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Inspection on 15/05/09 for Brackley Cottage Hospital

Also see our care home review for Brackley Cottage Hospital for more information

This inspection was carried out on 15th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

One person told us "Staff wash me but they do it how I want." Another person told us "If you ask for anything they do it. My daughter said that I am spoiled here." Staff told us that, "People get really good care - because we are small we pick up on things straight away." One person told us, "The food is marvelous, could not want for better quality" another told us that the "Food is good, like we used to have at home, sausages or a joint of meat and always fish on a Friday." Staff turnover is low which gives people a good continuity of care. Staff spoken to said that they enjoyed working at the hospital. Staff were observed caring for people in a kind and sensitive manner.

What has improved since the last inspection?

The current Responsible Individual is currently acting as the manager of the hospital and is in the process of applying to become the registered manager. The treatment room is kept locked at all times to ensure the safety of all and prevent any unauthorised access to medication. Staff receive regular, recorded supervision. Staff have attended training on safeguarding adults. A PAT dog now visits the home. (Pets as Therapy dogs are dogs specially selected for their good temperaments that visit hospitals and care homes.) The hospital has appointed a bed coordinator to liaise with all service agencies to facilitate earlier, safe discharge. Some redecoration of the building has been undertaken recently.

What the care home could do better:

The hospital should consider ways of giving people opportunities for leisure activities to suit their individual needs and preferences. One person said that there were "Not many activities to do." Risk assessments for people who hold their own controlled drugs should be reviewed to make sure that they include a system for checking to ensure that people are taking and storing their medication safely. Various improvements needed relate to the environment which does not and cannot meet the National Minimum Standards due to the layout and age of the building.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brackley Cottage Hospital Pebble Lane Brackley Northants NN13 7DA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: Brackley Cottage Hospital Pebble Lane Brackley Northants NN13 7DA 01280702388 01280700329 brackley.hospital@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brackley Hospital Trust care home 14 Number of places (if applicable): Under 65 Over 65 14 old age, not falling within any other category Additional conditions: 0 No-one falling within the category of OP receiving nursing care and not intermediate care may be admitted to the home when there are 5 persons in this category already accommodated within the home. No-one falling within the category of intermediate care may be admitted to the home when there are 9 persons in this category already accommodated within the home. Service users whose anticipated stay exceeds 8 weeks may not be admitted into the intermediate beds. The 14 service users will be in the category of OP The beds located in the multi bed rooms must only be used for service users receiving intermediate care for rehabilitation, and must not be used for any other category, including palliative care. The total number of service users must not exceed 14. Date of last inspection Brief description of the care home Brackley Cottage Hospital is registered as a care home for older persons and provides nursing and intermediate care for up to fourteen people. Care Homes for Older People Page 4 of 26 Brief description of the care home The Hospital is situated in the market town of Brackley and is close to a bus route, a park and all the local amenities. Although there are no parking facilities within the grounds, some parking is available along Pebble Lane where the hospital is situated. The Hospital also provides a 24-hour First Aid Unit that is open to the general public. There is a Registered Nurse on duty at all times. Accommodation is on the ground floor; this comprises of two four bedded rooms, one double room and four single rooms. There are five beds for people requiring long-term, residential care and two four-bedded wards (one male & one female) and a double room for people requiring intermediate care. People receiving intermediate care can remain at at the Hospital for up to eight weeks. There are no en suite facilities but there are two bathrooms with adaptations for assisted bathing. There is a small communal sitting room and a small garden with seating to the rear of the property. Weekly fees ranged from 615 pounds for a shared room to 630 pounds for a single room. There are extra charges for hairdressing and newspapers. NB. Although Brackley Cottage Hospital is registered with the Commission For Social Care Inspection (CSCI), the environment does not and cannot meet the National Minimum Standards due to the layout and age of the building and has more of the atmosphere of a cottage hospital than a care home. As the service is known locally as Brackley Cottage Hospital so the term hospital is used in place of home throughout the report. Care Homes for Older People Page 5 of 26 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: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. It should be noted that this overall rating is effected by the poor rating given to the environment. Details about the individual quality ratings for each outcome area can be found in the body of the report. This was an unannounced key inspection which means that we focused on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. Two inspectors carried out the inspection visit. The lead inspector Catherine Perrins was accompanied by Tina Welford. Care Homes for Older People Page 6 of 26 As part of the preparation for this inspection a period of four hours was spent reviewing the information that CQC has about this service. We looked at all the information that we have received, or asked for, since the last key inspection or annual service review. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. The inspection visit lasted six hours during the morning and afternoon of a weekday. During the inspection four people were case tracked. This involves looking in detail at all aspects of their care and experiences at the hospital,including looking as their individual plans of care and other records, talking to them and talking to their care staff. A sample of staff files were also viewed as part of the inspection. The Manager was present for the inspection. What the care home does well: What has improved since the last inspection? What they could do better: The hospital should consider ways of giving people opportunities for leisure activities to suit their individual needs and preferences. One person said that there were Not many activities to do. Risk assessments for people who hold their own controlled drugs should be reviewed to make sure that they include a system for checking to ensure that people are taking and storing their medication safely. Various improvements needed relate to the environment which does not and cannot meet the National Minimum Standards due to the layout and age of the building. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 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 26 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 26 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. People are given good information about the hospital to help them decide if it is the right move for them. Evidence: Brackley Cottage Hospital has a combined Statement of Purpose and Service User Guide which details the services offered by the hospital. People who were staying at the hospital on a long stay basis told us that they were given good information before they moved in to help them decide whether it was the right move for them. The mananger explained that before moving into the long stay beds people are invited to visit and a full assessment of their needs is undertaken to ensure that they can be confident that the hospital is the right place for them. Care Homes for Older People Page 11 of 26 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 and personal care needs are met and their preferences respected. Evidence: Each person who lives at Brackley Cottage Hospital has an individual plan of care which gives staff the information that they need to care for people in the right way. Individual plans of care for the people who are staying in the long stay beds contained details about peoples preferences. One person told us Staff wash me but they do it how I want. Another person told us If you ask for anything they do it. My daughter said that I am spoilt here. Some people staying at the hospital have some specific healthcare needs such as PEG feeding (a tube inserted through the abdominal wall into the stomach which is used to give food and drink) records show that these needs are clearly documented so that staff have all of the information they need to care for people and meet their health needs. Care Homes for Older People Page 12 of 26 Evidence: Records show that whilst staying at the hospital people are seen by a range of health and social care proffessionals such as general practitioners, the tissue viability nurse, podiatrists and occupational therapists. Staff told us that, People get really good care - because we are small we pick up on things straight away, for example if someone has a cough. Records show that peoples health is monitored through checks such as blood pressure, pulse and weight. There was evidence of people being assessed for any risks of developing pressure sores, risks of falling and any risks relating to their nutrition. Records show that where people were shown to be at risk appropriate action is taken to reduce the risk, such as people being assisted to change position to reduce the risk of developing pressure sores. The administration of medication is generally well managed. Records show that a recent possible medication error was investigated by the home, an investigation report was not available but the registered manager was able to give a verbal account of the investigation and how the hospital had taken steps to make sure that the person who may have received the wrong medication was monitored to ensure that there were no adverse effects to her. Any controlled drugs held by the hospital are checked weekly, however, where people hold their own controlled drugs there is no record of these being checked. Controlled drugs are drugs that are prescribed that some people abuse by taking them when they have not been prescribed for them. The are laws and regulations that specify how controlled drugs should be stored and administered. Care Homes for Older People Page 13 of 26 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. People are generally happy with the lifestyle that they have at Brackley Cottage Hospital. Evidence: People told us that the food at Brackley Cottage Hospital was good. One person said, The food is marvellous, could not want for better quality another told us that the Food is good, like we used to have at home, sausages or a joint of meat and always fish on a Friday. Menus seen did offer choice but the second and third choice appeared to vary very little. One person told us that they would like to have more fresh fruit. Records show that the hospital does not have a structured programme of activities on offer. People told us that there were books available to read if they wanted to. One person told us that, We are quite happy keeping each other company Each room has a television that people can watch. Another person stated that there were Not many activities to do. The manager explained that the hospital is in the process of developing life histories Care Homes for Older People Page 14 of 26 Evidence: for people which may identify their hobbies and interests. The manager told us that a PAT dog now visits the home. (Pets as Therapy dogs are dogs specially selected for their good temperaments that visit hospitals and care homes.) Care Homes for Older People Page 15 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes policies, procedures and practices. Evidence: The hospital has received two complaints since the last inspection. Both are currently being investigated