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Inspection on 14/07/09 for Brookfield Nursing Home

Also see our care home review for Brookfield Nursing Home for more information

This is the latest available inspection report for this service, carried out on 14th July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Brookfield has a stable care staff team many who have worked in the service for several years. During our visit staff spoken with were keen to provide a good level of support to people living in the service. Staff were observed to be genuinely kind and cared about the work that they did. Health care needs are seen as a priority all people living in the service have access to their own doctors. If people`s health needs change the management team contacts external professionals such as dietician, tissue viability nurses ( a specialist nurse in the prevention of pressure ulcers) and chiropodist for advice and guidance. Some of the people living in Brookfield liked the quality of the food saying "it`s tasty". Staff were viewed as "polite", "caring" and very nice.

What has improved since the last inspection?

Since our last visit the manager and deputy manager have changed. Both the people living in the service and the staff felt that they were very supportive and were actively seeking to improve the quality of the service. The number of specialised beds that help people get in and out of bed independently and assist staff to move people safely have been increased. A record of all complaints raised with the manager is maintained with a description of what actions the service needs to take to rectify any issues and prevent them from happening again.

What the care home could do better:

The service has addressed requirements for the previous report. There are requirements and recommendations made from this visit. The areas that the service still needs to develop are care records. Despite clear efforts to increase the quality of care records and a significant amount of work from the staff team there are still care records that need to be clearer. In particular care plans, which are not specific to the needs of the people that the service supports, staff recruitment and training, activities information and some areas of medication are not sufficient to maintain a consistent service that meets people`s equality and diversity needs. The promotion of quality and the monitoring of the service is not sufficient to highlight the strengths of the service and the areas that need to be developed. Policies and procedures are not all up to date and some are not available. Although surveys are sent the result are not actioned in order to improve the service. The provider visits regularly but does not complete a report that is taken from the views of the people living in the service, staff and visitors. This would also assist in providing the manager with a plan of how to maintain and improve quality. People living in the home did not feel that the activities available meet the needs most wanted different activities and trips out of Brookfield.

Key inspection report Care homes for older people Name: Address: Brookfield Nursing Home Grange Road West Kirby Wirral CH48 4EQ The quality rating for this care home is: Two star good 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: Julie Garrity Date: 1 4 0 7 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the We review the quality of the service against outcomes from the National Minimum Care Homes for Older People Page 2 of 30 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) 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 Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Brookfield Nursing Home Grange Road West Kirby Wirral CH48 4EQ 01516255036 01516252037 enquiries@brookfieldcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brookfield Nursing Home (West Kirby) Limited None Care Home 25 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other Additional conditions: Number of places (if applicable): Under 65 category Over 65 0 25 Twenty Four (24) Older Persons (aged over 65) and one (1) named male person (aged under 65 years) within a total of 25 Date of last inspection: Brief description of the care home: Brookfield is a care home providing support for up to twenty five people with an age related condition. It is registered for people needing nursing support. Accommodation is provided over two floors with all but one room offering single occupancy only. One room is occupied by a married couple. Wheelchair access is provided in the home and a lift to the first floor. The service has a dining/conservatory/lounge available for people who live in the home to use. Brookfield has a no smoking policy and this is explained to all people wishing to move in. There is an enclosed, private garden to the rear of the home and a car park to the front. Brookfield is located in a residential area of West Kirby on the Wirral. Local amenities such as shops, library, cafes, restaurants, churches and pubs can be found nearby. There are also some local beauty spots such a beach and Dee estuary near by. Care Homes for Older People Page 4 of 30 Fees at Brookfield range from 477 pounds to 518 pounds per week depending upon the service required. Information about the home is available in the managers office. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Good Our judgement for each outcome: Choice of home Health and personal care Daily life and social activity Complaints and Protection Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The visit was carried out over a period of one day. We (the commission) arrived at the home at 10:30 and left at 19:30. We spoke with seven people who live in the service, two visitors, six staff and the deputy manager. The manager was not available at the visit. Following the visit we spoke to the manager at length in a phone call and received information from her via e-mail which is included in this report. Further conversations took place with the home owner and information from these discussions is also included. We completed the inspection by a visit to Brookfield, a review took place of many of the records available in the service. These included individuals care records, staff rota, staff files, maintenance records, menus, surveys, medications and information sent to us by Brookfield. The service sent us self audit known as an annual quality assurance assessment (AQAA), which contains information about how the service will increase the Care Homes for Older People Page 6 of 30 quality. This visit included discussions with people who live in the home, visitors, staff and management. We also received information from Social Services and this information is included within this report. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support them to make informed decisions in line with their choices. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 30 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 30 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 30 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 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. All individuals are given the chance to have their medical needs looked at (assessed) before they move in. Evidence: We spoke to people living in the home about the information they received before they moved into the home. None of the six people we spoke with could recall being given any written information. When we looked around the service to see where this information was located we were able to find one copy in the managers office. This information known as a statement of purpose (what services Brookfield will provide) had been updated but had not been made available to people living in the service or their supporters. When we reviewed this information we noticed that this had been updated recently. Several sections were unclear such as an explanation for the circumstances that a person can be admitted to Brookfield, the arrangements for emergency admissions and a clear detail of room sizes and staff skills. We also looked for information known as a service users guide (how these services are to be provided). We were unable to locate a copy of this in formats to meet the needs of people living in home. The AQAA for the service told us,All service users have a contract. We looked for contracts but were unable to see copies of these at the visit. Following our visit and in discussion with the manager she informed us that all new people moving into the service are given a contract. One person we spoke to did not recall being given any Care Homes for Older People Page 11 of 30 information about the service including a contact. All people living in the service need to have information about the services that the Brookfield provides in order to help them decide if the home is for them We looked at five peoples assessments (a review of peoples needs), all had received the opportunity to have their needs reviewed before they moved into Brookfield. This is done in order for the staff to decide if the individuals needs can be met by the service. Assessment documentation seen did include the opportunity to look at peoples social needs and food choices. In all of the assessments looked at these details were very brief and did not cover equality and diversity needs such as did they wish to manage their own medications or take into account changes in practice such as the Mental Capacity Act. The assessments did not clearly detail which people needed nursing support and which did not. We were informed that some people living in the home did not need nursing support. We requested copies of assessments done by external professionals such as social services these were also not available at the visit. Following our visit the manager assured us that they use all social service assessments as part of their own assessment. Staff spoken with told us that they did not see a copy of assessments but were told verbally what peoples needs were. As assessments are used to decide if peoples needs can be meet it good practice that all opinions the individual themselves, families and professional are used to look at the whole of the persons needs not just medical needs. The deputy manager showed us an assessment that she was thinking of putting into place. This was very much based on the individual and not on a task to meet their needs. This document is in-line with best practice guidelines and would support people living in the home to have all their needs fully looked at. 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. This is what people staying in this care home experience: Care Homes for Older People Page 12 of 30 Judgement: 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 who live in the service have their healthcare needs meet. Evidence: The care records for people living in the service were looked at. Where an individuals condition had changed such as losing weight or developing and pressure ulcer, staff in the home made sure that they contacted the appropriate external professional. The advice from these professionals was acted on to maintain the health of people living in the home. We spoke to one of the local doctors who told us that the staff contacted them appropriately and acted on their instructions. We looked at five care plans for people living in the home. The service has in use a system know as core care plans. These are plans that give set instructions to an identified need. The plans are then printed and named for the individual person. This practice means that instructions to staff on how support a persons needs are not individual to that person. This practice does not support individualised or person centered care. As an example each care plan for support with continence for each person with this need was identical and included phrases such as provide correct continence aid. There was no guidance as to which aid to use, in what manner, when or how. As such clear instructions that are individual to peoples needs are not available. Care staff spoken with told us that they do not read the care plans as this is a nursing job and they rely on a daily handover. This is a verbal account of specific actions to be taken for each person each day but does not provide an overview of their personal needs or how to meet them. Surveys sent out by the service also included comments about staff not always understanding peoples needs and as such support was not always correct. We spoke to people living in the home the majority felt that they received appropriate support comments such as lovely staff, very kind, treat me very well and Im happy staying here. None of the care plans we looked at had been