Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Brigstock Manor 129 Brigstock Road Thornton Heath Croydon Surrey CR7 7JN The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Williams
Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home
Name of care home: Address: Brigstock Manor 129 Brigstock Road Thornton Heath Croydon Surrey CR7 7JN 02086841912 02086843585 ann.denman@croydon.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Croydon care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 33) Physical disability - Code PD (maximum number of places: 33) Date of last inspection Brief description of the care home Brigstock Manor is a large residential establishment registered with the to provide personal care for up to 33 older people including 7 respite, short stay 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 Care Homes for Older People
Page 4 of 24 Over 65 33 0 0 33 Brief description of the care home 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. The premises are due to be replaced in a new for old process within about two years.We are advised that there have been no changes to the owners, London Borough Croydon but the manager has changed and will need to register with the Commission. Fees as at November 2008 were 487 pounds. Care Homes for Older People Page 5 of 24 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection included a tour of the premises; meetings with service users, with relatives and with a range of staff and the person in charge. We received only a small number of written responses to our questionnaire but they were positive. The site visit included examination of a sample of the statutory records. This inspection was also used to monitor compliance with previous requirements. Since this care home has been assessed as providing a good level of service over a number of inspections this visit was used to confirm that this remains the case and where there has been no changes then previous findings are restated in this report. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: One requirement is not fully met including the excessive reliance upon agency staff which residents have been very critical about in the past, they say the new temporary staff do not know what they are doing. The home has addressed this by trying to secure regular agency staff so they do get to know residents but the manager tells us that this is not always possible. The outcome is that some agency staff have worked in the home for many months whilst others for much shorter periods. The Commission is aware that this is due in part to the new for old process in which older buildings are being replaced by newer more modern ones and so staffing levels need to be adjusted in the longer term. The registered manager left Brigstock some time ago and so the new acting manager needs to be registered without delay. Although activities are available some residents said they do get a little bored and would like more local outings and more entertainers, this suggestion was passed on to the manager. The manager also felt staff need guidance in encouraging residents who tend through inertia to decline opportunities for activities when they are offered. One resident told us she needs a new wheelchair since her needs have changed and Care Homes for Older People Page 7 of 24 staff tell us there has been some delay in getting a suitable replacement even though a referral has been made through her doctor. The visiting inspector demonstrated a portable hearing device that several residents tried during his interviews. Residents found it very helpful in communicating with him so the manager has agreed to purchase some from the RNID, Royal National Institute for the Deaf. Also in respect of diversity and disability in particular we are advised, by another care home also owned by the LB Croydon, that arranging suitable transport to convey wheelchair users on outings can be a problem. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are being assessed prior to admission and the Commission was able to confirm that suitable arrangements are in place to assess the needs of short-stay residents prior to admission to ensure that even in the short term their needs are clearly identified. Evidence: We have checked this section several times and found it satisfactory and we have no evidence to suggest otherwise on this occasion. The residents were the first to contribute to this section of the report and several said they were very pleased with the service they received in arranging for their admission, the admission process itself and the information provided as well as organising of their affairs including transport, medication, money and clothing. The home will be aware that several short-stay residents have said they look forward to staying each year, a tremendous endorsement of the home efforts to ensure the smooth running of short stay
Care Homes for Older People Page 10 of 24 Evidence: admissions. The information pack provided to each new residents, including the Service User Guide is well presented and includes all the information a new resident might expect including details of activities, religious observance, how to complain, fire safety, their contract, and the Commissions latest report. A very god effort by the home. The commission cross-checked the details provided by residents by examining the Service User Guide and talking to the person in charge as well as checking a range of records including the complaints record, care plans and menus. Areas of strength are residents very positive opinions about their own admission arrangements plus the well presented information given to new residents and as no matters requiring improvement arise this section, about choice on admission, remains assessed as good. Care Homes for Older People Page 11 of 24 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents can be met. Evidence: As with other good sections of this report the manager has told us there have been no substantial changes to the way this section is addressed. A plan of care is drawn up with each service user setting out their individual social and health care needs so that staff can use this plan as the basis for the care they deliver and these care plan include assessment of any risks to the residents health or their safety. The home is promoting and maintaining service users health by ensuring they have access to health care services to meet their assessed needs and in doing so the home is supporting service users to make decisions about how their health will be managed. Each residents case file includes details of all professional contacts including doctors, nurses, chiropodists, and so forth. Daily notes record how health care is being monitored and additional records such as weight, food and fluid charts are kept if needed. The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service
Care Homes for Older People Page 12 of 24 Evidence: users who wish to be responsible for their own medication so that they may do so safely - for example when residents manage their own diabetes including daily insulin injections. A resident was hoping for a more flexible diet even though diabetic and it is recommended that the home consult the Diabetic service to see how this can be safely managed by the home. This may include more frequent blood testing of the resident so as to balance diet and insulin. A detailed check of the procedures for handling medication, including the storage, recording and administration of medicines, identified no problems. When providing personal care staff are ensuring service users privacy and dignity is being maintained at all times so that service users feel their right to be treated with respect is upheld. It was noted that staff knock the door before entering rooms and ask the opinion of residents when the occasion suggests they should - such as turning down the television volume and so forth. The service user guide also indicates the respect and dignity are core elements of the care that will be provided. Areas of strength are the good management of health and social care and the effective management medicines, and as matters requiring improvement arise this section, about health and social care, is assessed as good. Care Homes for Older People Page 13 of 24 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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, including ay expectations in respect of their diversity. Evidence: The daily routines in this home are reasonably flexible, within the constraints of a large service. Service users are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so and so it was noted on the day of the inspection that there were a wide range of visitors including family and friends, and church visitors as well as professional health carers. The visitors book, a required record, confirms this social and professional contact with the wider community including a number of entertainers. Service users are in general receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences. We noted that the cooks consult residents about their choices of meals and several residents said the food was good. The cooks are willing to provide specialist meals and did so on the day of inspection. Despite a few reservations about meals, in general the residents said they were very happy with the catering in this care home. The home has
