Inspection on 11/07/05 for Brigstock Manor

This inspection was carried out on 11th July 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

Brigstock Manor 04/11/08

Brigstock Manor 07/11/06

Brigstock Manor 17/02/06

Brigstock Manor 11/01/05

Brigstock Manor 19/04/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Brigstock Manor 129 Brigstock Road Thornton Heath Croydon, Surrey CR7 7JN Lead Inspector Michael Williams Unannounced 11th July 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. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brigstock Manor Address 129 Brigstock Road, Thornton Heath, Croydon, Surrey, CR7 7JN 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) 020 8684 1912 020 8684 3585 steve_liddicott@croydon.gov.uk London Borough of Croydon Ann Denman Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (OP/33) of places Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/1/05 Brief Description of the Service: Brigstock Manor is a large residential establishment registered with the CSCI to provide personal care for up to 26 elderly service users on a permanent basis, and up to 7 respite beds. The home is owned and run by the London Borough of Croydon.The home is situated on a busy main road in Thornton Heath and is therefore close to public transport. The stated philosophy of the home is to “provide a caring and homely environment for our service users and to endeavour to treat everyone equally regardless of their disability, gender or ethnic origins”. Accommodation is on three floors, with the ground floor being used for respite care. Communal areas comprise small lounges and dining rooms with kitchenettes on each floor. There are bathrooms and toilets on each floor and other facilities include laundry, kitchen administration offices. The home has a large, enclosed garden to the rear and parking space to the side of the premises. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted at midday whilst the main meal of the day was being served; this gave an opportunity to observe care practices such as moving and handling techniques and to observe care practices of the staff team and it provided an opportunity for service users to comment on the care provided and more specifically the meals. A very caring and attentive atmosphere was evident and the service users commended the meals provided. What the service does well: 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. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 6 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 Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 7 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) 3 Service users are being assessed prior to admission so as to assure prospective service users that all their health and social care needs can be met when they are admitted. Whilst intermediate care is not provided respite care is available and again the CSCI was able to confirm that suitable arrangements are in place to assess short stay service users’ needs prior to admission to ensure that even in the short term their needs are clearly identified. EVIDENCE: Service users have a comprehensive assessment carried out by the staff prior to their admission, which ensures that staff are able to meet service user needs. Service users, or their relatives where appropriate, are involved in the identification of their care needs and in planning how the staff will met those needs. The case records examined during the inspection indicate that the assessments are made known to the staff team to help them be met the specific needs of this rapidly changing group of service users can be met from the outset. One respite service user confirmed that she was supported appropriately to arrange her short stay including issues such as medication, money, laundry and visitors. This service user commended the staff for their helpfulness in preparing for her admission. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 8 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 Care Plans are in place for each service user. This means their health and personal care needs are clearly set out action plans to ensure their personal goals can be fully met in this care home. Medication can either be administered by the care staff or they will support service users to hold and administer their own medication in order to maximise their independence. Service users are treated with respect and dignity. EVIDENCE: Individual plans of care are in place for all service users. These documents include the initial assessments, from which arise the action plans. These are designed to meet the specific needs of individual service users. Service users health care needs are being fully met in this care homes as indicated by the record of visits by health care professionals including District Nurses, General Practitioners and Opticians. Medication is administered in most instances by the care staff but some service users such as those in the respite care unit do hold and administer medication themselves. Service users confirm that they are treated with respect and dignity. The effectiveness of this care plan and goal setting was demonstrated by the considerable improvement made by a particular service user who has recovered his health and self-respect and is now recognised as being very caring and supportive towards other more dependent service users. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 9 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 14 15 The home provides a comfortable setting for service users to engage in social and cultural activities as they choose and in accordance with their expectations of the home. The staff assist and encourage service users to lead as fulfilled lives as they wish or their frailty allows. Service users are encouraged and given every opportunity to maintain contact with family and friends and the community. A full and wholesome menu is available for all service users to ensure their health and well being and to provide them with a diet that suites them. EVIDENCE: A programme of activities is provided. Whilst service users mourned the loss of their independence and their own homes they nevertheless accepted that the care provided in this home was most agreeable to them. Many of the service users are very dependent and vulnerable so the exercise of choice and control of their daily lives is inevitably restricted but within those constraints the home offers a typical range of choices such as choice of meals, of activities, the time they rise and retire to bed, where and with whom they sit each day. The visitors’ book shows that friends and relatives are welcomed throughout the day. Service users also confirmed that they receive visitors without let or hindrance. The choices for the midday meal on the day of inspection was ham salad or cheese flan with a choice of vegetables. Service users report that meals in this home are tasty and in ample proportions. Their personal case files record their meals and choice of foods as part of their plan of care. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 10 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 18 Arrangements are in place for service users and their representatives to either complain or compliment the service. Effective procedures are in place to deal with complaints. Service users confirm that with these arrangements in place they are confident their opinions and concerns are dealt with in a professional and thoughtful manner. Arrangements are also in place to protect the vulnerable service users. EVIDENCE: A record for complaints is in place and shows that no complaints have been made since the previous inspection. No complaints arose during the course of the inspection but many service users complimented the service. The home has a copy of the local authority’s procedures for dealing with allegations of abuse but no such issues have arisen since the previous inspection. Staff were well aware of their responsibilities to protect service users and report allegations of misdemeanours. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 11 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 26 Service users live in a safe, well-maintained and comfortable environment. This is a purpose built care home and is subject to ongoing refurbishment. It was clean and comfortably warm at the time of inspection. EVIDENCE: This local authority care home is now a rather showing its age and regular maintenance is required to keep it in good working order but communal areas are pleasantly decorated. The individual rooms, though not spacious, are adequate and are fitted standard bedroom furniture and fittings. Minor points noted include an old metal bed-frame and worn furniture in some locations. This a large care home but the small units make it a homely environment for the small groups of service users. The home was clean and tidy at the time of inspection. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 12 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 29 Staffing levels and skills mix appeared adequate for the current care needs of service users so as to ensure their wide range of social and health needs could be met. Staff records are now being transferred to the home as required by Regulation but in one instance the manager was unable to confirm that a new member of staff had undergone the necessary up to date checks, which includes police checks, that are required to ensure the safety and well being of service users. A requirement is made to confirm that all necessary staff checks are in place before any staff are employed in the home. A number of temporary staff including agency staff are still being employed in the home; a recommendation is made to employ adequate numbers of permanent staff without unreasonable delay. EVIDENCE: For 28 service users on the day of inspection there were three carers; that is, one carer is allocated to each floor plus an extra member of staff acts as a ‘floating carer’ to work on any floor requiring extra support; there was also a duty senior in charge as well as the manager herself. The manager states that all senior staff, including the manager herself, provide direct ‘hands-on’ care as the needs of service users dictate. Also on duty were ancillary staff including catering and cleaning staff and a gardener, a man with special needs who was doing a good job keeping the garden neat and tidy. The manager is of the opinion that service users’ needs can be met with this range of staff. The manager is required to confirm that in every case the proper checks have been completed for all staff before they are employed - including the police check and the POVA check [Protection of Vulnerable Adults List]. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 13 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) 33 38 With a ‘people centred’ approach it was clear that this home is being run in the best interests of the service users and certainly the service users thought so. Just one lapse in health and safety was noted in so far as chemical store was left unlocked. EVIDENCE: Service users throughout the home were full of praise for the home, its staff and management. This is a competently run care home. The registered manager has been assessed by the CSCI as competent and fit to manage this home. The home is managed so as to ensure the health and well being of the service users. One hazards was identified and a requirement is made to ensure chemical stores are kept locked when not in immediate use. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 14 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 3 x x x x 2 Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 15 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 27 Regulation 18(1)(b) Requirement Staff: The manager advised the inspector that the home still has several staff vacancies and is reliant upon temporary agency staff. The home is required to employ staff who are not temporary in sufficient numbers to meet the needs of service users. The CSCI acknowledges that an action plan is in place to address this requirement within a reasonable timescale. Records: Staff records need to contain the details listed in the Regulations and Schedules inclduing details of police and POVA [Protection of Vulnerable Adults List] checks. This remains an outstanding requirement. Health & safety: It is required that all chemicals be kept in a locked cupboard in accordance with the Control of Substances Hazardous to Health Regulations [COSHH]. Timescale for action 30/8/05 2. 37 17 30/8/05 3. 38 13(4)a 30/8/05 Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 16 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 19 Good Practice Recommendations Bedrooms: it is recommended that the old ireon bedstead in replaced with a more modern and comfortable bedbase. Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 17 Commission for Social Care Inspection CSCI 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP 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 Brigstock Manor G53-G53 S43307 brigstockmanor V178222 110705 stage 4.doc Version 1.40 Page 18 - 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. 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