Inspection on 03/07/07 for Brook House

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/08/09

Brook House 10/09/08

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 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Brook House 2-6 Forty Close Forty Avenue Wembley Middx HA9 7UU Lead Inspector Ram Sooriah Key Unannounced Inspection 3rd July 2007 10:00 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 DS0000069397.V341685.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. DS0000069397.V341685.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 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) Barchester Healthcare Homes Ltd Manager post vacant Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (29) of places DS0000069397.V341685.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of 10 places for persons in rehabilitation under 65. Minimum staffing levels No less than 5 places and up to 19 places for Adults aged between 4064 years who are in need of nursing care. No less than 18 places and up to 34 places for older people during the home`s transition period until 18 places only for older people 4th October 2006 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. It is about 8 years old and used to be part of Westminster Healthcare. Brook House is found in Forty Close, just off Forty Avenue. It is easily accessible by buses, which pass on the Forty Avenue. The home has parking spaces for more than 10 cars and there is additional parking on the road. The nearest shops and amenities are found in Wembley, a short distance away by bus or by car. There is a petrol station with some shopping facilities about two minutes walk from the home. The home is purpose built and has been re-registered for 29 young physically disabled (YPD) residents and for 18 elderly residents above 65 years old in 2004. Previously it only had 10 YPD beds and the rest of the beds were for elderly residents. It did not have 29 YPD residents at the time of the inspection, as the home was still undergoing a period of transition where the unit on the first floor, which used to be only for elderly people, was changing category from elderly people to YPD. The plan is for the YPD residents to be accommodated on the ground and first floor and the elderly residents to occupy the second floor. Accommodation is in 46 single bedrooms with 44 of these, en-suite. The fees charged by the service are: • £550-£750 for elderly residents depending on the needs • £800-£1200 for YPD residents again depending on the needs At the time of the inspection there were 39 residents in the home. DS0000069397.V341685.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place on Tuesday 3rd July from 10:30 to 16:30 and on the 4th July from 10:00-15:00. This is the first key inspection for the period 2007-2008. The last key inspection took place on 4th October 2006. During the course of this inspection I was able to speak to a number of residents, some relatives of residents and visitors to the home as well as the manager and some of her staff. I was also able to tour some of the premises, looked at a sample of records and checked for compliance with previous statutory requirements. The home has not had a permanent registered manager since the previous registered manager left in August 2005. There have been at least four temporary managers. The current manager is an operations manager who has been brought in to deal with operational issues, to improve the quality of the service that the home provides and to ensure compliance with national minimum standards and care homes legislation. I was informed that the home was in the process of recruiting a permanent manager to the home. As was identified in the last report, the home requires a permanent manager who will provide leadership and support to all staff in the home and who will bring stability and consistency to the home. As will be identified in this report the home has still some way to go to ensure a good standard of service. I would like to thank all residents and visitors who spoke to me to share their experiences of living in the home and the manager and all staff for their cooperation and support during the inspection. What the service does well: What has improved since the last inspection? The service users’ guide has been reviewed by the current manager. Copies were available for all residents and visitors to the home. DS0000069397.V341685.R01.S.doc Version 5.2 Page 6 Care plans of residents are now more comprehensive and are drawn up and reviewed with the residents or their relatives. There have been some attempts at addressing the cultural and religious beliefs of residents. Progress has also been achieved with regards to addressing end of life care and the arrangements in place to manage the death of residents. The assessment of the social and recreational needs of residents has also been given prominence and is carried out for all residents as far as possible. The manager audits care plans to ensure that these are comprehensive. Care plans contain information about the administration of rectal diazepam and the monitoring of the level of some medicines in the blood circulation, in cases where monitoring is required. There has been some progress with the management of medicines in the home. Fewer issues than in the past were identified during the course of this inspection. The home now has automatic doors at the front of the home to improve the access of disabled people to the home, although more could be done to make these fully accessible to people with physical