Inspection on 14/08/09 for Brook House

This inspection was carried out on 14th August 2009.

CQC 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 10/09/08

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 16/02/2010.

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 14th August 2009 11:00 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.V377835.R01.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.V377835.R01.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) John Alasdair Gilfillan 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.V377835.R01.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 10th September 2008 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 ten 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 that pass on the Forty Avenue. The home has parking spaces for more than ten cars and there is additional parking on Forty Close when the are no events in Wembley Stadium. 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. 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.V377835.R01.S.doc Version 5.2 Page 5 The fees charged by the service are: £550-£750 for elderly residents depending on their needs and £800-£1200 for YPD residents again depending on their needs. At the time of the inspection there were 43 residents in the home. Brook House DS0000069397.V377835.R01.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. The key unannounced inspection took place on Friday 14th August 2009 from 11:00-19:15 and on Tuesday 1st September 11:30-15:45. The findings of the inspection are based on a partial tour of the premises, inspection of a sample of records and conversation with the manager, nine members of staff and six residents. A completed Annual Quality Assurance Assessment (AQAA) was also sent to the Commission as part of the regulatory process. This was completed by the manager and was used where appropriate in completing this report. Satisfaction questionnaires were sent to get the views of people who use the service. We received six questionnaires from residents, two from healthcare professionals and one from a member of staff. We would like to thank all the residents and the visitors who gave us feedback and the manager and his staff for their assistance during the inspection. What the service does well: Residents’ questionnaires say that staff are warm and friendly and give a good standard of care, including nursing care. Two of them commented that their visitors to the home are always made to feel welcome. One resident said that the home ‘is by far the best in terms of care service and standards’. The needs of residents are generally well addressed in care plans and risk assessments. These are agreed with residents and/or their representatives to ensure that these are what residents or their relatives expect from the service. The care plans and risk assessments are in place to promote the independence and inclusion of residents in the community. The home is on the whole well maintained and is appropriately decorated and furnished. The bedrooms of residents and the communal areas provide a homely and personalised environment for residents to enjoy. The home provides staffing levels that it thinks is required to meet the needs of residents and makes sure that staff are appropriately recruited and trained to meet the needs of residents that are accommodated in the home. The member of staff who returned a questionnaire said that the standard of training that the home provides, ensures that staff are skilled and competent to do their job. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 7 The manager of the home is experienced and familiar with running a care home for people requiring nursing care. He is aware of the outcomes that are required for the residents. Comments from two residents showed that he acts promptly when issues are raised with him and that he cares for residents. What has improved since the last inspection? What they could do better: The weakest area of the service is the management of medicines. Many issues were noted that could put residents at risk. We had identified during the last inspection that medicines management needed improving, but significant improvement has not occurred. The home must now improve the management of medicines as failure to do so will result in enforcement action. While improvement has been noted about the physical and nursing care that residents receive in the home we noted that the interaction and level of engagement of staff with residents need to improve. We noted some very good examples of interaction and engagement but also some examples where there was little interaction and practically no engagement of residents. In some cases staff seem to be driven by a ‘task centred’ approach to the organisation of care rather than meeting the individual needs of residents through a ‘person centred’ approach. One healthcare professional also noted that there is a reliance on caring for physical needs and completing paperwork rather than engaging with residents. A visitor to the home said that the atmosphere in the home is too quiet and that there is not enough interaction with residents. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 8 Apart from looking at the way the delivery of care is organised in the home to explain the low level of engagement at times, questions were also raised as to whether the level of engagement is low because of low staffing levels. Nursing staff were not always clear of the location of the first aid equipment, including the suction machine to make sure that they were fully prepared to deal with a first aid emergency. The suction machine itself was not prepared and ready to use in an emergency. The quality management system must be overhauled to make sure that areas that need improvement are identified by the quality management system so that the management of the home can then address these areas. The home has also had a number of trained nurses’ vacancies. One had been filled at the time of the inspection and there was another vacancy to fill. It is positive that the home has used agency staff where required to fill in the shortages of staff, but the absence of permanent members of staff has in some cases affected the quality and consistency of the provision of care and support to residents. The home must look at ways of retaining staff, as this is important to ensure consistently good outcomes for residents. 