signed by the person it was written to support and people living in the home were unaware that a care plan was available. It is important that staff have clear instructions that detail how to meet individual needs in order to provide the correct support. It is also important that the people care plans are about are included in this in order to agree that the support is what they would wish. A review of the medications in the home was undertaken. We found that auditing (checking) on medications was not possible for the majority of the medicines. This was due to the fact that the service did not keep a record of the amount of medications left over from the last month. Of the medications we were able to check including controlled drugs all had been given correctly. We spoke to the manager following this visit who told us that she intended to make sure that medications could be audited in the future. This is done in order to make sure that everyone receives their medications correctly. Care Homes for Older People Page 13 of 30 We looked at the times that staff gave medications and noted that this was done in the correct manner. Staff gave medications that needed to be taken before food in the morning before they had their breakfast. When we looked at the records kept for medications we noticed that instructions to staff were not always available. This included instructions to care staff for items such as creams and food supplements. One person kept and managed their own inhalers, the service did not have a risk assessment in place that showed that the person was able to manage this correctly and no monitoring had occurred in order to determine that the person did not need any support. Another person was having a sedative medication on a per required need basis. There were no instructions available for staff that told them the correct circumstances in which this medication was to be given. We noticed that service was overstocked on several medications. This had been due to the staff no seeing the medication scripts before they went to the chemist to be dispensed and not being fully aware of what the doctor had prescribed. The deputy and manager told us that as a result of this they had recently made arrangements to change the chemist that they got their medications from. They anticipated that this action would support them to manage medications in the service in a better manner. Care Homes for Older People Page 14 of 30 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. This is what people staying in this care home experience: Judgement: People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily living activities are not in place that meet peoples individual, needs, preferences and choices. Evidence: All people moving into the home have their nutritional needs looked at. Those people who are more at risk are monitored to make sure that they do not lose weight. If staff are concerned about their nutrition they take advice from external professionals. People in the home are asked on admission about some of their preferences and choices, social activities are not always looked at. The AQAA for the service told us we have improved the choice of foods. The menus viewed did not list breakfast or supper and there was no record of a choice available. Copies of menus were not made available to people who live in the service. . People spoken with told us that, never know what the food is its always a surprise, no one tells me whats for lunch and if I did not like it I suppose I could have a sandwich. When we observed staff during the day none of the people dining in the lounge were offered an alternative. The menu did not show alternative diets such as gluten free, diabetic or soft diets. Assessments for the home showed that some of the people living in the home had special diets as part of their assessed needs. Staff spoken with told us that breakfast and supper is available. The menus in the service do not show a choice of meals and do not provide people living in the service with the opportunity to make a choice. There are plans to revise the menus to include choices and alternatives but this is not yet in place. Care Homes for Older People Page 15 of 30 The garden provided a pleasant setting for people to sit with their relatives, especially in the warmer months. People living in the home told us that they had not had any trips out comments included dont get out enough and not enough trips out. Surveys that the service had done also showed that people living in thought that more trips out were needed. Staff told us that trips out had not been in place as they did not have a mini bus and had no budget to hire one. We looked at the activities available people living in the service told us, I have no idea what there is to do, I dont want to do join in stuff its not for me, dont want to play bingo and enjoy the quizzes, but I cant see them. Information about activities available was limited and the one notice board that included the programme for the week was in an area that the majority of people living in the home do not access. This was also handwritten and was difficult to read. All the staff spoken with did not think that the activities in place were suitable to peoples needs. Care Homes for Older People Page 16 of 30 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. This is what people staying in this care home experience: Judgement: 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 living in the service believe their concerns will be listened. Evidence: People living in the service told us that they would raise any concerns that they needed to and expected that the staff would resolve these. The service has a complaints a copy is available in the foyer of the service. This is not an area accessed by many of the people who live in the service. Information known as the service users guide should include a copy of the complaints process and given to people who live in the service in formats that meets peoples needs. People living in the service do not always have a copy of this information that would support them and their families to always be aware of how to raise concerns. The manager told us that the service keeps a record of complaints made this includes details of the investigation, timescales, outcomes or any actions taken. At the visit we were unable to view these