Inspection on 26/07/06 for Brooke House

This inspection was carried out on 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brooke House 22/01/09

Brooke House 11/09/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brooke House Brooke Gardens The Street, Brooke Norwich Norfolk NR15 1JH Lead Inspector Mrs Ginette Amis Unannounced Inspection 26th July 2006 10:15 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 Brooke House DS0000049956.V305823.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. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooke House Address Brooke Gardens The Street, Brooke Norwich Norfolk NR15 1JH 01508 558359 01508 558376 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) Regal Healthcare Properties Ltd Position Vacant Care Home 35 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (21) of places Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: 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 has recently completed a 14 bedded unit for people who are elderly and mentally infirm. This Unit has been completed to a high standard. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 10:15 am to 16:30 pm on Wednesday 26th July 2006. The appointed manager of the care home was on duty throughout the day and together with the providers’ representative who arrived soon after the inspection commenced courteously and helpfully assisted with the provision of information. Through out the day, members of staff were interviewed: these included the 2 senior carers on duty, one in the main home and one in the Dementia Care Unit together with 4 carers, one being the cook who also worked part time as a carer. All were pleasant, friendly and helpful. A large part of information was also gained through interviews with 5 residents and 3 relatives all of whom were keen to be as helpful and informative as possible. Further information was gained from the providers own quality assurance review that included copies of questionnaires completed by residents and their relatives and from copies of the Regulation 26 Inspection Reports completed by the provider and returned to CSCI. Further information came from the findings of a complaints investigation record and various incidental contacts that had occurred since the previous inspection. The overall quality rating for this home remains good. This is despite there being some areas rated as only adequate. In all the areas where groups of standards were judged as only adequate, the judgement was the result of there being one area of concern, set against a more generally good finding and those areas of concern can be readily addressed by the provider. What the service does well: Brooke House offers a generally good standard of accommodation in a pleasant and peaceful location. Communal areas of the main house are spacious and open out onto a terrace with views of the surrounding countryside. With the exception of one couple who have been sharing for some years all rooms are single occupancy with en suite facilities. Accommodation in the Dementia Care wing was custom built and finished to a high specification – though some adjustments remain necessary. It would appear that the organisation responsible for the care home is keen to invest in both the fabric of the property and the quality of the care that can be offered there. Where mistakes have occurred they were acknowledged and action taken to provide a remedy. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 6 The new manager in post (of 6 months) has been given encouragement to develop her skills and is progressing with NVQ level 4 accreditation in Care Management. Residents have welcomed her stabilizing influence. It remains for her registration with CSCI, currently in process, to be completed. The provider has ensured the care home is fully staffed but has been obliged to resort to recruiting in the wider European Union in order to accomplish this. Members of staff are offered training and supervision, including training to improve competence in the English language if necessary, and to enrol for NVQ accreditation, all with the aim of ensuring a good standard of service ensues. A number of the staff from the EU were previously qualified and working as nurses in their own country. What has improved since the last inspection? What they could do better: Some improvements need making to the Dementia Care Unit so that residents there have access to a secure garden, both via the dining room and from their own bedrooms. All these rooms have been designed with French doors opening into the grounds but none were in use due to the insecurity of the grounds outside. The bathroom in this wing would be improved by decoration designed to make it less institutional. Though significant steps are being taken to ensure elimination of any difficulties in communication between staff who do not speak English as their first language and the residents who only speak English, the situation needs to be continually monitored. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 7 A number of residents said they would like the care home to provide a wider range of activities and while the manager said some were already available it was evident that not all residents were aware even of these events. While all residents said the food at Brooke house was good and plentiful some said they would welcome a more adventurous menu including for example more Italian, Chinese and Indian food. Although the care home does have an appropriate complaints procedure and publishes this openly it was clear that residents and their relatives were not comfortably aware of the process and needed more information about it. 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. Brooke House DS0000049956.V305823.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 Brooke House DS0000049956.V305823.