Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Brookes House Care Centre 79-81 Western Road Brentwood Essex CM14 4ST The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Roberts
Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home
Name of care home: Address: Brookes House Care Centre 79-81 Western Road Brentwood Essex CM14 4ST 01277212709 01277200706 brookeshouse@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ashbourne (Eton) Limited Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Personal care to be provided to no more than 70 service users over 65 years of age. Total number of service users for whom personal care is to be provided shall not exceed 70. Date of last inspection Brief description of the care home Brookes 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 ensuite 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 Care Homes for Older People
Page 4 of 30 Over 65 70 0 Brief description of the care home 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) Care Homes for Older People Page 5 of 30 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited the home for a whole day and met with the manager and his team. Prior to this we reviewed all the information that we already had on the home and this included the operation managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to residents, relatives and staff at the home and prior to that we sent out surveys to all these parties, asking for feedback on the home. The response was, unfortunately, limited but these comments are referred to in the report. Whilst at the home we also reviewed records on all aspects of the running of Care Homes for Older People
Page 6 of 30 the home and undertook a tour of the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they will be properly assessed prior to admission to the home to ensure, as far as possible, their needs can be met. Evidence: The manager has an assessment system in place for prospective residents coming to the home. Both the manager and his deputy undertake the assessments. Three preadmission assessments were reviewed. These were seen to have been completed well and gave a good level of quite person centered information about the individual. The assessment then led into a pre-admission draft care plan. Not all of the information highlighted in the assessment was used to inform the new care plan and some key information was missed, affecting outcomes for residents, e.g that related to thier mental health or social care. Records showed that assessments were carried out in good time and they were seen to be repeated should a resident have spent time in hospital or if the admission had been delayed. This is good practice. In addition to the
Care Homes for Older People Page 10 of 30 Evidence: completed assessments, the management team also had in place, information from the referring authority to back up their assessment. On discussion, the manager at the home has been actively trying to reduce the dependency level of residents admitted, for the benefit of the home as whole. The home has a high turnover of residents due to short term contract beds via the local authority and respite beds. The respite room was viewed and was seen to be very pleasant and contained a copy of the service users guide to the home. Residents who commented on their admission to the home said that it was alright, that they had settled in and that they had just found their service users guide in the bottom of a cupboard. Not all new residents spoken to were aware of how to raise concerns. More work needs to be done to ensure that all new residents have the information that they need about the home on admission and that the service users guide is a working document. The operations manager in the AQAA states under what we could do better staff training in customer care and implementation of a key worker system. This may help to alleviate the shortfall in residents admissions. Care Homes for Older People Page 11 of 30 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident can expect to receive a good level of person centered care, helping to ensure that all their needs will be met in the home. Evidence: Since coming into post, the new manager has been working with the staff team to develop the care planning system for residents in the home. Overall the care plans were seen to be much improved with sufficient person centered information for staff to have an understanding of a residents needs and how to meet them. Care plans also evidenced residents rights and their preferences. More focus does however need to be given to residents pain management, mental health and social care needs as it was noted that identified needs did not always have a care plan in place. Staff spoken to said that we are concentrating on person centered care, looking at residents as individuals, we have also had some training on care planning and we try to make sure that everyone has what they want. The care plans reviewed were up to date and evidence was seen that care plans are