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.V377835.R01.S.doc Version 5.2 Page 9 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.V377835.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an admission procedure and has systems in place to make sure that people have all the necessary information for them to make an informed decision about using the service. Prospective residents’ needs are comprehensively assessed by the manager or his staff to make sure that the home will be able to meet the needs of the residents. EVIDENCE: Since the last inspection, the manager has been registered. He has had to update the statement of purpose and the service users’ guide as a result. We did not look at these documents on this occasion as the format and content of Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 11 these has in the past been appropriate. The manager stated that all new residents or their representatives receive a brochure when they are admitted to the home. Of the six residents who responded to our survey, only two said that they were asked about whether they would like to move into the home. This could well be because of their condition before they were admitted to the home. This to some extent is the responsibility of the funding and commissioning authority rather than the home. Five however, said that they received information about the service before moving in. The manager stated that prospective residents or their representatives are encouraged to visit the home, stay for meals and to meet members of staff and residents. The prospective residents and their representatives can then decide if the home is suitable and the home can also decide if the home is suitable for the prospective resident and if the latter will fit in with other residents who already live in the home. Two visitors that we spoke to confirmed that they visited the home to decide whether the home would be suitable for their friend/relative. One of them said they ‘instantly liked the home’. In addition to that the manager visits all prospective residents to assess their needs and to answer their questions. We found preadmission assessments of the needs of the residents in the care files of two newly admitted residents that had been completed by the manager. These were on the whole comprehensive and were signed and dated by the manager. In some cases the needs’ assessment of local authorities or discharge letters from previous places of stay were available to provide more information about the needs of prospective residents. We looked at the contracts/statements of terms and conditions for two residents and noted that these were signed by residents or their representatives and were in place in the care file. This is an improvement as in the past these have not been on file. The home admits people with younger adults care needs and people with elderly frail care needs requiring nursing care. Feedback from residents and their relatives showed that they were satisfied with the standard of care that is offered to residents. The younger adults are in the main accommodated on the ground and first floors and older people mostly on the second floor. The home is accessible to wheelchair users, including to those who self-propel. Most members of staff have worked in the home for a number of years and are familiar with the needs of the residents. Staff also come from the multi-cultural area of Brent and are familiar with the cultural, spiritual and ethnic diversity of people that live in the home. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 12 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): 7-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care records on the whole appropriately address the needs of residents and are agreed with residents or with their representatives. Residents are supported with their healthcare needs to ensure that these are appropriately met. There are some omissions with the management of medicines that could be putting residents at risk. End of life care is generally managed well although the resuscitation status of residents needs to be clarified and agreed with all concerned parties as appropriate. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 13 EVIDENCE: We looked at the care records of four residents and visited them to talk to them where possible to see if the care records accurately reflected the needs of the residents. We noted that the needs of residents were assessed in detail and recorded appropriately. Care plans were in place to address the needs of residents and there were action plans in place to describe how the needs of residents should be met. The care plans also addressed the cultural, religious and ethnic aspects of the needs of residents. There were also short term care plans when residents developed short term needs. Risk assessments were in place to address the risks that residents face in their daily life while enabling their independence. There were risk assessments for falls, pressure ulcers, manual handling and nutrition. Other risk assessments were in place such as when bed rails were used or when residents were not able to use call bells. Younger adults also had risk assessments in their care records to address areas of risk taking while developing or consolidating individual living skills such as going out and travelling by public transport in the community. Care plans and risk assessments were drawn up and agreed with residents or with their relatives. These were reviewed monthly or more often if required. Two residents said that staff and managers always listen and act on what they say and four said usually. One visitor mentioned that there could be more regular reviews with their involvement to discuss changes in residents’ conditions and to provide them with an update. Three residents out of the six who returned satisfaction questionnaires said that they never make decisions about what they do all day. One said always, one said sometimes and one did not respond to this