CARE HOMES FOR OLDER PEOPLE
Brook House 213 Barrack Road Christchurch Dorset BH23 2AX Lead Inspector
Gill Kennedy Unannounced 03 June 2005 10:00 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 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 D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brook House Address 213 Barrack Road, Christchurch, Dorset, BH23 2AX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 483960 mchaumoo1@aol.com Mr Mahomed Rechad Chaumoo Mrs Ludivina Thelma Chaumoo Care Home only 11 Category(ies) of OP - 11 registration, with number of places Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09 December 2004 Brief Description of the Service: Brook House is a residential care home registered to accommodate 11 service users under the category of OP (old age). It is an older style property situated on one of the main roads leading into Christchurch town centre. Most service users have lived at the home for several years. The home has been owned and managed by Mr and Mrs Chaumoo since 1988 and they live on the premises, being actively involved in all aspects of the day-to-day running of the home. Several family members are also involved in providing support for service users, which helps to create continuity of care, along with a family atmosphere. The majority of rooms are single, two being doubles. Service users rooms were found to be cosy and attractive. The home had a separate lounge and dining room and there was a garden at the back of the property with a pond for service users to enjoy. There was no lift in the home. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection had been conducted as part of the normal inspection process legally required. During this visit a considerable amount of time was spent talking to the proprietors of the home, Mr and Mrs Chaumoo, were available to answer questions and provide documentation as needed. A member of staff was also working in the home preparing lunch. The files of three residents were read during this inspection. Only one resident was spoken to during the inspection as all the other residents who were in the communal lounge declined being interviewed. Two residents who choose to stay mainly in their rooms were not seen on this inspection. There were no friends or relatives visiting the home during the inspection. CSCI comment cards were left in the home for residents, relatives and professionals to complete, but at the time of writing the report none had been returned. The bedroom of the resident interviewed was seen along with the communal areas and the kitchen. The time taken on this inspection was 4.5 hours and 12 standards were inspected. The terms resident and service user used in this report are interchangeable. What the service does well:
Brook House was found to be clean and homely. The home is run on family lines, being staffed with various members of the Chaumoo family. This ensures continuity of care for residents as there is minimal staff turnover and no agency staff are used. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
Whilst a lot of work has been done on writing care plans they are not easy to read nor do they provide clear information. A simple plan covering what staff need to do to meet all aspects of residents care needs and involving all residents, where they are able, would enhance records and ensure needs were more clearly defined. Some work still needs to be done on medication records and two recommendations have been made. There is a list of activities available, but there is little to indicate that there is a vibrant social atmosphere in the home, as the majority of residents spend their days in the communal lounge watching television. Only one resident wished to take part in the inspection so it was difficult to gauge if the lifestyle in the home matched residents expectations and satisfied their social needs and interests. The home could be more pro-active in providing social activities including outings to enhance residents’ social lives. The menus supplied to CSCI indicated that the main course served at teatime was varied but the additional food on offer included jam sandwiches every day for four weeks. Also on one day it was noted that the main meal served at 12.30 included two beef dishes and the evening meal was also a beef dish. It would enhance service user choice if the variety of sandwiches was increased at teatime, and where alternatives are on offer at lunchtime, different meats or a fish dish are always supplied. All service users have the complaints procedure posted on their door, however, this would be better displayed in larger print and placed in a central point in the home, unless residents had chosen to have this information on the door of their bedroom. The home had failed to report a serious accident involving a resident to the appropriate authorities, but since the inspection this has been corrected. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 7 Residents could be placed at risk by the home not making sure that small items of electrical equipment are tested at the required intervals. Another area of concern is the home’s inability to show that all care staff have current moving and handling certificates as this could place both residents and staff at risk of injury. There was one requirement carried forward from the last inspection that has not been addressed. This is to produce an annual development plan with an audit of the home’s progress in relation to staff training, accidents and so on. This would provide a useful basis on which the home would be able to judge whether it was achieving its stated aims and objectives. 