Inspection on 07/03/06 for Brooke House

This inspection was carried out on 7th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 26/07/06

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 Mr Christopher Handley Unannounced Inspection 7th March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 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.V285235.R01.S.doc Version 5.1 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 Deborah Ann Hall 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.V285235.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 2005 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.V285235.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection part of the annual inspection programme. The inspection commenced at 10.00 and was completed at 3.30pm. A wide range of documentation was seen and read, and a tour of the home was undertaken. Six members of staff, 6 residents and 3 visitors were spoken to. The Inspector briefly spoke to the District Nurse and Social Worker. Mrs T Fairhead, the newly appointed Manager of the home, was in charge of the home at the time of the Inspection. Mrs Mandy Masters, Operations Director, Miss Debbie McGovern, Director of Nursing, and Mrs H Gosling, Training Co-ordinator, were also present during the Inspection. What the service does well: What has improved since the last inspection? There is a new Manager, Mrs Fairhead, in place. There is a good deal of new furniture in the new wing, which is pleasantly decorated. Areas of the home have been redecorated and look better. The care of pressure areas, based on the advice of the District Nurse, has now improved. Staff moral has improved as there appears to be a more positive drive in the home. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 6 Some residents and relatives now sign care plans. The completion and management of documentation has improved. Specific training in care of the people who have dementia has been provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 All residents are supplied with a statement of Terms and Conditions. EVIDENCE: All residents are supplied with a statement of Terms and Conditions the Manager said, and showed the Inspector a copy of one which he carefully read. The document is well set out and contains all the information required. As a number of people admitted to the home may have poor sight, the Inspector recommends that the print size be increased so as to enable these residents to read the document. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 11 Each resident has a care plan but these need to be improved. The health care needs of residents are met. The home has a safe and effective medicine system. The home provides good care for the dying resident. EVIDENCE: All residents have an individual care plan which is kept in an A4 ring binder folder, with the resident’s name on. These documents are kept safe. In the last inspection a requirement was made that residents sign to denote their involvement in the reviews of care. This is now done by some, others do not wish to do so, the Manager said. The Manager is advised to continue to try to persuade residents and relatives to be involved in this important matter, so that it becomes part of the care culture in Brook House, and their involvement shows that care is a shared process with them and not an imposed process. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 10 There is a wide range of risk assessment documentation and in the last inspection a requirement was made that these documents be signed and dated and this has been done. Some of the elements in the care plans should be clearer. Each care plan should commence with a detailed assessment of the residents physical health, mental health and social interest/skills. There should then follow a plan - what is to be done, followed by implementation, when and who is to carry out the plan, and finally a review, did the plan work? Each of these elements should be clear and distinct. The Inspector recommends that the residents in the unit should have care plans which are specifically designed to meet the needs of elderly mentally frail people, and there are now a number of these available, and that training be provided before they are implemented. The Inspector also recommends that all staff receive instruction in care planning. These steps would ensure that the staff have the effective tools to carry out this important task, and that they have the knowledge required to develop care plans which are of a high standard. Staff provide the health care needs of the residents, with personal care being a important element of this. In the past there have been a number of residents who had pressure sores. Since the last inspection a good deal of work has been done in this important area of care, with the input of the District Nurse, who the Inspector spoke to. At present there is one resident with a small pressure sore. Staff have received training on the prevention of pressure sores and this has improved the situation. Any equipment needed is provided by the District Nurse. More attention is paid to skin care than was the case at the time of the last inspection, and prevention of pressure sores is now an ongoing part of care delivery. Nutritional Screen takes place on admission and this is regularly monitored. Dental, chiropody, sight and hearing tests would be arranged if required. The psychological needs of residents in the dementia unit would be reviewed by the Mental Health team if needed. All residents are registered with a G.P, who would refer them on to any specialist services needed. Mrs P Caragon, the Senior Care Assistant, showed the Inspector the medicine system. The medicines are kept in two rooms, one in the older part of the home and one in the new wing. The practice and documentation is the same in both areas of the home. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 11 The medicines are kept in a designated locked trolley which in turn is kept in a locked room. Only staff who have undertaken training in the administration of medicines hold the keys. On arrival at the home the medicines are immediately locked in this room and later checked in. The home uses a Monitored Dosage System. There is a locked Controlled Drug cupboard with records kept. There is a drug refrigerator, which was ice free. All staff who administer medicines have received certificated training (Boots). There are two residents who self medicate. The trolley was neat and tidy and there were no loose or unidentified medicines. The prescription sheets are neatly written. It is recommended that the home keep a list of the signatures of staff that administer medicines. The home has a detailed medicine policy which was seen by the Inspector. The home has an arrangement for the disposal of unused medicines. The home enjoys a good relationship with the supplying pharmacist. If staff had any concerns about the effects of medicines on residents then the prescribing doctor would be informed. Medicines are reviewed on a regular basis and this is recorded. Based on what the Manager said, care and comfort are provided to residents who are dying, and their death is handled with dignity and their spiritual needs are addressed. The Commission has received no information to the contrary. Care is taken to ensure that pain relief is provided. The wishes of the dying residents are followed, and family and friends are involved where desired. Visitors may stay overnight if they wish, and refreshment is provided. The resident spends their last days in their own room, they are not transferred to another room. The home has polices and procedures in place for care of the dying. At such times more experienced staff will provide support to newer staff. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 12 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): 12,14 & 15 A wide range of daily activities are provided for both groups of residents in the home. Residents have a wide range of choice in their lives. The home provides a good standard of catering. EVIDENCE: The home encourages residents to maintain their own skills and interests. The Inspector saw the results of some of these skills, e.g. painting, as he toured the home. Some residents were quietly talking, some reading the newspaper and others doing the crossword. Planned activities take place on a regular basis in both parts of the home, and these include armchair exercise, aromatherapy, jigsaws, skittles, reminiscence sessions, piano playing, exercises. Some individual input is also given. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 13 The residents in this home have a wide range of choice in their daily life. They can stay in bed in the morning, and stay up at night if they wish to do so. They have a choice of meals and where they would like to take their meals. They can develop relationships if they wish to do so. The residents interviewed confirmed this and told the Inspector that they can “Do as I choose”. Drinks are provided through the day and night and small refreshments would be re provided if required during the night. There are a small number of residents in the unit who require assistance with their meals the Inspector was informed, and he briefly observed this, and it was done with great care. The residents interviewed spoke very highly of the meals provided and said that they were always “nice and tasty” and that there was “always enough”. The staff are aware of the importance of good nutrition and the state of residents’ nutrition is monitored on a regular basis. The Inspector was shown the menus which appeared varied, nutritious and interesting. At present special diets are provided but they are not recorded, and it is required that they should be. The cook meets residents shortly after they have been admitted to find out their likes and dislikes, choices and preferences, she also has the good practice of seeing residents on a daily basis to ascertain their choice of food. Residents interviewed spoke well of the meals provided. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 14 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): 16,17 & 18 The home has an effective complaints procedure. Residents legal rights are protected. The home has an Adult Protection from Abuse Procedure. EVIDENCE: The home has an effective complaints procedure , which is displayed in the main corridor of the home and was seen by the Inspector. There have not been any complaints since the last inspection the Inspector was informed. Residents interviewed were aware of how to make a complaint, but most said that they would contact a member of staff who would “sort it out”. The Manager said that the legal rights of residents are protected. Any legal representative would be seen in private. If needed advocacy services would be contacted. Residents use postal votes the Inspector was informed. The home has a procedure for staff to follow in matters of Adult Abuse. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 15 All staff have received training in this matter. The Manager has undertaken training in this matter, and is aware that abuse can take place in less obvious ways. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 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): 24 & 26 Residents’ rooms are of a high standard. The home has a laundry which has all the equipment required. EVIDENCE: The Inspector accompanied by the Manager and Operations Director made a tour of parts of the home, and during this tour visited a number of residents rooms. The rooms were neat clean and tidy. In the older part of the home there is a variety of shapes of rooms which gives them character, and contained ornaments and pictures brought in by residents which enhance the appearance of the rooms. Some of the residents in the home paint, and a number of their paintings were displayed in their rooms. There is overhead lighting, two electric sockets in each room and a call bell. A number of residents have telephones in their rooms. There is a range of adjustable beds. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 17 The furniture in the new wing is new and looks very nice, with colour being used to assist residents in recognising where they are. Parts of the home have undergone major improvement which include decoration, and re-carpeting, and they look much better for this. In the inspection dated 21/7/05 a recommendation was made that the home should have a list of maintenance requirements. Though work has been done this has not been recorded, and the Inspector repeats the recommendation. All the rooms were warm, neat and tidy. In one room the radiator was too hot to touch, and it is required that either the regulating valve be changed or the surface of the radiator is guarded. The laundry is so sited that soiled articles and infected linen are not taken through areas where food is stored, prepared, cooked or eaten. There are hand washing facilities available. The laundry floor is impermeable and the walls are washable. The home has polices for the safe handling and disposal of clinical waste. There is a sluicing facility on the washing machines , which are of an industrial type. The washing machines have specified programmes to meet disinfection standards. The Manager does not know if the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. This should be checked. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 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): 28, 29 & 30 There is an NVQ training programme in place. There is an effective recruitment procedure in place. Training is provided for staff. EVIDENCE: The Manager informed that Inspector that there were 12 members of staff who had NVQ II, there are 7 members of staff who will be undertaking NVQ II, and there will be members of staff who already have NVQ II who will be taking NVQ III. The required ratio is that the home should have 50 of staff who have NVQ training. There are 21 care staff, 12 of whom have NVQ, which represents 57 , which means that the home has achieved the required target. Both staff and the Company are commended for this. The Manager outlined the recruitment process. All posts are advertised, followed by short listing, references are obtained, and interviews which are carried out by two people take place. References, CRB checks and POVA checks are carried out. Copies of birth certificates are obtained. Staff are supplied with job descriptions, contracts and copies of the Code of Conduct. There are no volunteers in this home. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 19 In the inspection dated 21/7/05 a requirement was made concerning the lack of interview records. These are now fully completed and the Manager is aware of the importance of interviewing and the selection of staff. It is recommended that the Manager undertake training in interviewing and selection. All staff complete an induction training programme which meets NTO specification. Staff undertake a Foundation Training which meets TOPPS specification. Other training includes Fire Prevention, First Aid, COSH, Risk, Manual Handling, RIDDOR Accident Reporting, Adult Abuse Awareness, Basic Food Handling, Working with People who have Mental Health Problems, Accident Reporting, Prevention of Pressure Sores (provided by the District Nurse), Promotion of Continence, Basic Personal Care, Validation (In Dementia). This information is recorded on the individual files. At present an individual computer record of training is being developed and that all staff will have such records so that training and development might be better and more systematically organised. The Company is commended for the provision of this training. Staff receive three days paid training each year. There are a number of staff who come from overseas, and there is a clear expectation that they must speak English when at work and failure to do so may result in disciplinary action being taken. The reason for this being that some residents may be confused, upset/or distressed if they overheard a language which they do not comprehend. The Inspector spoke to a number of foreign staff and they spoke very good English. The Manager is advised to monitor this matter. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 20 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, 33 & 35 There is a relatively new manager in post. The home uses the companies Quality Assurance System. Health and Safety is promoted, but the home does not have all the documentation required. EVIDENCE: The Manager has been in post since the 2nd of January of this year having previously worked in care for 20 years. The Manager is currently undertaking her Registered Managers Award. She is responsible for this home only. The Manager and senior staff are familiar with the conditions associated with old age. There are clear lines of responsibility for the Manager, who is responsible to the Operations Director. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 21 It is recommended that the Manager undertake training in interviewing and selection of staff. The Company has its own quality system which consists of questionnaires being sent to residents and families which are sent to the Company. These questions are based on the Standards. The Company sends a response to the residents and relatives. It is required that a copy of this response be sent to the local office of the Care Commission. The Inspector was informed that it is the company’s intention to commence formal Quality Assurance system. The Inspector went through all the nine elements of Standard 38. The home has all the elements required except Standard 38.4 and it is required that it should have this important documentation. When the home has obtained this information the Inspector suggests that all the documentation be kept in one large file and clearly marked “Health and Safety” and ensure that it is available for use. Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 22 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 x 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 x x x x X 2 x 2 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x X 2 Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 23 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 OP15 OP24 Regulation Sched. 4 13 13,(4) (a) Requirement Timescale for action 01/05/06 01/05/06 3. OP33 4. OP26 5. OP38 It is required that Special diets are recorded. It is required that the thermostatic control on the radiator is repaired/replaced or the surface is guarded. 24(2) It is required that the Manager must ensure that the Commission is provided with a copy of the report produced in respect of any quality review of the service. 13 (4) ( c) It is required that the Manager take steps to ensure that the washing machines meet the Regulations. 13 4 ( c) It is required that the home should have all the information as set out in element 38.4 of Standard 38. 01/05/06 01/05/06 01/05/06 Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 24 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. Refer to Standard OP2 OP7 Good Practice Recommendations It is recommended that the print size of the Terms and Conditions be increased is size so as to enable those who have poor sight to read the document. It is recommended that: a) residents in the dementia care unit have a specific model of care plan b) training is provided before they are implemented c) all staff receive training in care planning d) the folders in which the care plans are kept are marked with the resident’s name. It is recommended that the plan of maintenance and renewal is developed and kept in the home. It is recommended that the Manager undertake Training in Interviewing and Selection of Staff. 3. 4. OP19 OP29 Brooke House DS0000049956.V285235.R01.S.doc Version 5.1 Page 25 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. 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