Care Homes for Older People Page 12 of 30 Evidence: also reviewed as and when required as things occur, not just on a monthly basis. Weekly reviews are also undertaken. Daily notes are maintained by the care staff on the care provided and, on the whole, these were seen to be informative, with staff noting changes in the residents themselves, as well as noting the cared they gave. Some staff need more guidance on completing these records. Records showed evidence that relatives had been invited to care reviews and that residents had attended and given their views. This is positive. The operations manager, in the AQAA sates that care plans are comprehensive and are reviewed and evaluated monthly as and when needs change. The evidence would concur with this. Should a resident have an acute, short term care need, good detailed information was seen at the front of the care plan to inform staff in order to support and care for the resident. Records showed that residents weights and nutritional status was being adequately monitored and residents were seen to be putting on weight where needed. Records also showed that staff were following up concerns appropriately, with dietitians etc. so residents received specialist input. Residents had the appropriate risk assessments on file and these were checked with observations on residents whilst touring the home, and these were noted to be kept up to date. Records showed that residents had good access to specialist advisors, for continence etc. and access to their GP was timely. Falls risk assessments were completed and risk levels noted. Whilst there was GP involvement for these residents at high risk, the manager does need to make contact with the local falls prevention team to progress this work further, so residents can be protected as far as possible. At the time of our visit there were no residents being cared for in bed and the manager reported that no residents were suffering from pressure sores. Residents were observed to have pressure relieving equipment available to them. Residents who commented said that I find the care staff very good, we chat, they do not rush me and they listen to what I say, some staff are more competent than others, things vary, it depends who is on duty and the staff have been very good to me, when staff help me get dressed, they ask me what I would like to wear. Relatives who commented said that the staff are good at contacting us if they have any concerns. On observation, staff could give more attention to supporting residents with the care of their nails and teeth, which on occasions were noted to require cleaning. Staff interaction with the residents was seen and heard to be friendly and caring. Staff were also observed and heard to treat residents respectfully. We also noted, during our visit, residents that we had met previously, had significantly improved in their general wellbeing and were now more socially interactive than before. Care Homes for Older People Page 13 of 30 Evidence: Medication management at the home was reviewed and found to be in good order. Medications are checked in properly and medication administration sheets were seen to be clear and completed fully. All residents were seen to have a protocol in place for any when required medications, giving staff guidance on their use. Medications were seen to be dated when opened, for audit and use by purposes and the controlled medications were managed correctly and the required records maintained. The management of the home do undertake comprehensive audits of this system and the last completed audit of July 2008 was seen and minimal errors were noted. Care Homes for Older People Page 14 of 30 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a generally positive outcome in relation to choice, activities and meals in the home although there are still areas for improvement. Evidence: Discussion with residents and the staff showed that, as far as possible, the routines of the day are resident led. Staff also showed an appreciation of residents rights and choices and have a person centered approach to the care they provide. This was however, more evident in the more experienced staff. Residents who commented said that you can get up when you want, you can lay in bed if you want and they will bring you your breakfast, they bring me tea now, which is nice, they didnt before, I spend my time how I like, I spend a lot of time in my room and you get up when you want, but you dont get tea until you go down to breakfast, but you dont have to wait for that. Residents were observed to be spending time in communal areas of the home as well as their bedrooms during the day and many take a daily paper. The home has two activities officers in post but still has ten hours vacant, which has been the case for quite some time. On discussion with the activities officer, she is aware of the diverse needs of the residents within the home. She says that they plan
Care Homes for Older People Page 15 of 30 Evidence: activities a month ahead and discuss with residents what they would like to do. They try and group people with similar interests together for an activity and try to ensure that they visit each lounge, so as many people as possible have access. Activities include, dominoes, bingo, group chats, hoopla, videos, magazines and papers - to keep people up to date, pat dog, quizzes, food tasting, gardening, manicures, entertainers, people giving talks, armchair exercises, crafts. The activities officers also visits people who tend to stay in their rooms for a chat or whatever they would like to do. Some residents recently visited a local school for a harvest festival service and where possible people are taken out to the local shops, for tea and shopping. Occasionally a bus is available and they take 10 people out for a drive. A programme of activities was seen to be displayed in the main entrance. More thought could be given to making sure residents in all parts of the home see this. Lists of residents preferences regarding social activities were seen in the care plans although there is no actual plan for care in relation to social needs and this could be developed in order to improve the residents quality of life through social care, promoting independence/self worth and maintaining skills. This could also be linked to the promotion of good mental health. Residents who commented said I would like to get out more but I cant because I need someone with me, I dont take part in activities but the activities officer comes and sees me, she is very nice and chats and spends time with me and they have a lady come