records and were unable to determine if the service had followed its policy on dealing with complaints. A copy of one complaint was forwarded to us following this visit. This showed that actions were decided on but did not show that these actions were put into place. The record stated a lockable draw to be fitted to the bedside cabinet; there was no evidence provided that showed that this action had been put into place. Staff told us that they were not aware of a formal means to report concerns such as filling out an incident form. Due to this they often resolved small concerns such as missing items from the laundry without reporting these to the manager. Without investigation records of all concerns that shows what actions have been taken the manager will not be kept informed of all concerns raised or how to prevent issues from reoccurring. The policies and procedures for Wirral Safeguarding (who are responsible for coordinating any safeguarding/abuse allegations) were available in Brookfield. On the day of the visit the homes own policy on dealing with safeguarding issues was not available. The manager informed us that it may have been borrowed by a member of Care Homes for Older People Page 17 of 30 staff and not returned. Not all the staff team had up to date training in safeguarding and the prevention of abuse. Records and discussions with staff showed that at least two people had not received any training in this area during their employment in Brookfield. The manager and the deputy manager have attended training regarding safeguarding and are intending to review their policies and procedures and provide training to all staff working in the service. Care Homes for Older People Page 18 of 30 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. This is what people staying in this care home experience: Judgement: 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 maintenance of the service is not sufficient to meet the safety of people living in the service or offer them an environment that fully meets their individual needs. Evidence: We looked at the environment and noted that several areas were in need or repair or refurbishment. This included ill fitting carpets, worn and flaking window frames at the rear of the building, worn and damaged furniture in bedrooms, conservatory and lounge areas. The main corridor through the service had flooring that was not in keeping with flooring that a person would have in their own home. This corridor was also cluttered with a tea trolley and at one point a trolley full of cleaning materials. There is a partition in the corridor area that sections the dish washing area from the corridor. This partition has lights that are uncovered and can be reached by people living in the home presenting a risk of burns. The manager told us that redecoration had been discussed with the staff and the owner of the building but as yet there are no written action plans in place to improve these areas that were made available at the visit. None were forward to us after our visit. We also noticed that several fire doors did not close properly and handrails were missing in some of the corridors we were informed following this visit that both these had been fixed. The kitchen had tiles missing in some areas, a kitchen door that opened against the cooker and incorrect bins, none had lids presented an infection risk. All food and storage temperatures were regularly recorded in order to make sure that food was stored and served at the correct temperature. There is a conservatory and lounge area that are also used as a dining area. The home has twenty five people living in it but does not have the space to support people to eat at a dining table should they wish to. We noticed that there was one dining table in place that was not used at mealtimes, people sat in lounge chairs with separate tables to eat their meals. We spoke to three people who wished to eat at a dining table but Care Homes for Older People Page 19 of 30 thought that this would add work to the staff. Staff helped people to eat at mealtimes but were limited in the space that they had to do this staff had to crouch next to the person eating and this looked very uncomfortable for the staff member. During the visit we were unable to find policies available that detail the prevention of infection. There are no records available that all staff have received training in the prevention of infection. Staff spoken with said that they did not recall this training. Disposable protective clothing such as gloves and plastic aprons were noted as available during the visit, except in the laundry, staff were seen to use these as appropriate. A review of the laundry did not show any arrangements for dealing with soiled items such as special laundry bags. Additional there were boxes of stockings, net pants (used with continence aids), socks and flannels none of these were named or a system in place that meant individuals were not wearing intimate items or using face clothes that had been used by another person. This practice does not reduce the risk of infection spreading from one person to another. We looked at individuals bedrooms, in most cases these were personalised and included items from individual own homes. Individuals spoken with said that they, would like my room to be redecorated dont know when that will happen and I like my room, I have all my pictures and bits and bobs in here. Several people said that they would really like their bedrooms redecorated. Some of the bedrooms had furniture that was worn and damaged and in one case flooring that was not in keeping with the kind of flooring that a person would have in their own home. We looked at the general maintenance records of the service all were up to date such as gas, electrics and lift maintenance. Other areas such as fire alarms and bedrails had been regularly checked. We noticed that the testing of portable appliances such as televisions had not been done for over a year and good practice as described by Health and Safety Executive is that these needs to be done yearly as a minimum or as items (not under guarantee) arrive in the service Care Homes for Older People Page 20 of 30 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. This is what people staying in this care home experience: Judgement: 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. Staff