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, 3 and 6 The quality rating of this group of standards was good. Prior to agreeing admission, prospective residents and their relatives or representatives have access to adequate information about the care home. The care home’s manager assesses all applicants for residency with a view to determining suitability. EVIDENCE: Information about the care home was available in the form of a comprehensive guide and this could be produced, along with other documentation in a font size to suit the individual. A copy of this guide had been given to every resident to keep. Another guide, along with a copy of the latest inspection report, was on display in the main foyer. Despite these efforts, some residents and their relatives felt that due to the highly emotional circumstances relating to the admission process, they later felt uncertain about some aspects of the life at Brooke House. This applied particularly to the complaints procedure. (See section on complaints and protection) Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 10 The manager had visited prospective residents in their own home to complete an assessment of their needs. The assessments contained in residents’ files appeared very thorough. Short stays were no longer available in the dementia care unit and only on very rare occasions elsewhere in the home. The provider stressed how in such event, the assessment process would be identical to that for permanent residents. There were no short stay residents at Brooke House at the time of this inspection. Brooke House DS0000049956.V305823.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 The quality rating of this group of standards was good. Efforts had been made to improve the scope of care plans for people living in the dementia unit. Members of the staff team had gained confidence in use of the care plans from training they had undertaken. Residents’ needs were comprehensively accounted for within the care planning process and plans had been regularly reviewed. Residents with special needs were being more closely monitored than before. EVIDENCE: Earlier this year, during investigation of a complaint made against the care home it was found that members of the care team were not fully aware of the importance of residents’ care plans. The care home undertook to take steps to remedy this. During the inspection, all 4 carers interviewed said they had received additional guidance regarding the use of care plans adding that entries they contributed, through the daily record keeping system, were always checked by senior staff. All claimed to find the care plans useful to their understanding of residents’ needs and how to meet these. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 12 The files of 6 residents were examined, 2 being from the dementia unit. Each contained a full assessment and comprehensive care plan that had been signed by the resident involved. Files contained a photograph, personal contact details, an account of health and care needs, risk assessments and for dementia care residents the recently introduced social profile. A relative described contributing to the social profile and one carer also commented on the usefulness of the information supplied in this way. The manager described how, since concerns were raised earlier in the year, a more proactive approach had been adopted to help safeguarded residents from the risk of developing pressure areas. There were currently 4 residents at risk and these were being monitored. The relatives of one such resident expressed confidence in the care being given. Residents’ care plans had been regularly and recently reviewed. There were appropriate policies in place regarding administration and record keeping, together with facilities for the storage of medication, as described at the last inspection. During this inspection the senior carer responsible for administering medication was accompanied as she offered prescribed medication to residents. Medication had been mainly supplied through a monitored dose system and along with some additional items was neatly stored in a purpose built drugs trolley. The senior carer, who explained she had received training enabling her to be given this responsibility, was able to demonstrate how she checked each residents’ record sheet prior to administering them any due medication, then appropriately completed the medication administration record. Five residents were interviewed in the course of this inspection and each independently stated they found staff to be helpful, respectful and courteous. This was a view upheld by residents’ relatives spoken with. (See section on staffing) In January 2006 the providers had conducted a quality review of the care home’s services. A questionnaire had been sent to each resident, for them, their relatives and representatives to complete. Of the 35 surveys sent out 19 replies were returned. Almost all the returned replies indicated they were very satisfied or generally satisfied with the care being offered. The 4 returns that expressed they were less content were anonymous but never the less, the provider stated were taken very seriously and all aspects of care provision featured strongly in the Regulation 26 inspection visits conducted each month by the provider. The results of a second survey (at 6 months on) were not yet known. Brooke House DS0000049956.V305823.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 The quality rating for this group of standards was adequate but would be good if some relatively small changes were made. Residents were generally comfortable and felt at home at Brooke House. Contacts with family and friends were well maintained. Residents felt they lacked sufficient distractions and would have liked there to be more organised activities to take part in. Residents did not feel the care home placed any restrictions on their daily lives. The quality and quantity of food available was much appreciated but some residents would have liked there to be a more adventurous menu. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 14 EVIDENCE: While the 5 residents spoken with each made the point that had it been possible for them, they would have preferred to continue to live in their own home, all were never the less resigned to the fact that their needs were such they benefited from the additional level of care and support available to them at Brooke House. While some residents felt it was their relatives who had made the choice on their behalf none expressed any level of disappointment with the care home. Relatives and friends were able to keep in good contact, and it was evident that many residents were frequently taken out. One resident made regular unaccompanied trips out in his wheelchair taking a mobile phone with him so as to remain in contact with the care home. All of the residents spoken with said however that there were no organised activities for them to take part in. This was a fact contested by the manager, who referred to a number of recent social events including a strawberry tea, musical entertainment and exercise classes. It was agreed that the care home needed to do more to ensure all residents were kept informed of any on going events and that efforts should be increased to discover what type of activities residents would enjoy taking part in. Staff in the Dementia Care wing gave account of having engaged residents in an exercise class that morning. During the course of this inspection, residents were observed taking lunch. This was conducted in a leisurely manner and those residents who required assistance were helped in a pleasant, discreet manner. Food was well presented, appeared of good quality and was plentiful. There was a choice of menu and a choice of hot and cold drinks available. Residents also confirmed that drinks and snacks were readily available at all times and there were jugs of juice and water in all those residents rooms entered. Residents’ weight was recorded regularly in their personal file and fluid and food records kept whenever appropriate. The providers’ own questionnaires indicate there was a high degree of satisfaction with the food available at Brooke House. Menus provided showed a consistent pattern of suitable choices. Information about the special dietary needs of some residents was available to staff working in the dining room as well as being included in care plans. Despite this, some residents spoken with said they would welcome more variety and adventurousness in their daily choice of menu with special requests noted. It was agreed the provider and manager should collate information about residents’ wishes for access to more exotic dishes so that these choices too could be catered for. Brooke House DS0000049956.V305823.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 The quality rating for this group of standards was adequate and would have been good had residents and their relatives been made aware of the procedures open to them to raise their concerns. An appropriate complaints procedure was in place though not always fully understood by residents. Members of staff were all CRB checked and made aware of the need to protect vulnerable adults from abuse. EVIDENCE: The care home did have in place a suitable complaints procedure and a copy of this was enclosed with the service user guide and on display in the main foyer. Despite this, residents spoken with were uncertain of the existence of an actual procedure, believing they would have to speak with relatives, their social worker or possibly could ask the manager to help them. One resident said he would be afraid to complain because he “did not want to upset anyone”. Relatives spoken with were also unaware of the complaints procedure in place though they did say they would take any concerns they had to the manager first. One relative thought it was their former social worker they should approach. Records did however show that any complaint made was fully and promptly investigated and viewed as serious by the provider. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 16 In light of this it was agreed with the manager that greater effort needed to be made to ensure that all residents and their relatives felt confident they could raise concerns or complaints if they needed to. Examination of the complaints log did show that complaints were promptly responded to and that they appeared to have been thoroughly investigated by the provider. Staff records showed all staff to have been CRB checked and the provider stated this was always done before any new member of staff was permitted to start work in the care home. Members of staff described their own induction process and said this had included training relating to the protection of vulnerable adults from abuse. An investigation evoked earlier this year had been appropriately conducted and its recommendations acted upon. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 17 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, 21 and 24 The quality rating for this group of standards was adequate and would have been good save for the few issues raised in this report. Though the care home was generally safe and well maintained the lack of forward planning could result in reaction to problems as opposed to making the most of given opportunities to develop the environment. There was a clear need to extend access to the garden for residents in the Dementia Care Wing and a requirement made to ensure this happens. The bathroom in the Dementia Care wing was austere and needed a change to its décor. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 18 EVIDENCE: At the time of this inspection, Brooke House appeared to be safe, clean and generally well maintained. An inspection of the premises was regularly included in the Regulation 26 visit reports submitted to CSCI by the provider and these inspections, together with any needs noted by the manager or maintenance staff formed the rationale for any remedial works undertaken. The provider stated that any maintenance needs identified in this way were always acted upon without delay and there was no reason to suppose otherwise. The requirements of the previous inspection had both been acted upon with provision of a new suitable washing machine and replacement of a radiator temperature valve. Evidence from the care home’s pre-inspection questionnaire would indicate that the premises, its equipment and services were all regularly checked and maintained. It was however recommended the provider and manager should jointly adopt a longer-term view so that plans could be drawn up for non-reactionary improvements. This was also recommended at the previous inspection. It would for example be helpful to plan redecoration that did not depend on residents’ rooms falling vacant. The conservatory remained unused due to its lack of suitability and a long-term plan could consider how best to capitalise on this currently wasted space. In addition it was noted how the bathroom in the new wing where people with dementia lived was particularly unattractive (though no doubt functional) and it was agreed with the manager and provider that steps should be taken to improve the décor. Residents’ rooms in the main house were all of varied size and proportion. Those entered were clean and comfortable and it was evident that residents had been encouraged to make themselves at home there. Rooms in the newly built dementia wing had been finished to a high standard and were both suitable and comfortable, as was the main lounge. However, at the time of this visit, the weather was particularly hot and it was noted how, the outside opening doors of residents’ rooms were always kept locked with regards to the lack of secure space outside. The sole secure outside space, accessed from the lounge, was extremely small in size. The units’ dining room, while just adequate in size for the number of people who dined there was far from spacious and uncomfortable in the heat due to its large windows and glass door (again kept locked when not in designated use because the area outside was insecure). Given the care home’s very extensive and well-kept grounds, the lack of outdoor facilities for people in the dementia unit appeared a gross oversight. A requirement was made to ensure the providers produce a plan then act to remedy this. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 19 By comparison, people using the main dining room not only enjoyed a spacious room with period features and comfortable table settings, but had access to an attractive terrace beyond the French doors. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 20 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 and 30 The quality rating for this group of standards is adequate, and potentially good so long as the care home continues to carefully monitor communications between residents and staff. The care home has staff in sufficient numbers and there was a training and development programme in place designed to ensure full competence. Steps were being taken to help staff recruited aboard to where necessary further develop their proficiency in the English language but the provider must closely monitor the situation to ensure residents’ needs were always met. Many of the staff recruited abroad already had professional qualifications in excess of those that might be considered essential for a care worker in this country. However the possible short duration of stay in this country of any individual employee from abroad could be a drawback to the providers’ stated aim for its workforce. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 21 EVIDENCE: From the on going staff rota and number of staff encountered on the day of this inspection it would appear Brooke House is generally well staffed. The manager is on duty each week-day from 8am – 4pm (and reportedly more often to a later time) with a deputy left in charge of the Dementia Care wing. The deputy takes on full responsibility for life in that wing, but refers to the manager in the event of any irregularity or problem arising. The deputy was in fact off duty on the day of the inspection and her place taken by a senior carer also attached to that wing and he had 2 care assistant working with him. A senior carer was also on duty in the main house along with 3 other carers in the morning and 2 through other shifts, 2 cleaning staff, a cook and kitchen assistant. All senior staff were enrolled to complete NVQ level 3 accreditation and had done training in the administration of medication. The pre inspection questionnaire stated that 41 of staff had or were enrolled in NVQ accreditation. It was noted how, where as 4 years ago the care home was staffed by people drawn almost exclusively from the local community the larger proportion of current staff (and all but one of the care staff interviewed during the inspection) were recruited from the wider European Union. It was also noted how for at least some of these staff, the possibility of remaining long term in this country was slight. And while the provider or employing organisation has as its’ stated aim “to provide the people who work in the service the opportunity to develop and grow as a workforce” to be better able to….”provide a service to the people living in the service” (Kingsley Care Homes Supervision Format – Training, Mentoring , Coaching for Care Workers – February 2006) achieving this aim would rely somewhat on having continuity in the work force. (This said, the providers’ organisation has in place a comprehensive training and development programme for its’ staff.) Conversely, staff from the EU who were spoken with during the inspection were qualified nurses of several years experience in their country of origin and it could be hoped residents at Brooke House would benefit from their knowledge and professionalism. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 22 Earlier in the year, in the course of the complaint investigation mentioned previously, concerns were raised over the ability of the members of staff coming from abroad to communicate in English. The 2 senior carers spoken with during the inspection were noted to have extremely good command of the English language. Other carers spoken with clearly had good understanding of the English language. They spoke English well though occasionally needing to search out the correct form of words. The provider stated that staff are forbidden to speak to one another in any language other than English while on duty. Without exception, residents and their relatives alluded to the otherness than English of staff members. As one resident put it “They are all of them very kind and helpful, though we sometimes get into sweet little misunderstandings.” Relatives spoken with however were less happy with the situation and expressed concerns that elderly residents with hearing problems or who were less than perfectly aware might be easily misunderstood. One relative said her mother’s food orders were frequently misinterpreted. The provider, having expressed concern to eliminate any possibility of problems due to lack of communication skills had organised for weekly and on going English lessons to be held at Brooke House. One such session was in progress on the morning of the inspection. Some members of staff were also attending English lessons at Norwich City College. While it remained clear the provider and manager were mindful of potential communication difficulties, (pointing not unreasonably to the difficulty of recruiting carers from the locality and steps they are taking to alleviate communication problems) there remained an on going need for the provider to ensure residents needs were safeguarded by monitoring the situation closely and a requirement was made for them to do so. This is particularly important as there is no guarantee the situation will gradually improve as members of staff may not stay in this country long enough for this to happen then be replaced by new, less linguistically experienced people. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 23 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, 35 and 38 The quality rating of this group of standards is good. Residents welcomed the new manager to the care home and hoped she would stay. It remained for the registration process to be completed. The provider was offering her a good standard of support. The care home took no part in administering residents’ finances. Health and safety was actively promoted. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 24 EVIDENCE: From review of the care home’s history, and from speaking with residents and their relatives it was evident that the care home had suffered from changes in manager, almost since the current provider took control. The manager appointed earlier this year had been in post for 6 months, exhibited clear commitment to the role and an application to CSCI for registration was in process. The manager had already completed a substantial part of her NVQ Level 4 Management in Care accreditation. In addition the provider was offering a comprehensive Training, Mentoring and Coaching programme much of which was provided by a qualified trainer on a one to one basis. As one resident commented, “There have been a lot of changes at the top and they all do things differently in their own way and that’s not so good.” Another speaking of the current manager saying “We all just hope she stays the course”. The care home takes no part in the administration of any of its residents’ finances. Health and safety regulations and guidance notices were accessible in the care home’s main office and records indicated how maintenance of all equipment was regularly undertaken. The fire officer last inspected Brooke House in 2005 and another inspection was due to take place in the following month to this inspection. All fire fighting equipment was regularly serviced and tested and fire action training last took place in March 2006. Members of staff spoken with were able to give a detailed account of the fire training they had been given. A small number of staff had accommodation at Brooke House but this was in a section of the care home separate to that occupied by residents and accessed by a private staircase. The care home had an outdoor fire escape from the upper floors. A fire risk assessment had been completed. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 25 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 2 X X 3 X X STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 3 Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 26 No 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. Standard OP19 Regulation 23 (2)(a) (o) Requirement The provider must devise a plan and implement it to ensure that people living in the Dementia Care Unit have access from their own rooms and from their dining room to a suitably safe outdoor area. The provider must continue to monitor the effectiveness of measures taken to ensure a good level of communication is possible between members of staff for whom English is not their first language and residents who only speak English. Timescale for action 30/11/06 2 OP27 18 (1) 31/07/07 Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 27 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. 4. 5 Refer to Standard OP12 OP15 OP16 OP19 OP21 Good Practice Recommendations Residents should be better informed of available activities and greater efforts made to ensure their wishes regarding activities are met. Residents’ wishes for some more exotic dishes to appear on the menu should be accommodated. Residents should be reminded of the existence of the complaints procedure, if necessary in a simplified format. A maintenance and renewal plan should be devised and kept in the care home. (Repeat Recommendation) The bathroom in the Dementia Care wing should be given a more pleasant décor. Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brooke House DS0000049956.V305823.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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