under the hospitals complaints procedure. The complaints policy was seen and contained the information that people need if they wish to raise a concern about the hospital. People spoken to were aware of how to raise concerns if they needed to. Staff were also aware of what they should do if they had any concerns about the hospital. Staff receive traing on the safeguarding of adults to ensure that they are aware of their responsibility to keep people safe. Care Homes for Older People Page 16 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Brackley Cottage Hospital does not and cannot meet the National Minimum Standards due to the age and layout of the building but people are provided with a generally clean and comfortable standard of accommodation. Evidence: Brackley Cottage Hospital was the local cottage hospital. It has five places for people requiring long-term, residential care and two four-bedded rooms (one male & one female) and a double room for people requiring intermediate care. People receiving intermediate care can remain at at the Hospital for up to eight weeks while they receive the necessary care and support to enable them to return to their home. The shared rooms used for intermediate care resemble hospital wards. The rooms used by long-term residents have been personalised. One person had brought in her own duvet cover, others had pictures, ornaments and other personal effects. There are no en suite facilities within the hospital but there are sufficient toilets and bathrooms with assisted bathing facilities. One person told us that one of the toilets was very cramped making it difficult to use. Care Homes for Older People Page 17 of 26 Evidence: There is a small communal lounge which the manager told us is not used very often. It had some pictures on the wall and a vase of flowers in an attempt to make it feel more homely. There is a small garden with seating to the rear of the building which people can use if they wish to. Some redecoration has been undertaken recently. There were no oxegen warning signs, which should be displayed on the walls visible. The manager told us that these had been taken down to decorate and would be put back up again. The home was generally clean but there was an unpleasant odour noticed in one area. The building is old and showing signs of wear and tear. The current accommodation within Brackley Cottage Hospital does not meet the National Minimum Standards. Both the CQC and the Trustees are aware of this and certain restrictions are currently in place, including only admitting one person who needs assistance with hoisting in each shared room. The Trustees explained that a site had been identified for the hospital to relocate to. The new cottage hospital will include a sixty bedded nursing home with twelve beds for people needing intermediate care. They plan to have the new premises in use in two years time. Care Homes for Older People Page 18 of 26 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. People are cared for by a well trained, caring and dedicated staff team. Evidence: Staff recruitment is well managed with staff having all of the necessary prerecruitment checks to make sure that they are suitable to work with older people. The manager and staff told us that staff turnover at the hospital is very low. Several of the staff have worked there for many years. Staff spoken to said that the enjoyed working at the hospital. One person told us, I feel as if I am respected and treated as an equal. Staff tell us that they undergo an induction when they first start working at the hospital. One staff member told us that she worked alongside an experienced staff member for three weeks to make sure that she was aware of all the information she needed to know about her role and responsibilities. Staff attend regular training course such as safeguarding adults, infection control, fire safety and moving and handling. This ensures that people are safe and well cared for. One staff member told us We are always being offered training. If we ask for anything the manager will look into it for us. We requested pressure care training and it has Care Homes for Older People Page 19 of 26 Evidence: been arranged. Staff were observed caring for people in a kind and sensitive manner. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The hospital is managed in the best interests of the people who live and stay there. Evidence: The current Responsible Individual is currently acting as the manager of the hospital and is in the process of applying to become the registered manager. The hospital had recently sent out satisfaction surveys to the people at the hospital. The results of these were viewed and showed that people were happy with the care that they receive. One respondent stated that they were treated with respect At all times. Records of Safety checks, such as fire checks, checks on the water system and portable appliance testing (PAT) were up to date. Servicing and maintence of lifting equipment had also been carried out in line with manufactueres recommendations. Care Homes for Older People Page 21 of 26 Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 23 of 26 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 19 16 The Trutees must provide an 01/09/2011 environment that meets the National Minimum Standards. This requirement will remain outstanding until new premise are found. It is recognised that the Trustees are in the process of addressing this problem. Although Brackley Cottage Hospital is registered with the Commission For Social Care Inspection (CSCI), the environment does not and cannot meet the National Minimum Standards due to the layout and age of the building and has more of the atmosphere of a cottage hospital than a care home. Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 24 of 26 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Risk assessments for people who hold their own controlled drugs should be reviewed to make sure that they include a system for checking to ensure that people are taking and storing their medication safely. The hospital should consider ways of giving people opportunities for leisure activities to suit their individual needs and preferences. 2 12 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!