do not receive a recruitment that determines that they are suitable Training is not in place for staff to maintain their skills and to help them meet peoples needs Evidence: People living in the service are satisfied with the support they receive to meet their needs. There are times when they may need to wait a short time for staff support and attention. All people spoken with said that they did not want to add extra work to the staff. Staff told us that staffing levels have been reduced recently. The manager said that staffing levels had been reviewed and reduced in line with peoples individual needs. We looked at the staff files. The office next door to the care home that manages the domiciliary care agency keeps copies of all staff files. We looked at both sets of files and noticed that these files were different and did not contain the same information about staff. We looked at five staff files and noticed that these files did not show that these five staff had been correctly recruited. None of the five files had all the necessary checks and training evidence such as two references, induction records or evidence of recent training. At our visit files for nursing staff had no evidence of nursing qualification or that the staff had been checked that they were registered with the nursing and midwifery council (NMC). Good practice indicates that this is done monthly and at renewal. All nurses must be checked that they remain registered with the NMC to be employed as a nurse. The manager told us following this visit that all nursing staff were checked that they were registered with the NMC. She forwarded information showing checks had been completed in April 2009. It is advised that these checks are reviewed as one persons PIN expired prior to our visit and two others contained warning information such as date of birth did not match the PIN number. A sample of training records both in staff records and the training file kept by the Care Homes for Older People Page 21 of 30 manager were looked at, there was no evidence that all staff, who needed as part of their job role had up to date training in fire safety, health and safety, food hygiene, moving and handling or safeguarding of adults. Some staff had not received training in some of these areas during their employment. Staff spoken with did recall some training but were not sure what it was or if their training was still up to date. There was no records that staff had received an induction into the Brookfield that covered peoples individual needs, health and safety or policies and procedures. Staff are given a handbook that covers some of the services policies in order to support them in their role. Care Homes for Older People Page 22 of 30 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. This is what people staying in this care home experience: Judgement: 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. There is a management team that are relatively recent into post. They have a number of good practice ideas to increase the quality of the service. Evidence: There have been three different managers in post in the last 18 months. The acting manager had been in post since Christmas. The Manager is not registered as yet with us but told us that an application will be submit shortly. A previous application had to be returned as the medical reference needed to be updated. Staff and people who live in the service were supportive and confident that the manager is having a positive impact on the service. Comments included, her door is always open and I like the manager. There are a number of tools available in the home that look at the quality of the service. These include surveys to people living in the service and their families. When we reviewed this we noted that feedback for activities was not positive. The service had no written plans in place as to how they would address these concerns. The manager does audit (checks on quality) some areas such as accidents and care plans. There was written audits in place for medications, staff files, staff training and the environment. Part of checks on quality is a minimum of a monthly unannounced visit from the registered provider, in which they discuss the service with the people who live in the service, checks on environments, talk to staff review complaints and provide the manager with a written report on their findings. At the visit we were unable to locate these visits. Following the visit the manager sent us minutes of meetings from visits by the providers representatives these did not review the necessary areas as described above. The Care Homes for Older People Page 23 of 30 AQAA from the service was fully completed but gave no firm plans of what the service intended to do to improve quality. We looked at the arrangements for health and safety in the home including risk assessments. At the visit we could not locate nor where we shown when we asked for them up to date environmental risk assessments such as a fire risk assessment. A fire risk assessment was available but this had no date and as such was not possible to determine when it was last reviewed. We noted that records for staff training in fire showed that all staff were out of date for fires safety training. The management team informed us that they plan to give all staff training in the near future, but there is no firm date as to when this will be completed. Individual risk assessments for people who live in the service have been done. These are regularly reviewed. We noticed that not all people had risk assessments in place for some areas such as managing their own medications. When we looked at available moving and handling risk assessments we noted that these did not detail what equipment was needed such as hoists or the amount of staff needed to move people safely. Risks had been identified but management plans had not been included that showed how the risks were to be minimised. Staff meetings were not happening regularly and there were no minutes available for us to look at when we asked to view them. Records reviewed showed that staff were not receiving 3 monthly supervision or checks on their competency to undertake their job roles. The manager told us that she was aware that supervision had not been done regularly she plans to give everyone an appraisal and undertake supervision at regular