in, I dont know her name, I have played pass the ball. On the day of the inspection many residents were observed to be activley participating in the activities offered. Since the last inspection, the mealtime routines at the home have been reviewed and improved upon. Mealtimes were seen to be much more efficient, with residents waiting less time to be served. Dining rooms are now staffed over the whole breakfast period so that residents are served straight away. The manager advised that the kitchen also now produces enough food that enables residents to have more choice, should they wish or change their mind from their previous menu choice. The manager has introduced the chef serving the meals now, so he can get feedback direct from the residents on the food being served. At the last inspection the proprietors advised us of a new nutritional system being introduced into the homes to ensure that residents were receiving a nutritionally sound diet, through planned menus. This system was stated to be a bit hit and miss in the home as the staff felt that they did not have access to the technology to back it up and use if effectively. Access to the computer is an issue and staff tend to rely primarily on residents preferences/feedback to decide upon the menus. Residents who commented on the food said that the food is good and bad, you get a menu to choose from every day and they do their best to accommodate your preferences, you always get biscuits with drinks, occasionally you get a bit of cake, at supper time there is always soup and a hot choice or salad and sweet - the food is
Care Homes for Older People Page 16 of 30 Evidence: always hot, The food is often not cooked properly, we had awful roast lamb yesterday that you could not cut or chew, sometimes the veg is not cooked properly, they always ask us what we would like and the food is alright. Whilst is is good that residents are getting choice, the quality of the food is sometimes in question and needs review. On the day of the inspection the manager advised that the cooker was in need of repair and had caused problems and this was being attended to. It also accounted for the lack of home made cakes available to residents. Fresh fruit was observed to be available on the tea trolleys and residents had access to drinks in their rooms but not always in the lounges between drink rounds. The manager plans to introduce a recording system to evidence the amount residents have eaten to provide a level of monitoring linked to risk assessments. Care Homes for Older People Page 17 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to and acted upon and that, as far as possible, they would be protected in the home. Evidence: The manager has a complaints procedure in place that is displayed in the main hallway and can also be found in the service users guide. Residents spoken to were aware of who to raise any concerns with and all knew who the manager was, including new residents. Systems should be put in place to ensure that new residents know who to speak to if they have concerns. Residents who commented said that I would raise any concerns I had with the deputy manager, she is very good and efficient and would do her best to sort things out for you and I would just speak to the manager. The manager logs all complaints and since the last inspection there have been five complaints. Records relating to these were reviewed and the manager was seen to have an objective approach and dealt with complaints thoroughly. The manager needs to ensure that all complaints are dealt with within the procedure timescales. Complaints related to clothing, staff behavior, medication management and residents falling. The operations manager in the AQAA said that they had improved by logging complaints with a recorded outcome and that they plan some customer care training for staff so that they are ware of what is a complaint. The team at the home have also received some compliments including one from the
Care Homes for Older People Page 18 of 30 Evidence: Continence Advisor who recently visited the home and stated I would like to compliment Brookes House. I have visited many times before and never been impressed. However, I have noticed a change in the home, its seems more cleaner and a much happier place. All the staff are friendly and work hard to maitain a good standard of care. Compliments from relatives included my relative was treated with such kindness, care and dignity by all the staff who attended to her every need and my relative was kept safe and comfortable. The manager has adult safeguarding procedures in place that are up to date. Since the last inspection there have been two adult safeguarding referrals which the management of the home have dealt with appropriately. One related to thefts of money from residents and the management have put further procedures in place to reduce risks and the other referral has yet to reach a conclusion. Staff spoken to were aware of adult safeguarding procedures and confirmed that they had attended training on this subject. Records showed that 80 of staff were up to date with this training and that further sessions were booked. The operations manager in the AQAA states that staff undergo training in the protection of vulnerable adults and whistle blowing and that this is ongoing. Care Homes for Older People Page 19 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that generally meets their needs but outcomes could be improved by making the home a more pleasant place in which to live. Evidence: A tour of the home was undertaken with the deputy manager. All communal areas and bathrooms were seen and a significant number of the bedrooms. Since we last visited some parts of the home have been redecorated and this includes bedrooms, corridors and lounges, although the lounges have yet