Inspection on 18/11/05 for Brook House Care Centre

This inspection was carried out on 18th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Care Centre 09/01/08

Brook House Care Centre 26/07/06

Brook House Care Centre 16/05/05

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 20 Meadowford Close Off Thamesmere Drive Thamesmead London SE28 8GA Lead Inspector Ms Pauline Lambe Unannounced Inspection 09:30 18 November 2005 th 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 Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brook House Care Centre Address 20 Meadowford Close Off Thamesmere Drive Thamesmead London SE28 8GA 020 8320 5600 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) brookhouse@lifestylecare.co.uk Life Style Care Plc ** Post Vacant *** Care Home 74 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (14) of places Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 14 beds for the physically disabled 60 beds for the nursing care of people aged 60 Date of last inspection 16th May 2005 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 DS0000006776.V268397.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors completed this unannounced inspection over 7.25 hours. The service was last inspected on 16th May 2005. A meeting was held between the Commission and the home manager on 6th June 2005. The Commission made further visits to the home in July, September and October 2005. Since the last inspection Bexley and Greenwich Council Services raised concerns in relation to the quality of care provided and poor record keeping in the home. Both authorities suspended admissions to the home for a period of time. Staff and management worked to improve standards and the authorities started placing residents in the home again. This 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. The inspectors reviewed how the home was implementing its action plan to improve standards. The outcome of the inspection was positive and there was evidence to show efforts were and had been made to improve standards. Residents were generally satisfied with the service and made comments such as ‘there are lots of activities’, ‘staff are very nice’, ‘the cook prepares special vegetarian sausages for me’ and ‘staff treat me with respect’. Relatives seen were also positive about the service. What the service does well: What has improved since the last inspection? Management had worked with the Commission and Social Service Departments to improve standards. All staff had received training on the identification, prevention and treatment of pressure sores. An issue in relation to ‘false recording’ had been appropriately managed and the staff involved had been disciplined. Care planning and wound management records had improved. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 6 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 Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 the following standard(s): 2, 3 and 5. Contracts for service were seen in some but not all resident files viewed. Preadmission assessments were seen but there was no evidence to show residents received written confirmation that the home could meet their assessed needs. EVIDENCE: The home manager, unit manager or a trained nurse completed pre-admission assessments. This process enabled an evaluation to be made, ensuring that the home could meet the needs of the residents prior to admission. At the last inspection it was noted that a number of residents had been admitted which were outside the home’s category of registration. The new home manager continues to work with the Commission to resolve this issue either by finding more suitable placements for residents or applying to the Commission for variations to registration. The Commission will continue to monitor this situation. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 9 Although the home had prepared a letter to send to residents stating the home could meet their needs following assessment, it was not evident in resident files viewed that residents did actually receive the letter. Requirements 1 and 2. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 and 11. Since the last inspection risk assessments and care plans had improved and in particular in relation to wound and pressure sore management. Medicines were generally well managed. EVIDENCE: Care plans were prepared and well laid out. A total of eight care plans were reviewed throughout the home. The care plans seen included the personal information required by regulation, assessment of need, risk assessments and prepared care plans to show how needs would be met. Care plans were reviewed monthly or as needed. Wound management was well recorded and it was evident that advice was sought from other professionals such as the tissue viability nurse on the prevention and treatment of pressure sores. Since the last inspection management had provided training for all care staff on the prevention and identification of pressure sores. It was evident equipment was provided for the prevention and treatment of pressure sores. On the ground floor concerns were identified in relation to the care planning for a respite resident. A number of risk areas were left blank and there was no Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 11 evidence to show that efforts had been made to obtain further information about the resident’s needs. It was evident in some care plans viewed that these were discussed with residents and or relatives. Records seen indicated residents had access to other health professionals such as the GPs, dentist, chiropodist, physiotherapy and tissue viability nurse. The majority of residents were registered with the same GP practice who visited the home routinely every week and when requested. Residents on the second floor who spoke to the inspector were satisfied with how their care was provided and the attitude of staff. Medications were inspected on the first and second floors. On the first floor medicines were stored in a small clinical room and the space was considered inadequate. The space could be improved by reorganising the cupboards. On the first floor some out of date homely remedies were seen. On