Inspection on 21/11/05 for Brewster House

This inspection was carried out on 21st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brewster House 05/11/08

Brewster House 17/01/07

Brewster House 27/02/06

Brewster House 04/03/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brewster House Oak Road Heybridge Maldon Essex CM9 7AX Lead Inspector Kay Mehrtens Unannounced Inspection 21st November 2005 11.45 X10015.doc Version 1.40 Page 1 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 Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 2 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. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brewster House Address Oak Road Heybridge Maldon Essex CM9 7AX 01621 853960 01621 857847 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Runwood Homes Plc Ms Allison Squires Care Home 62 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (62) of places Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 62 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 25 persons) The total number of service users accommodated in the home must not exceed 62 persons The registered person must not admit persons subject to the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 4th March 2005 Date of last inspection Brief Description of the Service: Brewster House is a large purpose built unit in the village of Heybridge near the town of Maldon in the county of Essex. The home accommodates 62 service users who are over the age of 65 years. All of the accommodation provided is on a single room basis spread over two floors. A large majority of the rooms have en-suite facilities. There are no double rooms. Outside of the home there is a central courtyard and gardens. There is a car park to the front of the property with ample spaces. The home is situated near to shops and is on a public transport route to Maldon, Witham and Colchester. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 21st November 2005, lasting 5.5 hours. The inspection process included: discussions with the manager six staff, ten residents and seven relatives. The premises were inspected. Samples of records and residents care plans were inspected. The outcome of a POVA investigation undertaken by the commission is included the report. The inspection covered fifteen key standards. The home was clean and well maintained. The staff were caring and had a positive approach to the training opportunities provided. The manager approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. What the service does well: What has improved since the last inspection? Care plans and assessments have improved since the last inspection. There was good evidence of residents’ involvement in their care plans and reviews. The manager has improved the admission process. Residents are given a welcome pack and allocated a member of staff on admission to help them settle in. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 6 The manager had worked hard to increase the training opportunities for staff as well as NVQ level 2 achievements. The quality audit undertaken by the provider, was used effectively by the manager to listen to residents comments and set an action plan to address some of the shortfalls highlighted as part of the audit. 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. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 the following standard(s): 3 The arrangements for pre-admission assessments are good so staff are aware of residents’ needs prior to their placement. EVIDENCE: The manager and senior staff undertake assessments as part of the admission process. The format used covers all aspects of residents’ needs and those sampled were detailed. Accompanying risk assessments were completed on areas of care need such as dementia and pressure care. Information about prospective residents was sought from them, their family and placing agencies. Residents and families liked completing the personal history form, which was a useful tool for staff to get to know residents, once admitted. The manager has produced a comprehensive assessment checklist that ensures that staff gather all the correct information and follow procedures when admitting residents to the home. New residents are allocated a member of staff on admission and introduced to other residents over a cup of tea. This was much appreciated by residents and their families. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 Care plans provided enough information to assist staff in meeting the needs of residents. The administration of medication was satisfactory. EVIDENCE: The assessment information gathered prior to admission and on admission was used effectively by staff, with the resident, to form a care plan that addressed identified needs. Care plans sampled were detailed and action plans for staff to help residents with their personal, health and social needs, were practical and informative. The home uses a key worker system and they work with team leaders to ensure that care plans reflect resident need and are regularly reviewed. Residents are involved in this process and there was good evidence of them input on the written plans. Some residents and their families were able to recall their input into the personal history and some parts of their care planning. The inspector was impressed by the caring and helpful instructions and actions, written by a member of staff, to enable everyone working with a resident with dementia to be helped in a positive way with their poor memory recall. The comments were informative and respectful. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 10 The inspector was pleased to see that the care plans for respite residents were as thoroughly written and actioned as those of permanent residents. Staff had worked well to ensure that the care plan for one respite resident contained all their personal wishes, pertinent risk assessments and health needs in sufficient detail to enable staff to work with the resident appropriately during their short stay. Monitoring forms and checks were put into place, as required, that enabled staff to assess and inform visiting health professionals. However, there were some examples of insufficient details on daily recording records. These records need to reflect the input by staff into meeting the identified needs on residents’ care plans, as well as reflect the responses of the residents to staff input and care provided. The home uses a monitored dosage system of medication administration and staff have received training. The staff were observed to give residents their medication in a very respectful and caring manner. The storage of medication was well managed. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 the following standard(s): 12, 13 and 15 Activities for residents with dementia are limited. Mealtimes are relaxed and pleasant occasions. The home is very welcoming of visitors and privacy is respected. EVIDENCE: The home currently only has one activity worker for 20 hours a week. The manager did inform the inspector that there was an additional 15 hours available, though the post was not filled. The staff were observed to spend time sitting and chatting with residents who clearly enjoyed their company. They were very good at informing the residents what was happening and offered choice and comments in a very respectful manner. However, the home does accommodate residents with dementia and whilst staff have received training in dementia care there was little evidence of meaningful activity and interaction with these residents that reflected their needs and difficulties. The residents told the inspector that they enjoyed different activities and were being visited, on the day of the inspection, by a “ pat-a-dog” and its owner. Several residents were occupied with craft and reading, as well as watching television programmes. Staff were encouraging residents to join in conversations and sit in lounges. Other staff had spent time doing manicures Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 12 and hand massages with some residents, as requested. The residents had used meetings and the quality audit to tell the manager that they would like more trips out. The manager recognised the need to address this issue and plan with the activity worker and staff to provide more outings. Monies for activities and outings are paid for through fund-raising by the staff and families, as the owners provide no budget. The inspector had the opportunity to meet several visitors during the inspection. As well as speaking highly of the manager and staff they also stated that they are always made welcome and their privacy respected. Residents also told the inceptor that they could have visitors whenever they like and were pleased that they are invited to special events in the home. The meal on the day of the inspection looked very appetising. There was a good choice and plenty provided. The residents told the inspector that they enjoyed the food, especially as it is home cooked. The staff were observed to sit and chat with the residents. They were gentle with those residents that needed assistance with feeding and used this time to sit and chat with them and make their mealtime a sociable occasion. The mealtime was a pleasant and social time, clearly enjoyed by all. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 The home has a clear complaints procedure that is actioned in a positive manner by the manager. The same approach is taken with regard to residents’ rights and protection. EVIDENCE: The home has a complaints procedure that is made available to staff, residents and their families. Concerns raised by families were well documented and addressed to the satisfaction of the residents and their families. The residents told the inspector that they felt able to talk to the staff and manager if they had any worries though they also said that they had “no grumbles and were very happy”. The “unit training records” evidence that some staff have received training with regard to Protection of Vulnerable Adults (POVA). The manager does need to ensure that all staff receive training on this standard and have a good awareness and understanding of polices and procedures for the home and Essex Social Services with regard to POVA. A POVA referral was made during the last year and was investigated by the commission. The manager cooperated well with the inspector and provided good information and evidence for the investigation. The investigation highlighted the need for refresher training on manual handling, for some care staff, and improved recording with regard to night checks. The manager was proactive and instigated staff training and addressed the shortfalls before the commission sent a formal action plan. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 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 the following standard(s): 19 Residents are provided with a safe, well maintained and pleasant home. EVIDENCE: The home is well maintained and decorated. Many areas of the home had been upgraded since the addition of new bedrooms and the conservatory. The home is bright, clean and welcoming. The residents and families spoken to at the inspection were very complimentary about their bedrooms and the overall feel of the home. There was one bedroom that had an odour problem. The manager was aware of this and domestic staff cleaned the carpet on a daily basis. However, it is the opinion of the inspector that the flooring in this room needs to be changed so that the residents’ dignity is upheld. The large conservatory is beautifully decorated and fitted with lovely blinds and flooring. It is space much used and appreciated by residents. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Staffing levels are sufficient to meet the needs of the residents though there is a high use of agency staff. Staff have a positive attitude towards the care of residents and the training provided. EVIDENCE: The manager informed the inspector that the home had 20 residents with dementia accommodated at the time of inspection. The home is registered to accommodate 25 and the number accommodated had increased since the last inspection. The staff rota showed that there were two seniors and eight care staff on duty during the morning, reducing to one senior and eight carers until the night shift of one senior and three staff. The staffing levels were sufficient to meet the care needs of these and other residents and need to be maintained. Though the inspection did highlight the need for more activities that meet the needs of residents with dementia. The staff rota was examined and from this and discussion with the manager it was evident that the level of agency staff had increased in use since the last inspection. There were instances when agency levels were over 50 , generally at the weekends. Several relatives and residents did comment upon this to the inspector. They did say that the staff were polite and respectful but that they did not like lots of different people on duty. This was an issue that the Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 16 manager was aware of and shared the concerns of the residents and their families. She informed the inspector that staff recruitment was being progressed but obviously had to use agency staff in order to meet the care needs of the residents. She went on to state that she used regular agency staff to ensure some consistency of care for residents and the staff team. This will be monitored at future inspections. Examination of the homes’ compliments record showed that several relatives were very positive about the care provided and the staff attitude. One from an agency carer stated that, “she felt supported… the staff were professional, sharing key values and friendly home atmosphere”. The inspector received many compliments from visitors and residents during the inspection about the manager and staff. There were lots of positive comments regarding the staff’s politeness, respect and good care practices. The inspector also observed several instances of good practice by the care staff. One carer impressed the inspector with their gentle and patient approach with a resident who was clearly anxious regarding the use of manual handling equipment. The carer helped the resident by providing respectful and caring reassurance that ensured their dignity was intact and their anxiety acknowledged and reduced. The commitment to staff training is good. The manager has well organised and detailed staff training records that highlight the need for refresher and required training. The manager is working well, with the support of the provider, in developing the number of care staff with NVQ level 2 or above. Records showed that 10 staff currently have NVQ2 or above, with an additional 13 currently working towards their NVQ 2. Once these staff achieved their level 2 the home will have more than 50 of the staff qualified and the standard will be well met. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 The management style is very much focussed on the best interests and needs of the residents. Practices and procedures ensure that the health and safety of residents are protected. EVIDENCE: The manager has a good understanding and awareness of the needs of the residents. She is well known to them and their families. Both residents and relatives spoke very highly of her. They felt that she listened and responded to comments in a positive and caring manner. The inspector also received complementary comments regarding the manager and her staff from one of the local doctors and visiting district nurse. The doctor stated that the manager and staff are caring “beyond the call of duty”. Representatives from the provider had undertaken an annual audit of the home. They looked at all aspects and standards of care and views were sought Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 18 from residents and relatives. An action plan including recommendations, observations and requirements was produced. The manager is working through the action plan, with her staff team, in order to address the shortfalls and comments raised as part of the audit. Health and safety records were well organised. The required checks with regard to electrics, gas and water temperatures are maintained and monitored. The manager was aware of the need to ensure that the required regulations for health and safety and implemented. The majority of the staff had received refresher training with regard to health and safety and fire awareness. Regular fire drills are now done with all staff including night staff. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 12 Requirement Timescale for action 23/02/06 2 OP26 16 3 OP27 18 3 OP30 18 The registered person must ensure that appropriate activities and are provided for those residents with dementia. The staff must be trained and competent in understanding and providing relevant activities for residents with dementia. The registered person must 23/02/06 ensure that the premises are kept free from offensive odours. This refers specifically to one bedroom highlighted during the inspection. The registered person must 23/03/06 ensure that a consistent and competent staff team are provided. This refers specifically to the high levels of agency staff. The registered person must 23/06/06 ensure that staff are trained with regard to understanding adult abuse, polices and procedures in the Protection of Vulnerable Adults. Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brewster House DS0000017780.V249883.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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