Inspection on 14/11/07 for Brookes House Care Centre

This inspection was carried out on 14th November 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brookes House Care Centre 14/10/08

Brookes House Care Centre 07/06/07

Brookes House Care Centre 07/02/07

Brookes House Care Centre 08/06/06

Brookes House Care Centre 23/01/06

Brookes House Care Centre 25/07/05

Brookes House Care Centre 02/03/05

Brookes House Care Centre 13/05/04

Brookes House Care Centre 05/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brookes House Care Centre 79-81 Western Road Brentwood Essex CM14 4ST Lead Inspector Michelle Love Unannounced Inspection 14th November 2007 09:00 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 Brookes House Care Centre DS0000018120.V353678.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. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookes House Care Centre Address 79-81 Western Road Brentwood Essex CM14 4ST 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) 01277 212709 01277 200706 brookeshouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70) of places Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Personal care to be provided to no more than 70 service users over 65 years of age. (Total number not to exceed seventy). Total number of service users for whom personal care is to be provided shall not exceed 70. 7th June 2007 Date of last inspection Brief Description of the Service: Brooks House Care Centre provides 24 hour accommodation and personal care for up to seventy older people. The home is not registered to care for people with dementia. It is a three storey building with residents accommodation on the first two floors and staff accommodation is provided on the top floor. It is situated a short distance from Brentwood Town Centre with its shopping areas and public transport. The home provides mostly single bedrooms and some double bedrooms. All bedrooms have en-suite facilities. There are lounges and dining rooms on both floors, which are accessible to residents by way of a passenger lift or ramp. Parking facilities are available at the front of the premises. There is a garden to the rear, which has a small patio area that is easily accessible to residents. Additional charges to residents relate to chiropody, hairdressing, personal toiletries, newspapers/magazines, participation within raffles and taxis. Inspection reports are contained within the homes Statement of Purpose/Service Users Guide. A copy of these documents was located within the main entrance to the care home. The current scale of charges ranges from £421.54 (Social services placement) up to £800.00 (private/single room) Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this unannounced key inspection over a period of approximately 10 hours. This inspection was conducted with assistance from the newly appointed manager. Additionally the operations manager from within the organisation was also present during part of the inspection and provided support to the manager. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was undertaken throughout various times of the day. An Annual Quality Assurance Assessment was completed by the registered provider and forwarded to us. Information from this assessment is reflected throughout this report. During the visit residents, staff and visiting professionals were spoken with and their comments are detailed throughout the main text of the report. Prior to the inspection relative’s surveys were forwarded to seek peoples’ views. It was disappointing to note that only a small number of surveys were returned to the Commission for Social Care Inspection. Comments from these surveys are highlighted within the report. What the service does well: What has improved since the last inspection? Some areas of the home have been redecorated and those areas provide residents with a homely and pleasant place in which to live. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 6 Since the last key inspection, a manager has been newly appointed. From inspection of the manager’s CV and from discussion with him, it is evident that he has the skills, experience and determination to ensure that the care home is run in the best interests of those people who live at Brooks House Care Centre. Despite issues highlighted in relation to the care planning processes and record keeping, some care plans have been reviewed and rewritten since the last key inspection. These are much improved and additionally a number of staff have received training relating to care planning. Staff working at the care home have received a significant amount of training in key subjects since the last inspection. Complaint management and record keeping detailing the nature of the complaint/concern, investigation, action taken and outcome has improved. 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. The summary of this inspection report can be made available in other formats on request. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 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 Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management of the home have an appropriate system for assessing the needs of prospective people prior to admission so as to ensure that they are able to meet individual’s needs. EVIDENCE: Records indicate that prospective residents are not admitted to the care home until a needs assessment has been undertaken. The assessment format was observed to be comprehensive, however care must be taken to ensure that all elements of the document are completed to ensure that the assessment covers all areas of need. On inspection of three random care files for newly admitted people, a pre admission assessment had been completed and additional information had been received from individuals placing authorities. The manager was advised to ensure that there is clear evidence to indicate that residents and/or their representatives where appropriate have been Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 9 involved in the assessment process and their views have been incorporated and taken into account. This was not clearly demonstrated on documents sampled. On discussion, the manager is very aware of the current high dependency levels of the residents in the home and is actively working to reduce this by admitting carefully to the home. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care delivery standards in the home are currently variable and some residents may not always be getting the care input and therefore outcomes that they need. EVIDENCE: The manager has a care planning system in place that is implemented in all Southern Cross homes. Whilst care plans are in place for each resident, the quality is variable at times with some being very up to date and person centred and others not covering or identifying all the residents current needs. The manager is developing/training senior staff so that they can review and update care plans in a meaningful, detailed and person centred way but this is taking time due to recruitment issues at the home. The manager has an objective and realistic approach to the development of care standards in the home and the need for sustainable improvements. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 11 Currently twenty percent of the care plans have been updated and these were seen to be very good, with life histories and plenty of resident led information. Other care plans, whilst containing some good detail, did not reflect all resident’s current needs and this is potentially leading to shortfalls in care provision. It was good to see that the manager has been auditing care plans and leaving information on the file to show care staff any shortfalls noted. The annual quality assurance assessment for the home states that they could do better with involving residents in the care planning system and that the care delivered could be more individualised and person centred. Some of the care plans in place did contain some person centred information, demonstrating that resident choice had been taken into account but this was limited in some cases and needs to be developed further, in line with the most recently updated care plans in the home. Unfortunately, from records and discussion with staff, some aspects of residents care had not always been followed through and this had the potential to leave residents at risk. This specifically related to pressure sores. It was also noted that staff need to have a more proactive, team approach to the care of some of their more challenging residents to ensure that they are receiving the level of care and monitoring that they require, so their needs are met in full. The training matrix detailed 88 of staff as having attained training relating to care planning. Reviews of the care provided were evident and it was positive to see that residents and their families had been actively involved and action points were noted and completed. In some cases residents had signed their care plans but this was nearly a year ago and requires a more consistent approach by staff. Daily notes were seen to be informative and on the whole evidenced the care provided and other relevant points. Resident’s healthcare needs were generally being met. Comprehensive risk assessments were in place, up to date and on the whole linked to care plans. Records show that GP’s are contacted in a timely manner although notes recording the actual visit and any guidance given was not always evident or limited in the care records. District nurses spoken to commented that information needed on recent GP visits were not always available to them and this could affect the care provided. The District Nurse also acknowledged that since the new manager has been in post, the team are trying to do a lot more and care overall is better. She also stated that the team at the home have to deal with some complex residents who have significant health needs that require a lot of input. Records showed that residents are being weighed on a regular basis and risk assessments completed. Residents who had identified needs in relation to fluid input were not being monitored in a formal way, which could be of benefit and this was confirmed through records and discussion with staff. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 12 Relatives who commented said that the staff are ‘very committed to client welfare and friendly’ and ‘they do well in taking care of the residents and meeting up with residents welfare. They care about the residents more than other things’. One relative said that the ‘attention to healthcare and the overall comfort of the client’ was something that the team at the home did well. Medication systems at the home were reviewed. The team uses a monitored dosage system and bottle to mouth. MAR sheets were reviewed at random and found to be kept in good order with clear prescriptions. No omissions in signing were noted and staff were also good at recording variable ‘as required’ medications. Blister packs checked tallied with the MAR sheet. Some residents are self-medicating, primarily inhalers, but records showed that not all had a risk assessment in place. Staff were seen to be consistent in using the coding system for when medication had not been given but they do need to be more proactive in following up regular refusals with the residents own Gp. Evidence of medication reviews were not always evident in the care plan. Residents noted to be on antibiotics had the appropriate care plan in place outlining the reason for the treatment and any related care that needed to be provided. Both the management of the home and the supplying pharmacist had recently undertaken comprehensive audits at the home with overall positive results. Any shortfalls identified concurred with our assessment. Training records show that 88 of staff have attained training relating to administration of medication. Some nice caring, friendly interaction was seen between staff and residents. Staff were observed to be chatting to residents when the opportunity arose and they involved residents to stimulate conversation. Brookes House Care Centre DS0000018120.V353678.