section. Only one said that they could do what they want during the day, in the evening and at the weekend. This therefore raises question about residents’ being assessed for capacity for them to make decisions about their care and support and staff complying with the outcome of the assessment to ensure that residents rights to make decisions about their care, are respected. If the home purports to promoting the dignity of residents then it must demonstrate that it promotes the rights of residents to make decision about their care. There was one resident in the home with a number of pressure ulcers that developed in the home. We noted that the home did not find out about how the pressure ulcers developed. This would have been useful to identify the possible reasons, if there were any, that led to the pressure ulcers developing Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 14 and to learn lessons to make sure that every step would be taken in the future to prevent pressure ulcers from developing. At the time of the inspection all the pressure ulcers were healing. While touring the premises we noted that the air pressure of a few pressure relief mattresses was not always adjusted to reflect the weight of the resident. In one case the pressure was too low for the resident and in two cases the pressure was too much. It is important that the pressure relief equipment be adjusted to the right pressure as without this the equipment might contribute to the development of pressure ulcers instead of preventing pressure ulcers. Care records showed that residents were weighed at least monthly and records were kept about the weights of residents. The nutritional risk assessments were kept updated to reflect the risk of malnutrition. Residents presented as having a good standard of personal hygiene. They were all appropriately dressed and groomed. Male residents were appropriately shaved and female residents appeared well groomed. Both healthcare professionals and residents who sent us questionnaires agree that the residents receive a good standard of personal care. One healthcare professional said that staff attend to the physical care needs of residents well. On the day of the inspection one resident did not have their hearing aids fitted appropriately but we were informed that the resident sometimes removes the hearing aids and does not put them back properly. We also noted that a resident was placed inappropriately in their chair, most likely from the time they were seated in the chair as they had a safety belt around them. The position that they were placed must have caused them some discomfort but this had not been noticed until we saw this and raised concerns at about 11:00. This incident although isolated raise questions as to whether staff give sufficient attention to detail when caring and supporting residents. There were times when we noted staff engaging and talking to residents but there were also times when there were little interaction and engagement. Staff seemed more engaged in completing the day to day tasks than engaging with residents. On one unit we noted that there were no staff in the lounge engaging with residents for at least one hour. We also observed that staff did not always engage with, or divert the attention of residents when they exhibited particular behaviours. One resident had a particular behaviour during meal times but we did not see any members of staff intervening to divert the attention of the resident from this behaviour. Care records showed that residents were seen by various healthcare professionals according to their needs. We also noted that there have been a number of occasions when the manager made referral through the GP service for residents to access particular healthcare services. The manager said in the Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 15 AQAA that he sometimes accompanies residents when they go out for outpatients. Staff demonstrated that they have to some extent addressed residents’ fears and hopes for the future including the end of life care of residents in the care records. There was however some progress to achieve in this area. For example one care plan about the fears for the future of residents said, when it was first written that relatives need to be approached for more information about this area of care. We noted that for this specific person, this area has still not been addressed more than six months after they have been admitted. The care records contain a section to record the resuscitation status of residents. We noted that the resuscitation status of residents has still not yet been clarified in the care records of three of the four residents’ records that we looked at. We looked at the management of medicines on all the floors. There is a medicines room on each floor but only the first floor medicines’ room is airconditioned. The temperature readings of all medicines rooms and of medicines fridges were taken once daily and recorded to demonstrate that the temperature of these areas was suitable to store medicines. There were new medicines reference books in the home for staff to refer to, if they had queries about medicines. We noted that one resident ran out of a medicine for about twenty-one days and another resident ran out of a blood pressure medicine for three days. The medicines should have been ordered in a timely manner to ensure that the medicines do not run out. In the case when a resident ran out of a medicine for three days, records showed that staff still signed that they gave the medicine on the second day after the medicine had run out. There were a number of signatures missing on the medicines administration chart for at least three residents suggesting that medicines were either not given or not signed for. Not administering medicines to residents could have a detrimental effect on the welfare of the residents. In at least one case a code was used in the MAR, but no definition of the code was given to explain the reason why the medicine had been omitted. A few medicines were not carried forward after a medicines’ cycle had finished to the new medicines’ cycle and it was therefore difficult to audit the amount of medicines. The amount of at least five medicines in stock on the day of the inspection did not match the amount that should be in place taking into consideration the amount that has been received and the amount of medicines that has been administered. This again could be because medicines had not been administered or because the amount of medicines that remained from a previous cycle had not been brought forward. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 16 In one case the wrong dose of an anti-coagulant medicine was signed for when there were instructions from the anticoagulation clinic to give a different dose of the medicine. This suggests that the wrong dose of medicine was administered, which could have had a detrimental effect on the welfare of the resident. The management of controlled drugs (CD) was appropriate. We checked the amount of a few CD medicines and checked the CD book and noted that the amount of these CD medicines reconciled with what should have been in place. Brook House DS0000069397.V377835.R01.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides some internal and external social activities for residents, although at times there is an evident lack of engagement and stimulation for residents. Residents receive a nutritious and varied diet and are able to make choices about their meals. EVIDENCE: Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 18 Residents have an assessment of their social and recreational needs and a ‘life history’ in their care records. These provide information about their backgrounds and their social and recreational interests. Care plans are also in place to address these needs. The home had a bank activities coordinator to temporarily replace the permanent activities coordinator at the time of the inspection. We noted that a programme of activities was in place. After talking to staff and the activities coordinator we concluded that a number of internal and external activities are arranged for residents. However, our observation during the inspection showed that the level of interaction of staff with residents were different on different floors. We noted good interaction of staff with residents and we also noted occasions when residents sat on their own in communal areas, for part of the day with little stimulation and engagement. In these circumstances, we noted that members of staff were involved in completing various tasks and that as a result there was nobody to engage with residents. Comments were also received from a healthcare professional and one visitor to substantiate this. They say that there is an over reliance on the television to stimulate residents. We noted that the home encourages residents, particularly younger adults to be involved in the local community and to build independent living skills. The home has a minibus but there are also residents who travel by public transport. We found that residents have gone to the cinema, sea-side, shopping, swimming pool, for walks, to places of interests and to places of worship. Older people also have the opportunity to go out and to take part in these external activities. One resident said that they have been shopping. A few residents were noted sitting on the patio area and garden at the back of the home, sometimes with their visitors. Most of the residents who sat outside were those who could propel themselves and there were no residents that were wheeled by staff to sit outside. One comment that we receive in our questionnaires suggests that more residents could be taken to the garden by staff, to enjoy fresh air and the warm weather. They suggest that care staff are so busy that they do not have the time to take residents outside. Representatives from the main local churches visit the home on a regular basis to offer spiritual support to residents. We noted that residents from other churches/religions also receive spiritual support that they or their relatives have arranged. We noted that they were supported by members of staff in these endeavours. Lunch on the first day of the inspection consisted of spinach soup, chipped potatoes, fish, carrots and peas, vegetables with pasta and for desert there was apple and cherry crumble with cream. For supper there was Chinese chicken soup, egg Florentine, ham and potato salad, a selection of sandwiches Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 19 and banana and custard. We also noted that fresh pastry was baked for residents to have with their afternoon tea at 15:00. In addition to that the chef prepared other choices for residents who did not eat the above meals, taking into consideration the cultural choices and needs of residents. The dining area was generally prepared to provide a congenial atmosphere for residents to have their meals. In one case however food started to be served without the tables being set appropriately and staff wearing appropriate protective clothing. Residents were supported with their meals as required and on the whole in a discreet and appropriate manner. The kitchen was tidy and clean and we were informed that all items of equipment were working as required. We noted that checks of fridges’ and freezers’ temperature were undertaken and recorded. The cleaning schedule was also complied with. Brook House DS0000069397.V377835.R01.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): 22-23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Practices in the home ensure that complaints and allegations and suspicions of abuse are taken seriously and acted upon as required to ensure the safety of residents. EVIDENCE: We looked at the complaints records that the home keeps and noted that there have been four complaints since the last inspection. All the complaints were acknowledged and responded to as per the complaints procedure of the organisation. Copies of the complaints procedure are available in the service users’ guide and in the foyer of the home. The manager states in the AQAA that ‘Staff receive POVA training and are aware of the whistle blowing policy. Relatives and residents can approach the manager at anytime. Complaints are treated with all due importance even the smallest thing. They are not deterred from speaking to head office and CQC’. He also adds that the fact that he has an open door policy ensures that people can approach him and talk about their concerns and most of the times the issues are addressed before these become formal complaints. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 21 All six residents who responded to our survey said that they knew who to speak to if they were unhappy about their care and five said that they knew how to make a complaint. Five also said that they are always treated well by the manager and his staff and one said usually. Since the last inspection one allegation of abuse has been reported by the home to the safeguarding team of the Local Borough. Discussion with the manager shows that he is fully aware of the action to take if allegations of abuse are made to him. Members of staff that we spoke to are also aware that they should report all allegations or suspicions of abuse to the manager. The training records showed that nearly all the staff have had training in safeguarding adults. The manager confirmed that whistle blowing is included in the safeguarding adults training. Brook House DS0000069397.V377835.R01.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): 19,24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a maintained and comfortable environment for residents to enjoy. EVIDENCE: The grounds of the home are well maintained. The garden at the back has been improved in terms of access and landscaping and offers a pleasant area for residents and their visitors to enjoy. The manager stated that there are Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 23 plans to make part of the garden a ‘sensory garden’. The exterior of the building was on the whole maintained. The home was in a good state of decoration and maintained. Corridors and communal areas were in an appropriate state of décor and fixtures and fittings were in good order. We noted that the carpet along the main stairs was being replaced on the 2nd day of the inspection. There was evidence of ongoing decoration in the home. The manager stated that bedrooms of residents tend to be repainted when they become vacant ready for the next admission. There are dining areas on all floors and these areas were also in an appropriate state of decoration and appropriately furnished. We visited a few bedrooms and noted that the ones that we visited were in a good state of décor. Many bedrooms have been personalised and we noted that residents or their relatives have brought their photos, pictures and items of decoration to personalise their rooms. The home is fully wheelchair access and has a number of aids to promote the independence of people with physical disabilities. Hoists are maintained as required. Each floor has a sluice, which was kept clean. There were facilities for hand washing in all bedrooms of residents and in bathrooms and toilets. Alcoholic hand rub was also available in clinical areas. There was evidence that universal precautions were being observed when caring for residents. We noted that precautions were also in place to address the care of residents that had specific infections. One visitor mentioned that they have observed, particularly new members of staff not removing gloves when they have attended to residents and then touching other things in the rooms with the gloved hands. We did not observe this during the inspection. The home was clean and there was no odours during the inspection. Four residents out of six who sent questionnaires said that the home is always fresh and clean and two said usually. Two persons commented that the home and the bedrooms of residents are usually clean and one person said that ‘the main corridor is occasionally a bit smelly’. Brook House DS0000069397.V377835.R01.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriate staffing levels to meet the needs of the residents that are accommodated in the home. Members of staff receive a range of training to make sure that they are skilled and competent to do their job. EVIDENCE: The home provides a trained nurse and two carers for the ground floor, one trained nurse and three carers for the first floor and a trained nurse and three carers for the second floor. At night there is a trained nurse and a carer for each floor. The home has a trained nurse vacancy at the time of the inspection. One trained had recently been recruited and was working her first few days in the Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 25 home. We were informed that a few nurses had left. The home however used agency staff where required to ensure appropriate nurse cover on all the units. Feedback from questionnaires shows that residents are satisfied with the way that they are treated by staff. There were many positive comments about staff such as ‘they always try to do their best’, ‘staff are warm and friendly’ and ‘carers and nurses are good’. As discussed in the section under ‘Personal and Health Care’ we are of the view that while staff generally attend to the physical needs of residents well, there is a lacking with regards to the level of engagement and stimulation of residents by staff. We looked at the personnel files of three members of staff. The administrator, who was new at the time of the last inspection, has updated the files and has made sure that the personnel files were kept up to date. Each file that we looked at contained an appropriately completed application form, two references, evidence of proof of identity and eligibility to work in the UK. Induction records for each member of staff, whose files were inspected, were also available. The home has appointed a trainer. She gave us records about the training that has been provided to staff and the training that has been arranged in the home. She is also responsible to provide the induction of new members of staff and to ensure that all staff are up to date with all mandatory training. As a result of this, we were able to see a marked improvement in the standard of training that staff receive in the home. The records provided showed that the majority of staff were up to date with training in mandatory areas such as fire training, manual handling, protection of vulnerable adults and food hygiene. Other training has been provided for staff in areas such as catheterisation, catheter care, nutrition training, tracheostomy care and customer care. The AQAA told us that the home has 34 care workers. The latest list provided by the manager indicates that 18 care workers have an NVQ level 2 in care. As a result the home does now have 50 of its care workers trained to NVQ level 2 or above. The areas for improvement for the home according to the AQAA is ‘To offer a wide variety of training and professional development and encouraging more staff to do their NVQ’s or higher training. To maintain staff audit and training records for each member of staff’. Brook House DS0000069397.V377835.R01.