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 D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 9 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 standard(s) None of these standards were inspected. EVIDENCE: Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 The care planning system in place does not give clear and accessible information to provide staff with the details they need to meet service users needs. Residents are able to access health and other ancillary services to ensure their health is promoted. The home has improved their medication procedures since the last inspection, but some minor changes are still required. EVIDENCE: Three files were seen during the inspection. Whilst it is clear that a lot of effort has been put into developing care plans and various assessment tools are used Mr and Mrs Chaumoo have been considering how they can devise a simple care plan that incorporates all the items in standard 3 and guides staff in what is required to meet residents needs. There was evidence that the home was involving some residents in their care plans, but one resident who was spoken to said ‘we don’t need writing to be looked after’. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 11 The home relates to two GP surgeries and where practical residents would retain their own doctor. The District Nurse visits regularly to monitor two residents and the chiropodist visits the home every six weeks. Other specialist services are obtained depending on residents’ requirements. Records indicated that nutritional screening was being undertaken with one resident who had been admitted underweight showing a steady increase. There were no residents with pressure sores and three accidents were recorded at the home since the last inspection. The CSCI pharmacist inspected the medicines in the home on the last inspection and Mr and Mrs Chaumoo have made considerable efforts to meet the requirement and recommendations she made. The medicines policy has been updated to include the additions she suggested. Most medicines are supplied in the monitored dosage system (MDS), but for those that are not a clear audit trail is available. It was noted on one resident’s file that there was an allergy to some medication but this was not recorded on the MAR chart. There still needs to be a list of staff authorised to give medicines along with their specimen initials. At the time of the inspection no residents were administering their medication and two were not taking any medication at all. Mr Chaumoo said he aims to keep residents medication to a minimum. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Residents show little wish to engage in activities and there is no evidence seen of any action taken to motivate them. A wholesome and nutritious diet is provided in a separate dining room, but there is a lack of variety particularly in the teatime menu. EVIDENCE: Mr Chaumoo produced a list of activities available for residents and the Statement of Purpose says ‘social activities will be an important aspect of the home’, but observation during this inspection and on previous visits has failed to show that there is a vibrant social atmosphere with residents engaging in various interests and activities. Whilst care plans recorded service users interests there was little indication on daily records of residents being involved in social activities. On the last inspection prior to Christmas Mr Chaumoo said he would arrange for singers to come in from the local church to sing carols, but this did not materialise as residents were said to be not interested. The provider says residents are even reluctant to leave the home and go out with relatives and there are no outings arranged from the home.
Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 13 Mr Chaumoo says he has obtained information about local shows, but residents would be unwilling to pay for them. It was difficult to gauge whether the lifestyle in the home meets service users preferences as only one resident wished to take part in the inspection. He was satisfied with the social life in the home, enjoying watching TV in the company of other residents and reading books obtained from the mobile library. The other residents were watching TV and joked and chatted amongst themselves. Service users are offered three meals a day and morning coffee, afternoon tea and an evening drink is also available. A selection of menus supplied to CSCI indicated that whilst a variety of main courses were served for the evening meal the accompanying food was monotonous with jam sandwiches being served daily over a four week period. Also on one day the menus showed that for the main meal which is served at 12.30 both dishes were beef and the evening meal was also a beef dish and this failed to provide service users with a real choice or an alternative to red meat. On the day of the inspection residents had a choice for their main meal between fish, chips and peas or roast beef, cabbage and roast potatoes followed by homemade cream caramel. Two residents were having fresh fruit instead. The resident spoken to confirmed that there was a plentiful supply of food and this was borne out by records indicating one person who had been admitted underweight had steadily put weight on since coming into the home. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16,18 The complaints procedure is available to residents but may not be accessible to everyone in its present format.l Policies are in place to protect residents from abuse. EVIDENCE: There have been no complaints made at the home or to CSCI since the last inspection. The complaints procedure is posted on each resident’s door but is in small print that is difficult to read and could be unreadable to some residents. There are policies on Adult Protection and Whistle Blowing and a copy of the ‘No Secrets’ document published by the Local Authority in conjunction with Department of Health Guidelines. Mr Chaumoo is aware of the issues surrounding the Protection of Vulnerable Adults register. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19.26 The home is clean and comfortable providing a homely environment for residents. The floor covering in the laundry heightens the possibility of cross infection. EVIDENCE: The home is in good decorative order but there are no records to demonstrate if any repairs or redecoration had been done or if there were any plans for improvements. . However, it would be beneficial if an ongoing repair and maintenance plan was available to indicate service users live in a home that is regularly decorated and upgraded. The Environmental Health Officer visited the home in January 2005 and made some recommendations that Mr Chaumoo states he is now complying with. The Fire Officer visited the home in March 2005 and the home was meeting the fire regulations. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 16 Since the last inspection a new washing machine and dryer have been installed. Linoleum is partly fitted in the laundry, but there is also carpeting which could be the cause of cross infection. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Service users are accommodated in a homely, informal environment with sufficient staff to meet their needs. EVIDENCE: The home currently has ten residents; three with medium needs and seven with low care needs. Brook House is run on family lines, the tasks in the home being shared to include domestic, cooking and caring tasks. Two members of staff were on duty during 08.00-20.00 hours each day and one of them would be responsible for cooking and food preparation. Mr Chaumoo stated that he or his wife were always on the premises, but this was not always reflected on the roster. There was one waking member of staff on duty at night from 20.00-08.00 and three other members of staff sleep in at the home to provide additional support if needed. There has been no new staff employed since the last inspection and the home does not use agency staff. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38 The home recording policies need to be improved to ensure the best interests of residents are safeguarded. Whilst some systems were in place to ensure the health and safety of residents there were some omissions that could place them at risk. EVIDENCE: The accident record indicated that three accidents had taken place; none of these have been reported to CSCI. One of the accidents involved a service user sustaining a fracture and being admitted to hospital, this should have been reported to RIDDOR. Mr Chaumoo agreed to make written notifications in retrospect. The accident book is also not in line with what is required under the Data Protection Act and information was supplied to the proprietor on how to obtain a suitable book.
Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 19 Records show that fire equipment and the electrical maintenance in the home were in order. However, the testing of small items of electrical equipment was out of date, only being valid until August 2004. All staff have fire training three monthly, which is in excess of the standard for day staff. The proprietor was unable to demonstrate that all staff providing care in the home have a current moving and handling certificate. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x x 1 2 Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The service users care plan must set out in detail what actions need to be taken to meet all aspects of of the health,personal and social care needs of service users as outlined in Standard 3. The home must be able to demonstrate that a varied diet is supplied at all mealtimes. The home must give notice without delay of any serious injury to a service user and this must be recorded in line with Data Protection regulations. The registered person must comply with the relevant acts and regulations and report accidents to RIDDOR as required. The home must be able to demonstrate that all small items of electrical equipment have a current test certificate. All care staff must have a current moving and handling certificate. Procedures must be in place for the registered manager to audit all aspects of the homes care practice, occupancy,
D55 S26771 Brook House V227750 030605 Stage 4.doc Timescale for action 03.09.05 2. 3. 12 38 16 37 03.09.05 03.09.05 4. 38 17 03.09.05 5. 38 12 03.09.05 6. 7. 38 33 13 24 03.09.05 03.09.05 Brook House Version 1.30 Page 22 housekeeping, staff training, staff turnover, accidents and incidents, mdication usage and accounts to ensure the home is achieving its stated aims and objectives. An annual development plan must be produced as a result of the audit. (timescale 05.08.04 not met.) 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. 4. 5. 6. Refer to Standard 9 9 12 16 19 26 Good Practice Recommendations Any allergies noted should be clearly recorded on the MAR chart. A list of all staff giving medicines with their singatures and specimen initials should be available with the medicines records. The home should take a more pro-active approach to encourage service users to engage in stimulating activities to help increase their confidence and social skills. The complaints procedure must be supplied in writing big enough for service users to read. An ongoing maintenance and repair plan would provide good evidence to demonstrate that service users live in a safe and well maintained environment. The laundry floor should be readily cleanable to preven the risk of infection. Brook House D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF 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 D55 S26771 Brook House V227750 030605 Stage 4.doc Version 1.30 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. 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!