the second floor medicines were well managed but records were not been kept for medicines waiting disposal. Controlled drugs were properly stored and recorded. Medicine trolleys were provided on all floors to administer medicines. Medicine fridges were provided and temperatures were checked daily. Administration records were well maintained. There was no system in place for the disposal of medicines and the registered person must address this as a matter of priority. In the meantime records must be kept for the medicines waiting disposal. Staff were observed interacting appropriately with residents, personal care was being given in private, residents were well groomed and appropriately dressed. Attention to detail was noted with ladies wearing jewellery, men being shaved, and attention given to hair care. Some care plans seen included a brief reference to preferred choices during the process of dying or for funeral arrangements. The home had policies and procedures relevant to care of the dying. Requirements 3, 4 and 5 and recommendation 1. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 the following standard(s): 12 and 15. Residents on the first and second floors were satisfied with the activities provided. Some improvement was seen in the activities provided on the ground floor. Meals were nutritious and varied and residents on all floors were satisfied with the quality and choice of food. EVIDENCE: Activity programmes were provided and individual records seen included resident’s social history. Some residents involved in biscuit making or were playing bingo, which they seemed to enjoy. Two full time activity organisers were employed, they prepared and organised the activity programme, did one to one work with residents and prepared a monthly newsletter for residents. On the ground floor, the unit for younger residents how the home met the standards 11,12,13,14,15 for younger adults was assessed. The activity organisers prepared a separate newsletter for this floor. On this floor residents were supported to fulfil their spiritual needs but none on the residents had access to practical life skills such as assertion and confidence training. Residents could access a computer but none of the current residents would be able to attended formal education. Residents were included on the electoral role and a discussion took place about the need to ensure that residents who are eligible to claim mobility allowance are supported to do so. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 13 This would enable them to fund transport to activities. Generally activities had improved on this floor with a focus placed on celebrating special events such as Halloween and firework night. Some activities on this floor took place outside the home but this should be developed further and residents supported to go out and do their own shopping, visit cinemas, pubs and local leisure centres and generally participate more in the local community. Residents in the home for log term placements should have an annual holiday. The residents were on this floor were satisfied with the visiting arrangements and the contact they had with family and friends. Lunch was observed on all floors. The meal was served in a relaxed and helpful way with staff being attentive to resident needs. Residents said or indicated they enjoyed the meal. The cook said she had requested advice from the dietician on how to enhance the calorie intake for residents who needed this. The cook was implementing the advice and using the recipes the dietician provided. Requirement 6. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18. 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. Records were kept of complaints made about the service. Since the last inspection the home investigated one complaint and records showed this had been properly managed. The Commission investigated a further complaint. The complainant was dissatisfied with the provider’s investigation. The complaint included concerns in relation to the quality of care provided. The Commission upheld all but one section of the complaint and appropriate requirements were made for the provider to improve the relevant standards. The home had policies and procedures on how to manage allegations or suspicions of abuse, which were last reviewed in December 2004. Staff who spoke to the inspector had a good understanding of adult protection. Since the last inspection concerns about the quality of care provided and poor recording caused both Greenwich and Bexley Social Services to suspended admissions for a period of time. Management worked with the Commission and the social services to improve standards. They prepared a specific action plan to address the issues and kept this under review. In view of the improvements both authorities recommenced placing residents in the home. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 the following standard(s): 19 – 26. The home was clean and tidy and the standard of décor varied and a number of bedrooms required redecoration. Bathing facilities were adequate but bathrooms could be more homely in appearance. Residents voiced their satisfaction with the environment and the lay out of their bedrooms. EVIDENCE: The home was clean and tidy with no unpleasant odours noted. Residents who spoke to inspectors were satisfied with the environment. A number of bedrooms needed redecoration and management said this work was due to commence soon. Some bedrooms were nicely personalised and others were quite bare. In a number of en-suites continence pads were stored on the w.c cistern and some were on the floor. Both for hygiene and dignity reasons these items must be stored properly and discretely. Furniture and furnishings were in a satisfactory condition. Adequate hoisting and moving and handling equipment was provided. The decoration on the younger persons unit on the ground floor was considered very bland and bedrooms in particular did not reflect individuality Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 16 or personality of residents. Management should involve the residents in the decoration programmes. Efforts must be made to improve the communal areas as currently, in the older persons units on the first and second floors, residents were all seated in the main lounge. These rooms were quite crowded and made it difficult for residents to meet visitors. On the younger persons unit, the ground floor, the communal areas could be improved and include leisure equipment suited to this group of residents including facilities to enable service users to make there own drinks and snacks. Staff were provided with protective clothing however they were not provided with a uniform. As this is a nursing home consideration should be given to providing a staff uniform to help prevent the spread of infection. The laundry was well organised and managed. Some of the personal clothing seen in the laundry was labelled using room numbers or writing the name on the garment. This practice should be discouraged, as it is disrespectful to residents. Requirements 7 and 8 and recommendations 2, 3 and 4. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home maintained adequate staffing levels. Recruitment procedures were satisfactory. Residents admitted outside the homes’ category of registration could be placed 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. Staff continued 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 there is a risk this could affect the quality of care provided. Six staff files were viewed and found to be satisfactory. Staff received training relevant to their role however concerns remained in relation to staff ability to meet the needs of residents admitted outside the home’s category of registration, see requirement 7. Staff said they received training relevant to their roles. A senior in the home coordinated training and kept records to monitor individual training and to ensure update training was provided when due. There was evidence provided to show what training had been provided since the last inspection. Recommendation 6. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 37 and 38. Records were maintained as required by regulation. The home had a new manager in post. Attention was given to ensuring a safe environment was provided. EVIDENCE: A new manager came into post in October 2005 and has applied to register with the Commission. The manager has many years experience working with older people and was supported in her role by a regional manager. Formal supervision had not been commenced for all staff however plans were in place to organise this. Records were maintained as required by regulation and improvements had been made to resident’s individual records. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 19 Accident records were kept and audited monthly. A random selection of safety records seen showed these were up to date and attention was given to service and maintenance of equipment and systems. Requirement 9. Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 3 3 2 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 3 3 Brook House Care Centre DS0000006776.V268397.R01.S.doc Version 5.0 Page 21 No 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 The Registered Person must confirm in writing to residents that based on assessment the home can meet their needs in respect of health and welfare. (Timescale of 30/06/05 was not met.) The Registered Person must not admit residents outside the home’s category of registration and must continue to keep the Commission informed of progress made to review, assess and identify appropriate placements for such residents already in the home. The Registered Person must ensure risk assessments are completed for all residents and care plans prepared to show how identified needs will be met. The Registered Person must ensure out of date medicines are removed from stock and properly disposed of. The Registered Person must ensure records are kept of medicines due for disposal and these must be stored safely DS0000006776.V268397.R01.S.doc Timescale for action 30/12/05 2 OP4 14 30/12/05 3 OP7 15 30/12/05 4 OP9 13 30/12/05 5 OP9 13 30/12/05 Brook House Care Centre Version 5.0 Page 22 6 OP12 16 7 OP24 23 8 OP26 13 9 OP36 18 while waiting disposal. The Registered Person must ensure residents have the opportunity to engage in local community activities, provide in the home age appropriate activities and consider arranging an annual holiday for residents. This requirement applies mainly to the residents on the younger adult unit. The Registered Person must ensure bedrooms are decorated and maintained adequately. The Commission must be informed in writing when the planned redecoration of bedrooms is due to start and finish. Efforts must be made to involve residents in planning colour schemes and in personalising their rooms. The Registered Person must ensure hygiene standards are maintained. Continence products must not be left on the en-suite floors and to ensure respect for residents must be stored discretely. The Registered Person must ensure a system is in place to provide staff with supervision. 28/01/06 28/01/06 30/12/05 28/01/06 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 OP9 OP20 Good Practice Recommendations The Registered Person should review the use of space in the clinical room on the first floor with a view to improving the space available for medicine storage. The Registered Person should review the layout of the lounges on the first and second floors to ensure residents DS0000006776.V268397.R01.S.doc Version 5.0 Page 23 Brook House Care Centre 3 4 5 OP21 OP26 OP27 are not crowded and can receive visitors in comfort. The communal area on the ground floor should reflect the needs of the occupants and have some leisure equipment provided which is age appropriate. The Registered Person should review the décor of the bathing facilities and try to make these less clinical and more homely. The Registered Person should consider providing staff with a uniform to ensure hygiene standards are maintained. 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 DS0000006776.V268397.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup 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 DS0000006776.V268397.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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