Inspection on 10/09/08 for Brook House

This inspection was carried out on 10th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brook House 14/08/09

Brook House 03/07/07

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 13/03/2009.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Brook House 2-6 Forty Close Forty Avenue Wembley Middx HA9 7UU Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 10:25 10 September 2008 th X10029.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 Brook House DS0000069397.V366950.R02.S.doc Version 5.2 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 and Care Homes for Adults 18 – 65*. 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. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address 2-6 Forty Close Forty Avenue Wembley Middx HA9 7UU 020 8904 8371 F/P 020 8904 8371 brook@barchester.net www.barchester.com Barchester Healthcare Homes Ltd 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) Manager post vacant Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (29) of places Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N 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 34) 2. Physical disability - Code PD (maximum number of place: 29) The maximum number of service users who can be accommodated is: 47 3rd July 2007 Date of last inspection Brief Description of the Service: Brook House is part of Barchester Healthcare, which is a national company providing care mostly for the elderly and physically disabled younger adults. The home is about 9 years old and used to be part of Westminster Healthcare. Brook House is found in Forty Close, just off Forty Avenue. It is easily accessible by buses, which pass on the Forty Avenue. The home has parking spaces for more than 10 cars and there is additional parking on the road. The nearest shops and amenities are found in Wembley, a short distance away by bus or by car. There is a petrol station with some shopping facilities about two minutes walk from the home. The home is purpose built and has been re-registered for 29 young physically disabled (YPD) residents and for 18 elderly residents in 2004. Previously it only had 10 YPD beds and the rest of the beds were for elderly residents. It did not have 29 YPD residents at the time of the inspection, as the home was still undergoing a period of transition where the unit on the first floor, which used to be only for elderly people, was changing category from elderly people to YPD. The plan is for the YPD residents to be accommodated on the ground and first floor and the elderly residents to occupy the second floor. Accommodation is in 46 single bedrooms with 44 of these, en-suite. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 5 The fees charged by the service are: £550-£750 for elderly residents depending on the needs £800-£1200 for YPD residents again depending on the needs At the time of the inspection there were 43 residents in the home. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This is the first unannounced inspection that looked at the key standards for the period 2008-2009. It started on the 10th September 2008 at 10:25-19:00 and finished on the 11th September at 09:55-17:00. To obtain evidence about the service that the home provides we talked to residents, visitors to the home and members of staff. We also toured some of the premises and looked at a sample of records that the home keeps including the care records for five residents, personnel files and health and safety records. The manager completed an Annual Quality Assurance Assessment (AQAA) that was forwarded to the Commission in a timely manner. The AQAA was on the whole appropriately completed and was used in producing this report. We received two questionnaires from healthcare professionals and five from residents. We have used this feedback in this report. We also talked to seven residents, two visitors and six members of staff during the inspection Ten requirements have been imposed following this inspection as compared to twenty-three during the last inspection in July 2007. This shows improvement of the service. However many of the requirements that have been imposed during this inspection are in key areas that may affect the safety of residents. This is therefore reflected in the rating above. We would like to thank all residents, the manager and all his staff for a kind welcome to the home and for their support and cooperation during the inspection. What the service does well: The grounds of the home are maintained to a good standard and provide a pleasant view of the home. The home itself provides a homely and warm environment that is on the whole in an appropriate state of decoration. The communal areas are furnished to a good standard and provide comfortable surroundings for residents. The home offers a friendly and informal environment for residents and their visitors. Residents move wherever they want to, unless there were significant risks that have been identified. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 7 There is an opportunity for residents and their relatives to contribute to the running of the home. Residents’ meetings, relatives meetings and staff meetings are held regularly in the home. The manager has an open door policy to encourage people to approach management if they have issues that they want to discuss. On the whole the home’s staff are familiar with the needs of the residents and they try hard to make sure that the needs of residents are met. Staff understand the need to stimulate residents, to support them with social and recreational activities and to engage them in the local community. The home benefits from the use of a mini-bus that is used to take residents out for outings and to involve them in the local community. The home provides a flexible approach to the provision of meals and kitchen staff makes every effort to meet the wishes and choices of residents with regards to meals. Complaints are taken seriously and are addressed as required to reassure people that their concerns will be addressed as required. What has improved since the last inspection? One of the main areas where there has been improvement is the management of the home. The recruitment of a permanent manager and of a deputy manager to the home has brought some degree of stability and consistency to the home. Staff, residents and visitors