Inspection on 01/03/06 for Brook House Nursing Home

This inspection was carried out on 1st March 2006.

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 Nursing Home 07/07/09

Brook House Nursing Home 13/12/08

Brook House Nursing Home 18/09/07

Brook House Nursing Home 28/09/06

Brook House Nursing Home 09/06/05

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Brook House Nursing Home 28 The Green Wooburn Green Bucks HP10 0EJ Lead Inspector Mr Guy Horwood Unannounced Inspection 1st March 2006 09:40 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 Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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 Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brook House Nursing Home Address 28 The Green Wooburn Green Bucks HP10 0EJ 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) 01628 528228 Centurion Health Care Ltd Care Home 35 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (35) of places Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly Physically Frail Requirements and Recommendations: Mr & Mrs Akhtar have agreed to address all of the requirements and recommendations detailed within the Announced Inspection report of the 27th October 2004 within the agreed timescales. That the current registration allows for the care of 8 (eight) service users with a Dementia - type illness. The home`s registration therefore permits the continued accommodation of 8 (eight) service users with dementia type illness (DE) who are already accommodated at Brook House Nursing Home. First Floor Lounge: That the first floor lounge can be used as bedroom accommodation for up to two residents and that this variation is permitted for the sole purpose of refurbishment and redecoration of residents` bedrooms. This variation will cease on the 22nd May 2006, whereby the home`s conditions of registration will revert to those stated in the current registration. Date of last inspection 9th June 2005 3. 4. Brief Description of the Service: Brook House is a care home providing care with nursing for up to 35 elderly people. The home is situated in the village of Wooburn Green, with several small shops located nearby. The home consists of an older building, which has been renovated, and extensions that have been added in 1980 and 1997. Of the homes 31 bedrooms, 27 are single and 4 are shared, with 14 of the single bedrooms in the modern extensions possessing en-suite facilities. An additional 6 bathrooms and 6 toilets are provided. The home has 2 through-floor lifts to allow Service Users access to all levels of the home, and mechanical hoists are provided to enable the safe moving and handling of Service Users. Toilets and bathrooms have grab rails, and some disabled bathing facilities are provided. The home has three lounge areas, one of which also provides a dining area. This dining area can seat approximately 15 Service Users. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 5 A registered nurse is required to be on the premises 24 hours a day, and a team of carers, caterers, laundry and housekeeping staff are employed. Access to allied health care professionals is possible either by direct contact or through referral by the Service Users General Practitioners, who can be contacted by staff. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Brook House Nursing Care Home on the 1st March 2006, between the hours of 9.40am and 3.15pm. The lead inspector was Mr Guy Horwood, who was accompanied by Miss Chris Schwarz, Inspector. The home’s newly appointed manager, Mrs Sharon Pither, and the new deputy manager, Mrs Beverley Roberts, met the inspector’s. The home’s owner and responsible individual, Mrs Ferida Akhtar, joined the inspection during the course of the morning. The inspection consisted of meeting with residents and staff and viewing records and documents pertaining to the provision of care and the running of the home. The inspectors toured the building and viewed residents bedrooms and communal areas. As is evidenced in previous inspection reports, parts of the home are old and in need of attention. It is also reported that the on-going maintenance of the premises and its equipment has been neglected in recent years. It was therefore extremely pleasing to find that the new providers have instigated an extensive programme of internal redecoration and refurbishment. This programme has included the replacement of carpets throughout the home, which alone has made a vast improvement to the appearance and atmosphere of Brook House. However, a lot of work required from previous inspections has yet to be undertaken, and in some cases timescales for completion have not been met. Where required, new timescales have been negotiated. The inspectors were of the opinion that the staff team, under the guidance and support of the new proprietor, Mrs Akhtar, and through significant change at the home, have worked hard to address previous inspection requirements with regards to care provision. Mrs Akhtar displays a desire to improve not only the environment of the home and the quality of care afforded to all residents, but also the motivation and performance of staff. The inspectors anticipate further improvements will be evident at the next inspection. The inspector’s found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents for their time, conversation and company, and for allowing the inspector’s into their home. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 7 What the service does well: What has improved since the last inspection? What they could do better: All medicines need to be stored, handled and administered safely. Work is still needed to address previously served requirements in relation to the condition of the home and to bring the environment in line with National Minimum Standards. The provider is required to undertake recorded monthly monitoring visits, and is to forward copies of reports of these visits to the Commission. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 8 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 Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 9 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 Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 10 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): 3 Pre-admission assessments of potential residents are conducted, and this allows the home to make an informed decision as to whether they can meet a residents needs. As a consequence, residents appear to be placed appropriately. EVIDENCE: The pre-admission assessments for two recently admitted residents were viewed. These showed improvement over previous inspections, with assessments completed and containing relevant details and supporting documentation from external agencies. Assessments were signed and dated by the person completing them, and identified where the assessment had taken place. It is anticipated that this standard of the assessment of potential residents will be maintained. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9. Service Users health care needs are identified in care plans. These care plans are orderly and user friendly, and much improved on those viewed at previous inspections. However, those care plans viewed did not hold sufficient detail as to how identified healthcare needs are to be met, and therefore staff may not have sufficient information to enable them to meet and monitor residents needs. Residents have access to healthcare services in order to meet their assessed needs. Medication is not consistently stored and handled safely and may place residents at risk. EVIDENCE: Through the tracking of specific care provision for 2 recently admitted residents, 2 care plans were viewed. It was evident that this aspect of record keeping within the home had been reviewed and reformatted since the last inspection, and a more orderly and user-friendly document was found to be in use. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 12 The two care plans viewed held good details about the residents, and identified past and current health care needs. One identified a resident’s current healthcare need of insulin dependent diabetes and a past medical history of an MRSA infection, and the other identified a history of a clostridium difficile infection. Neither care plan detailed what action staff were to take to meet these specific needs, or what action should be taken if signs and symptoms relating to these conditions should present. The inspectors were informed by the manager, Mrs Pither, that it was intended for the newly appointed deputy manager, Mrs Roberts, to audit all care plans and to instigate action to improve any short falls. Given that Mrs Roberts had commenced in post the week of the inspection, the inspector will return to review progress in the coming months, by which time it is anticipated that further improvements will have been made. All residents are registered with a General Practitioner, and the home has liased with the local tissue viability nurse. Mrs Akhtar stated that some support with training and practice issues had been provided through liaison with Buckinghamshire County Council. In one residents bedroom Paracetamol tablets were found on their table. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 13 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, 13 & 14. The provider has taken steps to establish an activities programme to provide stimulation and enjoyment for residents, thus hoping to improve their quality of life. Residents may receive visitors at times convenient to them. EVIDENCE: The home has recently appointed an activities co-ordinator, and it was ascertained that this person had previously worked for age concern as a befriender and in a school as an activities organiser. This staff member was friendly, cheerful and polite, appeared motivated, and was able to give an account of her intentions to provide individual and group activities. Following the inspection, the inspector provided details to Mrs Akhtar of other care services and their activities organisers to facilitate liaison with them. The activities programme will be reviewed at the next inspection. The home operates an open visiting policy and visitors were noted to come and go during the course of the inspection. All visitors have to be granted access to the home by a member of staff. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not assessed at this visit. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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, 21, 24 & 26. Significant improvements to the internal fabrication of the home have been undertaken and more are planned for the coming months. This work has improved the environment to the benefit of the residents and staff. A number of previously set requirements have been reiterated for work, which is still required within the home. It is anticipated that the programme of work will continue in order to enhance the homely environment sought by the provider. EVIDENCE: As is evidenced in previous inspection reports, the environment of Brook House has been neglected in recent years. It was therefore extremely pleasing to find that the majority of the premises had been re-carpeted prior to the visit, with the lounge and dining room being fitted at the time of the inspection. These carpets appeared domestic in design and appeared to be of an appropriate material. This work has made a vast improvement to the appearance and atmosphere of the home. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 16 Mrs Akhtar described plans to create an enclosed nurses station in the reception area in order to provide space for confidential discussion and secure storage for records. Work to refit the kitchen, as required at previous inspections, has yet to commence. Mrs Akhtar anticipates that this work will be undertaken following other work for the provision of appropriate wheelchair access between the reception and lounge. Timescales for this work were discussed. Several areas of flooring in bathrooms were noted as worn and stained and to detract from the homely environment. Bathrooms identified at the last inspection as requiring decoration and the replacement of equipment have not been attended to. Mrs Akhtar stated that she has sought advice to address these requirements. The timescale for completion has been extended on this occasion. Mrs Akhtar enquired as to the use of an upstairs lounge for temporary accommodation of residents to enable the decoration of existing bedrooms. At the time of writing this report a variation to the homes registration has been approved by the Commission to enable this room to be used as such on a temporary basis. Mrs Akhtar described work that is scheduled to improve the environment of Brook House. This included the redecoration of rooms; the refitting of the kitchen; refurbishment of a bedroom and adjacent corridors; and the