CARE HOMES FOR OLDER PEOPLE
Brookdell Retirement Home Foreside Barrowford Nelson Lancashire BB9 6AE Lead Inspector
Mrs Julie Playfer Unannounced Inspection 15th November 2005 10:00 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 Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Brookdell Retirement Home Address Foreside Barrowford Nelson Lancashire BB9 6AE 01282 603224 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) Mr Derek Howard Mrs Doreen Howard Mrs Anna Mary Nicholson Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: Brookdell is registered to provide accommodation and personal care for up to 15 older people over the age of 65. The home is a mature detached property offering homely accommodation, surrounded by private, attractive and accessible gardens. Garden furniture is provided, for the residents’ use in fine weather. The home is located in a fairly secluded position, away from the centre of the village. Accommodation is provided in five single rooms and five shared rooms, which are located on two floors. Access to the first floor is by chair lift. Communal space is provided in two inter connecting lounge/dining rooms. Various aids and adaptations to assist with mobility and self-help skills are available. The home only permits smoking in the conservatory/porch, where seating, but not heating is available. Staff provide 24 hour care in response to individual needs and wishes. Brookdell is situated towards the outskirts of the village of Barrowford, however, there are some community resources quite close to the home including a post office, church, public house and the local heritage centre. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over seven hours on 15th November 2005. The previous inspection was carried out on 23rd May 2005. No additional visits have been made to the home since the last inspection. On the day of inspection there were 14 residents accommodated at the home. Information was obtained from staff records, care records and policies and procedures. The inspector also spoke to the residents, the staff on duty and the registered person. A tour of the premises was also undertaken. What the service does well: What has improved since the last inspection?
Since the last inspection the registered manager had introduced a new care plan format, which covered the residents’ assessed needs including health care needs. The style of writing was easy to understand and it was apparent the residents had participated in the development of their own plan. The frequency of care records had been significantly increased. These records provided information on the residents’ changing needs and supported the care plans. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 6 The percentage of the staff team who had completed NVQ level 2 had increased to 54 . This figure was above the expected standard. The registered manager had received the electrical safety certificate, which was not available at the last inspection. The certificate was valid for five years. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 The admission procedure was well managed. Residents were provided with appropriate written information and received assurances their needs could be met by the home. EVIDENCE: Written information was available for residents in the form of a statement of purpose and service users guide. The guide was presented in a suitable format and was readily accessible in all bedrooms. All residents were issued with a statement of terms and conditions of residence or contract, if they were purchasing their care privately. The ‘case tracking’ process demonstrated that residents had their needs assessed prior to admission to the home by a social worker and/or the registered person. The registered manager had also informed the residents in writing that having regard to the assessment the home was suitable for meeting their needs. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 9 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 and 9 The care planning system addressed the needs of the residents and provided clear guidance to staff on how these needs were to be met. Improvements must be made the management of medication. EVIDENCE: Since the last inspection, the care plan format had been revised and updated. From the case files seen, it was evident each resident had a plan of care, based on an assessment of needs. The plans set out in detail the action needed to be taken by staff to ensure all needs were met. It was apparent the plans had been reviewed once a month and agreed with the service user and/or their representative. The plans had been updated in respect to any changing needs. The care plans were comprehensive and were written in a suitable format for both the staff and residents. However, not all the care plans included risk assessments. It was noted that care records had been maintained on a much more frequent basis. These records supported the care plans and provided information on changing needs and any recurring difficulties. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 10 Healthcare needs were appropriately assessed and were included in the care plan. There was evidence to indicate the residents had access to NHS services and advice from specialist services had been sought as necessary, for instance the District Nursing Team. A separate chart was maintained to monitor the residents’ weight. The home operated a monitored dosage system for the administration of medication, which was dispensed into blister packs. Policies and procedures were available to cover all aspects of managing medication in the home. Appropriate records were in place to record the receipt and administration of medication. However, there were some shortfalls noted in the overall management of medication. The registered manager must therefore ensure that a full record is made of all medicines/tablets leaving the home, medication is always administered in line with the prescriber’s instructions and details on the prescription label are entered onto the medication administration record. In addition, the registered person should devise protocols for the administration of medication prescribed “as necessary”. The registered manager must also ensure the controlled drugs register is accurately maintained at all times. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 11 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 and 15 Residents were able to exercise choice and control over their lives and maintained good contact with their family and friends. However, to improve consultation residents’ meetings should be arranged on a regular basis. EVIDENCE: The residents said the daily routine was flexible and they were able to get up and go to bed at a time of their choosing. The plan of care gave information of the resident’s preferred daily routine and for staff to support residents to make decisions wherever possible. The residents’ interests were documented in the care plans. A range of activities were planned and implemented by staff and a programme was displayed in the hallway. Activities arranged in the home included music and movement, church services and professional entertainers. The residents spoken to said, they were satisfied with the frequency and type of activities. Since the last inspection four residents had been on holiday to Llandudno, one of the residents said the holiday “was a lovely break”. It was noted there had been no residents meetings since the last inspection and consultation with the residents was therefore reliant on informal conversation.
Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 12 The residents were able to receive visitors at any time and were able to entertain their guests in private. All the visitors spoken to on the day of inspection expressed satisfaction with the standard of care provided by the home. The menu was on display in the home and the choice of meals was discussed with the residents prior to every mealtime. The residents were satisfied with the quantity and variety of meals, which were homemade. Drinks and snacks were available at all times and set times throughout the day and evening. The residents spoken to described the meals as “very good” and “varied”. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Systems were in place to ensure any concerns of residents would be acted upon. Policies and procedures were in place to respond effectively to any allegations or suspicions of abuse. EVIDENCE: The complaints procedure was incorporated in the service users guide and displayed around the home. The procedure contained the necessary information should a resident wish to raise a concern with the home or direct to the Commission. The registered manager had received no complaints. The registered manager had a copy of “No Secrets in Lancashire” and an adult protection procedure specific to the home. Minor amendments were required to the adult protection procedure to bring it in line with the “No Secrets” document. The registered manager had a good awareness of the procedure and the response required in the event of any allegations or evidence of abuse or neglect. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 14 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, 20, 22, 23, 24, 25 and 26 The residents were provided with a clean, comfortable and well- maintained environment. Risks had been assessed appropriately to minimise any hazards to residents’ health and safety. EVIDENCE: Brookdell is a mature detached property, surrounded by its own grounds. The gardens are attractive, private and well-maintained. There was a patio at the rear of the property. The residents said they enjoyed sitting in the garden in the fine weather. The residents had personalised their bedrooms with their own belongings and decoration was good throughout. The residents said their rooms were comfortable and warm. Residents had been provided with aids and adaptations to assist their independence skills, these included grab rails, handrails and raised toilets. The chair lift accessed the main stairs to the first floor accommodation.
Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 15 A suitable number of toilets and bathing facilities were provided in the home. However, the privacy lock on the bathroom door on the first floor must be repaired. A call system with an accessible alarm was placed in every room, with the exception of the conservatory/porch. This part of the home was a designated smoking area. Should a resident use this room for smoking the registered person must fit an accessible alarm facility to this room and an appropriate source of heating. To minimise the risk of scalding preset valves had been fitted to the baths. Valves had not been fitted to the hand washbasins but risk assessments had been carried to determine if any of the residents were at risk from hot water. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 16 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): 27, 28, 29 and 30 Suitable arrangements were in place to ensure staff received appropriate training in line with the needs of the residents. EVIDENCE: The registered manager maintained a master rota and explained the staff carried out the same duties every week. In the event of absence, alternative staffing was recorded in the diary. The level of staffing was in line with guidance previously issued by the Local Authority. The registered manager had not recruited any new staff since the last inspection. However, the registered manager reported that an audit had not yet been undertaken on staff files to ensure records are collated in line with the Care Home Regulations. The registered manager had devised a training and development programme and suitable arrangements were in place for the induction of new staff. At the time of the inspection 7 members of staff had completed NVQ level 2 and a further 2 members of staff were working towards higher qualifications. This equated to 54 of the staff team were qualified at NVQ level 2 or above. Staff had also received training on Medicine Management by the Primary Healthcare Trust and First Aid. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 17 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, 36, 37 and 38 The staff and residents enjoyed positive relationships, which promoted an open and friendly atmosphere. However, staff must receive supervision and training updates on moving and handling to ensure they have the appropriate support and knowledge to meet the needs of the residents. EVIDENCE: The registered manager had the overall responsibility for the management of the home and had completed NVQ 4 in Management and the Registered Manager’s Award. However, the registered manager had not completed an NVQ level 4 in Care. Relationships within the home were good and staff spoke about the residents with respect. The residents valued the help and support they received from the staff, who they said were “very good” and “caring”. One person also said that “you only have to ask for anything and it’s done”. The staff received
Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 18 supervision but this was mostly informal, to ensure the staff are appropriately supervised and supported they must receive at least six formal supervisions a year. The registered manager had established systems to monitor the quality of the service, which included the annual distribution of satisfaction questionnaires. The registered providers had not carried out any visits to the home in accordance with Regulation 26. It was noted the electrical safety certificate was available in the home and was dated 12/02/05. The certificate was valid for 5 years. At the time of the inspection the registered manager had not arranged for the staff to receive a training update on moving and handling techniques. Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 19 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 2 3 3 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X 2 2 2 Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 20 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 Timescale for action The registered person must carry 15/12/05 out risk assessments, which incorporates risk management strategies. Medication must always be 15/11/05 administered in line with the prescriber’s instructions. A record must be maintained of 15/11/05 all medication/tablets leaving the home. Details from the prescription 15/11/05 label must be recorded exactly on the medication administration record. The controlled drugs register 15/11/05 must be accurately maintained at all times. The adult protection procedure 15/12/05 must be amended to closely align with No secrets in Lancashire. The privacy lock on the 15/12/05 bathroom door on first floor must be repaired. The conservatory/porch must be 15/01/06 fitted with an accessible alarm facility and appropriate heating. (Previous timescale of 23/05/05 – not met).
DS0000009506.V261077.R01.S.doc Version 5.0 Page 21 Requirement 2 3 4 OP9 OP9 OP9 13 (2) 13 (2) 13 (2) 5 6 OP9 OP18 13 (2) 13 7 8 OP21 OP22 12 (4) 23 Brookdell Retirement Home 9. OP36 19 10. OP37 26 11. OP38 13 Staff must receive formal supervision at least six times a year, which is planned and recorded. The registered person must ensure visits carried out under Regulation 26 are completed and documented on a monthly basis. A copy of the report must be sent to the Commission once a month. (Previous timescale of 23 May 2005 - not met). All staff must receive moving and handling updates. 01/01/06 01/01/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP9 OP12 OP25 Good Practice Recommendations Protocols should be devised for the administration of medication prescribed “as necessary”. Regular Residents Meetings should take place and minutes documented. Preset valves of the type unaffected by changes in water pressure and which have a fail safe device should be fitted to water outlets on hand wash basins to provide hot water at 43 degrees centigrade. An audit should be undertaken of all staff files to ensure records are collated in line with the Care Home Regulations. The registered manager should achieve NVQ level 4 in care by 2005. 6. 7 OP29 OP31 Brookdell Retirement Home DS0000009506.V261077.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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