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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and fully aware of his roles and responsibilities in ensuring that the aims and objectives of the home are met. Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 27 The home manages the personal money of residents to a good standard to safeguard the interests of the residents. The quality management system is used to monitor the quality of the service that is provided. Health and safety issues are taken seriously and are addressed to ensure the safety of all people that use the premises. EVIDENCE: The manager was appointed in April 2008 and since then has been registered. He has many years experience managing care services and is a trained nurse and has the Registered Manager’s Award. He is supported by a deputy manager and the line management from Barchester. The manager keeps an active presence on the floors and has an open door policy. All residents seem to know him well and he was also familiar with the needs of residents and their circumstances. Minutes of meetings with residents, relatives of residents and staff were available for inspection. The manager stated that there is a residents meeting practically every month. Minutes confirmed that there was a meeting every 1-2 months. The home uses the quality assurance procedure of Barchester. A yearly satisfaction survey is conducted and there is a range of audits that is undertaken. There are ‘theme’ monthly audits and a full yearly audit that is carried out by the quality assurance department of Barchester. The themes for monthly audits are chosen by the Quality Assurance department and address areas such as hygiene, infection control, catering or care records. The manager reported that the last survey was carried out in October 2008 and that another survey will be conducted around the same time later this year. We looked at the management of the personal money of residents. We were informed that the home keeps very little money of residents and that in most circumstances any expenses that are made on behalf of residents are paid by the home and then added to the monthly invoice of the individual resident. We noted that property record sheets were in place and that in most cases these were completed to record the property and valuables that had been brought into the home by residents or by their representatives. We looked at all the records regarding health and safety checks and maintenance and noted that all were being carried out as required. These included weekly fire detector tests, emergency lights tests, hot water Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 28 temperature checks and general bedroom and health and safety checks. Records were also in place to show that items of equipment were maintained as required. Mandatory training with regards to health and safety was also provided to all staff and the home had up to date health and safety and fire risk assessments. Brook House DS0000069397.V377835.R01.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 3 4 3 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 x 22 x 23 x 24 3 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 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.V377835.R01.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 OP8 Regulation 12(1) Timescale for action The home must have a system in 06/11/09 place to monitor and ensure that the pressure relief equipment is set up according to the individual circumstances of the residents to ensure the optimal benefit of the equipment. That all first aid equipment, 06/11/09 including the suction machine is prepared and ready for use. All trained staff must be aware of the location of the first aid equipment should they need this in an emergency. The home must review the level 06/11/09 of engagement and interaction of staff with residents as this contributes to the psychological welfare of residents Medicines must be administered 06/11/09 as prescribed to ensure the safety of residents and the appropriate records must be kept. If not administered the correct endorsement must be used. (Repeated requirementtimescale 15/11/8 not met) All medicines must be ordered in 06/11/09 a timely manner to ensure that DS0000069397.V377835.R01.S.doc Version 5.2 Page 31 Requirement 2 OP8 13(4) 3 OP8 OP12 12(1) 4 OP9 13(2) 5 OP9 13(2) Brook House 6 OP9 13(2) 7 OP10 12(1,4) residents do not run out of their medicines. All medicines that are brought forward from a previous medicines cycle must be recorded to enable a full audit to be conducted. That residents’ ability to make decisions and the areas where they are able to make decisions be assessed and recorded. Staff must always take these into consideration when caring for residents. 06/11/09 06/11/09 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 OP7 Good Practice Recommendations In cases when pressure ulcers developed the home should investigate the cause(s) of the pressure ulcers developing to ensure that lessons are learnt to prevent these from developing again. That the resuscitation status of residents be clarified in the care records and agreed with the relevant parties as required. The dining areas and tables should be appropriately prepared before dishing out the meals for residents. 2 3 OP12 OP15 Brook House DS0000069397.V377835.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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.V377835.R01.S.doc Version 5.2 Page 33 - 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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