Inspection on 14/07/05 for Brackley Fields Country House

This inspection was carried out on 14th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brackley Fields Country House 05/03/07

Brackley Fields Country House 11/04/06

Brackley Fields Country House 06/10/05

Brackley Fields Country House 07/10/04

Brackley Fields Country House 26/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brackley Fields Country House Halse Road Brackley Northants NN13 6EA Lead Inspector Sheila Smith Unannounced Thursday, 14 July 2005 at 10:00 am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brackley Fields Country House Address Halse Road Brackley Northants NN13 6EA 01280 704575 01280 704614 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lt Col John Richard McLennon Rayner Lt Col John Richard McLennon Rayner CRH 24 Category(ies) of DE(E) x 5 Dementia over the age of 65 years registration, with number OP x 24 Old Age of places Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: To include one Service User over 50 years of age with Alcohol Dependence Date of last inspection 7th October 2005 Brief Description of the Service: Brackley Fields Country House is situated in a rural location on the edge of Brackley town. It stands in it’s own grounds set back from the road, with private car parking. Resident’s accommodation is in single or double rooms, either in the original house or in a single storey extension. There are currently three lounges, two conservatories, a library and a dining room. A pleasant and well-kept garden is also available The Home offers twenty-four hour personal care for up to 24 frail older people including 5 residents with a diagnosis of dementia. The home is owned and managed by Lt Col John Richard McLennan Rayner. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents, and upon their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 3 residents and tracking the care they receive through discussions with them, and with the care staff, review of their records, and observations of care practices. The inspection took place during a day, over a period of 5 hours and was carried out on an unannounced basis. On the day of the inspection nine of the residents had left the building for a days boat trip, escorted by members of staff. Communal areas, and some bedrooms were visited. A selection of care records, and essential records of the home were reviewed. A number of the residents were spoken to as part of the inspection process. The Registered Manager Mr J Rayner was present for most of the inspection. During the inspection visitors to the home and a district nurse were spoken to and their comments have been incorporated into the report. The Commission had also received one comment card from a relative prior to the inspection. In the main the comments about the home were positive and praised the staff for the way in which the care is provided. What the service does well: The home offers a friendly warm environment in which residents and staff are very friendly and welcoming. One resident said ‘ I am very happy living here’, and a relative expressed her satisfaction with the care that her relative received. Residents are encouraged to be as independent as possible and to maintain links with relatives and friends in the community. A visitor said that she was welcomed to the home, and found the atmosphere to be calm and relaxed. An activity organiser is employed for 10 hours per week and was able to give evidence of appropriate activities that she provided for the residents. A craft instructor also visited the home twice a month to assist the residents with craft activities, and examples of the activity were displayed around the home. A district nurse visiting during the inspection reported that she and her colleagues were satisfied with the standard of healthcare, and had always found the staff to be kind and helpful, and found that residents health needs were well monitored. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 The assessment process, prior to admission is inadequate, so that residents and their families may not be confident that the home will meet their individual needs. EVIDENCE: A contract is in place for each resident. This agreement needs minor adjustment but otherwise clearly sets out the terms and conditions of occupancy, and had been signed by the resident or their representative. There was no evidence in the three case files seen during the inspection that a pre- admission assessment had been carried out. The home is registered to provide care for up to five older people with dementia but there is only a limited number of staff who have received dementia care training. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 The current practice in the home does not ensure that the residents health, personal and social care needs are fully met. EVIDENCE: Limited progress has been made on improving care plans. Of the three files examined during the inspection the care plans were not specific, had not been summarised and did not instruct the staff as to the care needs of the individuals, nor give detailed information about how individual needs could be met. (This was the subject of a requirement made at the last inspection and has still not been met) There was no assessment of the emotional needs of a resident suffering from dementia, or clear instructions for staff to deal with challenging behaviour thus meaning that staff may respond to situations inappropriately. Risk assessments were incomplete and did not outline what actions staff should take to minimise the risks identified, and the management actions to monitor the risks. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 10 Moving and handling records of a recently admitted resident were found to be incomplete. The Registered Manager said that the chiropodist and optician visited the home on a regular basis but kept their own attendance records; advice was given to retain them in the individual residents files. A district nurse visiting the home on the day of the inspection said that she and her colleagues were very happy with the care provided in the home, residents were appropriately referred to them, and health needs were well monitored. There was evidence that fluid balance charts and food monitoring charts in place. The day of the inspection was a very warm day, and although residents said that they had had enough to drink, it is recommended that a procedure be put into place to ensure that residents are offered drinks on a regular basis. There is some improvement in the medication system, and an audit of one of the resident’s medication was found to be correct, however there are still some gaps of signatures or codes on the medication and administration records. A medication profile was found to be out of date. Staff administering medication have not received formal medication training Observations of practice made in the course of the Inspection showed that good practice and positive relationships have been built up between staff and service users, and there was a relaxed and friendly atmosphere. There was no evidence of any shortfalls in this area. The home has policies and procedures in place dealing with death and dying, and discussion with staff indicated an understanding of the importance of maintaining dignity and of keeping relatives informed. A relative confirmed that she was kept well informed by staff, whenever her relative was ill. There is no consistent record of individual wishes and needs in this respect, on individual service user records, which could compromise the Home’s ability to achieve the policy and procedure Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Social activities and meals are both well managed, creative and provide daily variation and interest for most people living in the home. EVIDENCE: A resident interviewed said that that he was happy with the routine at the home and felt able to follow his own interests. Nine of the Residents had chosen to go on a boat trip for the day, and had taken a picnic lunch, whilst others were observed to be making choices about how they filled their day; some were reading others were watching television. The activity co-ordinator was observed arranging to play a game with some of the residents. As stated in the first section of this report the interests of all residents are not always recorded through the information gathering process at the time of admission, and as a consequence staff may only have limited information on which to base any planning of activities. No particular consideration is given to people with dementia in this aspect of care. The residents spoken with on the inspection said that they were happy with the visiting arrangements. Visitors were in the home on the day of inspection and all were very happy about the standards at the home, and one spoke of the Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 12 caring nature of the staff, the welcome she always received when she visited the home, and the high standard of the food. Another visitor spoke of her friends deeply religious faith and felt that the home met her needs by inviting a local priest into the home for a communion service, on a regular basis. The kitchen area was viewed during the inspection, and meals were discussed with the cook. The kitchen appeared clean and tidy, and well organised. Cleaning schedules were in place, and policies for the prevention of cross infection. Residents and visitors commented that the food was good and that a choice of food is offered. Advice was given to record when a resident chose different food to that on the menu. One resident described the food as ‘ plain and plentiful’ which was obviously what she liked. On the day of the inspection the residents had a choice for their evening meal of a hot meal, sandwiches or soup. The cook said that there were three residents presently suffering from diabetes and said that she had received training, in the kind of meals to prepare from a district nurse. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaint process within this home is adequate and sufficient to protect residents. EVIDENCE: A complaints procedure is available, and visitors said that they would complain to the staff if necessary. The Registered Manager said that there has been one formal complaint during the last 12 months, although this could not be checked, as the records were not available during the inspection. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The standard of the décor within the home is reasonably good, and the standard of hygiene was high, so that the residents have a homely place in which to live. EVIDENCE: The Home is situated in a rural location, set within pleasant grounds and gardens. Accommodation is in single or double rooms either in the original house or in a single storey extension. The communal areas of the home seen, were maintained and furnished to an acceptable standard in a homely manner. Since the last inspection the home has continued with a redecoration and refurbishment programme and four bedrooms have been redecorated. Personal possessions were seen in the bedrooms observed during the inspection. There is a stair lift to rooms situated on the second floor. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 15 On the day of the inspection general hygiene and domestic maintenance was good, and a District Nurse reported that the home maintained a good standard of hygiene at all times. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. Staff morale was high, resulting in a workforce that works with the residents to improve their quality of life. EVIDENCE: The number of staff on duty on the morning of the inspection was two care staff, two cleaners, and two kitchen staff, caring for eleven residents who had not gone out on the boat trip. The normal ratio of staff is three carers, during the morning including the Deputy Manager during the week, and two carers during the evening supported by a kitchen assistant. Two waking night staff are employed overnight. Visitors and a District Nurse confirmed that there always appeared to be enough staff on duty. Staff interviewed said that there was enough staff, but that if needed additional staff would be employed. From a sample check of staff files and discussion with the Registered Manager there was evidence that the recruitment procedure is followed, although all files did not contain all of the information required by schedule 2 of the regulations. Staff confirmed that new staff received a three-day induction, then after 6 months foundation were encouraged to undertake National Vocational training. One of the staff on duty during the inspection said that she was a National Vocational Assessor for the staff and was given one day a week to complete her assessments. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 17 Staff confirmed that they received statutory training such as Health and Safety, Manual Handling, Fire prevention, Health and Hygiene, and First Aid on a regular basis. Only two staff has received dementia care training Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Poor care plan records could compromise the Health and Safety of residents EVIDENCE: Staff confirmed that equipment is replaced or repaired, and observations made during the inspection confirmed that the residents live in a safe environment. Records observed included the accident book, and the fire log- book, which were found to be satisfactory. Staff confirmed that they had received fire training but did not appear to be aware of how to handle fire extinguishers. The registered Manager agreed to ensure that training be given in the use of fire equipment. The issue of the lack of resident’s individual records was discussed with the Registered Manager who agreed that more time must be given to ensuring appropriate risk assessments and manual handling plans were in place. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 19 Policies and procedures relating to safe practices were available for all staff. Staff confirmed that there was an adequate supply of disposable gloves and aprons available for staff who need to assist with personal care. Manual handling plans were incomplete, so that staff did not have clear instructions of how to assist residents to move, which could result in staff assisting residents inconsistently, which may cause injury to the service users or to themselves. Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 12 Regulation 16(2)n Requirement The Registered Person is required to ensure that activities are provided to meet the needs of the different service user groups within the home. In particular, those service users with a diagnosis of dementia( Previous timescale of 1/06/04 not met) The Registered Person must ensure that the information required by Schedule 2 of the Regulations is available on each staff file( Previous timescale of 1/06/04 not met) Evidence must be available that all service users have been assessed prior to admission in order to ascertain that their needs may be met in the home. There must be evidence of service user or their advocate having input into this assessment. ( Previous timescale of i/11/04 not met) Service user plans must be formulated for all identified needs, which give specific guidance on how these needs should be addressed. These plans must be made in Timescale for action 30/09/05 2. 29 19 30/09/05 3. 3 14 31/08/05 4. 7 15 30/09/05 Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 22 5. 7 13 6. 9 13 7. 8. 19 27 13 18 conjunction with the service user or their advocate and evidence of this input demonstrated(Previous timescale of 7/11/04 not met) Up to date moving and handling assessments must be available for all service users( previous timescale of 7/11/04 not met) The medication administration and records sheets must be signed or the appropriate code inserted if the medication is not administered. The carpet in the lounge must be straightened out . Specialist training must be arranged to ensure that staff are adequately trained to meet the Residents needs, specifically in the areas of dealing with dementia care. Comprehensive risk assessments must be undertaken fo all sesidents. 30/09/05 31/07/05 31/07/05 30/09/05 9. 10. 38 13 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 11 9 9 Good Practice Recommendations A procedure should be available for staff detailing additional care required for the residents during periods of excessive heat. Records should be maintained of residents wishes in relation to deterioration of health Residents medical profiles should be accurate and reflect the current prescribed medication. Formal medication training should be arranged for staff administering medication. C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 23 Brackley Fields Country House Commission for Social Care Inspection 1st Floor, Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brackley Fields Country House C51 C08 S12716 Brackley Fields Country House V232692 140705 Stage 4.doc Version 1.40 Page 24 - 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. 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