disabilities. Some items of furniture have been provided which suit the tastes of younger people and make the environment more homely. Recruitment procedures in the home are adhered to, to ensure that all new employees have all the necessary records as required by legislation. The home has been carrying out audits of various areas of the service to monitor the quality of the service that it provides. The home’s quality management system is being implemented and actions plans are produced to address issues, which need correcting. The home conducts a satisfaction survey of stakeholders to gain information about the quality of the service that it provides. A number of health and safety issues identified during the last inspection have been addressed although more need to be done to ensure that all the issues are addressed in a timely manner. What they could do better: All residents must receive a contract/statement of terms and conditions of the home when they are offered accommodation in the home. The assessments of the needs of residents are on the whole comprehensive but could include more information about the purposes of the stay of residents, particularly for younger adults and with regards to the rehabilitation and promotion of independence of residents. The cultural and religious beliefs of residents could be made more explicit in care plans. DS0000069397.V341685.R01.S.doc Version 5.2 Page 7 The provision of disability equipment in the home has not been fully reviewed to look at equipment, which can promote the independence of residents particularly that of YPD residents. The new automatic doors, while improving the situation do not yet fully promote the independence of residents who are wheelchair users or who have poor manual dexterity. Residents must be offered a call bell when in their room to call for assistance unless there is a risk assessment. Evaluation of care plans must give an indication of how well the needs of residents are being met and must include changes in the action to take to meet the needs of the residents. Care plans for tissue viability must be more comprehensive to include the arrangement for sitting out of bed and the arrangement for turning the residents in cases where residents have pressure ulcers or when they are at high risk of developing pressure ulcers. When a resident self-administers medicines, the medicines must be kept securely for the protection of the resident and other residents. The instructions on medicines charts must be updated as soon as possible after changes are made to the frequency of administration or doses of the medicines. The environment of the home must be reviewed to look at equipment and technology, which may promote the independence of disabled residents. A high standard of cleanliness must be maintained at all times to prevent cross infection. The induction of new care staff must include the completion of the common standards as per Skills for Care to ensure that new staff are as competent as possible to care for residents that the home accommodates. The home must have a registered manager as soon as possible to ensure the stability of the home, secure further improvement and to introduce a consistent approach to the management and running of the home. The home must address a few issues with regards to health and safety, such as ensuring that all safety certificates are up to date and that appropriate risk assessments have been carried out, to demonstrate that all precautions are being taken to ensure the safety of residents, staff and visitors to the home. 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. DS0000069397.V341685.R01.S.doc Version 5.2 Page 8 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) DS0000069397.V341685.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive information to decide if they want to move into the home. There is not enough disability equipment in the home to ensure that the home is fully equipped to meet the needs of YPD residents. EVIDENCE: A copy of the service users’ guide (SUG) was provided for inspection. It has been updated to include information about changes in the management of the home. Copies of the SUG were available in the bedrooms of residents. The manager stated that copies are provided to all new residents and visitors to the home. DS0000069397.V341685.R01.S.doc Version 5.2 Page 10 The home has contracts with funding authorities for the placement of residents who are publicly funded. These residents get a copy of the relevant contract. Residents who are privately funded have a contract/statement of terms and conditions with the home. It was noted that the residents who are publicly funded did not always receive the home’s contract/statement of terms and conditions, which reinforces the home’s and residents’ obligations and rights with regards to the stay of the residents in the home. The manager stated that all new residents to the home have a pre-admission assessment of their needs prior to the home deciding to offer a place to the residents. Residents or their relatives are encouraged to visit the home and to meet staff and other residents before deciding if the residents want to move in the home. The preadmission assessments were available for inspection. Copies of the needs’ assessment and care plans of the placing authorities were also available on file. Residents’ needs are more comprehensively assessed once they are admitted to the home. There have been some attempts at addressing the residents’ expectations, hopes and concerns about the future, particularly for the