Inspection on 21/04/05 for Brighstone Grange

This inspection was carried out on 21st April 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

Brighstone Grange 20/10/08

Brighstone Grange 03/11/06

Brighstone Grange 28/09/05

Brighstone Grange 13/10/04

Brighstone Grange 02/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Brighstone Grange Brighstone Isle of Wight PO30 4DZ Lead Inspector Mark Sims Unannounced 21st April 2005 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. Brighstone Grange Version 1.10 Page 3 SERVICE INFORMATION Name of service Brighstone Grange Address Brighstone, Isle of Wight, PO30 4DZ 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) 01983 740236 01983 740472 wendydickson_bcl@hotmail.com Brighstone Care Ltd Mrs Wendy Patricia Dickson Care Home 23 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (20) of places Brighstone Grange Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13/10/2004 Brief Description of the Service: Brighstone Grange is a residential home that caters for 23 elderly service users, with the categories of dementia (3 places) and older persons (20 places). The premises is a large country house set within its own substantial grounds and has commanding views across the surrounding countryside to the English Channel. Residential accommodation is currently set out on two floors, with access to the first floor presently provided via a chairlift or the stairs, although plans are in place to build a shaft lift, which will encompass the first floor and open up the second floor for use by service users. 17 of the 21 bedrooms at the home are en-suite, 19 are single rooms and 2 double rooms, which can be used by people preferring to share. Brighstone Grange Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours and was carried out as part of the annual inspection process. The service provides care to 23 people, mainly within the Older Persons category and a large number of these individuals were spoken to as part of the inspection process. Additional information was also considered as part of the inspection and included care planning records, duty rosters, tour of the premises, actvities schedules, discussions with staff and observational situations What the service does well: What has improved since the last inspection? The managing proprietors have overseen the recent redecoration and refurbishment of the main lounge, as well as arranging for the entire ground Brighstone Grange Version 1.10 Page 6 floor (excluding service user bedrooms and WCs, etc.) to be re-floored in a light coloured wood effect flooring. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brighstone Grange Version 1.10 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 Brighstone Grange Version 1.10 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) St 3. The home’s pre-admission assessment process is thorough and comprehensive, collecting valuable information, pertinent to the prospective service user, which enables the managing proprietor to determine the suitability of the initial placement prior to the offer of accommodation being made. EVIDENCE: The pre-admission assessment plans of three service users were reviewed during the inspection. The plans had been completed by the managing proprietor during visits to the prospective new resident and contained information pertinent to the person’s current needs and wishes. A copy of each pre-admission assessment is maintained on the service user file and is used in the initial production of care plans, which are used in the delivery of a service to the resident, until a fuller and more detailed assessment can be undertaken and plans updated accordingly. In conversations with numerous service users it was clear that they felt the home met their needs and confirmed that prior to moving into the home a Brighstone Grange Version 1.10 Page 9 member of the staff team had visited them and in some case they to had visited the home or knew of the home because of previous involvement with the service. Brighstone Grange Version 1.10 Page 10 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) St 7, St 8. The care plans produced by the management were detailed and comprehensive documents, emanating from a pre-admission assessment or re-assessment tool. Each care planning record contains details of all health and social care contacts/visits, as well as evidence of attendance to clinic or hospital appointments, etc. EVIDENCE: The care plans of three people currently residing at Brighstone Grange were reviewed, each containing an abundance of information relating to the service user including: • • • • • • • Admission checklists Client information/details Pre-admission assessments Medical histories Health Professional visit sheets Details of Health and Social care professional involved with the resident Medication details Version 1.10 Page 11 Brighstone Grange • • • • • • • • Personal care plans Risk assessments Assessment tools – nutritional screening, moving and handling, etc. Social histories Contact with families or visitors Care plan review information Inventories of personal effects Care Management or case review information. In discussions with staff it was evident that these documents were regularly used, reviewed and updated and that key workers were responsible for ensuring their specific clients’ care plans, etc. were reviewed and updated accordingly. Service users, whilst not necessarily aware of the content of their individual care plan, knew the records existed and several plans had sections bearing signatures of residents or their next of kin if appropriate. During the inspection a member of the ‘District Nursing’ team visited the home and during a brief conversation confirmed that the home was well run, well organised and met the needs of the service users, in her opinion. She felt staff knew and understood the needs of the service users and that staff were also always available to assist in the delivery of care if required. In conversations with service users no complaints or issues of concern were raised regarding access to health care support, although one client was a little concerned that her care manager was not as pro-active in keeping in touch with her as she would like, as she was wishing to arrange to go home following a period of convalescences. This was discussed with the manager who advised that the care manager had been in touch with the resident but that there were some additional issues that required addressing with the resident’s family prior to her being able to go home. Generally the residents and the management felt