CARE HOMES FOR OLDER PEOPLE
Brookdell Retirement Home Foreside Barrowford Nelson Lancashire BB9 6AE Lead Inspector
Mrs Julie Playfer Unannounced Inspection 21st November 2006 09:30 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.V314939.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. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 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.V314939.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 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. At the time of the inspection, the scale of fees ranged from £330.00 to £352.50. Additional charges were made for hairdressing (£8.50 - £16.00), chiropody (£4.75), tickets/holidays and personal magazines and newspapers. Information was made available to prospective residents by means of a statement of purpose, service users guide and brochure. The brochure was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. The service users guide was displayed in each bedroom. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Brookdell on 21st November 2006. At the time of the inspection there were 12 residents accommodated in the home. The inspection comprised of spending time with the residents, looking round the home, looking at residents’ care records and other documents and discussion with the staff and the registered manager. The inspector also spoke to a relative, who was visiting the home. As part of the inspection process the inspector used “case tracking” as a means of gathering information. This process allows to the inspector to focus on a small group of people living at the home. Prior to the inspection the registered manager completed a questionnaire, which provided useful information and evidence for the inspection. Comment cards were sent to the home for residents and their relatives. 12 cards were returned from relatives/visitors to the home and 10 cards were received from the residents. What the service does well:
The admission procedures involved an assessment of peoples’ needs. This enabled the registered manager and prospective residents to determine whether or not the home could meet their needs. Each resident had a plan of care. This document provided details about the residents’ personal and healthcare needs, which meant the staff had clear guidance on how best to meet the residents needs. Residents spoken to felt they received a good standard of care and the staff respected their rights to privacy and dignity. The residents described the staff as “approachable” and one person said “they are absolutely first class and charming”. Varied, nutritious and well-presented meals were served. All the residents spoken to said the meals were “very good” and confirmed there was always plenty to eat, with a choice each mealtime. Visitors were welcome in the home at any time and residents were supported to maintain good contact with their family and friends. All the relatives and visitors who completed a comment card expressed satisfaction with the overall care provided and one person commented that Brookdell was a “very homely residential home with individual care”. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 6 Residents were provided with clean and nicely decorated bedrooms that were well-maintained. All residents spoken to said they felt the home was always kept clean and was very comfortable. Effective arrangements were in place to maintain the health and safety of the residents. What has improved since the last inspection? What they could do better:
At the time of the inspection, one element of a person’s medication was not available on the premises. The registered manager must therefore ensure all such medication is ordered in good time and is available for administration. The conservatory/porch must be fitted with an accessible call facility, to enable the residents to call for assistance when using this part of the house. An annual development plan must be devised as part of the quality assurance systems, so that the residents, their relatives and all other interested parties are aware of how the service will be developed over the coming year. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 7 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.V314939.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 Brookdell Retirement Home DS0000009506.V314939.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The admission procedure was well managed. The residents had their needs properly assessed and they were provided with appropriate written information to enable them to make an informed choice about where to live. 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. There was also a colour brochure available which presented an overview of the services and facilities available in the home. All the residents spoken to were aware of the service users guide and confirmed they had a copy in their bedrooms. All residents were issued with a statement of terms and conditions of residence or contract, if they were purchasing their care privately. It was noted the contract had been signed by the residents’ representative and included information about the level and payment of fees.
Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 10 The ‘case tracking’ process demonstrated that the residents had their needs assessed prior to admission to the home by a social worker and/or the registered manager. The registered manager had also informed the residents in writing that having regard to the assessment the home was suitable for meeting their needs. Since the last inspection the assessment tool had been developed to provide staff with clear information about the residents’ needs, preferences, likes and dislikes. Brookdell Retirement Home DS0000009506.V314939.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care planning system addressed the needs of the residents and provided clear guidance to staff on how these needs were to be met. Appropriate records were in place to manage medication in the home. EVIDENCE: 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. The residents spoken to during the inspection were familiar with their care plans and confirmed they had discussed their care needs with the manager or a member of staff in the home. As such, one resident commented “I discuss it (the plan) with the staff and they update it every now and again”. Further to this eight of out of the ten residents who
Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 12 completed a comment care indicated they always received the care and support they required. The care plans were supported by the records of care, these were detailed and provided information on changing needs and any recurring difficulties. 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 residents spoken to felt the staff respected their right to privacy and all made complimentary remarks about the staff, for instance one resident said the staff would “do anything to help you, they are absolutely first class”. The staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred term of address. 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, administration and disposal of medication. The controlled drugs register was complete, accurate and up to date. It was noted that improvements had been made to the management of medication, such that clear protocols had been devised for medication prescribed “as necessary” and all medication had been administered in line with the prescriber’s instructions. However, it was noted that some prescribed cream had run out and there was none available on the premises. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were able to exercise choice and control over their lives and maintained good contact with their family and friends. The residents were provided with a nutritious varied diet according to their assessed requirement and choice. EVIDENCE: The residents said the daily routines were 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. One resident said, “I can do what I like and decide for myself”. 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 occasional professional entertainers. The residents spoken to said, they were satisfied with the frequency and type of activities. One resident said she had enjoyed a recent trip to Blackpool and was looking forward to a forthcoming trip to a pantomime.
Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 14 Since the last inspection residents’ meetings had been arranged on a regular basis. These meetings gave the residents the opportunity to voice their opinions about life in the home and discuss their views about activities. The residents were able to receive visitors at any time and were able to entertain their guests in private. A visitor spoken to on the day of inspection expressed satisfaction with the standard of care provided by the home and commented “I can’t find any faults at all”. The relatives and visitors who completed a comment card prior to the inspection made very positive comments about the home including, “the home is immaculate and the staff are very caring and friendly” and “Brookdell has always come across as a very caring and homely environment”. The menu was on display in the home and the choice of meals was discussed with the residents prior to every mealtime. This practice was observed by the inspector during the inspection. 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 “nicely cooked”. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. 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 in each bedroom. 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 one complaint since the last inspection. Records had been maintained of the investigation and outcome. The residents were aware of the procedure and knew who to speak to if they had a concern. The registered manager had a copy of “No secrets in Lancashire” and an adult protection procedure specific to the home. The procedure set out the appropriate response in the event of any allegation, suspicion or evidence of abuse. The registered manager had a good awareness of the procedure and the staff had access to a whistle blowing procedure. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents were provided with a clean, comfortable and well- maintained environment. EVIDENCE: Brookdell is a mature detached property, surrounded by its own grounds. The gardens are attractive, private and well-maintained. There is a patio at the rear of the property. Accommodation is provided in five single bedrooms and five double bedrooms. One double room has an ensuite facility. Communal space is provided in two lounge/dining rooms. An overall check of the environment was made twice a year and systems were in place for ongoing maintenance. The residents had personalised their bedrooms with their own belongings and decoration was good throughout. The residents said their rooms were
Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 17 comfortable and warm. One person also said “my room is very nice and very clean”. 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. Since the last inspection the privacy lock had been replaced on the bathroom door on the first floor, to ensure the residents could lock the door easily. 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 and was accessible to residents and their visitors. Since the previous inspection a portable heater had been placed in the conservatory. The home was clean and hygienic in all areas seen, during the inspection. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. 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. Hence, recruitment records were not inspected. 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 6 members of staff had completed NVQ level 2. This equated to 66 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, first aid and moving and handling. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 19 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, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The staff and residents enjoyed positive relationships and the staff benefited from regular supervision. Appropriate arrangements were in place to protect the health, safety and welfare 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. At the time of the inspection, the registered manager was working towards 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
Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 20 staff, who they said were “very good” and “caring”. One person also said “the staff are very nice, they look after me and are always courteous”. Since the last inspection the registered manager had established a programme to formally supervise each member of staff. Records seen of the supervision indicated that the staff were given the opportunity to discuss all aspects of their work, including the care of the residents and training. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of monies was found to be correct. Records were also maintained in respect to the amount of fees charged and received. The home was reaccredited with an Investors in People Award in November 2006. Satisfaction questionnaires had been distributed to the residents and their relatives in March 2006. The results had been collated and displayed in the home. The residents were consulted informally, as part of daily practice in the home and formally by means of the residents’ meetings and the questionnaires. Ongoing checks were made on the environment and health and safety issues. However, an annual development plan had not been devised, in order to set out the planned developments of the service for the coming year. There was a set of health and safety procedures available, which included the safe storage of hazardous substances. Staff received health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Information was available in respect of infection control. Documentation was seen during the inspection which, confirmed gas and electrical systems were serviced at regular intervals. The electrical safety certificate was dated February 2005 and was valid for 5 years. The fire log demonstrated that staff had received instructions about the fire system and fire equipment was tested on a monthly basis. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 21 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 X 3 Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP9 OP22 Regulation 13 (2) 23 Requirement All prescribed medication must be available on the premises at all times. The conservatory/porch must be fitted with an accessible alarm facility and appropriate heating. (Previous timescale of 23/05/05 and 15/01/06 - not met). An annual development plan must be devised based on a systematic cycle of planning, action and review, reflecting the aims reflecting the aims and outcomes for service users. Timescale for action 21/11/06 01/02/07 3. OP33 24 01/02/07 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 OP31 Good Practice Recommendations The registered manager should achieve NVQ level 4 in care. Brookdell Retirement Home DS0000009506.V314939.R01.S.doc Version 5.2 Page 23 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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