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Outcomes for residents with regard to routines, activities and mealtimes are variable and need to improve overall. EVIDENCE: The manager is currently reviewing specific aspects of care and positively changing routines in the home to suit resident’s individual needs. This was confirmed by a member of staff who stated that they were now managing continence in a more proactive, resident led way. From care plans and observation it is clear that the team do still have some way to go with regard to an individual approach to care/routines. The current staffing levels do not aid these changes. However the manager and the staff are keen to develop resident led routines and this is seen as a positive move. The annual quality assurance assessment for the home states that the team is working with residents to build upon information that they have within the care planning system to inform activity within the home. Care plans show that staff have an increasing awareness towards the provision of care that acknowledges and acts upon resident choice. The 20 of the care plans that have been updated, to a good standard and with a person centred Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 14 approach, evidence this, but the staffing at the home needs to be such that the staff can actually implement the new care plans in full and in line with residents wishes. The manager employs an activities person who works 25 hours per week. From discussion with this person it is clear that she knows the residents well, their abilities and preferences with regard to activities. She is very keen to ensure that their needs are met in both and individual and group way and is very clear about the residents right to choose. She stated that she is currently undertaking a piece of work where she is obtaining views from residents to inform her programme planning, which is currently under review. The plan covers all seven days and is flexible on the day, in most cases. From discussion and records, the information that the activities officer has on individual resident’s preferences is not always contained in the care plan and also does not always tie in with other aspects of social care such as the life history, which is increasingly available in the care plans. It is clear that the activity officer has some input into the care plan but this needs to be formalised and therefore the information held available to all staff. More use should be made of this valuable information and it needs to link in with a social care plan, which contains assessed needs and residents preferences. The activities person has very limited time for the number of residents in the home, their differing needs and the layout of lounges etc. This really needs to be reviewed and the manager is aware of this. The annual quality assurance assessment for the home states that `further time could be given to activities` and the previous manager had interviewed for a further activity co-ordinator but at the time of this inspection there was not a second officer in post. The manager has 10 further hours in the budget that are vacant. Outings are an issue due to time and staff availability. The activities officer has taken two residents to Southend recently and six residents attended a harvest festival at a local school. Other activities include reminiscence, knitting, which residents were seen to be enjoying, quizzes and sing-a-longs. The activities person also stated that the care staff are better at involving residents in activities that promote their self worth, such as laying tables, but it was observed that this could be developed further. On relative who commented said that the home could improve by providing more activities. Relatives said that as visitors to the home that they were made to feel welcome. At the time of the inspection, the team at the home have started working with a local group developing interim employment training opportunities. Supervised students are visiting the home and providing positive input with regard to activities and this is proving popular with residents who said that they ‘liked the young people coming into the home’. The activities person also arranges other activities such as the pat dog once a week. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 15 The meal service was discussed with the manager who outlined that a new menu was being developed with the chef. This menu is also linked to a new system that ensures that meals are nutritionally sound. When complete the menus can be printed off and made available to residents in a user friendly format. The manager states that he is aiming for a resident driven menu but acknowledges that at the current time, although residents have had input, it is not at the level he would want and plans further work on this. Menus show that residents do have a choice and the residents spoken to regarding mealtimes confirmed this. They also commented positively on the food and said that it was hot, tasty but they were not offered seconds. Residents confirmed that they would like a menu as although they had choice they had often forgotten what they had chosen by dinnertime. The manager has purchased another hot trolley since the last inspection and food was observed to be hot and appetising when it reached the residents. The amount of food