that the service provided by their local health clinic was good and that there were never any issues of concern with regards to accessing or arranging for GP visits or visits by other allied health professionals. Brighstone Grange Version 1.10 Page 12 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) St 12, St 15. A varied activities schedule is available within the home, which meets the needs of the service users and was endorsed by relatives. The food served at the home was widely praised by the service users and appeared to be well presented, well balanced and individually portioned during mealtimes observed. EVIDENCE: During the inspection visit eight service users were observed participating in music to movement. The activity provider, stated that she was an ex-physical education teacher, who now developed and provided structured activities and exercises in residential settings. She also stated that normally the sessions at Brighstone Grange were well attended and well received, a statement supported by both service users and relatives, who confirmed that the visits were enjoyable occasions. During the inspection the activity provider was involved in several exercises, all performed to music and all designed to encourage resident participation and enjoyment, people using bells and maracas, etc. to mark time along with the music. Brighstone Grange Version 1.10 Page 13 On display around the home were a number of items which help in the promotion of entertainment and leisure for the service users. A schedule of forthcoming activities and events is exhibited outside the main lounge and advises people of future and important dates to remember. The home also circulates an in-house newsletter, a copy of April’s newsletter pinned to a notice board opposite the dining room, advising people of forthcoming events, recapping previous events and exploring internal issues of interest. In discussions with the service users it was clear that whilst the activities programme arranged in-house is appreciated and enjoyed, people are looking forward to the onset of summer and being able to get out into the gardens and on trips/outings, which during the winter month tail off. Time was spent in and around the dining room when diners were being served. Two main choice meals were available to residents; pork chops or breaded chicken, each served with a selection of stir-fried vegetables, French beans and potatoes. Pudding consisted of fruit and ice cream, which whilst not the most inventive of sweets, clearly met with the approval of the residents who cleared their bowls. Shortly before lunch time was spent talking to some of the people in the dining room about meals, etc. within the home. People confirmed that everyone (more or less) eats together and that each person has his or her own preferred position within the dining room. The food served was generally described as good and people appreciated that a choice of main dishes was provided daily. However, some people were a little upset that one of the cooks was leaving for pastures new, although in conversation with the manager it was established that a new cook had already been employed, commenced her induction and had already cooked for everyone, receiving praise for her efforts. Within the kitchen, changes have been made to the layout and set up of the environment, which the management may need to monitor over the summer months, as already people are noticing that the changes have made the kitchen environment hotter. Food stores according to the cooks are fine and records are being maintained in accordance to the Environmental Health officers’ directions and the Commission’s guidance. As with all parts of the building the dining room and kitchen are well maintained and/or well decorated and furbished environments. Brighstone Grange Version 1.10 Page 14 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) St, 16 The complaints process established by the home is well set out and structured and provides clear information on the role of the home and the Commission in investigating and resolving people’s complaints/concerns. EVIDENCE: Details of complaints made to the home are recorded using the home’s complaints logging system, which also documents outcomes and resolutions to complaints addressed internally. In conversations with several of the residents it was clear that their understanding of the complaints process was rudimentary, people stating that they would speak to the manager, etc. if they had any issues to raise or complaints to make. This willingness to approach the right people, seniors on duty or the manager should ensure the right people are informed of people’s concerns. The comments of a relative also confirmed that people generally understood the complaints process, ‘mother would notify Wendy (manager) if she was upset’ and to a lesser extent the Commission’s role in addressing complaints/concerns. Brighstone Grange Version 1.10 Page 15 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) St 19, St 26. The home is extremely well maintained both internally and externally and is decorated to a high standard throughout. Cleanliness and hygiene issues are well managed by the domestic staff team and care staff team, all of whom have completed infection control and health and safety training. EVIDENCE: Since the last inspection the lounge has been completely redecorated and new furniture, fixtures and fittings installed. A new floor covering has also been set down and extends out to incorporate the main corridor, dining room and central foyer. The revamped lounge was a hit with those people using it during the inspection, people commenting on the fresh, clean look created. However, the new flooring was less popular with some residents expressing an opinion that it was too modern and light, whilst others thought the extent to which wood effect flooring had been used was too great. Brighstone Grange Version 1.10 Page 16 However, overall opinion seemed to be that the work undertaken to ensure the premises remained tidy and liveable had succeeded and that the management’s commitment to the home was good. The tour of the premises, as on other visits to the home, confirmed that no two bedrooms within the home are identical with service users furnishing rooms with their own possessions, rooms individually decorated and shapes and sizes varying throughout the home, creating a really welcoming atmosphere. Whilst in one lady’s bedroom the inspector’s attention was drawn to the new liquid crystal screen television that her son had fitted to one of her bedroom walls. This very modern