intervals in the future. Policies and procedures that would advise and guide staff were not always available or up to date. The management of peoples personal finances was unclear. The office staff for the domiciliary care agency maintains these accounts. The manager told us that she thought that the service did not manage personal allowances for people but did hold money deposited with them by families. There was no evidence forwarded to us to confirm this from the manager. Letter correspondence from the provider stated that service did not hold any funds for anyone, but a float was in place if people needed to access some funds. Care Homes for Older People Page 24 of 30 Are there any outstanding requirements from the last inspection? Yes 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 Care Homes for Older People Page 25 of 30 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 1 5 The service needs to 31/08/2009 produce a written guide to the care home (service users guide) which shall include, a summary of the statement of purpose, the terms and conditions in respect of accommodation to be provided for people living in the home, including as the amount and method of payment of fees, a standard form of contract for the provision of services and facilities. A copy needs to sent to us and each person living in the service or wishing to live in the service. All people wishing to move into the home need to have information about the service in a format that meets their needs. Staff need to have the information such as policies and training that they need to recognise and appropriately deal with safeguarding and complaints. 2 16 13 28/08/2009 Care Homes for Older People Page 26 of 30 3 19 23 These needs to be done in order for all complaints, concerns and allegations to be dealt with in a manner that maintains the safety of people living in the service. The service needs to review 25/09/2009 the environment. The premises need to be of sound construction and kept in a good state of repair externally and internally. All parts of the care home need to be reasonably decorated. There needs to be adequate sitting, recreational and dining space provided separately from peoples private accommodation. The communal space provided for people needs to be suitable for the provision of social, cultural and religious activities appropriate to the needs and choices of people living in the service. A plan of how the service will improve and maintain the suitability of the environment needs to be in place. People who live in the service need to have a welcoming, well maintained environment that supports their needs. The service should not 21/08/2009 employ a person to work at the care home unless the person is fit to work at the care home. Relevant checks such as references that have been authenticity need to be done and records maintained. A robust policy and procedure needs to be put into place and followed for all staff. Staff need to be recruited 4 31 19 Care Homes for Older People Page 27 of 30 5 31 18 and checked correctly in order to make sure that they are fit to undertake the job role. The service needs to make 21/08/2009 sure that any persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. Training needs to be relevant to their work role, meet other legislation such as health and safety legislation and kept up to date. Staff need training that supports them to meet the needs of people and maintain their safety. The responsible individual or 21/08/2009 one of the providers needs to visit the service unannounced at least once a month. As part of the visit they need to interview, with their consent and in private people living in the service, their representatives and persons working at the care in order to form an opinion of the standard of care provided. Additionally a review of the premises, its record of events and records of any complaints needs to take place. A report needs to be prepared on the conduct of the service with a copy supplied to the manager and made available for review This needs to be done to assist in reviewing the quality of the service and support the manager to take appropriate action as needed. 6 31 26 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The service needs to review its care plans and make sure that they are individual to the person that they are written for. The person that the care plan is for needs to be involved in this and agree to the care that they are to receive. Staff in the home need to access care plans for instructions and not rely on verbal communication which runs the risk of being incorrect. Audits for medications need to be in place in order to make sure that medications are given out properly and staff are competent handling medications. Menus and activities need to be developed that are taken from the expressed views preferences of people who live in the service. Information needs to be available about the choices available in form that meets individual assessed need. Staff need to be guided into reporting all concerns to the management team in order that they can be monitored. Any actions decided on need to be recorded when they are completed. The service needs to contact environmental health for their advice regarding the maintenance of the kitchen, temperature of the kitchen during summer months, damaged tiling and disposal of waste. Staff training with regards to infection control and supporting policies and procedures that provide staff with correct guidance needs to be available. Correct equipment and practices that reduce the risks of infection and maintain peoples dignity need to be developed. A training plan needs to be in place that identifies the training needs of staff and plans how to meet those needs. Staff training should not be allowed to go out of date as this places both staff and the people they support at risk. Put into place the opportunity to audit the quality of the service including care plans, staff training, staff recruitment, medications and environment as examples. Review the arrangements for managing peoples personal funds and put in place arrangements to support people to access their funds as they wish. 2 9 3 12 4 16 5 26 6 26 7 31 8 33 9 35 Care Homes for Older People Page 29 of 30 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. 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