Inspection on 09/01/08 for Brook House Care Centre

This inspection was carried out on 9th January 2008.

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 26/07/06

Brook House Care Centre 18/11/05

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 9th January 2008 09:20 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.V335403.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 Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 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 020 8310 6363 brookhouse@scheathcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd 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) 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.V335403.R01.S.doc Version 5.2 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 26th July 2006 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 registered care provider is Southern Cross Healthcare. The three-storey building is located close to Thamesmead town centre, shops and local bus routes and was purpose built. The home consists of a kitchen, laundry, administration facilities, a fourteen bed unit for young physically disabled people on the ground floor and two thirty bed units for older people requiring nursing care on the first and second floors. Each unit has its own lounge, dining area and kitchenette. All bedrooms are for single occupancy with en suite toilet and hand basins. There is a car park in front of the home and a garden to the rear with a patio and garden seating. Current weekly fees on the older person units’ range from £551 - £766 and on the younger adult unit from £848 to £999. Residents pay privately for personal items such as hairdressing, newspapers and toiletries. Brook House Care Centre DS0000006776.V335403.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 completed over two days 9th and 11th January 2008. Three inspectors attended on the first day and one on the second day. The service had a key inspection on 26th July 2006 and a random inspection on 5th November 2007. The acting manager was in charge of the home and with staff assisted with the inspection. At the time of the inspection sixty six residents were in the home and there were eight vacancies. The random inspection on 5th November 2007 was carried out as a result of the Commission and social services receiving a high number of concerns and complaints about the care provided and the management of the service. The report on the random inspection is available by contacting the Commission. This inspection process included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, staff, management, visiting professionals and reviewing compliance with previous requirements. Information provided in resident and relative surveys was also reviewed. Time was taken to review compliance with previous requirements. As mentioned in this report the residents and staff have experienced a period of instability in management. A high number of complaints were made about the service to the Commission and social services over a short period between October and November 2007. This resulted in a drop in standards, some staff resignations and a demoralised staff team. A new manager took up post in December 2007 and is working with staff and senior management support to resolve issues and improve standards. The service will need and be given time to stabilise and rebuild staff morale. What the service does well: What has improved since the last inspection? The current manager presents as having the skills and experience to manage the home through this period. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 6 The recently employed team leader on the ground floor also presented as having the ability to lead by example and to identify the needs of the younger residents in the unit. Management and staff presented as committed to improving standards in the home. What they could do better: Residents outside the home’s category of registration must not be admitted, this issue was raised at the last inspection. The service provided to residents on the ground floor must be reviewed to ensure it meets the needs of younger people particularly in relation to social needs and individual development. Residents care needs must be fully assessed and care plans prepared to show how to meet those needs. Wound care plans must show the condition of the wound and the frequency and type of dressing used. This issue was also noted at the last inspection. Care records must show when residents have a bath or shower. Where needed staff must ensure every effort is made to have resident care needs reviewed by other professionals as needed. This issue was raised at the last inspection. Safe systems must be in place to manage medicines including keeping accurate records for medicines so that an audit trail can be completed. This includes homely remedy medicines, medicine charts must show that all medicines including topical preparations are administered, medicines must be securely stored at all times, all prescribed medicines must be provided and administered to residents and the temperature of medicine storage rooms and fridges must be monitored. Individual social care plans must be prepared with residents, records must be kept to show the activities provided to each resident and efforts must be made to improve activities on the ground floor that meet the needs of younger people. Foods must be pureed separately to ensure they look appetising, all residents must be offered a choice of meal, tables must be fully laid for meals and condiments provided and residents specific dietary needs, such as vegetarian diets must be met. Records must be kept for all complaints made about the service and evidence to show what the complaint included and how it was managed. The Commission must be kept informed in writing as to progress made with the environment improvement plan. All bathing facilities must be well maintained and available to residents. Adequate numbers of hoists must be provided on each unit to meet resident’s needs. An audit must be completed on the pillows, linen and mattresses and new supplies purchased as needed. This issue was raised at the last inspection. Carpets in resident’s bedrooms must be kept clean and bedrooms maintained and decorated to a satisfactory standard. A dependency level must be completed for residents on the first and second floors and converted to care hours to ensure adequate staffing levels are Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 7 provided. A copy of the dependency analysis must be sent to the Commission together with details of any changes to staffing levels. The information required by regulation and schedule 2 must be obtained for employees and available for inspection. This issue was raised at the last inspection. Staff must receive training relevant to their role and in particular training on dementia care and the needs of younger people with a disability. The service must have a registered manager. Staff must receive regular supervision. A system must be in place to monitor hot water outlets in the home. Three recommendations have been included in this report for the provider to consider. 