Inspection on 28/09/05 for Brighstone Grange

This inspection was carried out on 28th September 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 21/04/05

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 Grange Brighstone Isle Of Wight PO30 4DZ Lead Inspector Mark Sims Unannounced Inspection 28th September 2005 13:00 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 Brighstone Grange DS0000047002.V249133.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. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brighstone Grange Address Brighstone Grange Brighstone Isle Of Wight PO30 4DZ 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) 01983 740236 01983 740472 wendydickson_bd@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 DS0000047002.V249133.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Brighstone Grange is a residential home that caters for 23 elderly service users, within 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. Accommodation is currently set out on two floors, with access to the first floor presently provided via a chairlift or the stairs, although plans have been drafted for the development of a shaft lift, which would, if built, provide access to 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 are double rooms, which can be used by people preferring to share. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced and lasted approximately 6 hours, 4 hours on the first visit and 2 hours on the second visit, the second visit required as the manager was absent at the first visit and some records were therefore not accessible. What the service does well: What has improved since the last inspection? As already mentioned the external presentation of the home has been improved by the complete redecoration of the exterior aspects of the property Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 6 and the attention given to the grounds, although the gardens have always been well kempt. Training or more specifically the induction-training programme has been improved for new recruits, with far more structure and clarity brought to the induction system by the manager. The home’s induction training now consisting of an initial introduction to the company, the company policies and procedures, the general layout and environment of the home, the service users and fellow carers. On completion of the home’s induction the new staff member is then given time to work through a more in depth induction programme, which follows units identified by ‘Skills for Care’ (the sector skill council for the social care profession), as essential or core skills required when working within the caring profession. 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. Brighstone Grange DS0000047002.V249133.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 Brighstone Grange DS0000047002.V249133.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): Standards 1 & 2. The statement of purpose documentation is clearly and readily accessible within the front entrance hall and contains all relevant information and a copy of the most recent Commission inspection report. All prospective service users are provided with a copy of the service users’ guide and statement/terms and conditions documentation prior to accepting the offer of accommodation. EVIDENCE: Whilst undertaking a tour of the premises the opportunity arose to review the home’s statement of purpose documentation, which was accessible within the front entrance hall. On reading through the statement of purpose the inspector could easily identify all those areas of the document created in accordance with the recommendation of the national minimum standards. In addition to the information contained directly within the statement of purpose the management had also provided access to copies of previous Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 9 Commission inspection reports, those available dating from 21 August 2002 up to and including the 21 April 2005. On talking to service users’ relatives it was apparent that the management had provided the service users with ample information prior to admission and that people knew generally that the Statement of Purpose documentation was available. It was also apparent in discussions with a senior member of the staff team, that copies of the home’s ‘brochure’ (service users’ guide) are also regularly sent out and confirmed that she had on numerous occasions provided people with copies directly or arranged to post copies of the document to people on enquiry. The service users’ guide or ‘brochure’ literature was also a well set out and structured document, which included information as recommended within the national minimum standards and additional information relevant to the home and its overall service, aims and objectives. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 the following standard(s): Standards 9 & 10. The management of service users’ medications should be tightened up to ensure errors or oversights are limited. Service users and their relatives felt the staff were respectful and conscious of people’s rights to the promotion of dignity and privacy. EVIDENCE: A review of the home’s medication system revealed one or two procedural issues that the manager needs to address in order to promote safety and consistency. A large number of medications, which should have been returned to the pharmacy, were found still in the home, despite either the person no longer being in the home or the medication ceased, etc. It is important to establish a programme whereby medications that are no longer required are appropriately returned and destroyed and that records are available in house to support the fact that the items have been properly disposed of. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 11 The second issue discovered when undertaking the medications review revolved around loose medicines and a large number of tablets found lying around at the bottom of medication storage units or on one occasion the floor. Medications are legally controlled substances, which should be carefully and appropriately handled and stored at all times. The staff should also recall that they take on the responsibility for looking after or helping people with their medications because they are often unable to look after their own medicines and trust the home to take suitable measures to ensure their medications are properly handled. Whilst errors were found with the home’s approach to managing people’s medications, no such problems were encountered with regards to how staff approach the promotion of dignity and respect for service users. It was noticeable, whilst located in the lounge, that the relationship between the service users, their relatives and staff appear based on a mutually respectful, amiable and friendly foundation. People often referred to by their first name, both on the part of the staff and the service users and people happy to engage in conversation or friendly banter when the opportunity arose. In talking with both service users and their relatives it was evident that they appreciated the relaxed and friendly atmosphere created within the home but were quick to point out that regardless of the situation staff always remained professional and polite. An observation supported by comments made during the home’s service user and relative survey, where people describe staff as welcoming and friendly, scored their attitudes to care as either very good or excellent. The remarks made during the home’s internal audit mirroring the majority of comments made to the Commission, when they conducted a similar survey earlier in the year, when people described feeling made welcome, etc. to the home. It was also very pleasing to note during the tour of the premises that people generally choose to keep their bedroom doors shut, even when occupied and that staff appeared to both knock and wait for a reply before entering, giving the occupant time to respond before the doors were open. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 the following standard(s): Standards 13 & 14 Service users are supported in the maintenance of community contacts and are welcome to receive visitors to the home at any time. Comments from service users support the fact that they feel able to exercise both choice and control over their lives and activities, etc. they pursue. EVIDENCE: The manager advised that the home imposes no restriction on visiting times, although all doors, etc. are secured in the evening, resulting in visitors to the home having to seek out staff when they are preparing to leave. This particular issue was highlighted by service users completing the company’s service user survey, suggesting that a time limit could be introduced for visits, although the manager and staff felt this would be unreasonable, given people’s lifestyles and the preferences of the majority of service users for more flexible visiting. Details of the home’s visiting arrangements are presented within the statement of purpose and service users’ guide (brochure) documentation, which as previously stated is readily accessible or provided to people prior to admission. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 13 During the inspection the inspector had the opportunity to speak with one visitor who confirmed that the arrangements for visiting were sufficiently flexible to meet both the needs of her relative and herself. On the whole the number of visitors seen during the inspection seemed reduced, compared to previous visits, although relatives and community visitors (clergy) were noted to be present around the home at different times. In conversation with service users it was apparent that generally they were happy with the visiting arrangements in place and stated that their relatives were able to visit at times that suited them. People also discussed options for going out with families, which varied from full outings in cars, etc. to quick turns around the garden, although the latter relied on settled weather conditions. People also discussed options for going out with staff, which are possible as the company provides access to a car, some people expressing a preference for outings when something active occurred at the end, shopping, etc., whilst other people seemed to prefer more sedate drives around the countryside or visits to local attractions like the recent visit to the Lavender Farm. What was also pleasing to hear, whilst talking with a group of service users, was how the ethos of the home promoted self-determination and choice, a classic example being the scrabble games entered into, which apparently go on late into the night and according to two are supported by the staff who during the games bring in drinks and snacks, as required. Other observations made during the inspection visit leant weight to the comments of the service users and supported their view that the general ethos or philosophy of the home promoted independence, observations such as the bedroom doors being closed, staff knocking and waiting for replies before entering, locks on bedroom doors and terms of address and responses to questions, which were all appropriate. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 the following standard(s): Standard 18 Recent training undertaken by the manager should help reduce the potential for abuse within Brighstone Grange. EVIDENCE: In conversation with the manager it was apparent that she had not been available on the first day of the inspection process as she had been involved in adult protection management training and in particular had attended a threeday course to become an adult protection instructor. The course having been arranged and organised by the local authority ‘adult protection team’ and designed to equip people with the necessary skills and knowledge to train others working within the private care sector. To this end the manager is planning to commence adult protection training with her staff shortly and was able to talk the inspector quickly through the training package provided. She also discussed how this training would build upon the training completed by staff during their induction training, the ‘Skills for Care’ induction units covering adult protection procedures and National Vocational Qualifications, which also considered issues around promoting the safety and wellbeing of service users. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 the following standard(s): Standards 23, 24 and 26. The private accommodation provided at Brighstone Grange was felt to meet the needs of the service users. Bedrooms visited during the inspection had clearly been personalised by the occupant in accordance with their own wishes. 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: During the tour of the premises the inspector visited a handful of residents within their bedrooms, which revealed that the individuals had set out, decorated and furnished their bedrooms in accordance with their personal preferences and reflected the wishes of the occupant to create a personal space that was familiar and comfortable. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 16 People using both small items, such as pictures, paintings and ornaments and larger pieces of furniture, chairs, televisions and wardrobes from their own homes to generate the sense of ownership and belonging. In conversation with the service users it was evident that they were happy with the accommodation and felt it generally met their needs, most people opting to retire to their bedrooms in the evening to watch their own televisions, etc. in peace. Replies to the company’s service user satisfaction survey providing further evidence of people’s happiness or contentment with the accommodation, people commenting on the pleasant environment, cleanliness of the premises and comfort of their room. The tour of the property also confirmed that the domestic staff’s approach to cleanliness is good, with no signs of dust, cobwebs or any offensive odours to be detected anywhere around the home. All staff are provided with access to infection control procedures and have information available for guidance provided by the ‘bug busters’ organised by the Local Authority Infection Control Nurses. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 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): Standard 29. The home’s recruitment and selection procedure is generally robust and thorough, although the home must remember not to cease supervision until details of the Criminal Records Bureau check are returned. EVIDENCE: During the visit the inspector reviewed the staffing file of one recently recruited staff member, who is the only person recruited since the last inspection. It was evident, given the file inspected, that the home’s general approach to the recruitment and selection of new staff is robust and consistent, with tracking or monitoring forms used by the manager to ensure each new staff member’s recruitment follows a very similar pattern and that all relevant information is applied for and received. All prospective staff are required to complete an application form as part of the process, the application form designed to obtain details of the person’s employment history, educational history, medical history and references, etc. Once the application has been submitted the manager arranges to meet with the applicant, for the purposes of interview, and retains information relating to the outcome of the interview on file. Once an applicant has successfully completed the preliminary stages of the recruitment process, they are issued with written confirmation and subject to Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 18 the successful return of their references and Criminal Records Bureau check and POVA check, are invited to attend for induction. One issue, which did come to light whilst reading through the employment file was that the Criminal Records Bureau check for this person had not been received back prior to the individual being allowed to work with service users unsupervised. The managing director has been reminded that on receipt of a clear POVA (Protection Of Vulnerable Adults) clearance a staff member may commence employment, although they should continue to work under supervision. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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 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): Standards 33 and 35 The company proactively seek feedback from the service users and their relatives on their experiences of the home and service. The financial system adopted by the home ensures that service users’ financial interests are safeguarded. EVIDENCE: As reflected throughout the inspection report the home had recently conducted a service user and relative survey which at the time of the inspection was being sifted through for regularly occurring themes or issues of specific significance which might require immediate attention. What became clear on reading through the questionnaire was that people felt able to comment openly and honestly about all aspects of the service, comments ranging from the positive to the negative without fear of retribution or reprisal. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 20 It was further evident from conversations with service users that they regarded the managing director and the staff as approachable and accessible and that when problems were encountered staff were often quick to respond, taking action to remedy situations. The general atmosphere within the home would, in the opinion of the inspector, best be described as open and supportive and is clearly intended to encourage service users, their relatives and staff to make comments on the service provided and to seek to change and improve the delivery of care, etc. wherever possible. It continues to be the policy of the home ‘not to become involved in supporting service users with the management of their monies’, which is explained in the ‘Service Users’ Guide’. The manager does ensure where people wish to retain monies within the home that adequate lockable facilities are provided, although most service users appear to opt for external support from family members, professional sources or independent advocates. The manager is happy to arrange and liaise with external sources when assisting service users address financial management issues, or alternatively the company is prepared to purchase items on behalf of service users and invoice them at the end of each month for the items brought. Spread sheet information and receipts are available for inspection should families require proof of the items purchased prior to settling accounts. Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 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. 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 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X 3 3 X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 22 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 OP9 Regulation Requirement Timescale for action 17/11/05 2 OP29 Regulation The management must make 13 suitable arrangements for the safe handling and storage of service users’ medications. Regulation Staff should not commence 19 unsupervised work with service users until appropriate CRB and POVA clearance is received. 17/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brighstone Grange DS0000047002.V249133.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 DS0000047002.V249133.R01.S.doc Version 5.0 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!