Edge house has a complaints policy in place, giving advice and guidance in how to raise any concern or make a complaint, if there is a need. There have been no complaints since the last inspection. The complaints procedure is situated in the entrance to the home. We suggested to the acting manager that it would be good practice if the complaints procedure was made more accessible throughout the home. The opportunity for people to make anonymous complaints would also be seen to be positive. There was a thorough policy in place to deal with a suspicion or allegation of abuse. Training records were examined and it was evident that staff have received appropriate and satisfactory training in the safeguarding of adults. However, in discussion with the acting manager and with one of the directors of the organisation, it was apparent that there was a limited understanding about the process for referring a safeguarding incident to the local authority safeguarding team. It is essential that the management within the organisation have a full understanding about the safeguarding of vulnerable people, specifically the process for making safeguarding alerts. Care Homes for Older People Page 18 of 31 Evidence: This is needed to help ensure that all of the staff team are aware of the correct procedures to follow, which would help ensure that vulnerable people are protected from harm or abuse. The previous inspection carried out by the Care Quality Commission (CQC) identified an issue, whereby one person working at the home had not had the correct recruitment checks carried out. This issue has been satisfactorily addressed and nobody working at the home is without a criminal record bureau check (CRB) having been carried out. This helps to give added assurance that people are protected. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 issues identified at the last inspection visit have generally been addressed. There is a need to continue with the redecoration programme that has been implemented. Evidence: A full tour of Brown Edge House was completed. The previous report highlighted that the car park was quite uneven in places and it needed some attention, to improve safety. We observed that work on the driveway and car park has commenced. Generally the home was observed to be fresh smelling, clean and comfortable, with fresh flowers placed around the home. The dining room tables were observed to be set with table cloths, flowers and condiments. We saw that the conservatory was being used as the designated smoke room, which continues to limit other people from using the conservatory. It was suggested to contact the environmental health department and seek advice about providing smoking facilities that meet with current legislation. We saw that a number of bedroom doors contained locks that could only be locked from the outside. Service users were unable to lock their doors from the inside. This was discussed with the management and it was suggested that appropriate privacy locks be made available. This would enable people to lock their own rooms, promoting Care Homes for Older People Page 20 of 31 Evidence: privacy. Advice needs to be sought from the Fire Service regarding locks that meet with legislation. The previous report mentioned the need for redecoration in some of the bedrooms. We saw at this inspection that some bedrooms have been redecorated to a very good standard. We were informed that the redecoration programme is ongoing. Peoples bedrooms were seen to be individualised with their own personal items. This helps people feel familiar and comfortable with their surroundings. New bedroom furniture has also been provided in the redecorated rooms. Some of the wardrobes are free standing, which potentially could be a safety hazard. Wardrobes need to fastened to walls to prevent them being accidentally pulled over. We saw that some two bedrooms did not have hot water. It was advised to carry out an audit of the hot water in all of the rooms. All service users should have access to hot water. We observed that some of the windows on the first floor did not have their restrictors in operation. It is necessary to ensure that windows are fitted with opening restrictors to prevent accidents. The homes laundry was seen to be adequate for the needs of the people living at the home and it was accessible to all. We saw large containers of disinfectant and other cleaning materials in the laundry, these products should be stored appropriately. Other cleaning products were observed being stored in the communal bathrooms. These products should be stored under the control of substances hazardous to health (COSHH). Some bedroom doors were wedged open with, door wedges, chairs and zimmer frames. It was recommended to the management to seek advice from the Fire Service regarding appropriate door retainers. The feedback received was generally positive about the cleanliness and comfort of the home. Overall it was evident that the provider is committed to improving the environmental standards within the home. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust recruitment process in place at the home. This helps to show that the provider is committed to only employing people who have had the correct checks made. Evidence: Brown Edge House was observed to be satisfactorily staffed. It was evident that a number of the staff team have worked at the home for some time. This gives an assurance of continuity and familiarity for the people using the service. Six of the staff files were examined including the most recent person to be employed at the home. The files were well organised with a front page checklist, a photograph of the person, supervision notes and job description. All of the necessary recruitment documentation was in place including, application forms, two written references for each person Criminal Record Bureau (CRB) checks (this was a previous shortfall) contracts of employment and records of induction periods. There was available evidence to show that all members of staff have received appropriate, relevant and satisfactory training including the safeguarding of adults training. The training provision is assessed to be good and people using the service are supported and cared for by a satisfactorily trained and skilled staff team. Care Homes for Older People Page 22 of 31 Evidence: Although as previously mentioned, there is a need for the management team to familiarise themselves with the safeguarding alerters process. Overall with the feedback received and in observation, it was apparent that the dedication and commitment of the staff team is of a good standard. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need to appoint an experienced and suitably qualified manager. This will help give assurance that the home is run and managed effectively. Evidence: The previous registered manager for Brown Edge House resigned at the end of March 2010. At the time of this inspection the overall management was being provided by an acting manager and two of the company directors. On the day of the inspection visit the acting manager and one of the directors was available throughout the day. We were informed that the acting manager has one a day a week for management tasks and the other days works hands on. We regard this to be insufficient allocated management time, for a care home of this size. We were informed that the home does not have any structured quality assurance system in place. It is necessary to have an appropriate system in place, that is able to obtain the views of service users and relatives. Care Homes for Older People Page 24 of 31 Evidence: It was apparent that the requirement for the provider to carry out regular visits (Regulation 26) were not being actioned. This task is necessary to ascertain the views of service users and staff and to also regularly assess the day to day running of the home. We saw that the home maintains a Pocket Money File, with each person having a personal expenses allowance sheet/record. The record gave the opportunity to record the date, amount of credit, item purchased with the amount and balance signed for. However the records did not fully show where the money had come from. It was suggested to have more detailed records and to obtain receipts for all transactions. This would help safeguard peoples finances. The health and safety policies and procedures were checked and they were found to be up to date and accurate. The health and safety inspection certificates were also examined and they were found to be up to date including, electric inspection certificate, gas certificate (CORGI) hoists, the passenger lift inspection certificate and the portable appliance testing record (PAT). One of the directors has recently completed training for Portable Appliance Testing. This helps to ensure that portable electrical appliances in the home are regularly checked, helping to maintain safety. Care Homes for Older People Page 25 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. Some of the bedrooms are in need of being redecorated and modernised. 31/03/2010 Care Homes for Older People Page 26 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Complete, clear and 31/05/2010 auditable records of medicines handling (receipt, administration and disposal) need to be maintained. And, Where people selfadminister medication or when medicines are needed whilst people are away from the home. Written assessments must be completed. To support and evidence the safe handling and administration of medication. The registered person ensures there is a simple, clear and accessible complaints procedure. People to have appropriate access to the complaints procedure and to be able to complain anonymously if needed. 30/06/2010 2 16 22 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 18 18 The registered person 30/05/2010 should ensure that all members of staff receive the training appropriate to the work they are to perform. The management team need to be fully aware of the safeguarding of Adults process. 4 31 9 A person shall not manage a 31/07/2010 care home unless he has the qualifications, skills and experience necessary for managing the care home. The home needs to be managed by a suitably qualified and experienced manager. This will help ensure that the day to day organisation and running of the home, meets all of the relevant management standards. 5 33 24 The registered person shall establish and maintain a system for reviewing at appropriate intervals, the quality of care provided at the care home. A quality assurance monitoring system would help ensure that people are given the opportunity to 31/07/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action express their views about the care they are receiving. 6 33 26 Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation. The responsible individual or one of the partners should carryout a monthly monitoring visit. This would include speaking to service users, members of staff, inspect the premises, records, check any complaints and write a report. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/06/2010 1 3 Service users files would benefit from being audited. This would help ensure that up to date, relevant and appropriate assessment documentation is better organised. It is recommended that peoples care plans contain more information regarding individual backgrounds and history. The food menu should be kept up to date, accessible to service users, with suitable alternatives offered. This enables people to have a choice of meals. The redecoration programme to be actively promoted. This would ensure that there is a consistency of good quality decor throughout the home. The fixing of free standing wardrobes to walls is Page 29 of 31 2 3 7 15 4 19 5 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations recommneded to reduce the possibilty of accidents. 6 7 19 26 Window restrictors should be used, in order to prevent any accident ocurring. Advice should be sought from the local infection control nurse, regarding the products needed to promote and manage infection control safely. Advice to be sought from the environmental health department, regarding the present legislation on smoking in care homes. Advice to be sought from the Fire Service regarding approoriate locks that can be used on bedrooms to promote privacy for service users. It is recommended that the management team familiarise themselves, with the Local Authorities Safeguarding of Adults procedures. It is recommended that more detailed records of individuals personal finances and receipts of purchases be maintained. 8 26 9 26 10 30 11 35 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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