provided would be sufficient for one good portion each but would leave very little or none for possible second servings and this should be reviewed. Upon arrival to the home, some residents stated that they had not received a drink since getting up that morning. One resident stated, “I’m fed up and I haven’t had a cup of tea yet” and became distressed and started to cry. Within another dining area, one resident was observed to attempt to drink out of an empty/dry plastic beaker. It was evident that staff deployment within the dining areas was poor at this time and many residents were left without staff support as a result of providing personal care to other residents before bringing them to the dining room for breakfast. The manager was advised of the inspector’s observation and consideration must be given to ensure that residents are adequately supported at all times, not placed at risk and receive sufficient beverages in a timely manner. Both inspectors observed the lunchtime meal within three dining areas. Dining tables were laid with tablecloths, small vase of flowers, cutlery and napkins. Not all tables were seen to have condiments readily available for residents use and some residents had to request this. The manager should consider condiments and jugs of juice to be readily available/accessible so as to enable some residents to maintain independence and skills. Additionally the management of the home should consider the option of all residents receiving a choice of hot/cold drinks. Actual staff support was seen to be inconsistent with some residents receiving good support whilst for others support was limited primarily as a result of insufficient numbers of staff readily deployed to the dining areas and poor team work between some staff members. This was visible within the smaller dining room on the ground floor, whereby residents were observed to wait a long time before getting their meal, residents were not provided with a drink promptly and were observed to wait for up to 40 minutes before receiving one. Additionally staff were not available to deal with one resident’s unhappiness Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 16 and the inspector observed the resident raising their voice. One staff member was observed to walk out of the dining room without dealing with the situation. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of complaints is satisfactory and positive outcomes are experienced by residents and relatives. Further development is required to ensure that safeguarding issues are dealt with by the organisation so as to ensure residents are protected from abuse and/or possible harm. EVIDENCE: Complaint records were seen to be satisfactory. The management of the home has received three complaints since the last inspection. Records included information relating to the actual complaint, investigation and action taken where appropriate. Additionally it was positive to note that the management and staff from the home had received letters and cards complimenting them for the care/services provided. The proprietor has a complaints procedure and this is displayed on a notice board in the home. Consideration needs to be made to ensure that this is developed in an alternative format (larger print, simple language and/or pictorial) to ensure that the majority of people who reside at the care home are aware of the complaints procedure and know to whom they can voice concerns. Prior to this inspection the home had no safeguarding issues. Following this inspection one safeguarding matter was highlighted. It was positive to note that the manager of the home was able to clearly demonstrate a full Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 18 understanding of safeguarding policies and procedures, both corporate and local authority, and had instigated these with immediate affect, keeping all necessary agencies fully involved and up to date. Further evidence indicated that more improvement is required by the organisation to deal effectively with safeguarding issues so as to ensure individual resident’s wellbeing. The training matrix detailed that 97 of staff have received up to date training relating to safeguarding and 67 of staff had received training relating to challenging behaviour. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are happy, a continued programme of redecoration would further improve the environment and outcomes for residents. EVIDENCE: A partial tour of the premises was undertaken by the inspectors and then subsequently discussed with the manager. Since the last inspection work has been undertaken to redecorate lounge/dining areas and in some cases new floors have also been laid. Some bedrooms have also been redecorated and new lighter furniture has been purchased and this is planned to continue. There remain bedrooms in the home that require re-decoration and a regular programme needs to continue, to ensure that all the bedroom environments are acceptable. The condition of the woodwork around the home is poor in some areas and gives the home a tired appearance. The annual quality Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 20 assurance assessment for the home states that work is to continue in the lounge areas on both the ground and first floors. Attention is needed to the bathrooms in the home. The manager is aware of this and is working with the provider to address the issue. The current condition of some the bathrooms reflects poorly on the home and includes broken toilets, poor flooring and odours. It was noted that the sluice requires a new lock to ensure the health and safety of residents. Hot water temperatures were found to be acceptable on nearly all outlets tested and records showed that there is a system in place whereby the maintenance man checks and adjusts temperatures on a regular basis. The hot water temperature is not acceptable in the staff office, where staff have a key opportunity to wash their hands and no valve control is fitted. The manager informed us that work is planned for this area in the near future and it is still under question as to whether the sink will stay. Residents spoken to were happy with the accommodation and liked the new décor in the dining rooms. Relatives who commented said that the bedrooms are kept very clean. The home was seen to be clean, generally tidy and no odours were noted other than in the bathrooms. More attention could be paid to the cleanliness of items used for decorating the dining tables and to personal items in some resident’s bedrooms. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure that residents needs, can be met and that they are safe. EVIDENCE: The manager advised the inspector that the home’s staffing levels remain at 2 senior staff and 6 care staff between 07.15 a.m. and 9.15 p.m. and 1 senior member of staff and 3 care staff between 9.15 p.m. and 07.15 a.m. each day. On inspection of four weeks staff rosters, it was evident that staffing levels as detailed above have generally been maintained, however there are some occasions when the above staffing levels have not been met and no Regulation 37 notifications have been received by us detailing a reduction in staffing levels and measures undertaken by staff to deploy additional staff to the care home to meet residents needs. Concerns were expressed to the manager of the home pertaining to staff deployment during the morning and lunchtime periods. The outcome is this has had a detrimental affect on actual care delivery and resident’s wellbeing, Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 22 resulting in some residents being left for long periods of time without staff support and not receiving drinks/meals in a timely manner. Staff rosters continue to evidence that some staff had been undertaking long days and/or double shifts on occasions and some staff are working up to 70 hours per week. The manager must ensure that the hours worked by some staff are monitored and that staff remain competent and not to tired to undertake their role and to ensure resident’s wellbeing and safety. Staff recruitment files for four newly employed members of staff were examined. It was positive to note that records relating to all four members of staff were readily available and the majority of records as required by regulation were in place. Some gaps were noted in relation to the proof of identification for one person not being decipherable, no record of induction for three members of staff and although one file contained a POVA 1st notification, there was no evidence to indicate that a Criminal Record Bureau check, had been received or that the newly appointed employee was being supervised. Additionally there was no evidence of a POVA 1st or Criminal Record Bureau check for one person. The manager was advised of the above at the time of the inspection and needs to ensure that robust recruitment procedures are adopted at all times to ensure that people who reside at the care home are protected. As stated at previous inspections to the home, no file was available for the manager, however the manager was able to produce a curriculum vitae, detailing his employment history. A copy of the homes training plan/training statistics for staff was provided for inspectors. Evidence recorded at the time of the inspection indicated significant progress in attaining training for staff relating to fire safety, fire drills, moving and handling, COSHH (Control of Substances Hazardous to Health), safeguarding, infection control, nutrition, administration of medication, care planning and challenging behaviour). In addition to the above the manager advised that three people have recently completed a five day course entitled Valuing Older People and this encompasses pressure area care, attitudes to older people, diabetes/blood sugar monitoring, asthma, foot care, communication, record keeping, stoma care and care of the dying. Also most recently eight people have completed training relating to continence. Brookes House Care Centre DS0000018120.V353678.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management of the home is seen to be effective and run in the best interests of those people who reside at Brooks House Care Centre. EVIDENCE: The manager has been employed at Brooks House Care Centre since June 2007, following the last key inspection. The manager has worked in a care field setting since 2002, primarily working with adults who have a learning disability and/or mental health care needs. The manager has completed NVQ Level 4 (Care) and the Registered Managers Award. In addition to the formal qualifications, the manager has attained training relating to supervision managing performance, quality assurance, risk assessment/care planning, person centred planning and dementia awareness. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 24 The manager is aware of shortfalls raised at previous inspections. The manager is committed and keen to erase poor practice and to raise the home’s standards. It was evident at this inspection that the manager is trying to communicate a clear sense of direction and leadership for both residents and staff and stated “I’m not here to do a quick fix” and “we have a long way to go but I’m confident that this will be achieved and it is a work in progress”. The manager advised that he is ensuring that staff working within the home follow the organisation’s policies and procedures and have a greater understanding and knowledge of the National Minimum Standards and Care Homes Regulations. The manager feels that he has a clear vision and responsibility to turn the home around. Currently the manager is without a deputy manager, however steps are