Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ The quality rating for this care home is: The rating was made on: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Chris Schwarz Date: 1 3 1 2 2 0 0 8 Information about the care home
Name of care home: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ 01628528228 01628529892 brookhousecare@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Centurion Health Care Ltd The registered provider is responsible for running the service care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability 35 0 35 Over 65 0 35 0 Conditions of registration: The registered person may provide the following category/ies of service only:Care home with nursing - to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category - (OP) Dementia (DE) Physical Disability (PD) The maximum number of service users to be accommodated is 35. Date of last inspection Brief description of the care home Care Homes for Older People Page 2 of 11 Brook House provides nursing care for up to 35 older people. The home is located in the village of Wooburn Green and is close to pubs and local shops. There is a bus route into High Wycombe near by. Accommodation is in mainly single bedrooms, some with en suite facilities. A few shared rooms are also available. There are communal bathrooms and toilets located around the building. The home has spacious lounge areas and an enclosed garden. Care Homes for Older People Page 3 of 11 What we found:
This unannounced visit was carried out on a Saturday by Chris Schwarz. It focused on some of the core areas that are assessed during key inspections, to check that the home is providing good standards of care. It included speaking with staff, people using the service and visitors, looking at some of the records that homes are required to keep and observation of care practice. A selection of surveys had been sent out prior to the visit and were returned in time to help with planning the inspection. Comments and findings are included in the report. The last key inspection of Brook House took place on 18th September 2007. Thirty two service users were being cared for at the time of this visit. A care plan was in place for each person and a sample of these was looked at. Each one followed the same format and provided a good range of information about peoples care needs. A photograph of the person was in place at the front of the files and documentation about the admission process. Peoples preferred name, their date of birth, marital status, who they were referred by and reason for admission were noted. Information about where they used to live, their next of kin, past and current medical history and observations on admission were recorded plus what types of medicines they were taking at that time. Assessments of care needs at the time of admission were detailed. They had been dated and signed by the person carrying out the assessment. Care plans followed the same format and identified needs in relation to communication, personal hygiene and dressing, elimination and continence, mobility and dexterity, moving and handling, tissue viability, nutrition, breathing, pain, sleeping, mental state and cognition, expressing sexuality, fears for the future, social interests and hobbies and family, carers and friends involvement. Information had also been added about peoples life stories. All documents had been dated and signed with evidence of regular review. A range of risk assessments was in place in each file, such as for moving and handling, risk of developing pressure damage and falls. These had been reviewed regularly and were dated and signed. People were being weighed regularly. In three care plan files, weight records showed that two service users had lost over one kilogramme each when weighed at the start of December, the third person had lost over two and a half kilogrammes in November and had since gained some weight. It was not noted in records of health care appointments/visits or from nutrition care plans whether these service users had been referred to their doctors or a dietician or if measures had been put in place to investigate the causes. The provider confirmed after the visit that people who have lost weight are referred to health care professionals for advice, although the records do not always back this up. A requirement is made it address this to ensure that people receive the medical support they need. A recommendation is made to put in place nutritional risk assessments to supplement the information on peoples files. Medication was being securely stored at the home. One of the two trolleys and accompanying medication administration records was looked at. A photograph of each service user was in place plus information about any allergies or difficulties in Care Homes for Older People Page 4 of 11 administering medicines. A monitored dose system of medication administration was in use with dates of opening written on bottles and packages which are not suitable for blister packs. Homely remedy authorisation had been obtained from peoples doctors for simple linctus, paracetamol and Gaviscon. Medication administration records had some gaps alongside prescribed dose times with no indication of the reason on the records. It is important that accurate records are maintained of medicines administered to people using the service and a requirement is made to address this. The controlled drugs cupboard was checked. There was just one medication being stored in there and the quantity tallied with records in the controlled drugs register. It was noted that three packs of the same skin patches had been opened when one would have been sufficient. The controlled drugs cupboard was also being used to store money belonging to a named person. Storage of items other than controlled drugs is not advisable and there are more suitable places for the money to be kept. It was noticed in the treatment room that there was a large quality of medicines that need to be destroyed or returned for disposal. The home has contractual arrangements in place for this, and for disposal of sharps. One large drum was already filled and a second one was in use. Additionally, the sharps bucket had been filled above the safety line and needs to be disposed of. Recommendations