replacing of bedroom lighting. Timescales for the completion of certain aspects of this work have been discussed with the inspectors. Mrs Akhtar is required to provide regular updates as to work carried out at the home through the provision of reports of visits that she must undertake as per regulation 26 of the Care Homes Regulations 2001. New height adjustable beds have been purchased. Pressure relieving mattresses were seen to be in use. An old mattress, similar to those required to be replaced at previous inspections, was found in use on an unoccupied bed in room 19. This mattress, and any similar, are to be replaced. A fire exit from the 2nd floor of the home leads down a steep external metal staircase. This fire exit door is fitted with a break glass lock, which secures the door. This lock was found to be broken at the time of the inspection and the door was easily opened from inside. It was required that this lock needed to be replaced as soon as possible to reduce the risk of persons accidentally exiting by this door. At the time of the visit the home was clean and tidy, despite the on-going work of the carpet fitters, and no offensive odours were noted. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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): 29 Staff recruitment records and the process of employing staff have improved. However, procedures are still not sufficiently robust in order to protect residents from the risk of abuse. EVIDENCE: A selection of 4 recruitment files was viewed. These held the majority of information required by Regulation 19 and Schedule 2 of the Care Homes Regulations 2001 and were much improved on records seen at previous inspections. However, each file was missing at least one piece of information as listed under schedule 2, (Photograph; Copy of birth certificate; Evidence of medical fitness; Gaps in employment history not explored.) In one case a member of staff had commenced in post before a PoVA First and / or Enhanced Criminal Record Bureau check had been received. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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, 32, 33 & 38. The home has a newly established management structure, which is in the process of reviewing the policies and procedures pertaining to the running of the home with the intention of providing a good quality service. The provider does not undertake quality monitoring visits as required by the Care Homes Regulations 2001, but along with the manager is in the process of reviewing policies and procedures pertaining to the running of the home. EVIDENCE: The newly employed manager, Mrs Sharon Pither, has recently submitted her application to the Commission in order to be registered as required under the Care Standards Act 2000. Mrs Pither is a registered nurse who has previously worked with adults with learning disabilities, and has some experience of care of the elderly and care of people with a dementia type illness. Mrs Pither is currently undertaking her registered managers award. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 19 A deputy manager has been appointed who is a registered general nurse with experience in elderly social care including the care of residents with a dementia type illness. Mrs Akhtar, Mrs Pither and Mrs Roberts described how they are continuing to review policies, procedures and practices within the home. It is anticipated that the home will continue to show improvements now that a senior management team is in place. At the last inspection a requirement was served for the undertaking of visits as described under regulation 26. Mrs Akhtar was reminded of the need to undertake these monitoring visits and provide reports to the Commission. A previous requirement in respect of regulation 26 visits has been repeated. In some bathrooms, toilets and bedrooms, boxes of gloves for care staff use during the provision of personal care were noted. These detract from the homely appearance that the home seeks to provide, and may present a risk to those residents with a diagnosis of dementia. It is recommended that alternative storage for gloves be sought. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X 2 X X 2 X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X X X 2 Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 Requirement Care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Residents care plans must be kept under regular review. 01/10/05 All environmental issues identified at the announced inspection of the 27th October 2004, and unannounced inspection of the 17th February 2005, and described within the subsequent reports of those inspections, are to be attended to within the timescales stipulated. A programme for the replacement of old, tired and worn furnishings is to be established, with records kept evidencing the progress of this programme. 01/10/05 Flooring is to be replaced in the bathrooms next to room 20 and 26. 01/01/06 The bath is to be replaced in the bathroom next to room 26. 01/01/06 DS0000062534.V292923.R01.S.doc Timescale for action 01/06/06 2 OP19 23 01/10/06 3 OP24 23 01/06/06 4 5 OP21 OP21 23 23 01/06/06 01/06/06 Brook House Nursing Home Version 5.1 Page 22 6 7 OP21 OP33 23 26 8 OP38 13(4) 9 10 OP9 OP29 13(2) 19 and Schedule 2 11 OP24 23 The bathroom next to room 16 is to be redecorated. 01/01/06 The providers must undertake monthly, unannounced visits as described under Regulation 26 of the Care Homes Regulations 2001. 01/10/05 The glass locking mechanism to the fire exit on the second floor is to be replaced as soon as possible. Medication must be stored, handled and administered safely. Staff are not to commence in employment unless all of the information required under regulation 19 and Schedule 2 has first been obtained by the employer. The mattress in room 19 is to be replaced with a new one, as are any other similarly old, worn and stained mattresses within the home. 01/06/06 30/04/06 01/05/06 01/05/06 01/05/06 01/10/06 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. Refer to Standard OP38 Good Practice Recommendations Gloves are stored in such a manner as to reduce potential risks to residents and to promote the provision of a homely atmosphere. Brook House Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Nursing Home DS0000062534.V292923.R01.S.doc Version 5.1 Page 24 - 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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