Inspection on 22/01/09 for Brooke House

This inspection was carried out on 22nd January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brooke House 11/09/07

Brooke House 26/07/06

Brooke House 07/03/06

Brooke House 21/07/05

Brooke House 31/01/05

Brooke House 23/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brooke House Brooke Gardens The Street, Brooke Norwich Norfolk NR15 1JH     The quality rating for this care home is:   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. Lead inspector: Marilyn Fellingham     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Brooke House Brooke Gardens The Street, Brooke Norwich Norfolk NR15 1JH 01508558359 01508558376 tracey@kingsleycarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Regal Healthcare Properties Ltd Name of registered manager (if applicable) Mrs Helen Jane Gosling Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Brooke House is a large Edwardian style house situated in the quiet village of Brooke just south of Norwich. The home is a large property with rooms on the ground and first floors to provide residential accommodation for up to 35 older people. The access to the property is via a long gravel drive that leads to a parking area at the front of the building. The grounds are substantial and well maintained providing nice views from all aspects. The home also provides a small unit called Brookfields accommodating people who have dementia. 0 Over 65 35 care home 35 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over eight hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and residents records and staff Care Homes for Older People Page 5 of 26 files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 26 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have good information about the home before deciding if it is right for them; the needs assessment means that peoples needs are identified and planned for before admission. Evidence: We looked at two records of assessment for newly admitted residents, we noted that a full assessment of needs had been carried out for both these residents. The assessments were very detailed and contained relevant information relating to both residents. The home after having completed the needs assessment then established if the residents needs could be met; this is then confirmed in writing. We spoke with one of the residents whose records we had looked at and they confirmed that they had received sufficient information about the home before they committed themselves. The manager explained to us that wherever possible prospective residents are given the opportunity to visit the home prior to admission. Care Homes for Older People Page 10 of 26 Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means thatthe residents can be confident that their health, pyscological and personal care needs will be met. Evidence: We spoke with five residents who are living in the home, they all commented that they felt that they were well cared for; one said the services are good, I have choices and I could not ask for anything better. One relative we spoke with saidall the staff are delightful, I feel confident that my mother is well looked after. Another remarked we have no concerns it is as good as it could be and the staff are very kind. A resident told us that they felt that they were treated in a dignified manner. We looked at care plans for five residents two of which were for residents in the Dementia Unit. These had records for manual handling, risk assessments for skin integrity and assessment documentation for their nutritional status. We also noted that the residents are weighed on a monthly basis and more if there is any concern about the residents nutritional status. There was evidence of continual review of care and as needs change so the care plans have been updated. Care records for those in the Care Homes for Older People Page 12 of 26 Evidence: Dementia Unit contained an informative life history with significant events and overall the five care plans we looked at had assessments in place for the residents physical as well as their psychological well being. Those members of staff we spoke with have an overall understanding of the care planning process and knew how to use the care plans to give the care. We noted that the residents who are in receipt of p.r.n. medication (when required) did not have care plans for this, the manager stated that they were aware of this and arranging for those residents to have care plans to justify continued use of p.r.n. medication, (when required). There were good daily records with notes about G.P visits and other professionals. We noted on the Dementia Unit that the carers interaction with the residents was at the right level and carried out with dignity and concern; it was obvious that they used knowledge about the residents life history to interact with them. We also noted how careful they were with moving and handling one resident from her chair to a wheelchair. We also noted one resident interacting with another one and ensuring that they were drinking their tea. The handling and administration of medicines is mostly managed well, however we did note that there was an incident when a medicine was not given for two days, fortunately the home does frequent audits of medication and this mistake was soon picked up and addressed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have the opportunity to participate in meaningful and motivating activities. Meals and mealtimes are managed well. Evidence: We were able to discuss with some residents and relatives about the activities within the home, the manager also gave us many examples of some activities that had been taking place. On the day of our visit some residents were having one to one interaction with staff members. The manager explained to us that she is aware that the provision of activities could be improved and an activity co-coordinator is being introduced. There were also activities being carried out in the Dementia Unit where we noted the carers were communicating with residents on a one to one basis and one was being helped to read the newspaper, another resident was having a conversation with a carer about the sheep that could be seen from the lounge window. A meeting has been held with the residents to discuss what they want to do in relation to activities. The activities that have been taking place include arts and crafts, skittles and carpet bowls, a physio team is involved in the mobility games. One lady told us Care Homes for Older People Page 14 of 26 Evidence: that she enjoyed walking to the duck pond that is in the village; we noted one visitor bringing her dog in to visit their relation. Visitors to the home are made welcome and this was confirmed by one visitor who told us staff are very welcoming, another said the staff always offer us refreshment. Menus that were seen offered a variety of well-balanced meals and one resident told us food is better since we had a new cook and a visitor told us food is good since a new chef has started. The chef uses a system that helps to provide nutritious food for the elderly and those residents we spoke with approved of the food that they were offered and told us that there were always choices. We noted in both units of the home there were bowls of fruit available for the residents and we noted that the residents could have snacks on the Dementia Unit. We observed lunch being served and those that needed assistance were being helped in a dignified way, this was particularly so for those residents that have dementia. The dining room is pleasant with separate tables and all residents choose where they would like to eat their meals. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe and listened to. The staff have the knowledge to recognise all aspects of abuse, this means that every effort is made to protect the residents. Evidence: A complaints procedure is in place and made available to the residents and other interested parties. The procedure is also cited in all residents rooms and in the entrance hall to the home. We spoke with some residents and relatives who said they knew how to air their concerns. One relative told us we always feel listened to and our concerns are responded to. Another relative told us I would speak with the manager if I had any concerns. Three residents we spoke with were confident that their concerns would be addressed and all three knew who to approach if they had any concerns. We looked at the records for complaints, these were in good order and showed us how each complaint that the home had received had been dealt with. The staff we spoke with were aware of the procedure for making a complaint, we also spoke with them about all issues relating to safeguarding adults. They were well informed and knew about their responsibility to raise any concerns with the manager. We checked the staff files to confirm that all staff had had training in issues relating to safeguarding adults. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued maintenance and awarness of what needs to be done in the environment means that people live in an adequate and safe environment. Evidence: We toured the premises and found them to be clean with no unpleasant odours. A new sluice room has been provided downstairs, new boilers have been installed and the home felt comfortably warm. We found that all bathrooms and need to be updated and the manager is aware of this and said that all improvements to the premises was an ongoing project. Although there is a safe area outside for those residents with dementia the manager said that the whole area was going to be made into a safe area to accommodate all residents. We found one bath hoist that was most unsafe with no rails for the residents to hold onto and it had an unsafe method of holding the chair to the bottom of the bath. The manager said that they would deal with it immediately and ensure that a safe system was put in place. The dining room is very pleasant although it was a bit dark and the manager explained that the lighting in this room was going to be improved; the tables were set out with small vases of flowers and table cloths. Every effort has been made in the dementia unit to help the residents find their own rooms the corridors are fitted with visual clues and appear far less clinical. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are protected by the homes recruitment practices. Staff training could be further improved, which would result in better outcomes for those people using the service. Evidence: We looked at the duty rosters and noted that new staff had been recruited and that the home was adequately staffed in relation to the residents assessed needs. We spoke with a number of residents, one remarked I always feel there is someone about and another commented I always feel confident in the night that someone will come when I ring my bell. Records for newly appointed staff were looked at, these were seen to reflect a robust checking system before staff are employed. This was confirmed by new members of staff we spoke with who also told us about the induction that they had undertaken at the commencement of their employment. We spoke with four members of the staff team and they were all very enthusiastic about their roles. They confirmed with us that they had, had training in safeguarding adults, infection control, fire training and some had done some training in relation to dementia care. One staff memebr told us we have had medicine training which has given us a better understanding of the medcines the residents are taking. We did note however that the care staff lacked training in relation to specific care needs of the Care Homes for Older People Page 20 of 26 Evidence: residents, however the manager was aware of this and all training needs are identified at the staffs formal supervision sessions. We looked at a training matrix that identified all learning needs with the purpose of enhancing the skills that the staff already possess. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good management structure in place which ensures that the service is being run in the best interests of the people who are using the service. Evidence: There have been some changes in the management of the home since the last Key Inspection; a new manager has been appointed and has only been in post a short while before our visit. All the staff we spoke with commented that there had been improvements in the way that the home is now managed, one member of staff told us the manager listens to us and sorts things out another said we are a more cohesive team now whilst another commented the manager is easy to approach and there is a better atmosphere in the home. Records for formal supervision were seen, one staff member told us that they discussed their professional development with their supervisor. The manager keeps us informed of any incidents that have happened in the home and is aware of changes that need to take place to achieve better outcomes for those Care Homes for Older People Page 22 of 26 Evidence: people using the service. A system is in place for monitoring the quality of the service the home provides and this was seen by us. Accidents are recorded and audited, this allows the service to identify if there is a pattern and how they could be prevented. A sample of health and safety information was checked, these records were in good order. The home does not retain any monies on behalf of the residents. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 1 19 23 The manager must ensure that the bath hoist is appropriately fitted. This will ensure the safety of all residents using the bath. 06/05/2009 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 30 17 It is required that all staff receive training appropriate to the work they are to perform the improvement in taining should result in better outcomes for those people using the service. 30/07/2009 Recommendations 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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