to be completed with pictures and new curtains etc. A new lino floor has been put down in the large conservatory to the rear of the home and outside, in the back garden, an extension to the patio has been completed giving residents better access and another seating area. The front of the home does look unkempt and reflects poorly on the home when you arrive. On touring the home it was noted that signage for residents has improved since our last visit with toilets and other key areas being more identifiable. Whilst some of the toilets have been decorated the bathrooms remain unrefurbished and generally in need of upgrading. This was noted at our last visit, with one bathroom being particularly bad with the floor around the toilet being damp and odorous. Toilet seats were noted to be loose and sliding in several bathrooms, creating a potential risk to residents. The bathrooms again reflect poorly on the home. The regional manager showed us a redecoration programme for the home but this had yet to be signed off and actually
Care Homes for Older People Page 20 of 30 Evidence: commenced. The operations manager stated that they were steadily replacing furniture in the home, by buying chairs on a monthly basis. The operations managers AQAA stated that the home needs to formalise the decorating programme so areas do not become as tired looking as they do at present. One large communal room is designated as the smoking room and is used by one resident. There is no extraction and this impacts on this part of the home. The management need to review the use of this space and its is impact on the communal space available for all residents. Some rooms were noted not to have access to hot water, whilst other rooms, such as the staff office, where there are key hand washing facilities, the water was noted to be too hot to wash your hands comfortably. The regional manager stated that the hot water system in the home was going to be sorted out but as yet they did not have a date. The management of the home are aware of the potential risks to residents and staff. A maintenance man is employed at the home and completes a monthly check of the water temperatures, wheelchairs and call bells etc. When these have been completed the manager signs them off. Staff have a book where they list items that need attention and a good level of reporting is evident, however, there is no evidence that these items have actually been attended to. An alteration to the way the records are kept would help this and also provide a monitoring tool. It was noted that the windows of the home were in need of a good clean and so much so they affected the view out of the home, especially at the front. Odd bedrooms were noted to have odours but this was not affecting the home as a whole and the staff team were observed to have the equipment to deal with this. One room, with lino down needed particular attention. Overall the home was seen to be clean and tidy and had improved since our last visit with more attention being given to residents personal items. Residents who commented said that my room is nice and quiet, I am quite happy with my room and I have brought some of my own things in with me and I like my room and spend a lot of time in here. Residents who commented in surveys felt that the home was always fresh and clean. The manager has an up to date fire safety risk assessment in place and other records also show that there are regular tests undertaken on the fire alarm and emergency lighting systems. Records show that the manager undertakes regular fire drills with the staff team and maintenance certificates are in place for all fire safety equipment.
Care Homes for Older People Page 21 of 30 Care Homes for Older People Page 22 of 30 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst residents benefit from a well trained staff team, outcomes will improve once the team has a period of stability. Evidence: Since the new manager has been in post, he has recruited a significant number of new staff. The home is nearly up to a full compliment of staff and the use of agency staff is down. Agency was last used three weeks prior to this inspection. The operations manager in the AQAA states that we have retained a core team of staff and this is evident from observation. At the time of the inspection the home only had 48 residents and staffing of the home was at a satisfactory level for the residents living there, as dependency levels have also reduced. Residents who commented said that staff have a lot to do but they never rush me , when you ring the buzzer it sometimes takes time to get an answer, but this depends which staff are on duty, staff are chatty when the help you and they ask you what you would like to do or choose and if you use the buzzer the staff are quite good at coming promptly. Staff at the home are encouraged to undertake NVQ qualifications and staff spoken to confirmed this. At the current time records show that the home has 32 care staff and of these 19 have achieved NVQ level 2 or above, therefore achieving the recommended 50 standard. Records show that of the 19 staff with an NVQ 6 have