younger residents. The needs assessment however continue to lack with regards to addressing rehabilitation and promotion of independence, although evidence was seen during the inspection of the input of the physiotherapist and occupational therapist in the care of the YPD residents. There has been some improvement with regards to access to the home by residents who have poor mobility and dexterity, but who are nevertheless independent with regards to mobility such as with the use of self-propelling or electric wheelchairs. There is one set of automatic doors to the home. Once the doors have opened automatically, it is necessary to enter a code on a keypad for a second set of doors to open in the lobby of the home. Not all residents are able to operate the keypad or the doorbell, which is in front of the home to draw staff’s attention to open the door. One resident said that the new doors are not helpful to him for the above reasons and do not improve his access to the home. Apart from the new doors, the provision of disability equipment to promote independence of residents has however not been further explored. For example call bells continue to be the same as before. The use of call bells with flat pads, which can easily be activated by people with poor manual dexterity, has not been explored. As a result there are still some lacking with regards to meeting the needs of disabled younger adults. This will continue until such time until the above is addressed. Staff in the home were familiar with the needs of the residents who were accommodated in the home. Some of them have worked for a number of years in the home. Staff were also aware of the cultural and religious needs of residents to which they were sensitive. There was evidence that they supported residents in maintaining their cultural and religious identity. This included providing culturally appropriate food to residents, supporting DS0000069397.V341685.R01.S.doc Version 5.2 Page 11 residents to wear culturally appropriate clothes and supporting residents with regards to worship and practising their (the residents’) religious beliefs. DS0000069397.V341685.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): 7-11 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care plans of residents are not comprehensive enough to ensure that all the needs of residents are addressed. Some issues were identified during the inspection which needed addressing to ensure that the healthcare needs of residents are fully met. The management of medicines could have been better to fully protect residents from harm. The home provides a good standard of end of life care for the residents who are accommodated in the home. DS0000069397.V341685.R01.S.doc Version 5.2 Page 13 EVIDENCE: I looked at the care records of seven residents. These were kept in good order and were stored in filing cabinets or in drawers, which could be locked. There were audit sheets in care records to show that the manager has carried out audits of the care plans to ensure that these addressed the needs of residents and that the records were kept up to date. Signatures and entries in care records showed that residents or their representatives were involved in drawing up and in reviewing care plans and risk assessments when this was possible. This is good practice. The action to take to meet the needs of residents was fairly detailed and clear but not always updated when there have been changes. It was noted that the care plans and risk assessments were not always reviewed monthly or more often if required. Furthermore evaluation of the plans of care and their effectiveness in meeting the needs of residents was not always recorded. It was therefore not always clear whether the care plans were updated to reflect the actual care that residents were receiving. For example, although there has been some progress in having care plans addressing the future and expectations of YPD residents, there was no evaluation to measure how well these were being met. One resident who did not wish to be in the lounge still had a care plan saying that ‘she should not be left in her room alone’. A resident who returned to the home from hospital with a change of medication to control her pain have not had her care plan updated to reflect the changes. The care plan of one resident said that the latter should be stimulated by taking part in daily activities. The resident however stayed in his room during the inspection and it was not very clear why he was not taken to the lounge to be with other residents. Either the care plan needed to be updated or it is not being implemented. There has been some progress with regards to care plans addressing the cultural practices and religious beliefs of residents. However the care plans on personal hygiene and on nutrition could have been more comprehensive by addressing culturally appropriate interventions. The care plan of one resident said that the latter likes gospel music but pop music was being played. Care plans on sexuality were in place but could have been more comprehensive by addressing this issue, particularly for young people who live in the home. Care plans contained a range of general risk assessments and individual risk assessments according to the needs of the residents. All residents had manual handling risk assessments, nutritional assessments, pressure ulcer risk assessments and falls risk assessments. Continence assessments were also in place to promote continence and to manage incontinence as required. DS0000069397.V341685.R01.S.doc Version 5.2 Page 