Care Homes for Older People Page 14 of 24 Evidence: a quiet, tranquil atmosphere. There is ample space for residents to sit where and with whom they please. Staff were with them throughout the day and often engaging them in some activity or conversation. It was also pleasing to hear residents in the various lounges supporting each other and chatting about their news and views clearly a group of residents who are getting on well together. Some residents have visual and hearing impairment and no specialist hearing devices are available for example in communal areas to enable residents to join in conversations and hear the television so a recommendation is rested to consult the RNID and RNIB who can supply suitable equipment. In respect of diversity, the person in charge advised the inspector that all residents use English as their language of choice although one or two are not English by birth. Other aspects of diversity were discussed, such as the accommodation of residents who may sensory or mobility problems, and the home seeks to meet such needs whenever possible, as it is registered to do so, and will be following suggestions about hearing aid devices for use in communal areas. Matters of sexuality diversity were also discussed and the person in charge said all residents are treated with tolerance and forbearance whatever their lifestyle or sexual orientation. Areas of strength are open and welcoming atmosphere of the home, the satisfaction of almost all service users and the social activity available to the that wish to participate. No matters requiring improvement but a recommendation is made again about meals hearing and visual support. This section, about daily life and social activities, remains assessed as good. Care Homes for Older People Page 15 of 24 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitable arrangements are in place to deal with complaints and the protection of adults. Evidence: No formal complaints arose during the course of the inspection. No complaints were made during this inspection, in fact many people complimented the home and staff team. Complaints the home receive appear to be dealt with properly, they are recorded are being dealt with in a professional and timely manner. The service user guide provides information to residents about how they may complain and the home appears to be very receptive to any concerns the residents or their representatives may raise. In respect of the protection of vulnerable persons from abuse staff were clear about reporting untoward incidents to managers and external agencies such as the local Social Service Department or the Commissions inspectors. The procedures for protecting vulnerable service users is satisfactory, the home has a copy of the local authoritys procedures for dealing with allegations of abuse but no such issues have arisen since the previous inspection. Areas of strength are manner in which complaints are dealt with and the procedures for protecting residents and as matters requiring improvement arise so this section, about complaints and protection, is assessed as good. Care Homes for Older People Page 16 of 24 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although an old and out of date building it is meeting current needs of residents. Evidence: Service users live in a safe, well-maintained and comfortable environment. This is a purpose built, but rather aged, care home and is subject to ongoing refurbishment. It was clean and comfortably warm at the time of inspection. Care Homes for Older People Page 17 of 24 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and the 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. Evidence: There were 23 residents in the home and there were 5 carers plus senior staff who can assist in the care of residents as required; plus the acting manager as the person in charge of the home. There were also numerous ancillary staff, including the Activities Lady, cooks, cleaners and maintenance personnel. A requirement is re-stated - to employ adequate numbers of permanent staff without unreasonable delay because agency are still employed regularly in this home. By interviewing staff it was apparent that they are well informed about their duties and are highly regarded by the service users. The home is still using many temporary agency staff each week; for example. The manager explained that on any one day there could be from one to four agency staff on duty. She did however explain that most would be regular agency workers with as much knowledge of the residents and their needs as the permanent staff. Several residents have in the past been critical of this and have said so in their feedback to the Commission but no critical comments about staff were made during our visit in 2008. The Commission is aware that the programme of new for old means that staff need to be redeployed around the local authority care homes as they are demolished and rebuilt but wherever possible staff must not be temporary if it will
Care Homes for Older People Page 18 of 24 Evidence: affect the continuity of care. Staff induction and training is satisfactory but last year there was no evidence in the staff files that staff are receiving regular supervised. There is now in place a computer based programme of supervision and appraisal which acts as tool for senior staff to support, monitor and supervise all staff and to monitor competencies. We checked a number of examples to confirm this system is in use and is ensuring regular supervision as required. Areas of strength are the kindliness of staff, their induction and ongoing training whilst a matter for continued improvement is the need for a stable staff team. So this section, about staffing, is again assessed as only adequate. Care Homes for Older People Page 19 of 24 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is being run in the best interests of the service users and. The manager needs to register with the Commission so as to confirm that she is a person competent to run this care home. The home is well managed, including finances and medication for example, and is safe for service users. Evidence: Service users throughout the home were full of praise for the home, its staff and management team. This is a competently run care home. The new manager is not yet registered with the Commission but she says she has many years experience in running care homes. The home is managed so as to ensure the health and well being of the service users. Record keeping is proficient. A wide range of records were checked, including the Visitors book, menus and other kitchen records, staff files, residents care files, cash handling records, the Service User Guide, fire and accident records and the record of complaints. All are maintained to an acceptable standard, so administration in this home is clearly satisfactory. Quality monitoring is based upon
Care Homes for Older People Page 20 of 24 Evidence: the views of service users this home is being run in the best interests of the service users. The home is ensuring that in so far as it is reasonably practical to do so, the health, safety and welfare of service users, and staff, is being promoted and protected and on this occasion no matters of safety need to be addressed. Areas of strength are the overall management of the home and the high regard in which management and staff are held by residents, although one matter requiring attention is the need to register a manager for this home this section is nevertheless assessed as good. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 27 18 The home is required to employ a consistent team of staff. So as to ensure continuity of care. 02/01/2009 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 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!