multimedia system has fitted nicely into her bedroom and has helped create space were previously a television and stand were located. Discussions with the management about the premises raised the issue of future development work at the home, which would enhance the service provision by enabling the home to install a passenger lift to all floors, as well as creating several additional bedrooms and communal bathing/WC facilities. As mentioned earlier within the report, the location of home is one of its most positive features, with wide ranging views across the surrounding countryside and English Channel. However, the extensive grounds and well maintained gardens are additional features of the home, much enjoyed by the service users during the summer especially, which have not been referred to so far. The main patio area of the home is situated to the rear of the property and can only be reached by either the front entrance or side entrances. To the front a path has been created to ensure level and safe access is available, whilst the side passage leads to a raised seating area and down via a ramp to the patio. The patio area of the gardens has several features designed to add to people’s enjoyment, including raised flowerbeds and a pond, although last year the raised flowerbed was given over to growing vegetables for the residents, which they enjoyed consuming. The front aspect of the premises opens up onto a sparsely wooded area, which on the day of the visit the gardener/handyperson was attempting to make user friendly, by removing tree stumps and levelling of the ground. In conversations and discussions with service users it was evident that during the summer the gardens are a popular place to be, with people talking about sitting out and around the patio area getting fresh air and enjoying the warmth. Brighstone Grange Version 1.10 Page 17 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) St 27, St 30 The home is experiencing difficulties in recruiting new staff, although existing staffing levels are being maintained and the safety of service users ensured by staff taking on extra duties. Access to suitable and appropriate training is being provided to members of the staff team. EVIDENCE: One of the first aspects of the inspection the managing proprietor wished to discuss was the difficulties the home has been experiencing recruiting new staff, which is the downside to the much extolled rural location of the home. The manager was quick to point out that staffing levels are being maintained at the normal level, although this is mainly thanks to the goodwill of the staff, a fact confirmed later in conversation with staff who stated they had been picking up additional duties/shifts and that in the short-term they were happy to continue doing so. The manager has recently filled two posts, which will alleviate the strain on the home and the existing staff, although these new staff’s start dates were subject to successful return of Criminal Record Bureau and Protection Of Vulnerable Adults checks. It should be possible for these staff members to commence employment prior to these checks being returned if the manager is able to provide appropriate levels of support and supervision, which given the induction requirements should be achievable. Brighstone Grange Version 1.10 Page 18 The managing proprietor is also considering other avenues of recruitment in case the situation does not improve, although these other possibilities were in the early stages of formalisation and not explored extensively. From the prospective of the residents their care has not directly been affected and they are generally happy with how the home is operating, however one individual did comment on the comings and goings of staff and pointed out that the cook was also due to leave, although this issue had already been raised, explored and resolved with the manager. The fact that the staffing levels across the home’s shifts were being appropriately maintained were confirmed by the home’s duty rosters, which indicated that all shifts were covered by the requisite number of care staff and that in addition to the care staff catering, domestic and maintenance staff are available. Staff training did not appear to have been affected by the shortages of staff experienced with care staff discussing recent distance learning courses they completed on health and safety issues and the management of medications. Staff also advised the inspector that most of them were enrolled on or had completed National Vocational Qualifications, ranging from level 1 course to level 3 qualifications. Brighstone Grange Version 1.10 Page 19 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) St 38. Health and Safety of service users and staff is being addressed through a programme of staff training and education and risk assessment, both environmental and personal. EVIDENCE: As highlighted above the staff have recently completed specific health and safety training, although they also undertake additional training around fire safety, moving and handling and infection control. Within each service user plan inspected there was evidence that individual and personal risk assessments are being undertaken, promoting their welfare and wellbeing and general environmental risk assessments are being completed and updated according to the management. In conversations with residents and relatives no specific issues regarding concerns for their safety or wellbeing were raised and as highlighted earlier Brighstone Grange Version 1.10 Page 20 within the report, people generally feel well cared for and happy residing at Brighstone Grange. The tour of the premises enabled the inspector to check the availability of hand-washing areas for staff around the home, with all communal areas and staff WCs containing liquid soap and paper towels, this simple procedure reducing the likelihood of cross contamination of infections, etc. Brighstone Grange Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 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 3 Brighstone Grange Version 1.10 Page 22 No 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 Regulation Requirement Timescale for action 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. Refer to Standard Good Practice Recommendations Brighstone Grange Version 1.10 Page 23 Commission for Social Care Inspection Mill Court Furrlongs Newport PO302AA 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 Brighstone Grange Version 1.10 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. 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!