14 Residents continue to be involved in activities outside the home such as going out independently, going to the cinema, shopping and meeting friends. In the home they are also involved in activities to promote their independence such as cooking and being involved in managing their finances. It was noted that risk assessments were not in place in these cases to manage the safety of resident while encouraging them to take appropriate risks. The home has a comprehensive format for the manual handling risk assessment of residents. It was noted that the care plans on manual handling were not always very clear about the equipment to use and the manual handling manoeuvres that should be carried out when moving and transferring residents. One of the care plans suggested that a stand-aid hoist should be used to transfer a resident up and down the bed. There are much more simpler ways of doing this than to use a stand-aid. The care plan of another resident, who could not weight bear, said that a standing hoist should be used. All residents presented as appropriately dressed and clean. The standard of personal hygiene was good. Relatives and residents commented that they were satisfied with the standard of personal care. Personal care was provided in the bedrooms of residents or in the bathrooms to ensure the privacy of the residents. At least two residents were seen in their rooms without a call bell. Risk assessments were not in place to address the reasons for them not to have a call bell. One of the residents’ care records mentioned that he should be given a call bell to ensure that he can ring the call bell instead of trying to get up when he could be at risk of falls. Records showed that residents were seen by healthcare practitioners according to their needs. The healthcare practitioners involved in the care of the residents included the GP, dentist, chiropodist, optician, and palliative care nurse. Care plans addressing tissue viability needs of residents did not always addressed the pressure relief equipment in use and the seating regime of residents. A resident with recurrent pressure sore did not have a care plan addressing the times for the resident to sit out and the cushion in place on the chair for pressure relief. A resident with a wound on a toe had good records documenting the management of the wound. It was noted that the resident did not have a bed cradle to prevent pressure on the toe from the bed linen. Two residents were noted to have a particular infection. There was evidence that alcohol handrub and appropriate disinfecting hand washing facilities were provided. The care plans also addressed the management of the wounds, but did not address the management of the infection, which could have been in other areas of the body. DS0000069397.V341685.R01.S.doc Version 5.2 Page 15 The home has some equipment, which can be used in an emergency to assist the provision of first aid. It was noted that the suction machine did not have a suction tube readily connected and available should the suction machine be required in an emergency. There were no mouthpieces in the home to assist staff in the provision of resuscitation. Residents had care plans in place addressing their concerns and hopes for the future as well as wishes and instructions with regards to end of life care. In cases where this was not possible an entry was made in the care plan. Staff in the home were familiar with the needs of older people and in managing the end of life care. There has been progress with addressing this aspect of care. The management of medicines was inspected on the first and on the second floor. Random checks were made in the medicines administration records (MAR) charts and a sample of medicines was inspected. An improvement was noted when compared to the findings of previous inspections. Records were maintained as required and records with regards to the management of controlled medicines were noted to be of a good standard. Risk assessments were in place when medicines were administered in an altered state or when residents were self-administering their medication. The risk assessment for self-administering was reviewed three monthly, but on checking the storage of the medicines, it was noted that the medicines were not being kept safely in a locked cabinet/facility. The amounts of a few medicines were not recorded when received in the home. Most liquid and topical medicines had a date of opening. Codes were used when medicines were not administered but the codes in some instances were not appropriate. A code, which was used for not administering a laxative because that was not necessary, was used for not administering an antidepressant. It was noted that the instructions for the administration of a number of medicines were changed while residents were in-patients in hospital or by the GP, but these were not reflected on the MAR sheets. It is required that when there are changes in the instructions for the administration of medicines, that these are also reflected in the MAR sheet and on the label for the administration of the medicines to prevent mistakes as much as possible. DS0000069397.V341685.R01.S.doc Version 5.2 Page 16 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): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in indoor and outdoor activities according to their choices. Meals are provided to suit residents tastes and choices. EVIDENCE: There has been progress in ensuring that the social and recreational needs of residents are appropriately assessed. The life history sheets were