underway to recruit to the post. It was positive to note that the manager feels supported by the organisation and from all levels. The manager advised that he has received formal supervision (individual/group). The manager advised that following a satisfactory Criminal Record Bureau check an application to be formally registered with us will be forwarded as soon as possible. Following the last inspection, quality assurance surveys have been completed by residents and/or their representatives. The manager advised the inspector that as yet the outcomes of these surveys have not been collated, however the results will be made available once completed. It was positive to note that one survey stated, “use of a computer would be helpful” and this has been provided and is up and running. On the day of inspection residents were observed to use this facility. In addition to the surveys, monthly audits/validation reports have been completed. Evidence was available to indicate that regular staff meetings are being conducted at the home and records of minutes were available to confirm these had taken place. The homes supervision tracker was inspected and this indicated that since August 07, the majority of staff had received formal supervision, however some gaps were noted. Records indicated that there are efficient systems in place to ensure effective safeguarding and management of individual’s money and this includes record keeping. Safety and maintenance certification for equipment and fixtures in the home were checked at random and found to be in good order, apart from the electrical wiring safety certificate which was not available. This needs to be addressed. Following the inspection the manager advised that this could not be Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 25 located, however measures were underway to have the electrical system reinspected as soon as possible. Accident records were reviewed and were seen to be completed clearly. The manager reviews accident forms and an audit is carried out the end of each month. It was noted, from the accident forms, that there were regular accidents in the morning but the audit tool does not allow for pin pointing times of accidents and the value of this was discussed with the manager. The manager stated that he checks resident’s falls risk assessments against accident records and that he is trying to find out whether there is a falls prevention team locally. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 26 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans to be person centred, detailed and comprehensive reflecting individuals care needs so as to ensure appropriate delivery of care by staff. Timescale for action 01/02/08 2. OP7 13(4) Previous timescale of 1.11.05, 1.6.06, 1.1.07, 14.4.07 and 1.8.07 partially met. Risks assessments to be devised 01/02/08 for all areas of assessed risk so as to ensure residents safety and wellbeing. Previous timescale of 1.4.06, 1.8.06, 1.1.07, 14.4.07 and 1.8.07 partially met. Healthcare needs of all residents to be recorded, monitored and met to ensure individuals wellbeing. All residents to receive an appropriate programme of activities which meets their individual and social care needs. Previous timescale of 1.8.07 partially met. Residents to receive appropriate DS0000018120.V353678.R01.S.doc 3. OP8 12(1)(a) 14/11/07 4. OP12 16(2)(m) and (n) 01/02/08 5. OP15 12(1)(a) 14/11/07 Page 28 Brookes House Care Centre Version 5.2 access to drinks throughout the day and residents to be supervised and supported where necessary so as to ensure residents wellbeing. Previous timescale of 14.12.06, 14.4.07 and 14.7.07 partially met. To ensure the health and welfare of residents are promoted and safeguarded at all times, the registered person must adopt and assume appropriate robust procedures in line with agreed local guidance and protocols. Equipment in bathrooms to be maintained in good working order so as to ensure residents safety and wellbeing. All areas of the home to be clean and odourless so as to ensure that residents live in clean and homely environment. Sufficient numbers of staff must be on duty to ensure that residents are provided with appropriate support at all times by staff so as to meet their needs and ensure that they are kept safe. Previous timescale of 1.10.05, 14.4.06, 21.7.06, 14.12.06, 21.4.07 and 14.7.07 not met. Robust recruitment procedures to be adopted to ensure that staff are recruited in line with regulation and residents are safeguarded from possible abuse. Previous timescale of 1.9.05, 1.4.06, 1.8.06, 14.12.06, 21.4.07 and 14.7.07 not met. Staff to receive regular training so as to meet residents needs and to feel confident about DS0000018120.V353678.R01.S.doc 6. OP18 12(1)(a) 14/11/07 7. OP19 23(2)© 01/01/08 8. OP26 23(2) 14/11/07 9. OP27 18(1)(a) 01/01/08 10. OP29 19 14/11/07 11. OP30 18(1)(c) 01/03/08 Brookes House Care Centre Version 5.2 Page 29 providing good care. Previous timescale of 1.10.07 partially met. Staff to receive regular supervision, so that residents and other interested parties feel secure in the knowledge that staff are supported. Previous timescale of 1.9.06, 14.12.06, 1.5.07 and 1.8.07 partially met. 12. OP36 18(2) 14/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP33 OP38 Good Practice Recommendations Residents daily care records should be detailed and include an account of the resident’s day, outcomes and staff interventions. The homes quality assurance outcomes should be made readily available within the home. Electrical safety inspection to be undertaken to determine that the home is safe. Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brookes House Care Centre DS0000018120.V353678.R01.S.doc Version 5.2 Page 31 - 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. 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