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 Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4. Standard 6 does not apply. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Pre admission assessments were completed for residents and they received written confirmation as to the suitability of the placement. A number of residents outside the home’s category of registration had been admitted to the home. Consideration must be given to improving the service on the ground floor for the younger people. EVIDENCE: Care records for two residents were viewed on each floor. These showed that pre-admission assessments were completed for residents. There was evidence to show that residents received written confirmation that based on assessment the home was suited to meeting their needs. A number of residents outside the home’s category of registration had been admitted over time and in particular residents suffering with dementia or with mental health problems. The statement of purpose for the service provided Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 10 little detail on the criteria for admission to the first and second floor units and did not refer to providing care to residents with dementia. Staff expressed concerns about their lack of training and experience to care for people with dementia. The provider had taken steps to address this situation and was in the process of applying to the Commission for a change in registration category for admissions to the second floor. This will be a major variation and will be handled by the Commission’s registration team. In the meantime residents outside the home’s registration must not be admitted. The other area of the service that required improvement is the younger persons unit on the ground floor. The provider must consider how to improve this unit, provide clear information on the criteria for admission and ensure it meets the needs of the occupants particularly in relation to social activity, community contact and individual development for the residents. Requirements 1 and 2. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were prepared but required improvements. Resident’s healthcare needs were generally met but care must be taken to refer residents to other professionals when needed. Improvements were needed to medicine management. No concerns were identified in relation to respecting resident’s privacy. EVIDENCE: Care records for two residents were viewed on each floor. These records included care plans, risk assessments and other relevant documents. The care plans seen were kept under review, however changes to resident needs had not been changed in the relevant care plans on occasions. For example one care plan seen did not reflect the residents current moving & handling needs as the resident was now being nursed in bed. Another care plan did not reflect changes identified to a resident’s nutritional needs or show that staff were monitoring their diet intake despite this being part of the care plan. To ensure staff can clearly see resident needs from care plans these must be re-written when care needs change significantly. On the second floor bathing records Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 12 were poor and it was not possible to see when residents had a bath. This was also an issue noted on the ground floor with care plans in relation to bathing not being followed. Records viewed for residents with dementia did not have care plans to show how this element of their care was to be managed. Residents spoken with did not raise concerns about their care. Completed surveys were received from four relatives and provided positive feedback about the care provided. Requirement 3 and recommendation 1. Wound management care plans were viewed for two residents. These required some improvements such as clear information regarding dressing frequency, ensuring records were fully dated, recording wound progress with the use of photographs and ensuring staff follow the advice give by other professionals. The dressing recommended by the tissue viability nurse for one resident was not always used. However despite these issues both resident’s wounds were healing. The tissue viability nurse and the dietician had seen both residents. Records for one resident showed they should be referred to a psychogeriatrician but there was no evidence to show that this had been done. There was evidence in records seen that where needed resident’s were referred to other professionals such as the GP, dietician and tissue viability nurse. During a tour of the premises it was evident residents had access to pressure relief equipment such as special mattresses and cushions. Requirement 4. Medicine management was reviewed on all floors. On the second floor the medicine storage room was found unlocked. Staff said the key to the door was broken and had been for some time. The manager was informed and situation resolved by the end of the inspection. Apart from this the medicines were stored correctly and records kept for receipt, administration and disposal of medicines. Medicine records for three residents were viewed. One resident had a supply of medicines, which were not on the medicine chart so it was not clear whether these were currently prescribed. One record was correct. One record showed a discrepancy in that the remaining stock did not tally with the amounts dispensed and administered. A number of residents were prescribed topical preparations but it was not always evident from the medicine charts that these had been administered. Homely remedy medicines were kept and inaccuracies were noted with the stock for one of these. On the first floor records of receipt, administration and disposal of medication were very good. Some issues noted were that staff did not record how many tablets they administered for one person who was prescribed a variable dose, a prescribed medicine for one resident had not been supplied or administered, one medicine checked showed that the remaining stock did not tally with the amount dispensed and administered, there were the same concerns noted regarding the administration of topical medicines as on the top floor and the storage room was noted to be very warm and the temperature was not monitored. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 13 On the ground floor the thermometer for the medicine fridge had been broken for some time. Two members of staff had the same initials, which could cause confusion when signing medicine administration records. Requirement 5 and recommendation 2. Care plans seen included reference to respecting resident privacy and dignity. All bedrooms were for single occupancy and during the inspection staff were seen knocking on doors before entering rooms. Residents were well presented and none of the residents spoken with raised concerns as to how staff respected their privacy. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 14 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): Standards 12 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives and friends were welcome to visit the home. Residents and some care plans seen indicated they could make choices about their lives. Improvements were needed to activities and food provision. EVIDENCE: Two activity organisers were employed providing eighty hours activity time. However one of the staff also worked as a care assistant and it was unclear how much of their time was actually allocated to activities. Staff shared their time between the older people and the young adult units. An activity programme was prepared and delivered flexibly. The programme looked reasonable for older people but did not meet younger peoples social needs. An activity room was provided on the ground floor and the ground floor unit included a large dining room, two smaller lounges and a designated smoking room, providing plenty of scope to introduce more age appropriate equipment for younger people. Activity staff had said they had a good budget, which allowed them to have two entertainers and two outings for 4-6 people each month. Activity records were under discussion as Southern Cross had a tick box activity record but staff felt this provided little useful information as to how people enjoyed and benefited from the session or not. Activity staff were Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 15 concerned about the time it would take to write individual records about activities provided. It was suggested that a diary was kept to show what activity took place, who attended and how residents received it. There was little evidence to show what activities residents had taken part in. Activity care plans seen on all units lacked detail as to the resident’s preferences or to show how social needs were met. It was apparent through discussions with residents and from observation that activities were taking place. One resident who was confined to bed said that the activity person came to have a chat almost every day however this was not the case for all residents requiring one to one time. The activity person helped out with feeding at lunchtime and had developed a good relationship with residents and staff. Requirement 6. The service had an open visiting policy and residents who could comment said they enjoyed family and friend visits. Most of the residents on the first and second floor sat in one lounge, which meant the rooms were quite crowded. It was therefore not easy for relatives to sit by residents during visits. Residents could see visitors in their bedrooms if they wished. Only two relatives were seen during the course of the inspection and both said they were able to visit when they wanted, contribute to their family members care and had no concerns. Some care plans seen included the resident’s preferred time for going to bed and getting up and preferences for a bath or shower. Residents spoken with said staff involved them in decision about their care and lives. However a high number of residents in the home were unable to make informed choices or to voice their views of the service. At the time of this inspection a new head cook had been in post for a short while. The cook was working with the acting manager to prepare suitable menus. Time was needed for this to develop and progress will be monitored at future inspections. The kitchen was viewed briefly and was found to be clean and tidy, all equipment was working and clean, food, fridge and freezer temperatures records up to date. Good supplies of fresh, frozen and dried foods were seen. Lunch was observed on all units on the first day of the inspection. On the second floor the dining room tables were laid but no condiments provided. All residents on this unit had the same meal at lunch and the meat and vegetables had been pureed together and this did not look very appetising. Residents spoken with said and others were observed to enjoy their meal and staff offered assistance where needed. A high number of residents on this unit required assistance with feeding. On the first floor part of breakfast and lunch was observed. The cooked breakfast looked appetising. Tables were laid out nicely with paper napkins, condiments and juice. At lunch there was evidence of choice but one resident said they were not always asked about their food choices. Four out of five people said the meal was nice however one person who had fishcakes said they were tasteless. Staff assisted residents where needed. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 16 On the ground floor residents who were able clearly had a choice about where they wished to have their meals. A lot of discussion took place regarding the provision of vegetarian meals, as for one resident the meals they had were very repetitive. For this resident records seen showed was that the resident was given lots of meals with cheese for example broccoli with cheese, cauliflower cheese, cheese salad, cheese omelette and pizza. Staff said that they would discuss the resident’s diet with the cook with a view to introducing more variety into the meals. Requirement 7. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate policy and procedures were provided in relation to safeguarding adults and managing complaints. Improvements were needed to recording of complaints made about the service. EVIDENCE: The service had a complaints procedure and this was included in the statement of purpose and service user guide. A complaints log was kept and showed that only one of the two complaints made about the service since the last inspection had been recorded. The record log included responses to the two complaints but as a copy of the original complaint was not seen it was not possible to assess whether complaints had been investigated in line with the home’s policy and procedure. The annual quality assurance assessment (AQAA) provided by the provider to the Commission said that eleven complaints had been made about the service since the last key inspection. The Commission received a high volume of concerns and complaints about the service over a short period of time in October 2007 resulting in the Commission carrying out an unannounced random inspection. Requirement 8. The service had a policy and procedure in relation to safeguarding adults. Staff spoken with displayed an understanding of safeguarding adults and how to report suspicions or allegations to a senior member of staff. Staff said they had received training on this topic. The staff training matrix showed that Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 18 twenty four staff members had received training on safeguarding adults since the last key inspection. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 19 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): Standards 19, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of much of the environment such as corridors, bathing facilities and bedrooms required improvement. Staff did not have access to adequate numbers of hoists or bed linen. EVIDENCE: Although the home was generally clean, tidy and free of offensive odours many areas of the environment were tired and worn and required repairs and redecoration. An improvement plan was in place and a copy given to the Commission to improve the entire home. This work had begun and included repainting all corridors and some other areas, refitting new corridor carpets and other general decoration and upgrading. Progress on completion of the programme will be monitored at future inspections. The registered person must keep the Commission informed in writing as to progress made with the environment improvement plan. Recommendation 3. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 20 Bathing facilities were included in the environmental improvement plan. However on the first day of the inspection the lighting in two bathrooms on the second floor was not working properly and two on the three baths the knob to turn on the tap was missing. The shower room required some repair and redecoration as the shower door was not fitted and one wall was quite damaged. On the first floor the door lock in the bathroom opposite room 29 was broken. The bathroom on the ground floor was out of order and had been for about two months. It is recognised that staff may have been unable to implement resident personal hygiene care plans in relation to bathing recently due to staff shortages and a number of bathing facilities requiring attention. Requirement 9. Staff spoken with said they have had problems with hoisting equipment for some time. This problem was identified and the random inspection on 5th November 2007 and was brought to the attention of management. At this inspection this concern remained and all floors were short of moving & handling equipment as a number of hoists required repairs. Staff said that this had an impact on resident care as residents often had to wait for assistance with toileting and other personal care. The service has two lifts and the large lift had been out of order for some time. This was being addressed and they were waiting for a part to arrive to complete the repair. Requirement 10. The linen cupboards on the first and second floors were almost empty and staff on both floors said they could not make beds until the afternoon when the previous days bed linen came back from the laundry. At the last inspection a shortage of bed linen was noted. The laundry assistant said that all the laundry was completed daily and that adequate hours were allocated to complete the work. During the course of this inspection a supply of new bed linen was ordered and some delivered by the second inspection day. Some pillows seen were of a poor quality and two mattresses seen on resident beds on the ground floor were considered substandard. Bedrooms seen varied as to the standard of decoration and hygiene. In some of the bedrooms viewed carpets required cleaning, areas required repainting and walls had been damaged by equipment. The environment improvement plan included the redecoration of some bedrooms and management said that maintaining a good standard of décor in bedrooms would be part on a rolling programme. Requirements 11,12 and 13. A housekeeper was employed and worked with the domestic team to ensure the home was kept clean and a satisfactory laundry service maintained. Residents spoken with said there bedrooms were kept clean. Staff had access to adequate supplies of protective clothing and hand-washing facilities were provided in areas where waste was handled. Sluice areas were provided on all floors. Laundry staff spoken with said they had adequate time to complete their daily work and all the laundry equipment was in working order. (See requirement 13.) Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 21 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): Standards 27 – 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were not always maintained. Efforts were being made to meet the standard in relation to NVQ training. Improvements were needed to staff recruitment and induction. Staff were provided with adequate and relevant training. EVIDENCE: As previously mentioned the Commission received a number of complaints about the service in October and November 2007. Many of these were in relation to inadequate staffing levels particularly on the first and second floor units. The staff rosters seen at the time of the random inspection on 5th November 2007 supported this information. Management agreed to ensure adequate staffing levels would be maintained and that where necessary agency staff would be employed to cover shifts. Staff rosters seen for December 2007 and up to the date of this inspection showed that on many occasions the service was inadequately staffed both in numbers and skill mix. Residents and relatives raised concerns about staffing levels in the feedback surveys sent to the Commission. The dependency level of residents on the second floor was very high. Management must complete a dependency level on residents and translate this to care hours and staffing levels to ensure adequate staff are on duty at all times to meet resident needs. Staff, particularly those working on the second floor said that in their opinion the current staffing levels were inadequate to meet resident needs. The reason for this was that a high Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 22 number of residents on this floor required assistance with feeding and the assistance of two care staff to meet their personal hygiene and moving & handling needs. It was apparent through discussion with staff that there had been serious staffing issues but staff spoken with said this had improved and the service was more settled since the current manager came into post. Requirement 14. From the provider information in the AQAA thirty four care staff were in post and twelve of them had achieved NVQ level 2 or above. A further twelve care staff were working towards this qualification. Four employee files were viewed. None of the files complied with regulation, one did not have a recent photograph of the person and references had not been verified, one did not have a recent photograph of the person, one file for a person transferred from another Southern Cross home did not have any references and registration with the NMC had not been checked and one file had one reference, which had not been verified. There was no evidence in any of the files of induction. Staff spoken with said that lately induction of new staff had not taken place as it had in the past. Three files contained evidence of recent relevant training. Management recognised this was an area requiring improvement. Requirements 15. There was evidence of recent staff training on the employee files viewed. The organisation had a training co-ordinator and a planned training programme. Training needs were identified through supervision and a matrix kept on computer to ensure staff received mandatory training and updates. Within the staff team there were four moving & handling trainers and link nurses for tissue viability, continence, nutrition, diabetes and infection control. The staff training matrix seen showed that since the last key inspection staff had access to training such as fire safety, food hygiene, moving & handling, COSHH, safeguarding adults, infection control and medication management. Staff spoken with said they received adequate and relevant training. Despite the training provided staff lacked the ability to meet the needs of residents with dementia and of some of the residents on the ground floor. For example it was noted on the ground floor that staff fed a resident with a visual impairment and had not got advice from other relevant professionals on this need, staff put bibs on all some residents for meals who may not have needed to have them on and staff were heard discussing residents needs in their presence. On the positive side this unit had a new team leader in post since December 2007. The new team leader presented as able to lead staff by example and displayed a good understanding of the category of residents in the unit. Requirement 16. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements were needed to the management of the service. Satisfactory systems were in place to address safety for residents and others and to manage resident’s personal allowances. Staff were no receiving formal supervision. EVIDENCE: Since the last key inspection the service has had two manager changes. One manager took up post in September 2007 and was dismissed in December 2007. During the manager’s time in the home a number of concerns were raised, staff were very unhappy with how the service was managed, a number of staff resigned and the service became very unstable. This resulted in the Commission doing a random inspection in November 2007 and Greenwich social services holding a strategy meeting to assess the service. Following the Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 24 meeting Greenwich and Bexley social services decided not to admit residents until the home was reassessed and resident safety ensured. An acting manager took up post on 20th December 2007 and this has resulted in the service beginning to stabilise however it will take time for staff to benefit from this change and for standards to improve. Two full time deputy managers supported the manager in her role. The acting manager, senior management and staff were working to resolve the issues that occurred and to improve standards within the home. Progress made to improve the service will be monitored at future inspections. Staff said the current acting manager and deputy managers were approachable and helpful. Requirement 17. A system was in place to carry out in-house audits on areas such as medicine management, care plans, infection control, catering, accidents and pressure sore management. Copies of these audits were available to view. Management carried out night visits and where necessary action was taken to address any issues identified. Comment cards were made available for residents and visitors. Joint resident and relative meetings were held and minutes kept. The last meeting was held on 9th January 2007. The provider planned to carry out an annual satisfaction survey to get the views of residents, relatives, stakeholders and others. This aspect of the quality assurance will be monitored at future inspections. Meetings were held with staff groups such as deputy managers, registered nurses, clinical meetings, heads of departments and staff meetings on each unit. Regulation 26 reports were sent to the Commission occasionally. Satisfactory systems were in place to manage resident’ personal allowances. A random sample of financial records for three people were checked and found to be correct. The administrator said that a small number of valuables were stored in the safe and a computer record kept. It was not possible to check the record against the items as the computer system was down at the time of the inspection. Due to the recent instability in management