appropriately completed and care plans were formulated as required addressing this aspect of care. DS0000069397.V341685.R01.S.doc Version 5.2 Page 17 The home has a part-time activities coordinator and was still in the process of recruiting for another activities coordinator. The current activities coordinator is responsible for arranging all activities in the home in consultation with residents. On one of the days of the inspection, one resident stated that he wanted to go out and buy an item of toiletries. It was noted that a member of staff supported him and arranged for him to go out. Another older resident also went out to the shopping centre for a trip, which she enjoyed. A few younger residents went to the cinema in the afternoon. I was informed that residents regularly go out to different places in the community in the mini-bus of the home. The mini-bus is driven by staff members and provides an opportunity for residents to go out in the community. Other residents are able to go in the local community in their wheelchairs either on their own or with their relatives and friends. There was evidence that the home was helping residents integrate in the local community. This was considered an important part of building independent living skills since a few residents (Younger adults) are expected to move out of the home to live in their own accommodation in the longer term. A few residents have successfully moved out to live on their own or in assisted living facilities. Residents have also been involved in developing a small area of the grounds in the front of the home to be the ‘residents’ garden’. I was informed that residents helped to clear the area from bushes and shrubs, and helped to choose the plants and flowers that would make the area more colourful and pleasant for them to sit out and enjoy. On the day of the inspection there was a religious service in the home, which was attended by residents. This happens every week. It was also noted that the home supports residents in practising and maintaining their religious identity by providing transport for them to attend places of worship and by respecting the religious beliefs of the residents. Meals were served to residents in appropriately prepared and congenial dining areas. There has been some input from the head office about improving the presentation of dining areas. The improvement was noted. I observed lunch being served. Residents’ choices were noted on a daily choice sheet and sent to the kitchen. A number of choices were available on the day of the inspection. Residents who did not want the main meals were provided with other choices and in some cases the chef prepared individual meals for a number of residents in relation to their cultural background and religious beliefs. All residents gave positive comments about the provision and flexibility of meals in the home. DS0000069397.V341685.R01.S.doc Version 5.2 Page 18 The kitchen was clean and tidy. Most records were kept as required except for a record of all the meals which are cooked in the home to enable a person inspecting the records make a judgement about the suitability of the meals provided to residents. The kitchen was recently inspected by the environmental health officer of the borough and it was noted that the plaster of a small partition wall in the kitchen needed to be repaired and that a broken bin was overflowing. The issue with the bin has been addressed and quotes have been received to repair the damaged plaster. DS0000069397.V341685.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously by the organisation and are dealt with according to the home’s complaints procedure. The appropriate procedure is followed in cases of allegations of abuse to ensure the safety of residents. EVIDENCE: The manager stated that she has not been able to locate the file with regards to past complaints in the home. However since the last inspection there has been one complaint, when it was alleged that one member of staff was not respecting the choices of the resident. The manager said that she has now started to keep a register of complaints in the home. She stated that she has an open door policy. This was noted from the inspection and from feedback from residents. She reported that she deals with the concerns of residents/representatives before these are expressed as formal complaints. Residents spoken to said that they would approach the manager if they had any concerns about their care or that of others. DS0000069397.V341685.R01.S.doc Version 5.2 Page 20 Copies of the complaints procedure are available in the SUG and in the lobby area of the home. There have been two allegations of abuse in the home since the last inspection. These allegations were both referred to the safeguarding adult team of the local authority. They were both appropriately dealt with and resolved. Staff spoken to were aware of the need to inform the person in charge when they have suspicions of abuse or when allegations of abuse are made to them. They said that they have had training on abuse. Training records indeed confirmed that most members of staff have had training on abuse, including ancillary members of staff. This is commendable. DS0000069397.V341685.