Inspection on 02/05/07 for Brook House

This inspection was carried out on 2nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 16/05/06

Brook House 24/05/05

Brook House 24/01/05

Brook House 14/09/04

Brook House 05/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brook House 45 Seymour Street Cambridge CB1 3DJ Lead Inspector Don Traylen Key Unannounced Inspection 2nd May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brook House DS0000015239.V335670.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. 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 DS0000015239.V335670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address 45 Seymour Street Cambridge CB1 3DJ 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) 01223 247864 01223 213055 Brook Healthcare Ltd ***Post Vacant*** Care Home 33 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (33) of places Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: Brook House is owned by Brook Healthcare Ltd, a subsidiary of ExcelCare Holdings PLC. The home provides care, support and accommodation for a maximum of thirty-three people, including up to eight who have are diagnosed with dementia. The home is close to a popular shopping area of Cambridge; accommodation is on two levels the upper floor being accessed by stairs or shaft lift. The home is also divided in to four units Blue, Grey, Pink and Green. All rooms are for single occupancy. There are separate dining areas, sitting rooms and a kitchenette in each of the units. Staff support is provided 24 hours a day and an on-call manager is always available. The home has a cat, which provides company and interest for residents who are fond of animals. At the time of inspection the fees charged by the home ranged from £364 to £500 per week and vary according to needs and to funding status. Privately funding service users are asked to pay from £425 – £500 per week according to their needs. There are six rooms for privately paying service users, whilst Cambridgeshire County Council/PCT has a contract with the home to provide a specific number of places for people whose care they commission. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection occurred on the 16/05/2006. Two Random inspections have been undertaken since this date: one on the 06/09/2006 and a specialist pharmacist inspection on the 14/11/2006. These random inspections were conducted because of a concern that was reported to the Commission and for compliance with the outstanding requirements made on the 16/05/2006. These two inspections found serious concerns that needed to be addressed. This inspection occurred on the 2nd May 2007and was conducted by one inspector. The requirements made as a result of the pharmacist inspection were not assessed during this inspection. A separate pharmacist report will be made when the pharmacist returns to assess compliance with the requirements. The day was extremely hot and the sunshine was strong. A number ofpeople living at the home were sitting outside in the garden. The acting manager and team leader were present throughout the inspection. 16 service users were spoken to either in groups or individually and four care staff and the cook and the activities co-ordinator were also spoken to. A tour of the premises was made and observation of care and of staff interactions with service users was made. Care plans, assessments, two staff files and some policies and documents were read. What the service does well: What has improved since the last inspection? Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 6 The acting manager has made a considerable amount of effort and has sought out and arranged a number of topics for staff training that were required. She has improved the overall internal decorative condition and maintained the external gardens and seating areas, ensured a good standard of hygiene and ensured the kitchen is maintained to a clean standard that is acceptable by the Health and Safety Officer. She has also employed a new cook and sorted out the functions of the kitchen staff and organised a new cook and a dedicated activities worker to take sessions for five days each week. The acting manager has applied to become the registered manager and her application was being processed at the time of the inspection. What they could do better: There are four main areas where improvements can be made: 1. 2. 3. 4. Care plan details and general construction of the documents. Offensive odours in one particular area of the home. Staffing levels in the dementia care unit in the home. The earlier promotion of safeguarding adults during the induction of new care staff. Promoting adult protection more vigorously during the induction period and providing this awareness raising and training at a very early stage of new staff inductions can achieve other improvements to the service. It is recommended that the home consider nominating a person to become a trained key practitioner in adult protection as recognised and trained by Cambridgeshire County Council Adult Protection training manager. Assessments carried out by the home should be more detailed so that they are able to ensure that service users needs are established and can be met. 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 DS0000015239.V335670.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, Quality in this outcome area is good. Assessment information is gathered prior to planned admissions so that service users needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were available in the entrance/reception area of the home. Other documents and information about protecting vulnerable adults and whistle blowing and advocacy were also available in the reception area and gave appropriate information to prospective and existing people who use the service. It was good practice to see that the acting manager had information about the mental Capacity Act 2005 (Active 2007) and the recently implemented Independent Mental Capacity Advocate service available in Cambridgeshire. The manger and inspector discussed some additional references and points of information that could be added to the Statement of Purpose. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 9 Assessment admissions were read for two recently admitted service users one of whom was paying for their care. The self-funding person’s assessment had been carried out by the service and was considered that more detail should have been captured at this pre-admission stage. The acting manager was advised that any person appearing to be in need of care has the right to an assessment by their local authority (PCT) under the Community Care Act 1990 and that this service user is likely to be assessed by the PCT should his financial position change and he cannot any longer fund his care. This was relevant to the service user’s admission when he should be informed of the funding arrangements and criteria applied by his local authority and the financial planning that he or his representative might need to know about. There was no evidence to show that these issues had not been considered at the time of his admission and the organisations financial department may have addressed them. The Service User Guide did not contain details of fees and the acting manager stated this and other information about Safeguarding Vulnerable People would be included in the Statement of Purpose. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10, Quality in this outcome area is adequate. Improvements to care plan reviewing would benefit people so that people who use this service are assured improved care plans. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 9 was not assessed and will be assed by the pharmacist inspector. However, the team leader safely kept the keys to the medication trolley. Two service users care plans were read. Their files contained assessment details and daily notes and weight charts and activities and professional visits. Care plans were read that contained adequate detail about their care needs and descriptions of how care should be given or offered. However, in one person’s care plan there was a lack of acknowledgement about the necessary changed pattern of care, after the service users had fallen. The fall had been recorded but the altered pattern of care and changed needs had not been recorded or described. The areas of need covered more than one topic of care after the Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 11 person had become confined to her room. This issue was discussed with the manager and team leader during the inspection. The care plans files also contained assessment detail that was mixed with care giving tasks and were unnecessarily cumbersome and detracted from the core care plan. It is recommended that the risk assessments be extended to include more areas of risk. For example, the case of one service user who uses a mobility scooter was discussed with the manager for the potential and known risks that had not been documented. One person whose care plan was read stated that she had read her care plan and knew of the details and had agreed to it and had signed her agreement. Supervision notes were read and supervision arrangements are in place for all staff. Approximately 20 of staff have achieved NVQ level 2 in care awards although more staff are prepared to undertake this training. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. Everyday life is planned to be comfortable and involving so that people are stimulated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People were enjoying a planned activity of bingo. It was a happy and lively atmosphere and a cat was lying near to the service users. People affected by dementia were integrated with other service users. The co-ordinator was aware of the different functioning abilities of the service users and had accommodated their needs into the game. Other people living in the home were spoken to who were outside enjoying afternoon tea and biscuits in the warm sunshine. Parasols and the shade of nearby trees had provided protection from the strong sunshine. A lunchtime meal was observed being served in each of the four parts of the home and people remarked they liked the food, which was well presented and included dishes of fresh vegetables. I spoke to one of the two visitors to the home during the inspection. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People who use the service are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff are trained in protecting vulnerable adults from abuse. The home has a policy regarding abuse although they could not locate the Cambridgeshire County Council guidance. There were clear contact numbers of where to report an allegation of abuse. It is recommended that the service ensure that their induction programme for new care staff is delivered at the very stage of the induction programme, such as within the first two days. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26, Quality in this outcome area is good. People who live in the home have a comfortable and well-maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Redecoration of the sitting rooms and dining rooms and the main reception has been undertaken. Pictures had been hung in these rooms. New net curtains had been fitted to all windows and have given better privacy and a homely feel to the home. The kitchen had been extensively cleaned and a new oven had been purchased. The acting manager’s office had been re-organised. Overall the home was very clean and greatly improved since the last inspection visit. A company maintenance worker is allocated to work two or three days each week in the home. Six rooms were seen and they had been furnished to the liking of people living in the home. One area of the home in the corridor Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 15 within the ‘pink’ unit outside the toilet smelled of stale urine. This area was shown to the acting manager and the smell was discussed. It was discussed that it could emanate from the concrete floor of from a part of the plumbing. This smell must be eradicated. Despite the small area where the offensive aroma was, the outcomes for the service were good. There were no obstacles or hazards, or unsafe areas and all doors marked “keep locked”, were locked. People living at the home were outside in the garden enjoying afternoon tea and biscuits in the warm sunshine. Parasols and the shade of nearby trees had provided protection from the strong sunshine. Six rooms of people who live at the home were seen and they had each been furnished to their liking. One area of the home in the corridor within the ‘pink’ unit outside the toilet smelled of stale urine. This area was shown to the acting manager and the smell was discussed. It was discussed that it could emanate from the concrete floor of from a part of the plumbing. This smell must be eradicated. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is adequate. The outcomes for people who use service user can be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One relative who regularly visits and sits in the dementia unit of the home stated that she considered that generally there are not sufficient carers on duty during the afternoon. She stated that once she had to ask a team leader where the staff were. Observations made during the inspection revealed that there was only one care assistance working during the afternoon in this unit as there was in each of the units. All units are separate and are on two floors and are of a spacious layout. It was observed there were times when service users were alone and were in two groups both inside and outside of the building. When staff take a break, this is covered by the team leader who is on call through the day in addition to her role. The care assistant stated she would go to the team leader office to speak to the team leader and leave the unit without a care assistant. It was considered that the staffing arrangement is not sufficient to ensuring the safety of eight service users service in the dementia unit users and that two care assistants must be with the people who live in the dementia unit at all times. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 17 The acting manager has secured staff training and all staff are trained in Protecting Vulnerable Adults, Moving and Handling, Basic Food Hygiene and Awareness of Health and Safety. Medication training has also been implemented for some staff and so has dementia care. Personal folders for training undertaken provided clear evidence that training had been undertaken. A working programme of training provided had been written by one of the Team Leaders. Staff have been issued with a medication workbook. Staff are motivated by the home’s arrangement to acknowledge an ‘employee of the month’. Supervision notes were read and supervision arrangement are in place for all staff. Some staff approximately 20 have received NVQ level 2 in care awards although more staff are prepared to undertake this training. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37, Quality in this outcome area is good. The acting manager has improved the quality of care so that people who use the service benefit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has applied to become the registered manager. The acting manager demonstrated her leadership and her service user focused approach and to the numerous changes she has brought to the home since being employed. The home has extensive policies and the policies regarding abuse, supervision, complaints, administering medication and health and safety were read and considered to be appropriate. Money belong to the peopl living in the home is Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 19 not handled by the home. Regulation 37 reports have been regularly sent to the CSCI. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X 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 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 X Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 2 3 Standard OP1 OP7 OP26 Regulation 5(1)(bb) & 6(a) 15(2)(b) 16(2)(k) Requirement Timescale for action 01/08/07 4 OP27 18(1)(a) The Service User Guide must be reviewed so that the range of fees charged are included. Care plans must be reviewed and 01/08/07 clearly recorded when peoples’ needs have changed. The home must be kept free of 01/08/07 offensive odours. The previous timescale 14/11/06 has been extended. Staffing levels in the part of the 01/07/07 home that provides dementia related care must be reviewed so that people are safe and the needs of people are assured. 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 OP3 Good Practice Recommendations Assessments conducted by the home should ensure they capture extensive assessment detail about a person’s needs so that their potential care can be correctly planned. DS0000015239.V335670.R01.S.doc Version 5.2 Page 22 Brook House 2. OP30 The Induction programme for new care staff should include the adult protection training within the first two days of the induction. Brook House DS0000015239.V335670.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000015239.V335670.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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