are made to address these. People using the service had been assisted to look well presented and clean. Those people spoken with said their carers were friendly and kind but pointed out that it can sometimes take a long time for call bells to be answered, especially if they need assisting to go to the toilet. This was reflected in surveys that been returned and from observation during the morning. People said in surveys they usually receive the care they need. Additional comments included that a lack of toilets make things difficult and they sometimes have to wait thirty minutes. One person said that medically wise the home could be better and when I have hospital appointments the home does not always give my family enough time to get me there. Feedback from doctors included that the home seeks advice and acts upon it and that it meets peoples health care needs. They said peoples privacy and dignity were usually respected although one pointed out patients not always in their rooms so examinations eg chest have to be done in lounge or similar setting. They considered that medication was being managed correctly and that staff had the right skills and competencies to meet peoples care needs. One said the home communicates well with GPs to cater for medical needs of residents and another said what the home did well was its personal touch and knowledge of relatives concerns and circumstances. One doctor said communication was hampered by lack of language proficiency with already hearing impaired residents. Several visitors came to the home and were made welcome by staff who chatted with them and offered them a cup of tea or coffee. One visitor said he is always made to feel welcome and that he can have a meal at the home if he wishes, for a very small fee. People spoken with said the food was good and that there is plenty of it. Where people had specific requirements, such as soft or pureed meals, this was being provided. The sausage casserole for lunch smelled appetising and people said they had enjoyed it. Care Homes for Older People Page 5 of 11 The home was decorated for Christmas. One person said there was a good activities co-ordinator at the home and she had involved people in some of the colourful items that were on the walls. People who completed surveys said the home is kept fresh and clean. Additional comments included evident every care taken with hygiene. Personal clothing laundered and returned promptly, and cleanliness of room could be greatly improved, the eating table had fat which I had to scrape off and dust on fan, since new manager in post, decoration and installation of new bath greatly improved. Those areas of the home that were seen during this visit were clean and well decorated. People spoken with said their rooms were comfortable. The building was being kept warm. There were no unpleasant odours around the building and laundry was under control. The shift planner for the day showed that there were two nurses on duty in the morning and four carers. The rota for the afternoon showed only one nurse and two carers due to work, with other 2 pm to 8 pm shifts uncovered. When this was pointed out to the nurse in charge at around 1.20 pm, she said she would have to stay on duty and ring around other staff to try to get cover. It seemed late in the day to be doing this, especially for a Saturday where people are likely to be out. She said she did not know why the shifts had not been covered as someone else does the rotas. She added that they cannot use agency workers to provide cover. Feedback from people using the service and relatives met during the visit was that staff are attentive and kind and observation of interaction supported this. There were concerns from service users and relatives though at turnover of staff and the time it can take for call bells to be answered, as already mentioned. A requirement is made to ensure that there are enough staff on duty to meet peoples personal care needs at all times. People who completed surveys said that staff listen and acted on what they say and that they were usually available when they needed them. Additional comments included nurses and carers very friendly, treat residents with respect and mindful of dignity, on the whole most helpful and sometimes difficult to get help during lunch break and staff change over, however not proved to be a great problem and staff there as soon as possible. One person said there were not enough staff at night time. What the care home does well:
A pleasant environment has been created for people, providing them with warm, clean and well decorated surroundings. Food is well presented and appetising to ensure that peoples nutritional needs are met. Staff are caring and kind and interact well with people using the service and their visitors. Care Homes for Older People Page 6 of 11 Care plans provide a good account of peoples needs and how these are to be met. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 14 Where service users are 09/01/2009 losing weight, they are to be referred to their doctor or a dietician and a record kept of this and the outcomes. This is to ensure that people using the service receive the support they require and that the home can provide evidence of responding to changes in peoples well being. 2 9 13 Accurate records are to be 09/01/2009 maintained of medication administered to people using the service. This is to ensure that a clear audit trail is in place at the home. 3 27 18 Sufficient staff are to be on duty at all times. This is to ensure that people using the service receive the support and assistance they require in a timely manner. 09/01/2009 Recommendations Care Homes for Older People
Page 9 of 11 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 7 Nutritional risk assessments are to be carried out for people using the service to make sure that their needs in this area are identified and dealt with. Sharps buckets are to be disposed of more promptly to make sure that staff are not placed at risk of injury through contact with used needles and syringes. Medication that is no longer required is to be disposed of promptly to make sure that excessive amounts of medicines are not stored at the home. 2 9 3 9 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