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although the home was in an acceptable state of decoration, the environment has not been reviewed to look at its suitability for young physically disabled residents. EVIDENCE: The grounds and parking areas in front and at the back of the home were maintained and tidy. The exterior of the building was also in an acceptable DS0000069397.V341685.R01.S.doc Version 5.2 Page 22 state. There have been some attempts at landscaping some of the grounds at the back of the home, but not much progress has been achieved in this area. There is wheelchair access to all areas of the home including the patio areas and grounds at the back and front of the home. Residents enjoyed going outside in the grounds of the home and a few were observed sitting outside on their own or with their friends and relatives. There has been some redecoration to improve the environment of the home. The ground floor lounge has been redecorated and the carpet has been changed. Some of the furniture has also been replaced to reflect the needs of the younger people who live on the ground floor. Communal areas were all appropriately decorated and furnished. Residents were observed in wheelchairs, normal armchairs or specialist chairs according to the needs of the residents. The home has a small sitting area on the ground floor next to the foyer. This has also been redecorated and new furniture has been provided to make the area more like a small sitting room. Bedrooms of residents were also in a good state of decoration and items of furniture were suitable for the residents. The bedrooms of residents were also personalised to a good standard. As mentioned in section 1 of this report, the provision of equipment to promote the independence of residents who have mobility impairments could have been more comprehensive. Although there has been some changes to the front entrance to facilitate the coming and going of residents through the front door, the use of these by physically impaired residents is still a challenge due to the use of small items such as the front door bell and the key pad, which require good dexterity. Plans that were drawn up last year for the development of the home to specialise in the care of younger adult have not materialised. Equipment and assisted living technology to promote the independence of physically impaired people in the home have not been reviewed and are not in place. The home was generally clean, but it was noted that there was dust on the picture frames and bed frames in the bedrooms of two residents who had a particular infection. In these circumstances the rooms should have been subjected to the strictest level of cleanliness. DS0000069397.V341685.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing level has on the whole been adequate to meet the needs of residents. All records as required by legislation are in place before an applicant is offered employment, but new care workers do not receive induction as per Skills for Care, the training organisation for the social care sector. EVIDENCE: The duty roster was inspected for the month of June. Staffing normally consisted of 2 trained nurses and about 8 carers during the day and 3 carers and 3 trained nurses at night. I was informed that the first and the ground floors are run as one unit. There are 1 care worker at all times on the ground floor and 4 carers on the first floor under the supervision of a trained nurse. I was told that all the residents on the ground floor require the assistance of 1 member of staff for personal care and for mobility except for 1 resident who DS0000069397.V341685.R01.S.doc Version 5.2 Page 24 requires 2 members of staff for personal care. The carer from the ground floor is then supported by staff from the first floor. While this is what should happen in principle, I was informed that at times the carer on the ground floor has to work on her own and receives no support. There is a feeling among staff that the staffing is inadequate. A conversation took place with the manager and she stated that staff do not yet appreciate the fact that the two floors is being run as one unit under the supervision of 1 trained nurse. The organisation justifies this staffing level and says that this is in line with the current occupancy of the home. While the number of staff on duty during the day varies between 8 and 9 and trained nurses from 2-3 there was one occasion in June when there were 4 carers and 3 trained nurses on duty during the day and another occasion when there were 5 members of staff and 3 trained nurses in the morning and 6 carers and 3 trained nurses in the afternoon. There was no evidence that there was extra staff on those occasions. The home does not tend to use agency but in cases where there are quite severe shortages of staff, the use of agency staff or other arrangements must be considered to ensure adequate staffing to ensure the safety of residents at all times. The personnel files of 5 members of staff were inspected. All records as required by legislation were in place including references, CRB checks, and mostly completed work history of the applicants and evidence of eligibility to work in the UK. It was however not very clear how induction to the home was being carried out and there was no evidence that the induction as per the common induction standards of Skills for Care, the training organisation for social care, was in place in the home. I noted that new members of staff receive an induction to the home and to Barchester and that they do not always complete the common induction standards as per Skills for Care. The training grid and the training plan for the home were kindly forwarded to the inspector. Examination of the plan showed that out of 24 care assistants 7 have an NVQ qualification in care, 1 has a social work qualification and 8 are trained nurses from abroad. While this is a