Care Homes for Older People Page 23 of 30 Evidence: completed NVQ 3. All the senior care staff have NVQ level 3. Three staff files of new recruits were reviewed and it was found that the manager has a robust recruitment system in place, with the files containing all the required checks and documentation. The operations managers AQAA states that we have a robust recruitment system in place and the evidence would concur with this. Staff spoken to confirmed the recruitment process. Since our last inspection at the home the new manager has improved the staff induction system. Staff confirmed that they had two days induction at the home then, where appropriate, over a period of weeks they would be completing a Skills for Care workbook. Workbooks were reviewed and seen to be completed well, over reasonable timescales and staff are clearly supported by the Manager or other Senior staff. Staff spoken to confirmed training that they had received at the home, including adult safe guarding, manual handling, food hygiene etc. Staff training records show that the team at the home have quite good levels of compliance, for fire safety, manual handling, adult safe guarding, care planning, health and safety, infection control etc, but there is still room for improvement. The majority of staff have received training in most areas but some updates are a little behind. The managers training plan shows that sessions have been booked where required. It is positive to note that staff have been attending training on dementia awareness, challenging behavior and nutrition. Care Homes for Older People Page 24 of 30 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is developing the home positively to ensure that it is run in the best interests of the residents. Evidence: The manager has been in post since June of this year. He has a background in social studies and psychology and has extensive experience in managing residential care homes. He has achieved the NVQ level 4 but has yet to apply for registration with the Commission. Records show that he is keeping up to date with his own training that relates to work in the home. On discussion, he feels that the home is moving in the right direction and that the staff are willing to learn, although recruitment has been an issue. Staff who commented said that the new manager is very good, approachable and supportive and the senior team and manager are supportive and they help with any queries you may have. This home needs a period of management stability to enable it to keep improving and maintain the improvements made. Records show the manager has been holding meetings with both residents, relatives and staff. The
Care Homes for Older People Page 25 of 30 Evidence: manager also plans to meet with residents on an informal basis, during a sherry and chat get together, to gauge feedback on the home and services offered. Minutes show that a wide range of subjects are covered and that there is good interaction. The proprietors have an extensive quality assurance system in place. This includes a feedback questionnaire to residents and relatives and at the time of the inspection was about to be sent out again. A new outcomes based internal audit is now in place and it was possible to see a completed audit from September 2008. This had a reasonable, objective approach and covered all outcome areas as linked with the National Minimum Standards. Internal audits are also completed on areas such as medication management and care planning. These were seen to have been completed and had associated action plans. The proprietors manage money on behalf of residents and use a computerised system that keeps the money accounted for and gives residents access to a float held in the home. Computerised records are maintained and monies are held in an interest account where proportioned interest is assigned. The manager has a staff supervision plan in place. Staff spoken to confirmed that they were aware of supervision or that they had attended supervision. Whilst the supervision plan is underway and staff attitudes toward supervision are now more positive, this is an area the manager is still developing, although records show that approximately 80 of staff have recieved supervision. This has significantly improved since our last inspection. Accident records were reviewed and found to be completed well and followed up. The manager has a reviewing system in place for checking patterns of accidents over a monthly period. At the current time the manager is not aware of the local falls prevention team and he was advised to look into this in order to help residents at particular risk in the home. Safety certification for fixtures and equipment in the home were checked at random and found to be in good order. On a tour of the home the only health and safety issue noted was the hot water system in the home, which is outlined in Section 5 of this report. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action 1 19 23(2) Equipment in bathrooms to be maintained in good working order so as to ensure residents safety and wellbeing. 01/01/2008 Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 19 23 Maintain bathrooms in good decorative order and ensure that they are safe. So that residents have a safe and pleasant home to live in. 31/01/2009 2 26 23 Ensure that all parts of the home are odour free. So that residents can live in a pleasant environment. 31/12/2008 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Review the day of admission process to ensure that all residents have the information and support that they need at this time. Continue to develop the care plans in relation to pain management, mental health and social care. Staff should give more consideration to supporting residents with the care of thier teeth and nails. Develop social care plans to help ensure that residents needs are being met and that they are optomised. 2 3 4 7 7 12 Care Homes for Older People Page 28 of 30 5 15 Review the quality of the food being served in the home and consult with residents on this aspect of the meals service. Ensure that all new residents are aware of how to raise concerns and that complaints are dealt with within identified timescales. Continue with staff training on adult protection to ensure that they are all up to date. Continue to ensure that all staff are up to date with their required training. Continue to develop and put in place the staff supervision system. 6 16 7 8 9 18 30 36 Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!