CARE HOMES FOR OLDER PEOPLE
Brook House 72 High Street Riseley Beds MK44 1DT Lead Inspector
Katrina Derbyshire Announced 05 May 2005 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 I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brook House Address 72 High Street Riseley Beds MK44 1DT 01234 708077 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) Riseley Beds Ltd Lesley Honeywood Care Home 20 (20) (20) (20) Category(ies) of MD(E) - Mental Disorder over 65 registration, with number DE(E) - Dementia over 65 of places PD(E) - Physical Disablility over 65 Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 07/12/04 Brief Description of the Service: Brook House is a listed building located in the village of Risley in North Bedfordshire. The building was extended during 1995 and now provides accommodation for up to 20 older people. The ground floor is split level the lower part housing two communal areas and the higher level some bedrooms a dining room, kitchen, laundry, bathing and toilet facilities. Access to the top floor of the home is via a staircase fitted with a stair-lift, the remaining bedrooms, bathrooms and toilets are located on this floor. A day care facility for the use of service users and people in the surrounding area is available in an adjacent building. Car parking spaces for several vehicles is available to the front and side of the home. To the rear of the building is a raised garden that is accessed via a slope. The statement of purpose for the home identifies that the home is unable to accommodate service users who are unable to manage the stairs, which connect the split level lower floors. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 6.5 hours on 5th May 2005. All the communal areas of the home were seen and a sample of service users bedrooms; care records menus and staff rotas were examined. To seek the views of the service discussion with five service users and five staff took place and observation of care practices were made throughout the inspection. One comment card completed by a relative was returned to the Commission for Social Care Inspection and a pre inspection questionnaire detailing information on the home, policies and procedures, service users, staff and visiting professionals was completed by the home and is used as part of this inspection. The inspector is grateful for the help of the staff, service users and relatives who participated in the inspection. What the service does well: What has improved since the last inspection?
The service user guide and statement of purpose has been changed and it is now clearer on how the privacy and dignity of service users will be met. The redecoration of the dinning room and several other areas of the home had created a nicer environment in these areas. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 6 Improvements in the checks undertaken by the home when employing staff had taken place and checks on the Protection of Vulnerable Adults list and references were now being secured prior to their appointment. Also reviews were now taking place after service users had been in residence at the home for eight weeks. These meetings are to check if they are happy with the service the home provides and to plan future care: minutes of these meetings are taken and the service user receives a copy of them. 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 I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,5 and 6 Pre admission arrangements and paperwork is satisfactory to make an informed decision about moving into the home. Contracts are just sufficient to outline the rights and responsibilities of service users. Assessments however are inconsistent which results in a poor quality of care planning. EVIDENCE: The statement of purpose and service user guide on display in the home provided a detailed description of the service provision and this had been revised since the previous inspection; Information on staff qualifications, individual rooms and services available were included. Service user contracts contained the basic information needed; for example the room the service user would occupy and how much they would pay each week to stay at the home. The most recent admission to the home had one. In addition records contained entries to support that service users had been able to visit the home prior to making a decision about moving and if they so wished were able to stay for lunch or tea to enable them to have a better understanding of the home.
Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 9 A revised format for assessments had been introduced by the home as a requirement had been made at the inspection in December 2004 for improvements to be made in this area. Although developments had taken place, the assessments were not fully completed and, in one instance, the fact that a service user had been diagnosed with dementia had not been included. Therefore this requirement will remain with an extended date for compliance. Intermediate care is not offered by the home. Brook House I51 S14887 BROOK HOUSE V215084 050505 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 10 The home accessed healthcare when needed and service users benefited from a multi disciplinary approach. However care planning was not linked to assessments or completed in full and placed service users at a disadvantage, as the care they were to receive was unclear. EVIDENCE: The home had introduced a new system for care records but these were not fully completed and gave a limited amount of information to guide or instruct the staff on how to care for the service user. None of the service users, or their advocates, had signed the plans that were in place and the plans did not demonstrate the actual care being provided in the home. Although care planning was not clear daily entries and hospital documents demonstrated that service users had access to a variety of healthcare professionals. These included specialist consultants and nursing professionals. Discussion with staff suggested that all healthcare needs were met through the home making a referral to the service users General Practitioner and, in turn, them securing appropriate health services. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 11 It was observed that staff always knocked on doors before entering and the terms of address used for the service users were as they chose. Service users spoke of staff always being kind and supportive to them and that they received their care in a dignified manner. Brook House I51 S14887 BROOK HOUSE V215084 050505 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) 13 and 15 Dietary needs of service users are very well catered for with a balanced and varied selection of local food available that meets service users tastes and choice. Contact with families and the community is welcoming and informal and this benefits the service users. EVIDENCE: A number of people living at the home commented on how good the food was and that they always had a choice at mealtimes. “Excellent food, always fresh, always tasty and always lots of it” one service user said. Observation and discussion with staff confirmed that local fresh produce was always used for example for homemade soup. The kitchen was very clean and organised and the Chef was fully aware of all the dietary needs of the service users. One relative spoke of how welcome she has always been made to feel whenever she visited and that she could visit in a private area of the home. A Day Centre run by the home used by several of the service users also gives an opportunity to meet other members of the local community as they can also attend. Several service users said that they had the opportunity to participate in village life and join local clubs if they so wished.
Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Changes to the way the home recorded complaints and responded to concerns alongside a clearer complaints procedure, meant service users feel they are listened to and their concerns are acted upon. EVIDENCE: The homes complaints procedure was included in the homes statement of purpose and service user guide and gave straightforward guidance on how, and to whom, you could raise concerns or complaints. The Home Manager had day to day responsibility for recording any complaints and records showed, following a requirement made at the last inspection, that this was now being done to an acceptable standard. Service users spoke of being able to raise their concerns at any time and staff would always listen and act on their views and to their satisfaction. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22 and 25 Some improvements to the décor had been made and these areas were homely. Other areas remain outstanding and some affect the health and safety of service users. EVIDENCE: Several areas had been redecorated for example the dining area, and service users spoke of how pleased they were with the changes, one service user stated “it feels like home”. The external frontage of the home still needs slight repair and redecoration and a previous requirement made remains for the home to address this. Also, although the home has undertaken some work, the need to provide toilet facilities, which are easily accessible from all communal areas, and to maintain records relating to water temperature checks still needs to be addressed. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 15 An occupational therapist had undertaken a recent assessment of the premises and the home were working towards her recommendations. A copy of the report is available. Only one service user had a key to their room. An assessment had been undertaken to determine if having a key would be of risk, and this was the reason given for other service users not having a key. This assessment was not in place in any service user file and a previous requirement remains outstanding. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 and 29 The staff have a good understanding of the service users’ support needs. The positive relationships held, are beneficial to the service users. EVIDENCE: There has been a low turnover of staff at the home in the past 12 months. Staff spoken with had worked at the home for many years and had an in-depth knowledge of the service users and their needs. One service user said of the staff “ l know them and they know me, l don’t have to ask sometimes they know me so well”. Staff and service users felt that the only time extra help was needed was around tea time and the manager is actively trying to recruit to this post. Staff files contained all the necessary checks and a requirement made at the last inspection had now been met. All staff recruited had received an enhanced disclosure check and had been checked against the Protection of Vulnerable Adults list, this was for the protection of the service users. It was observed that staff attended to service users promptly when needed in a sensitive and relaxed manner, and the interaction between them was encouraging and supportive. Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 17 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) 35 and 38 The lack of risk assessments and some documentation in relation to Health and Safety puts service users at risk. Accounting and financial procedures in the home for service users money are robust enough to safeguard the service users. EVIDENCE: General and specific risk assessments were not available in relation to all Health and Safety matters. Records of water temperature checks and boiler temperature checks must be maintained to ensure the risk of accidental scalding and growth of legionella is reduced. Changes to the way the home manages service users personal allowances have improved this area. Two staff now sign on all transactions and records are kept, which make clear the amount spent and the balance remaining. Receipts are kept so that balances can be checked for accuracy.
Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 18 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 3 3 1 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 4
COMPLAINTS AND PROTECTION 2 x 2 3 x x 2 x STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x 2 Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 19 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 OP3 Regulation 14 Requirement A comprehensive assessment must be undertaken for all service users. The assessment must include all needs, and must be kept under review. Care Plans must be generated from comprehensive assessments, with consultation whever possible with the service user, and this forms the basis for the care delivered and that it is reviewed at least monthly. Previous requirement timescale of 31/03/03, 30/11/03, 30/06/04 and 31/03/05 not fully met. The window frames must be repainted and the window frames repaired, to the exterior front of the building. Previous requirement timescale of 30/06/05 still remains. Toilets must be easily accessible from the communal areas of the building. Previous requirement timescales of 21/03/03, 30/06/04 and 31/03/05 not met. Evidence must be available that the temeratures of hot water supplies throughout are Timescale for action 30/06/05 2. OP7 15(1)a 30/06/05 3. OP19 23 30/06/05 4. OP21 23(2)(j) 30/11/05 5. OP38 13,16 & 23 30/06/05 Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 20 regulated to prevent the risk of accidental scald and also to prevent the growth of Legionella bacteria. Previous requiremet timescale of 31/03/05 not fully 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. Refer to Standard Good Practice Recommendations Brook House I51 S14887 BROOK HOUSE V215084 050505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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