and staffing supervision had not taken place. The manager was aware that this area of support was necessary for staff and planned to restart supervision sessions. Staff spoken with confirmed that they used to have supervision and that plans were in place to restart this. Requirement 18. Since the last key inspection the service had two changes of maintenance technicians. The current person had not been in post long at the time of this inspection and was still learning the safety procedures and systems. From information provided in the AQAA routine service had been completed in relation to gas supply and electricity supply and other relevant areas. Fire safety records showed the system was serviced in October 2007, weekly fire alarm tests were completed and fire drills had been held at times to include Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 25 night and day staff. There was no evidence to show that hot water outlets were routinely checked. Requirement 19. Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 26 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 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 2 X 2 X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 12 Requirement The registered person must ensure that residents outside the home’s category of registration are not admitted. (Timescale of 30/11/07 was not met) The registered person must review the service provided to residents on the ground floor to ensure it meets the needs of younger people particularly in relation to social needs and individual development. The registered person must ensure: That residents care needs are fully assessed and care plans prepared to show how to meet those needs. That wound care plans show the condition of the wound and the frequency and type of dressing used. (Timescale of 30/11/07 was not met) The registered person must ensure that every effort is made to get a review of residents care needs by other professionals as needed. (Timescale of 30/11/07 was not met) DS0000006776.V335403.R01.S.doc Timescale for action 28/03/08 2 OP4 12 28/03/08 3 OP7 15 22/02/08 4 OP8 12 22/02/08 Brook House Care Centre Version 5.2 Page 28 5 OP9 13 6 OP12 16 7 OP15 16 8 OP16 17 9 OP21 23 The registered person must ensure safe systems are in place to manage medicines. Accurate records must be kept for medicines so that an audit trail can be completed. This included homely remedy medicines. Medicine charts must show that all medicines including topical preparations are administered. Medicines must be securely stored at all times. The temperature of medicine storage rooms and fridges must be monitored. All prescribed medicines must be provided and administered to residents. The registered person must ensure individual social care plans are prepared with residents. Records must be kept to show the activities provided to each resident. Efforts must be made to improve activities on the ground floor to ensure they meet the needs of younger people. The registered person must ensure: Foods are pureed separately to ensure they look appetising. Residents are offered a choice of meal. Tables are fully laid up and condiments provided. Residents specific dietary needs, such as vegetarian diets are met. The registered person must ensure records are kept for all complaints made about the service and evidence to show how the complaint was managed. The registered person must DS0000006776.V335403.R01.S.doc 22/02/08 28/03/08 22/02/08 22/02/08 22/02/08 Page 29 Brook House Care Centre Version 5.2 10 OP22 13 11 OP24 23 12 13 OP24 23 23 OP24 14 OP27 18 15 OP29 19 16 OP30 18 ensure all bathing facilities are well maintained and available to residents at all times. The registered person must ensure adequate numbers of hoists are provided on each unit to meet resident’s needs. The registered person must ensure an audit is completed on the pillows provided and new supplies purchased as needed. (Timescale of 04/09/06 was not met) The registered person must ensure an adequate supply of linen is provided. The registered person must ensure carpets in resident’s bedrooms are kept clean and bedrooms maintained and decorated to a satisfactory standard. The registered person must ensure adequate staffing levels are maintained at all time to meet resident needs. A dependency assessment must be completed for residents on the first and second floors and this converted to care hours to ensure adequate staffing levels are provided. A copy of the dependency analysis must be sent to the Commission together with details of any changes to staffing levels. The registered person must ensure all the information required by regulation and schedule 2 is obtained for employees and available for inspection. Efforts must be made to check the authenticity of references. (Timescale of 04/09/06 was not met) The registered person must ensure all staff receive training DS0000006776.V335403.R01.S.doc 22/02/08 22/02/08 22/02/08 22/02/08 28/03/08 22/02/08 28/03/08 Page 30 Brook House Care Centre Version 5.2 17 18 19 OP31 OP36 OP38 9 18 13 relevant to their role and in particular training on dementia care and the needs of younger people with a disability. The registered person must ensure the home has a registered manager. The registered person must ensure staff receive regular supervision. The registered person must ensure a system is in place to monitor hot water outlets in the home. 28/03/08 22/02/08 22/02/08 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 OP7 OP9 Good Practice Recommendations The registered person should ensure care records show when residents have a bath or shower. The registered person should ensure a medicine profile is prepared for each resident, that a protocol is prepared for residents requiring ‘as required medicines’ particularly when a resident cannot verbalise this need and an annual competency assessment should be completed for all staff responsible for medicine management. Arrangements must be in place to identify staff initials on medicine charts when staff have the same initials. The registered provider should use regulation 26 visit reports to keep the Commission informed of progress made to implement the home’s improvement plan and to meet the requirements made in this report. 3 OP33 Brook House Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Care Centre DS0000006776.V335403.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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