Inspection on 07/09/07 for Brook House

This inspection was carried out on 7th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brook House 06/08/09

Brook House 15/08/06

Brook House 02/03/06

Brook House 05/09/05

Brook House 07/03/05

Brook House 18/10/04

Brook House 11/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Brook House Woodhill Morda Oswestry Shropshire SY10 9AS Lead Inspector Martin George Key Unannounced Inspection 7th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address Woodhill Morda Oswestry Shropshire SY10 9AS 01691 654167 01691 656128 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) Mrs K V Cosens Wendy May Johnson Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: Brook House is a private residential home providing personal care to 32 older people. It has been registered since 1984. The home is owned by Mrs Kay Cosens. The home is in a quiet rural area, not far from the village of Morda and Trefonen and only a few miles away from the town of Oswestry. Brook House stands in its own attractive and well maintained grounds with outlooks over gardens and surrounding fields. A patio area offering seating is available at the rear of the home. A number of raised flowerbeds with a variety of plants and flowers with varying fragrances can be enjoyed by all service users, families and friends. This area is particularly beneficial to those service users with a sensory impairment. The home has gone through major refurbishments and extension. Improvements to the home are an ongoing project, with some of the original windows due to be replaced and double glazed, further improvements in one of the bathrooms and a complete refurbishment of the kitchen, due to be completed in October. Accommodation is provided on ground and first floors, with a passenger lift providing access between first floor bedrooms and communal areas on the ground floor. The accommodation is well maintained, furnished and equipped to meet the needs of the service users. A range of communal lounges, dining rooms, the conservatory and smaller seating areas around the home provide choice for service users as to where they spend their time. The home makes their services known to prospective service users in the statement of purpose and service user guide. The inspection report is mentioned in these documents and is given out on request. Fees are reviewed annually and range from £285 - £385. Additional charges to service users are for hairdressing, newspapers, dry cleaning, alcohol, toiletries, private chiropody visits and non-NHS dentist, optician and audiologist appointments. This is clearly laid out in the terms and conditions. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by a single inspector between 09:35 and 14:10. As part of the inspection all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’ were inspected. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection CSCI was provided with written information and data about the home in their annual return (AQAA). CSCI was also provided with the views of a number of people living at the home and those of their relatives. All this information was analysed prior to inspection and helped to formulate a plan for the inspection and has helped in determining a judgement about the quality of care the home provides. On the day of the inspection staff and service users present were spoken to and observation of practice, and joining several service users for lunch, provided evidence in support of the records that were also checked on the day. From the moment of arrival the inspector found a very welcoming environment. What was particularly noticeable and pleasing was the inability to identify the building as an older people’s residential home, either from the outside or upon entering the building. Staff spoke very positively about how the home was run and appeared to have a good level of morale. Service users spoken to were very complimentary about all aspects of the service. The interactions observed between staff and service users was excellent. The home has undergone extensive refurbishment over the years and there is a continuing commitment to improvement. What the service does well: The home provides good quality care for up to 32 older people. The staff are sensitive and respectful to the needs of the service users. The range of activities offered is good and staff respect the right of service users to decline involvement. Appropriate levels of independence are encouraged and supported. Care staff are well supported and provided with the necessary induction, mandatory and specialist training. Records are well maintained and completed professionally. The home provides a very pleasant and comfortable place to live. The management structure is clear and appears to work effectively. Discussions with staff and observations during the visit suggest an open style of management, which creates a positive working environment, with the resulting benefits for service users. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 6 The home communicates well with families and professionals, both in written communications (seen in records checked) and through phone calls and face to face communication (observed on the day). What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is excellent. The information provided about the home is clear and comprehensive and is known about by service users. Assessments are comprehensive and link well to service user plans. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The statement of purpose and service user guide contain all necessary information and are written in plain English, making them useful for service users and their families. Two service users confirmed that they were familiar with the documents. They also confirmed that they were informed about what the home provided before being admitted. The service user files that were examined provided evidence of comprehensive assessments of need, undertaken prior to admission and reviewed and updated Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 9 as necessary following admission to ensure that any identified changes in need were being met. Discussion with a senior member of staff evidenced a very good knowledge about all the service users and this knowledge was replicated in the service user records that were checked. Discussions with the senior member of staff and the cook provided evidence of a good level of awareness of the physical and emotional needs of those living at the home. One service user expressed the view that the home fully met her needs and that she could not imagine a better home. One recent admission to the home is currently in a room without en-suite facilities but it has been explained that a move to a room with en-suite will happen as soon as possible and the service user told the inspector she understood and was happy with this. This reinforced the stated ethos of the home that they provide an open culture. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. The service user plans are focussed on meeting their needs. Health care is well monitored and links with health professionals are good. Service users are respected and treated well. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Based on the discussions with staff and service users and observations made during the inspection there is evidence of a high degree of respect for the service users. The personal and healthcare support is very good and recognises the need to promote and protect the dignity and privacy of service users in their everyday lives. Weight gain and loss for all service users is monitored monthly and is recorded on their daily sheets. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 11 Medication is stored, recorded and administered satisfactorily and in accordance with the policy in the home. The medication records checked were clear. The policy covers the issue of self medication. All staff administering medication have received accredited training on the subject. A blister system is used and once medication is no longer required it is returned immediately to the pharmacy. It can be seen that the needs of service users are being met in this area of practice. Over lunch one of the service users explained how she enjoyed the exercise sessions the home organised and the Quality Assurance Assessment identified that the Chairobics sessions are popular with service users. During the visit the inspector observed a discussion between a member of staff and a service user about her sight deficiencies and the need to visit an optician. Service users are well cared for and this is reinforced through how they are dressed. If a service user wishes to use a phone in private they have use of a phone that can be used anywhere in the home. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. Daily life and social activity are geared around the needs and wishes of service users. The home is staffed at a level that allows particular needs to be met. Visitors are welcome and the food is nutritious and well received. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Discussions with service users and observations on the day provided evidence that choosing what they wish to do, or not do, is fully supported by the home. The amount of space afforded by the home gives ample opportunity for service users to either choose to be part of a group or to spend quiet time alone. The grounds provide many areas which are ideal for quiet reflection too. The inspector sat down to lunch with about 10 residents. The quality of the food was good and was extremely well received by all, to the extent that conversation was minimal until plates were cleared. Menus that were seen gave evidence of a good range of nutritious meal options and much of the fruit and vegetables is grown in the garden and service users are involved in picking Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 13 and preparing the fruit. The cook was very aware of service user preferences and showed genuine interest in their dietary needs. During the inspection the neice of one of the service users was visiting. She was evidently very happy with the service being provided to her aunt and the inspector observed an open conversation between the relative and a member of staff about her aunt’s needs. A number of bedrooms were seen by the inspector and all have a pleasing view of part of the garden. The rooms are of good size and are personalised to the wishes of the service user. The layout of the garden has been carefully thought through. The inspector walked around all the grounds and was impressed with how potential trip hazards had been removed or minmised as much as possible. Several of the comments from service users to the inspector on the day, and in the surveys submitted prior to the inspection, clearly show the high level of satisfaction of those living at Brook House. Staff obviously pay as much attention to those on intermediate and day care too, as evidenced by comments made to the inspector by a service user on intermediate and another on day care. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. Concerns and complaints rarely occur but procedures are in place to resolve them effectively and promptly. Adult protection is given high priority and the open door culture for staff and service users helps to protect them from abuse. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home has a good complaints procedure, which is given to residents and their relatives before they move into the home. No complaints have been received by the home or CSCI since the last inspection in August 2006. The respectful and sensitive interactions between staff and service users is probably a key reason why complaints are so rare, as it allows minor issues to be resolved immediately, so reducing the liklihood of it escalating to the level of concern or complaint. Based on observations on the day the same culture of respect exists between staff and management, helping to create a consistent and co-operative team, which appears to be of benefit to service users. The home works in accordance with the protection of vulnerable adults procedures and issues/areas of potential abuse are included in staff training. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 15 The need for up to date training is recognised and acted on by the home to ensure the needs of service users continue to be met to a high standard. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Quality in this outcome area is excellent. The environment is of a very high standard, well maintained and undergoes regular refurbishment and improvement. Health and safety issues are well recorded and practical safeguards are evident throughout the home to ensure the safety of service users. Every effort is made to create a home from home. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The extensions and refurbishments over the years have been carefully thought through to best meet the needs of the service user group. The whole house is light and airy, giving a relaxed and comfortable feeling, which several service users spoke enthusiastically about. This relaxed feeling was reinforced through Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 17 a discussion with the senior about how episodes of verbal or physical aggression are managed and it was very evident that these are infrequent. A significant amount of effort is put into maintaining the environment to such a high standard, both inside and out. All the discussions during the day evidenced how the home thinks things through very much with the service users in mind. All areas of the house were clean and fresh, but without the lingering smell of disinfectant. The bedrooms all had the service user’s name on the door and the rooms the inspector visited (some with the service user present) all reflected the personal preferences of that service user, through photographs, ornaments, reading matter etc. The bathrooms and toilets were situated very conveniently throughout the home and all were well maintained and pleasant areas to use. The home has sitting rooms at either end of the house and both of these are able to have log fires in the winter months to further enhance service user comfort and create a homely feel. All staff have received training in infection control and laundry facilities were satisfactory. The checklist used by the maintenance man was seen by the inspector and this helps to ensure that the environment is kept safe for service users. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is excellent. Service user needs are well met by a consistent and competent staff team. Physical and emotional well being of service users is given high priority. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Recruitment at the home is thorough and all elements required by Schedule 2 of the Care Homes Regulations 2001 are maintained on file. Care is taken by those responsible for the recruitment of staff to ensure that those employed are able to provide good quality care to the service users. The file of a recently appointed member of staff was seen to be satisfactory. Staff turnover is very low and no agency staff are used. Morale in the team appears high and discussions and observations evidenced a well functioning team, meeting the range of service user needs. The commitment to training and qualification of staff is very good. The ratio of staff qualified to the appropriate NVQ level is good and the training provided recognises the skills and knowledge staff require to continue meeting the needs of the service users. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 19 Staff supervision is carried out in accordance with regulations and support to staff is also provided through regular staff meetings and appraisals. The location of the home means there are few admissions from minority ethnic groups and the staff team is predominently white British. Discussions with staff though provided evidence that the home is well aware of diversity issues and would make any adjustments necessary to meet any religious, ethnic, cultural or other need. The home also takes a responsible stance in the decisions it makes on who they can, or cannot, admit, based on their comprehensive assessments. This helps protect the needs of current service users. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. Lines of accountability are clear with a culture of open management, benefitting both staff and service users. Promoting the health, safety and welfare of service users is given high priority and all checks and maintenance are up to date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Cosens has been the Proprietor since 1984 and was also the manager until June 2007, when Wendy Johnson was approved as registered manager. The ethos of the home means there is an “all hands to the deck” approach when the situation warrants it and this is of enormous benefit to service users. The absence of any agency staff use helps to ensure a more consistent approach Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 21 and this too benefits service users, who get to know those who are caring for them. The AQAA, returned to the Commission in May 2007, identified two policies that have not been reviewed/updated since October 1985, these being the policy on sexuality and relationships and the policy on values of privacy, dignity, choice, fulfilment, rights and independence. Given the significant changes in legislation and government guidance across a range of Social Care issues it would be advisable to review these policies to ensure they continue to meet and protect service user needs and rights (as defined in recent legislation and guidance). Other policies have not been reviewed since 2002 and 2004 and these too would benefit from a review in the not too distant future. Although these policies have not been reviewed for some time it is important to note there were no practice issues identified that indicated any form of risk to service users. Although the manager was on holiday at the time of the visit the inspector was informed that she has now completed her Registered Manager’s Award. There is also a continuing commitment to getting staff appropriately qualified and skilled and knowledgable through access to suitable training opportunities. Service users have secure storage facilities in their rooms for things such as money and valuables and there is also secure storage in the office. Health and safety checks are carried out as required, and suitable records kept, to ensure the wellbeing of the service users and staff. At the time of this inspection no potential hazards were identified The accident records were satisfactory and a first aider is on site at all times, so that an immediate response can be taken to ensure proper medical attention is given to a service user whilst further medical assistance is sought, as necessary. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 4 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 4 4 X X 4 4 4 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 X X 3 Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP33 Good Practice Recommendations Policies and procedures that have not been reviewed or updated for some time need to be reviewed to ensure they remain consistent with legislation and guidance. Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brook House DS0000020704.V336495.R01.S.doc Version 5.2 Page 25 - 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. 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