good reflection on the calibre of staff, it must be noted that the home does not yet have 50 of its staff trained to NVQ level 2 even if it has such a good proportion of trained nurses from abroad. According to Skills for Care, while NVQ training is competency based some nurse training might be academic and therefore not always easily comparable. It was also noted from the training grid that a significant number of staff were not up to date with manual handling training, food hygiene and health and safety. There was also no indication that staff have had training in first aid to be appointed persons for first aid or to be first aiders. The training plan provided to the Commission addressed these deficits. DS0000069397.V341685.R01.S.doc Version 5.2 Page 25 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not have a permanent registered manager to ensure stability and consistency in securing lasting improvement of the service. DS0000069397.V341685.R01.S.doc Version 5.2 Page 26 The home has started to implement the quality management system to ensure that the home provides a quality service. Health and safety issues are managed appropriately although a few issues were noted which could be putting residents at risk. EVIDENCE: The home has not had a registered manager since August 2005. The current manager is the fourth manager who has been brought in to ‘turn around’ the home. She is experienced and has worked in a number of homes and has qualifications in management and care. While familiar with running care homes, the current manager is only temporary and I was informed that the home was in the process of recruiting a new manager. It is important that the home has a registered manager as soon as possible to ensure the stability of the home and that staff receive consistent support and direction with regards to achieving the aims and objectives of the service. The home uses the quality management system of Barchester. This consists of a series of audits which are carried out by the home and which are validated by senior management staff of the company. Different areas are chosen monthly and the standards with regards to each area are audited. Examples of the audit areas include health and safety, catering, care records, medicines, environment and activities. Actions plans were noted once the audits have been carried out. The home has carried out a satisfaction survey last year. A report detailing the findings of the survey was available for viewing. There are plans to conduct a survey yearly. I was informed that the management of the personal money of residents was limited to two residents who keep money with the home. The money is subject to audits. The residents keep some money with the home and draw the money as and when they want to and sign for the money. Should there be expenditures on behalf of residents, the home pays for the expenses and invoices representatives of the residents for the money. A number of safety certificates were available for inspection. A gas safety certificate was seen but it did not cover the dryers in the laundry. LOLER certificates for the two lifts and the hoists in the home and a certificate that the water was being treated for legionella, were also available for inspection. The electrical wiring certificate was dated October 2006 and stated that there was some urgent (code 1) work that needed to be carried out for the system to be of a satisfactory standard. I was informed that quotes have been received for the work that needs to be completed. There was evidence that the emergency lighting, nurse call system and fire alarm system were also maintained. A health and safety audit checklist and DS0000069397.V341685.R01.S.doc Version 5.2 Page 27 fire audit checklist were seen, but a health and safety risk assessment was not available for inspection. A fire risk assessment has been carried out but a fire emergency plan has not yet been developed. DS0000069397.V341685.R01.S.doc Version 5.2 Page 28 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 2 3 2 4 2 5 X 6 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 2 23 X 24 3 25 X 26 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 2 34 X 35 3 36 X 37 X 38 2 DS0000069397.V341685.R01.S.doc Version 5.2 Page 29 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 Standard OP2 Regulation 5(1)(b)(c) Requirement Timescale for action 31/10/07 2 OP3 OP7 14(1,2) 3 OP4 OP22 23(1)(a) The responsible individual must ensure that all residents receive a copy of the contract/terms and conditions of the home to ensure that the residents are aware of their obligations and of their rights while living in the home. The registered person must 30/11/07 ensure that the needs and aspirations of all residents are appropriately assessed and reviewed (Repeated requirement- timescale of 31/05/06, 15/08/06 and 30/11/06 not met), particularly with regards to rehabilitation and the promotion of independence within a risk assessment context. This to clarify the purposes of the stay of the residents in the home and to ensure that staff can plan to meet the aims and expectations of residents, as far as possible. The registered person must 31/12/07 ensure the suitability of the premises with regard to the provision of disability equipments and other DS0000069397.V341685.R01.S.doc Version 5.2 Page 30 environmental adaptations to promote the independence of service users accommodated in the home and to ensure that the needs of the service users are being met (Previous requirement- timescales 31/12/05, 31/05/06 and 30/11/06 not met). 