CARE HOMES FOR OLDER PEOPLE
Brook House 15 Bell Lane Husbands Bosworth Leicestershire LE17 6LA Lead Inspector
Keith Williamson Unannounced Inspection 29th September 2005 08:45 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 DS0000064289.V251593.R01.S.doc Version 5.0 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 DS0000064289.V251593.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Brook House Address 15 Bell Lane Husbands Bosworth Leicestershire LE17 6LA 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) 01858 880247 01858 881473 None Pradeep Arvind Patel Care Home 28 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (28) Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25-11-04 Brief Description of the Service: Brook House is a home for older people sited in the village of Husbands Bosworth, offering personal care for 28 older persons. Husbands Bosworth is sited between the market towns of Lutterworth and Market Harborough and has the benefit of the local bus service. The home is a converted house situated in the centre of the village, and has four shared bedrooms and twenty single bedrooms, a significant number of bedrooms have en-suite facilities, which consist of a toilet and wash hand basin. The home offers three lounges, two adjoining dining rooms. Bedrooms are found on the ground and first floor, which can be accessed, by stairs or a passenger lift. The home is situated close to local shops and green space. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day, commenced at 8.45 am and was completed in five and one quarter hours by one inspector. An opportunity was taken to view the care plans and other records in detail. Seven residents’ were spoken with on this visit; comments made from them are included in this report. No resident and relative comment cards were forwarded to the inspector and have therefore not been included. Three staff were also interviewed within the Inspection process. The acting manager assisted with the Inspection, spending time with the Inspector discussing the management of the home. This is the first visit by the inspector to this home, and it is recognised the home continues to function well in providing a homely environment for residents’, but a great deal of work is necessary in providing a secure method of medication administration. What the service does well:
Good written information is provided to residents. This gives good detail about what residents can expect from the home. There is a clear assessment process and care plans detail the needs of residents and how these should be met. Care planning does reflect the link from the initial assessment, completed prior to resident being admitted into the home. Care plans are well laid out and easily understood. A range of social activities are provided in the home, with residents given the opportunity to participate. Residents can choose how what they do on a daily basis; subject to risk assessments and particular care needs. Meals provided are nutritious, providing residents with a varied choice of well prepared and well presented food. The choice is extended by the addition of vegetables being presented in serving dishes, giving residents who have the ability to serve themselves. There are strong procedures in place regarding complaints and protection of vulnerable adults from abuse, and staff have a good understanding of the procedures. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 6 There is an adequate level of staff training in the home, both in National Vocational Qualifications in care, and in specific areas that relate to the needs of residents in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 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 DS0000064289.V251593.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Prospective residents and their relatives have the appropriate information provided within the admission process. EVIDENCE: The homes Statement of Purpose and Service User Guide has yet to be updated with the new owner and acting manager details. Resident assessments are completed prior to their admission, and care plans compiled from the information supplied. Contracts between the resident and the home are in place, and were placed appropriately in files. The home does not currently offer a service under Standard 6. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 & 9. Residents are looked after well in respect of their health and personal care needs, though issues around medication administration are poor, and leave residents in danger. EVIDENCE: Care plans are in place, are detailed on a personal basis and are reviewed periodically. Residents and their relatives are included in the care planning process, though some have elected not to participate. The medication system is poorly managed with the staff compromising the security of the system by adding medication, which was specifically supplied separately by the pharmacist. The recording of medicines administered by the staff also requires to be more securely managed, with a number of prescribed drugs being written in by the staff, drugs received at the beginning of the medication month, not being receipted properly and administration times and doses being changed by staff. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 10 This is very disappointing, as a large number of staff have recently completed an “accredited” medication training course, which is provided by a local education college, and is backed up with an examination. An immediate requirement was left by the inspector with regard to improving the medication system. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15. Residents are assisted to exercise choice and control over their lives. EVIDENCE: Personal choice is offered throughout the home, and evidence is in place to suggest the homes’ practices are flexible, promoting resident’s individuality and independence. A range of in house activities are offered to the resident group in the home. The size of the home offers a variety of areas in which residents can elect to spend time, eat and socialise with their relatives. The menu offered is varied and nutritional, and the meals produced reflect the residents’ individual dietary requirements. Vegetable dishes are placed on some of the tables, giving residents a positive choice in the vegetables provided at meal times. Comments made regarding the food were “the foods good” and “you will like the food, its very good”. The meal system is enhanced by the provision of pre-lunch sherry and wine being on offer. It is recommended that vegetable dishes to all residents, with the staff then assisting residents if necessary, again would improve the quality of meal provision for all residents. The provision of sauce and gravy boats to tables, where residents could specify the amount of accompanying sauce placed on their plate.
Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Complaints and adult protection procedures are in place for the protection of residents in the home in the event of a complaint or suspicion of abuse. EVIDENCE: The complaints procedure is publicly displayed in the foyer of the home, as well as in the Statement of Purpose and Service User Guide, which makes clear the process of making a complaint. Residents showed an awareness of the complaints procedure, one stating that they “would tell the staff, or see the acting manager. Residents stated they felt “at home” and “secure” in the home. Detailed examination of the adult protection policy indicated that sufficient information is contained in the document for staff members’ guidance on how to prevent elder abuse in the home. Two staff members spoken to displayed good verbal knowledge concerning the protection of vulnerable adults in their care. Evidence of advocates and advocacy information is publicly displayed on a notice board in the foyer of the home. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None. No Standards were viewed on this occasion. EVIDENCE: Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30. Residents are protected by sound recruitment practices. EVIDENCE: The staffing rota was examined and a physical count indicated that there was adequate numbers of care staff on duty. The staffing rota was viewed and discussion held with the acting manager indicated that there is appropriate skill mix of staff employed to work in the home. Residents’ spoken to indicated that there are staff members available when needed, and the staff were “nice and friendly”; and “the staff are friendly and communicate with you”. Of the staff files viewed all had the appropriate pre-employment checks in place prior to staff commencing in their post. Evidence of staff training and an organised training programme is in place, with a number of staff completing their NVQ level 2 and commencing level 3. Staff training on the whole appears good, with individual staff being knowledgeable on a number of areas including medication administration. Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None. No Standards were viewed on this occasion. EVIDENCE: Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 16 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? No. 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 OP9 Regulation 13(2) Requirement The Registered Person must ensure safe and accurate receipting and administration of all medicines in the home. The Registered Person must ensure that doses of medication are administered as instructed by the General Practitioner. The Registered Person must ensure that no medication is added to the “cassette” system after being dispensed by the pharmacist. The Registered Person must ensure that a policy is produced for residents self-administering medication. The Registered Person must ensure that all out of date medicines are returned to the pharmacy for destruction. The Registered Person must ensure that accurate instruction is obtained form the General Practitioner and put in place to enable the appropriate administration of varying dose medications such as tranquilisers.
DS0000064289.V251593.R01.S.doc Timescale for action 29/09/05 2 OP9 13(2) 29/09/05 3 OP9 13(2) 29/09/05 4 OP9 13(2) 01/11/05 5 OP9 13(2) 29/09/05 6 OP9 13(2) 13/10/05 Brook House Version 5.0 Page 18 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 2 3 Refer to Standard OP1 OP7 OP9 Good Practice Recommendations It is recommended that the changes to the Registered Person be accurately reflected in the Statement of Purpose and Service User Guide. It is recommended that all staff are instructed how and when to increase the detail in the daily reports. It is recommended that all medication be returned at the end of the medication period, be that a week, month or course; so no “carry over” exists, as this compromises the security of the medication administration system. It is recommended that where possible Medication Administration Records (MAR charts) are printed by the pharmacy prior the commencement of medication. It is recommended that the provision of sauce and gravy boats to residents’ tables, where residents could specify the amount of accompanying sauce placed on their plate. It is recommended that vegetable dishes are provided for all residents, with the staff then assisting residents if necessary, again would improve the quality of catering. It is recommended that all staff employed in the home have proofs of identification placed on file prior to commencing in the home. 4 5 6 7 OP9 OP15 OP15 OP29 Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brook House DS0000064289.V251593.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