to the home were positive about the future of the service and provided good feedback about the management team. All residents or their representatives now receive the home’s contract which they sign. This provides them with information about their rights and obligations when using the service. There has been an improvement in making care plans more comprehensive so that they reflect the care that is provided to individual residents. The needs of residents are appropriately assessed and care plans are put in place in cases where the needs of residents have been identified. Care plans of residents are now more comprehensive with regards to addressing the development of living skills or of other skills and appropriate risk assessments are in place if required. There has been progress in addressing the end of life care needs of residents. Staff are now more aware of the need to address this area of care in the plans after consulting with residents or with their representatives. There has been an increase in the involvement of residents and of their representatives in agreeing the care plans and risk assessments although more progress can be made in this area. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 8 The care plans addressing the prevention of pressure ulcers are more comprehensive about the repositioning regimes that are in place and the equipment to use. There is evidence that areas of health and safety are appropriately addressed and that appropriate maintenance of equipment is carried out as indicated, to ensure that equipment is safe to use. What they could do better: The preadmission assessment of prospective residents could be completed more comprehensively to demonstrate that the needs of the residents have been fully considered before the residents are offered a place in the home. When changes occur in the condition of residents or when the needs change, care plans must be formulated to address these areas. These must be drawn up with the residents or their representatives, to show that they have been fully involved in this process. The fact that some residents may be cognitively impaired does not necessarily mean that they cannot decide about their care. It would be appropriate to assess the different areas where residents have the capacity to make decisions about their life to promote their independence. The management of medicines must be tightened to make sure that all medicines are administered as prescribed and that appropriate records are kept to demonstrate that. That when controlled drugs are no longer in use in the home, that these be appropriately disposed of according to the medication procedure of the home. The recruitment of new members of staff must be carried out robustly. All the employment checks must be carried out as required and appropriate references must be in place for all members of staff. Once offered employment all new care workers must be offered the common induction standards as per Skills for Care. The personal identification number (PIN) for nurses must be checked against the register of the Nurses and Midwifery Council before they are offered employment and on a regular basis to make sure that nurses remain on the register to practice. Training must be provided to make sure that staff are fully trained to do the job that they do. They must have regular updates in all areas of statutory training including manual handling. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 9 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. The summary of this inspection report can be made available in other formats on request. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their representatives receive enough information about the service to decide if they would like to use the service. The needs of residents are assessed before the home accepts to take them, but the records about the needs’ assessments of residents are not that comprehensive. EVIDENCE: A copy of the service users’ guide (SUG) was kindly provided by the manager. It showed that it has been updated and contained the necessary information about the service, to enable people make a decision as to whether they would like to use the service. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 12 We checked whether people who use the service are offered a copy of the home’s contract. We found that a copy of the contact is normally included with the SUG when this is offered to new residents or their representatives. However there is a section at the back, in duplicate, to sign to say that they have received the contract. We noted that this section is not always signed. We looked at the care plans of three residents who were admitted to the home during the past year. Two had a pre-admission assessment that had been carried out by the home and third resident did not have one. We observed that the two pre-admission assessments had not been completed comprehensively and contained sections that had been left empty. These were also not always signed and dated. The findings of our inspection and feedback that was received during the course of the inspection suggest that the home is on the whole able to meet the needs of all residents that are accommodated in the home. All residents who sent comment cards were satisfied with the care and support that they receive in the home. Staff are sufficiently trained and are familiar with the nursing and personal care needs of the residents that are accommodated in the home. We also observed that staff interacted and communicated well with all residents including, the younger adults who live in the home. The composition of the staff’s group is also varied reflecting the work force that exists in the local community. They are therefore in a good position to understand the cultural and ethnic needs of the residents who are from ethnic minorities. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans on the whole reflect the needs of residents although these are not always kept updated when the needs of residents change. The home ensures that the healthcare needs of residents are met as required. The management of medicines is not always carried out to a standard that would ensure the safety of people who live in the home. End of life care of residents is provided to reflect the individual needs of residents in relation to this aspect of care. EVIDENCE: Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 14 We looked at the care plans of a sample of five residents to reflect the residents’ composition of the home. We found that the needs of residents were on the whole appropriately assessed and addressed in care plans. However the quality of the care records was different on the different units. Some care plans were very good and reflected the changing needs of residents while a few were not updated to reflect the changing needs of residents or when residents had new needs. For example the change in the elimination needs of a resident was not reflected in his/her care plan. Another resident was acutely ill and did not have a care plan and a third had a skin condition for which he did not have a care plan. A resident had a particular infection and no care plan was in place to address the management of this infection. The involvement of residents and/or their representatives in the care planning process also varied. Whilst some residents and/or their representatives were fully involved in the care planning process, in other cases residents, who might have been able to discuss their care, or their representatives were not involved. Whilst some residents may have some cognitive impairment, there are areas where they may still be able to make decisions and this should be encouraged. The above also identifies the need to assess residents’ ability to make decisions about their life at the point of admission and after regular period of time as these abilities may change with time. This is necessary to make sure that residents are involved as much as possible in making decisions about their life. Risk assessments were completed to address the risk of falls and developing pressure ulcers. There were also nutritional assessment and manual handling assessment. These were reviewed monthly or when the needs of residents changed. Care plans were in place when risks were identified. We however found from the care records that we inspected, that two out of the five residents have not been weighed in August and one of these two residents had also not been weighed in July. Residents must be weighed at least monthly, particularly when they are frail and at risk of malnutrition. Manual handling risk assessments were on the whole clear about the equipment to use and the number of staff that is required to perform the various manual handling manoeuvres. All residents presented as appropriately cared for and with a good standard of personal care, although the records about residents’ showers and baths were not kept comprehensively. All residents who replied to comment cards said that they were satisfied with the support that they receive in maintaining their personal care. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 15 Two residents in the home had pressure ulcers. There was evidence that the pressure ulcers were managed appropriately. Care plans were in place for people who had pressure ulcers or who were identified at high risk of developing pressure ulcers. The care plans were generally good and these were reviewed at least monthly. The equipment to use was identified and the repositioning regime was also identified. However repositioning charts were not always completed comprehensively to make them useful documents. There were risk assessments for younger adults who were involved in developing living skills such as learning to walk again or going out in the community. The purpose of the residents’ stay in the home and hopes and fears of the residents for the future were also addressed, to link with the skills that may need to be developed by the residents to achieve their aims. Progress was also noted with regards to addressing end of life care needs of residents. The needs, wishes and instructions of residents or of their representatives with regards to end of life care and funeral arrangements were identified at an early stage so that care plans could be put in place. The resuscitation status of residents was also addressed. Records showed that residents were seen by various healthcare professionals according to their needs. There was evidence to show that the GP, optician, dentist and chiropodist saw residents. We also saw comprehensive records about the input of the physiotherapist and the occupational therapist in supporting residents with regards to rehabilitation and developing new skills. Medicines management was inspected on all three floors. Each floor has a clinical room, but only one of the clinical rooms had an air conditioning unit, to keep the temperature below 25 degrees centigrade. The clinical rooms were kept tidy and clean. We found that the standard of medication management varied among the units. We found that there were some areas where signatures were not in place or where codes were not entered if the medicines had not been administered. We found in two cases that the amount of a medication to thin the blood, albeit by one tablet in each case, did not match what should be in place after considering the amount that had been received and the amount that had been administered, as per the records that were kept. This would suggest that on at least one occasion the residents did not get the right amount of medicines as prescribed, or that the records were not correct. On one occasion a medication was not transferred to a medication administration records chart in a timely manner which resulted in the resident not receiving three days of the medicine. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 16 One resident was involved in self-administration of some of the medicines and an appropriate risk assessment was in place. We were informed that appropriate storage facilities were also available to the resident. We checked the management of controlled medicines in the home and noted that all records were kept as appropriate. We also found the control medicines of three residents who were no longer in the home. One had not been in the home for about three months. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides social and recreational activities to suit the needs of the residents. A variety of nutritious meals are provided to residents to meet their individual needs. EVIDENCE: We found that the social and recreational needs of residents were appropriately assessed and recorded and that care records also contained a ‘life history’ of Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 18 the residents. Care plans were then put in place to address the social needs of residents. A weekly programme of activities was drawn up to reflect the general needs of residents, while individual needs that are specific to a resident are addressed on a one to one basis. Feedback from people about the provision of activities was most varied. Out of five residents who responded to comment cards one said that there is always activities in the home that the resident can take part in, one said usually, two said sometimes and one said never. We noted that residents have a choice of what they want to do, whether to take part in the communal activities or to do an individual activity. Some residents come to the communal areas and others stay in their rooms. A few residents have their own computers, music system and televisions. Some are able to watch DVD’s and satellite television according to their wishes. The home has its own mini-bus and arranges outings in the local community and to places of interests. We were informed that all residents, including older people have the opportunity to go for outings to places of interests. Some residents have been to bowling and to the cinema. Others have been to the shopping centres and to parks. We noted that a minister from a local church visited residents during the inspection and we were informed that ministers from the major churches regularly visit the home to offer spiritual support to residents. The home accommodates residents from a number of ethnic minorities. We were informed that the home supports the residents, where possible, to meet their religious needs and that residents and friends also take a role in supporting residents in this area. Inspection of the care plans showed that the spiritual needs of residents were appropriately addressed. Two out of the five residents who responded to comment cards said that they usually like the meals, one said he/she never like the meals and two did not reply to this section of the questionnaire. We observed Lunch being served on the first day of the inspection. There was tomato and red pepper soup, gammon baked with pineapple, cheese and tomato flan, roast and mashed potatoes, carrots and peas. For desert there was gooseberry pie with custard or ice cream and yogurts. The dining areas provided a congenial setting for residents to have their meals. The tables were all appropriately prepared and set for residents to have their meals. Some residents had their meals in the dining areas and others had their meals in their rooms, according to their wishes. The home also employs a hostess to help with the serving of meals. She spreads her time on all the floors and serves drinks and meals to residents and Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 19 to visitors to the home. This is an improvement of the hotel services to residents. The home has a four weekly menu cycle but the provision of meals was on the whole flexible to accommodate the wishes of residents and in many cases food that was not on the menu was prepared for residents, particularly for those residents from ethnic minorities. Residents who were able to make choices about their meals were asked about their choices and these were recorded and were available when the meals were dished out for residents. We noted that meals were served and presented appropriately for residents and that people who needed support with their meals were supported discreetly by staff. The kitchen was clean and tidy and all appropriate records were kept as required, except for the range of food that is cooked in the home to enable someone inspecting the records determine if the diet that is provided to residents is appropriate. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People can be confident that their complaints and concerns will be taken seriously and appropriately addressed. Allegations and suspicions of abuse are recognised and are appropriately dealt with to ensure the safety of people who use the service EVIDENCE: The home has had three complaints since the last inspection. All three were received by the commission. One was anonymous and was referred to the safeguarding adult team of the Local Borough and to the home for investigation. Another was referred to the home and was satisfactorily resolved and the third was withdrawn. Issues that were raised in the complaints included care practices, standard of personal care and medication management. All the complaints were dealt with according to the home’s complaints procedure and were appropriately investigated. Reports were produced as required. Some of the issues were Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 21 substantiated and others were not. Action plans were produced where required to address issues that needed to be addressed. As mentioned above there has been one referral to the safeguarding adult team following an anonymous complaint. The manager was able to describe the procedure to follow in cases of allegations or suspicions of abuse. We also noted that induction training in safeguarding adult is provided as part of the overall induction of all new staff. Further training is provided in safeguarding adult as part of the yearly update of staff. Staff who were spoken to said that they would report any allegations or suspicions of abuse to the person in charge. All residents who responded to comment cards said that they knew how to make a complaint and four out of the five said that they always or usually knew who to speak to if they were not happy about an aspect of the service that the home provides. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a clean, well decorated and homely environment for the comfort of residents. EVIDENCE: The grounds in the front of the home were tidy and maintained. The grounds at the back of the home have been landscaped and there were flower beds, Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 23 shrubs and bushes to provide a pleasant environment. There were also seating areas and we observed many residents sitting outside to enjoy this area. The communal areas on the ground and the first floors were decorated to very good standards. Items of furniture were of a homely nature and the areas were decorated to provide a homely feel. The communal area on the second floor was also good but not as good as those on the other floors. Bedrooms of residents were appropriately decorated and personalised. We saw that many residents brought items of decorations, pictures and photographs to personalise their rooms. The home was also flexible with regards to how residents wanted their rooms to be arranged to suit their individual needs. In the past we have mentioned the provision of equipment that would promote the independence of residents particularly for those residents who have mobility impairments and/or who are not able to fully use their hands and/or arms as a result of accidents, disabilities or illnesses. The equipment could be used to promote independence with simple tasks such as switching lights off, switching the TV on, setting the volume or calling the nurse. We were informed that one resident had such equipment and that no other residents require these items of equipment. The deputy manager reported that these items of equipment will be provided when residents are assessed as needing these. There is a set of double doors to the home. The outer set of doors open automatically if one is coming from the outside and the inner set of doors is operated by a code pad. Staff are able to operate the inner doors when there are visitors to the home. When going out of the home there are hand pads that can be pressed to go out. The home had a redecoration plan and we were informed that the rooms of residents are normally decorated when they become vacant. The manager stated that the organisation is keen to maintain the décor the home and to make sure that the home provides a homely and warm environment for residents. We observed many support workers during the course of the inspection cleaning the home. The home was on the whole clean and free from odours. One comment card mentioned odours in the hall way. We also noted that there was an odour in one of the hallways, but that was temporary as on our second visit to that area a few hours later, there were no odours. There are also laundry assistants to carry out the laundering of residents’ clothes. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole the needs of the residents are met appropriately by the staffing levels that are provided by the home as long as these are maintained. Recruitment of staff is not always carried out robustly to ensure the protection of people who use the service. According to the training records the standard of training is not very good to make sure that staff are fully trained and competent to do their job. EVIDENCE: On the day of the inspection there were one trained nurse and two carers for the ground floor, one trained nurse and three carers for the 1st and the 2nd floors. At night there were one trained nurse and 1 carer for each floor. Feedback from staff suggested that there have not been always two carers on the ground floor and that on many occasions there were only one carer. They Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 25 say that when this occurred then this put extra pressure on them to meet the needs of residents. The manager explained that the home had a vacancy of one trained nurse and two carers as a few members of staff have left for personal reasons. He added that he has been recruiting staff to fill the vacancy and that he would also recruit more bank staff. He said that there were occasions when staff were sick and the home had not been able to get a bank staff or agency staff to cover the shift. He now makes sure that are two carers on the ground floor with a trained nurse to meet the needs of the residents who are accommodated on that unit. We looked at the personnel files of four members of staff. The personnel files were kept tidy. We noted that on the whole application forms were filled as required except for two applicants when the work history were not completed close to the month, to ensure that there were no gaps in the work history. One member of staff had references from colleagues and not from the previous employer and another had two testimonial references addressed ‘To whom it may concern’. There was no evidence that the personal identification number (PIN) of a nurse had been checked against the register before offering employment to that person. There was evidence that CRB checks had been carried out and that eligibility to work in the UK had been checked for all the applicants. Staff’s training records showed that they received the home’s induction training when they were recruited. The home’s induction covered issues within the home and the organisation but we noted that it did not cover the common induction standards are per Skills for Care. These were downloaded by the manager for future use in the home. A training matrix was kindly provided to the inspector to analyse the training that has been provided in the home. We noted that most staff have had training in safeguarding adults and infection control. We however found that only eight members of staff were up to date with fire training, out of group of about fifty members of staff, and that thirteen were not up to date with manual handling training. According to the records staff have had training in cardio-pulmonary resuscitation, some aspects of palliative care, documentation and risk management. The AQAA said that all members of staff have had training in food hygiene although this was not reflected in the training matrix. From the AQAA we noted that the home has 37 permanent and agency/bank carers. Out of this number, 15 have an NVQ qualification in care. As a result, the home does not yet have 50 of its carers trained to NVQ level 2 or above. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 30, 33, 35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a permanent manager who runs the home in an open and inclusive manner. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 27 There are appropriate quality management systems in place to make sure that the home is able to monitor the quality of the service. Personal money of residents is managed appropriately to prevent financial abuse. Health and safety issues are addressed to make sure that residents, staff and visitors are kept safe. EVIDENCE: The manager of the home has been appointed since April and is the first permanent manager for a long time. There have been at least three temporary managers since the last inspection. The manager stated that he has managed care services in the past. He is a trained nurse and has a manager’s qualification. He stated that he was in the process of lodging his application to be the registered manager for the home. There was evidence of monthly residents’ meetings and staff meetings. He also stated in the AQAA that he has an open door policy. That was indeed visible during the inspection when many residents came to see the manager or talked to him. While talking about the care of residents we noted that he was familiar with the residents and their needs. The home has a quality assurance policy and quality control systems that consist of satisfaction surveys and audits. There is a schedule of audits when a particular aspect of the service is audited each month. For example, care plans may be audited one month, catering the following month, then personnel files etc….We were informed that this is carried out regularly according to the audit schedule that is drawn up by head office. The head office also monitors the individual services for compliance with the audit schedule. We were informed that the home carries out a yearly residents’ survey and the results are analysed a report is produced about the findings of the survey. This was available for inspection. Areas where the home did not score so well are identified and action plans are put in place. We checked the management of residents’ money by the home. We were informed that about four residents have money with the home. The money is banked in an account that is managed by head office. Expenditures by residents or on behalf of residents are made with the home’s petty cash. The head office then adjusts the residents’ money after notification by the home. We checked for a number of safety certificates. We noted that the gas safety certificate, electrical wiring certificate, portable appliances Test certificate and safety certificate for Legionella were in place. There was evidence of weekly fire detector tests and of monthly emergency lights test. The checks had not always been carried out regularly but with the appointment of a new Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 28 handyman, these checks are now carried out regularly. There were also records of water temperature, but we did not see records of checks on wheelchairs. Records showed that the fire detection system and fire fighting equipment were regularly maintained. Records also showed that there has been one fire drill, since January 2008.The fire drill took place during the day. It is recommended that a fire drill be arranged at night so that all staff are fully aware of the procedure to follow if there is a fire. The home had up to date health and safety risk assessment, fire risk assessment and an emergency fire plan. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 29 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 3 2 3 3 2 4 3 5 x 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 3 22 X 23 X 24 3 25 X 26 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 30 Yes 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 OP3 Regulation 14(1,2) Requirement That the preadmission assessments be completed comprehensively to provide as much information about the needs of residents as possible. These must also be signed and dated. Care plans must be put in place whenever a need is identified or when there is change in the needs of residents, including in cases when residents are acutely ill. These must be drawn up or reviewed with residents and/or with their representatives as far as possible. Residents must be weighed at least monthly to monitor their nutritional status. Medicines must be administered as prescribed to ensure the safety of residents and the appropriate records must be kept. If not administered the correct endorsement must be used. All medicines, including controlled drugs must be DS0000069397.V366950.R02.S.doc Timescale for action 15/11/08 2 OP7 15(1,2) 15/11/08 3 4 OP8 OP9 12(1) 13(2) 15/11/08 15/11/08 5 OP9 13(2) 15/11/08 Version 5.2 Page 31 Brook House 6 OP15 17(2) 7 OP28 18(1)(c) disposed of as required to ensure that medicines is managed safely in the home. There must be a record of all food that is cooked in the home to demonstrate that the home provides meals that are varied and nutritious to people who use the service. The home must have 50 of its care staff qualified to NVQ level 2 to ensure that staff are fully competent to care for residents (Repeated requirementtimescale 31/12/06 and 31/12/07 not met). 15/11/08 31/08/09 8 OP29 19(1) 9 OP29 18(1)(c) 10 OP30 18(1)(c) 15/11/08 The procedure for the recruitment of new staff must be strictly followed to ensure the safety of people who use the service. All employment checks must be carried out including ensuring that appropriate references are received and that the relevant personal identification numbers of nurses are checked against the register. That induction training be 15/11/08 provided, to all new care workers to cover the common induction standards as per Skills for Care. To promote health and safety, 31/12/08 all members of staff including support staff must be up to date with statutory training including fire training and manual handling training. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 32 No. 1 2 3 4 5 Refer to Standard OP2 OP7 OP8 OP8 OP38 Good Practice Recommendations That the home’s contract is signed to show that residents or their representatives have received/agreed to these That residents’ ability to make decisions and the areas where they are able to make decisions be assessed and recorded Repositioning charts should be completed comprehensively for these to be useful document The records about the showers and baths of residents must be kept comprehensively. Otherwise it looks like residents are not receiving showers and baths. It is recommended that a fire drill be also arranged at night so that all staff be fully aware of the procedure to follow if there is a fire. It is recommended that wheelchair checks are carried out monthly. 6 OP38 Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © 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. Brook House DS0000069397.V366950.R02.S.doc Version 5.2 Page 34 - 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. 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