4 OP7 15(1,2) The registered person must 31/12/07 ensure that the service user’s care plan set out in detail the action that needs to be taken by staff to ensure that all aspects of the health, personal and social care needs are met. (Repeated requirementtimescale of 31/05/06, 15/08/06 partly met). Care plans must, where possible, incorporate the cultural practices and religious beliefs of residents to ensure that the individual needs of the residents are being met. The registered person must ensure that there are suitable risk assessments in place, in cases where service users are being encouraged to develop individual living skills and to be more involved in the local community. (Repeated requirement, timescale of 30/04/06, 15/08/06 and 31/12/06 not met) Care plans and risk assessments must be reviewed monthly or more often if the needs of residents change. That the care plans are updated when required and when the needs of residents change. Evaluation of DS0000069397.V341685.R01.S.doc 5 OP7 13(4)(b) 30/09/07 6 OP7 15(2) 30/11/07 Version 5.2 Page 31 7 OP8 care plans must contain information about how well the needs of residents are being met to ensure that the plans of care are effective. 12(1)15(1) That care plans addressing the 31/08/07 tissue viability needs of residents, clarify the arrangement in place and the length of time for residents to sit out of bed, particularly for those residents who have pressure sores or for those at high risk of developing pressure sores (Repeated requirementtimescale 15/08/06 and 30/11/06 not met). 13(5) To ensure the safety of residents the manual handling risk assessments/care plans on manual handling must be clear about the equipment to use and the actual manual handling manoeuvre that must be carried out when moving or transferring residents. That the home reviews the provision of equipment available for resuscitation and first aid. These must be prepared to ensure that they are ready to be used in an emergency. Medicines must be recorded accurately when administered. If not administered the correct endorsement must be used. (Repeated requirementtimescale 30/05/06, 15/11/06 not fully met). To prevent mistakes during the administration of medicines, instructions of medicines on MAR sheets must reflect changes when the dosage and frequency of administration of medicines have changed. DS0000069397.V341685.R01.S.doc 8 OP8 30/09/07 9 OP8 13(4) 30/09/07 10 OP9 13(2) 31/08/07 11 OP9 13(2) 31/08/07 Version 5.2 Page 32 12 OP9 13(2) 13 OP10 12(4) 14 OP15 17(2) 15 OP26 23(2)(d) 16 OP27 18(1)(a) 17 OP28 18(1)(c) 18 OP30 18(1)(c) Medicines must be stored safely in cases of self-administration to ensure the safety of the resident and that of other residents. To maintain the rights and the dignity of residents, call bells must be provided to all residents sitting out, unless this is not indicated as per a risk assessment. The registered person must ensure that a record of all meals cooked in the home, is kept and made available for inspection to enable a person looking at the records make a judgement about the suitability of the meals which are provided to residents (Repeated requirement-timescale 31/01/07 partly met). The registered person must ensure that there is a high standard of cleanliness in the home to prevent cross infection as much as possible. That appropriate staff cover is provided when there is a shortage of staff to ensure that residents receive all the care that they require. The home must have 50 of its care staff qualified to NVQ level 2 to ensure that staff are fully competent to care for residents (Repeated requirementtimescale 31/12/06 not met). To promote health and safety, members of staff including support staff must have manual handling training. Staff must also have COSHH training and food hygiene training as required. There must also be nominated people trained in first aid. DS0000069397.V341685.R01.S.doc 31/08/07 30/09/07 31/08/07 31/08/07 31/08/07 31/12/07 31/10/07 Version 5.2 Page 33 19 OP31 9 20 OP38 13(4) 21 OP38 13(4) 22 OP38 23(4) 23 OP38 13(4) The home must have a registered manager as soon as possible to ensure that the person to manage the home has been fully vetted by the Commission (Repeated requirement-timescale 30/11/06 not met). There must be a gas safety certificate for all items of equipment, which use gas to ensure the safety of residents and staff. That all the ‘code 1’ remedial works identified in the electrical wiring certificate be completed as soon as possible to ensure that the electrical system is satisfactory An emergency fire plan must be available for inspection to ensure the safety of residents and staff (Repeated requirement-timescale 31/12/06 partly met). There must be an up to date health and safety risk assessment available for inspection to ensure the safety of residents and staff (Repeated requirementtimescale 31/12/06 partly met). 31/10/07 30/09/07 30/11/07 30/09/07 30/09/07 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 Refer to Standard OP8 OP8 Good Practice Recommendations That the use of bed cradles is considered in cases where these might be of some benefit to residents who have wounds on their toes/feet. That residents who have particular infection have care DS0000069397.V341685.R01.S.doc Version 5.2 Page 34 plans in place addressing the management of these residents. DS0000069397.V341685.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. DS0000069397.V341685.R01.S.doc Version 5.2 Page 36 - 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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