Inspection on 16/05/05 for Brook House Care Centre

This inspection was carried out on 16th May 2005.

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 Care Centre 09/01/08

Brook House Care Centre 26/07/06

Brook House Care Centre 18/11/05

Brook House Care Centre 02/11/04

Brook House Care Centre 27/05/04

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 HOMES FOR OLDER PEOPLE Brook House Care Centre Meadowford Close Thamesmere Drive Greenwich SE28 8RE Lead Inspector Pauline Lambe Unannounced 16 May 2005 10:30 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 Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brook House Care Centre Address Meadowford Close Thamesmere Drive Greenwich SE28 8RE 020 8320 5600 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) Life Sytle Care Plc Patrick Sena CRH 74 Category(ies) of PD 14 registration, with number OP 60 of places Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 14 Beds for Physically Disabled 60 Beds for the Nursing Care of people aged 60 Date of last inspection 2nd November 2004 Brief Description of the Service: Brook House Care Centre is registered with the Commission for Social Care Inspection to provide nursing care for 60 older people and 14 young adults with a physical disability. The home is located close to Thamesmead town centre, shops and local bus routes. The three-storey building was built and designed for the purpose of becoming a registered care home in 2001/2. The home consists of a kitchen, laundry, administration facilities, a unit for young disabled people on the ground floor and two thirty bed units for older people requiring nursing care on first and second floors. Each unit has its own lounge, dining area and kitchen. All bedrooms are for single occupancy with en suite toilet and hand washbasins. There is a car park in front of the home and a garden to the rear with a patio and garden seating. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the Commission carried out this unannounced inspection. The inspection was completed in 7.75 hours. The service was last inspected on 2nd November 2004. The manager was in charge of the home and staffing levels were those agreed prior to the introduction of the National Minimum Standards. The inspection included talking to residents, staff, management and relatives. Records required by regulation such as care plans, menus, medication, accident, safety and maintenance were inspected and the inspectors toured the premises. What the service does well: What has improved since the last inspection? What they could do better: A number of requirements are included in this report reflecting the areas that require improvement. Residents admitted outside the home’s category of registration could be placed at risk of not having their needs appropriately met. A number of residents on the first floor, Peacock Unit, had developed pressure sores in the home. Staff must ensure residents assessed as being at risk of developing pressure sores have care plans in place to show how the risk is to be managed. Management must ensure care assistants receive training on the prevention of pressure sores. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 6 The services provided on Admiral Unit must be reviewed and action taken to ensure they adequately meet the individual physical and social needs of the residents. Despite being registered for some time this unit did not have a clear development plan as to how the service would develop, meet its aims and objectives and how residents were to be included in that process. Again residents had been admitted outside the unit’s category of registration and this could place them and other residents at risk of not having their individual needs met. In view of concerns arising from this inspection in relation to residents admitted outside the home’s category of registration, the number of residents on Peacock Unit who had developed pressure sores and the lack of clarity around the service provided on Admiral Unit the Commission held a meeting with the home manager. At this meeting an agreement was reached as to how to address the issues with timescales for action. The Commission will confirm in writing to the registered manager the outcome of the meeting and the action required. 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 Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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) 3 and 4. Standard 6 did not apply to the service. A senior member of staff from the home assessed residents prior to admission and care manager assessments were obtained. This process residents had been admitted outside the homes’ category of registration and this placed them at risk of not having their needs appropriately met. The registered person had not applied to the Commission for variations to admit residents outside their category of registration. EVIDENCE: The home had a statement of purpose and service user guide. Information packs were seen in resident’s bedrooms. There was no evidence to show that written confirmation was sent to residents confirming that the home could meet their needs based on assessment. Residents had assessments completed prior to admission by a member of staff from the home and care managers. Three residents with a diagnosis of dementia had been admitted to the nursing floors. None of the staff had training to equip them to care for dementia sufferers. Staff had been unable to manage the behaviour of a resident with dementia and had handled the situation inappropriately. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 9 Four residents were admitted to the young physical disabled unit who were outside the unit’s category of registration. This could place them at risk of not having their needs appropriately met by a staff team who may not have the skills to meet their needs. In view of concerns identified with this set of standards the Commission met with the registered manager to review pre-admission assessments and to reinforce the need to comply with the home’s registration status. Requirements 1 and 2. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 to 10. Care plans were in place, reflected needs, involved residents and relatives and showed how health care needs were met. However five residents on Peacock Unit had developed pressure sores in the home and some residents on this unit assessed as being at risk of developing pressure sores did not have a care plan prepared to show how the risk was to be managed. Medication management was assessed as safe. Residents and relatives were satisfied with the way staff respected resident privacy and dignity. EVIDENCE: Seven care plans were inspected and showed assessment of needs was completed and cares plans prepared for most identified needs. More effort was needed to ensure residents assessed as being at risk of developing pressure sores had care plans prepared to show how the risk was to be managed. Pressure relieving equipment was provided however it was difficult to identify at what point this was provided to residents assessed as needing it. Some of the qualified nurses had received training on the prevention and treatment of pressure sores but it was not evident that care assistants received training on the prevention of pressure sores. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 11 Residents and relatives said staff discussed with them how care would be provided and this was evidenced in some of the care plans seen. Some residents had been admitted who were outside the homes category of registration. These raised concerns as to how appropriately their care needs were met and how their behaviour affected the lives of other residents. Staff did not have the training and skills needed to adequately meet the needs of residents with dementia or learning disabilities. Residents had access to health services and staff supported them to access these through arranging appointments and G.P referral. None of the residents managed their medication. Medication systems were inspected on Peacock and Admiral Units. Systems in place were considered safe and complied with regulation. However on Ladybird Unit some gaps were noted on medication administration charts but on checking the stock it seemed the dose had been administered but not signed at the time of administration. Residents and relatives said staff treated them with respect and relatives said residents were always well presented and their rooms kept clean and tidy. Requirements 1,3 and 4. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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) 12,13,24 and 15. Some residents on Ladybird and Peacock Units voiced satisfied with the activities provided. The activities provided on Admiral Unit did not meet the resident’s expectations. Meals were nutritious, varied, enjoyed by residents and suited to their needs. EVIDENCE: Activity programmes were provided and individual records seen included resident’s social history. Residents were enjoying a sing-a-long on Ladybird Unit on the morning of the inspection. Social activity care plans were kept by the activity organiser and not with resident’ care plans. Therefore they were not available to care staff at all times. Residents on Admiral Unit were not aware the home had an activity organiser and were not satisfied with activities provided. Residents on this unit had ideas for the type of activities they would like provided and the registered person must ensure they are consulted and involved with the activities provided. The home had an open visiting policy. Relatives seen said they could visit whenever they wished and were always made feel welcome. Residents enjoyed visits from family and friends and some enjoyed trips out of the home with relatives. Since the last inspection improvements had been made to meal service on Peacock Unit. Senior staff were involved with serving meals, tables were Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 13 nicely laid and condiments were provided. Menus were laminated and changed daily to ensure residents knew what the meal choices were for the day. Residents said they were satisfied with the meals provided. Lunch was observed being served on Admiral and Peacock Units. The meal was served in a relaxed and helpful way with staff being attentive to resident needs. The cook said she did an annual food satisfaction survey and involved residents with menu planning. The kitchen was not inspected and the cook said the home had received a food hygiene award from the council since the last inspection. Requirement 5. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 and 17. Adequate procedures were in place to manage complaints and ensure residents were protected from abuse. EVIDENCE: The home had a complaints procedure, which was included in the statement of purpose. Copies of the statement of purpose and service user guide were seen in resident’s bedrooms. Relative confirmed they received these documents at the time of viewing the home or when their relative was admitted. The home had policies and procedures on how to manage allegations or suspicions of abuse. These documents had been reviewed in December 2004 as required in the last inspection. An allegation of abuse to a resident was being investigated by Greenwich Social Services at the time of the inspection. The investigation found that a member of staff had acted inappropriately when managing the resident’s care and the member of staff involved no longer worked in the home. Resident finances were assessed on Admiral Unit only. These were accurate with receipts kept for money received and spent. The manager was aware of the need to comply with regulation 20 and to ensure residents personal finances were not placed in an account accessible to the organisation. The organisation was working with the Commission to ensure procedures to manage resident personal finances complied with this regulation. The Commission will monitor progress with this matter. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 to 26. The environment was suited to meeting the needs of residents in its category of registration. The home was clean and tidy and the standard of décor was adequate. Bathing facilities were adequate to meeting resident needs. Residents voiced their satisfaction with the environment and the lay out of their bedrooms. Clinical waste must be removed from the sluice rooms regularly to prevent the occurrence of unpleasant odours EVIDENCE: The home was clean, tidy and the standard of décor adequate. Since the last inspection new carpets had been fitted to corridors and new laminated flooring fitted in the smoking lounge on Peacock Unit. Bathing and toilet facilities met the needs of the residents. Two passenger lifts, assisted baths, showers and hoisting equipment were provided. Bedrooms assessed against the standards were found to comply and were individualised with resident personal items. Residents and relatives voiced their satisfaction with the environment and their personal space. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 16 Clinical waste had not been removed from one sluice on Peacock and Ladybird Units. As this created an unpleasant odour in areas close to resident bedrooms the waste must be removed regularly. Recommendation 1. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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) 27,28, 29 and 30. The home maintained the staffing levels set by the previous regulatory body. Improvements had been made to recruitment procedures however some gaps were identified in the information obtained on employees as required by regulation and this must be rectified. Residents admitted outside the home’s category of registration were at risk of not having their needs met appropriately by a staff team who may not have relevant qualifications, training and skills. EVIDENCE: Staffing rotas seen showed the home complied with its staffing notice. However staff tended to work long days and many care assistants worked three or four long days together. This practice should be monitored as dependency levels in the home were high and if staff get very tired this could have an adverse effect on the quality of care they provide. The manager said that staff turnover was reducing and this had a positive effect on the staff team. Staff recruitment procedures continued to improve and procedures had improved to ensure all staff had CRB checks completed. Four staff files were inspected and showed some gaps in the information required by regulation. Staff received training relevant to their role however there were concerns noted in relation to staff ability to meet the needs of residents admitted outside the home’s category of registration. Staff said the training provided and the one to one supervision sessions enabled them to improve the quality of care they provided and to identify their own development needs. Requirements 6,7 and 8 and recommendation 2. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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) 31,32,36,37 and 38 Records were maintained as required by regulation. The manager was registered with the Commission. Staff received supervision and attention was given to ensuring a safe environment was provided. EVIDENCE: The manager is registered with the Commission and has been assessed as having the skills and experience needed to manage the service. Team leaders on each unit supported him in his role. The home has two categories of registration and from evidence provided the service met the needs of the older people better than the younger adults on Admiral Unit. From comments made by older people they were satisfied with the service but the younger adult residents indicated dissatisfaction with the activities provided. Residents from this unit participated with activities on the other units, which were not appropriate to their age or expectations. The service on Admiral Unit needed to be reviewed and the details of the service Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 19 together with its aims and objectives made clear in the home’s statement of purpose. Safety records were well maintained and showed attention was given to ensuring a safe environment was provided for residents and others. Other records were maintained as required by regulation. Staff received one to one formal supervision and said this enabled them to focus on their role, improve the quality of care they provided and to identify their own training needs. Requirement 9. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 2 1 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 2 x x x 3 3 3 Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.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 3 Regulation 14 Requirement The Registered Person must confirm in writing to residents that based on assessment the home can meet their needs in respect of health and well being. The Registered Person must not admit residents outside their categories of registration. Residents must no be admitted unless staff have the qualifications and skills needed to meet their assessed needs. The Registered person must ensure staff sign medicine administration charts at the time of administration. (Timesclae of 30/11/04 was not met) The Registered Peson must ensure risks to the health and welfare of residents are identified and action take to reduce or eliminate the risk. Robust procedures and staff training must be provided to ensure appropriate action is taken to identify residents at risk of developing pressure sores and to ensure timely action is taken to reduce or eliminate the risk. G51s6776BrookHsev221265.16.5.2005Stage4.doc Timescale for action 30th June 2005 2. 4 12 15th June 2005 3. 9 13 15th June 2005 4. 8 12 15th June 2005 Brook House Care Centre Version 1.30 Page 22 (Timesclae of 21/11/04 was not met.) 5. 12 16 The Registered Person must consult residents about the programme of activities provided. This is particularly important on Admiral Unit where the residents needs are very different to residents on the other two units. (Timesclae of 30/11/04 was not met) 29th July 2005 6. 28 18 The Registered Person must 29th July ensure staff empolyed have the 2005 qualification required to meet the needs of the residents. This applied particularly to the provision of care to residents admitted outside the homes category of registration. The Registered Person must ensure they obtain the informaion required by regulation and schedule 2 for all staff employed. (Timesclae of 30/11/04 was not met). The Registered Person must ensure staff have the training appropriate to the work they perform. Care assistants must receive training on the prevention of pressure sores. The Registered Person must review the services on Admiral Unit and ensure the aims and objectives of the unit are clearly defined in the homes Statement of Purpose. 30th June 2005 7. 29 19 8. 30 18 29th July 2005 9. 4 32 29th July 2005 Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 23 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 26 27 Good Practice Recommendations The Registered Person should ensure clinical waste is removed from the sluices regularly to prevent the presence of unpleasant odours. The Registered Person should review the number of long days staff work together as the long hours may affect the quality of care provided to residents. Brook House Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Riverhouse Maidstone Road Sidcup Kent DA14 5RH 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 Care Centre G51s6776BrookHsev221265.16.5.2005Stage4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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