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Inspection on 07/02/07 for Brookes House Care Centre

Also see our care home review for Brookes House Care Centre for more information

This inspection was carried out on 7th February 2007.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home`s environment remains pleasant and homely and provides residents with a safe place in which to live. The home is located centrally and within reasonable distance of all local amenities and facilities.

What has improved since the last inspection?

The registered provider has employed a manager to manage the care home. The manager is committed and keen to improve the home`s poor performance and to eradicate poor care practices from within the existing staff team. The acting manager has demonstrated a good understanding of the Care Homes Regulations and National Minimum Standards.The acting manager has confirmation from the registered provider that a new treatment room is to be created.

What the care home could do better:

The Commission recognises that since the last `key inspection`, the acting manager has undertaken a lot of work within a short time to try and address previous identified shortfalls. It is unfortunate that despite these efforts 18 Statutory Requirements and 6 Recommendations were highlighted at this inspection. Improvement is required in relation to the homes pre admission assessment processes and care planning/risk assessments. Although there is an assessment/care planning process in place, documentation is relatively poor and does not depict in most cases information pertaining to resident`s social, physical and healthcare needs. Records indicate that only a small number of staff have received training relating to care planning. Additionally there is little evidence to indicate that residents and/or their representatives are involved in the devising of care plans etc. The home has an activities programme however the recording of activities is relatively poor and in some cases is meaningless, as detailed within the main text of the report. Innovative and creative ideas need to be explored for residents, with particular those who have complex needs. The registered provider also needs to ensure that sufficient staffing hours are given for activities each week. As stated within the report, existing staffing levels do not meet resident`s needs and must be rectified with immediate effect. Throughout the report examples are highlighted as to the effects this deficit has on individual residents. Although no new members of staff have been recruited since the last inspection to the home, the registered provider must ensure that information pertaining to the recruitment of the acting manager is made readily available and any gaps in others recruitment files addressed. Limited staff training was evident in relation to both necessary training (fire awareness, manual handling, food hygiene, infection control, first aid, health and safety, protection of vulnerable adults, challenging behaviour, etc) and that which meets those conditions associated with the needs of older people. The major area of concern is in relation to some staff`s treatment of residents and to the lack of dignity and respect afforded residents.

CARE HOMES FOR OLDER PEOPLE Brookes House Care Centre 79-81 Western Road Brentwood Essex CM14 4ST Lead Inspector Michelle Love Unannounced Inspection 7th February 2007 08:00 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.V329571.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.V329571.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 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.V329571.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. 8th June 2006 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. A smoking room and hairdressing facility is available. 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 accessible to residents. The homes weekly fees range from £413.28 to £426.09 for a Social Services contracted bed and £550.00 for a single room and £800.00 for a double bedroom. 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 will be located within the main entrance to the care home. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Unannounced `Key Site` visit was carried out by Michelle Love and Carolyn Delaney, inspectors, over a period of approximately 9 hours and totalling 18 hours. At this site visit both inspectors conducted the inspection with the acting manager. As part of the process a number of records relating to individual residents and care staff were examined i.e. care plans/risk assessments, staff employment files, training records, accident record etc. Additionally the homes medication systems were observed were observed and records inspected. During the visit several residents, relatives and members of staff were spoken with. Comments from relatives were generally very positive i.e. “care morning noon and night, day in and day out”, “we are always impressed by the cheerful and helpful demeanour and attitude of all the staff”, “the carers are all very willing”, “I have found all the staff very nice and friendly” and “very friendly and caring staff”. As a result of concerns raised at the last `key inspection` on 8th June 2006, an additional random inspection was conducted to the care home on 16th November 2006. Areas examined included pre admission assessments/care plans, activities, Statement of Purpose/Service Users Guide, Records of Complaints, Medication, Environment, Staffing Levels, Staff Recruitment and Staff Training. Many issues highlighted at that inspection remain outstanding and again highlighted at this inspection. What the service does well: What has improved since the last inspection? The registered provider has employed a manager to manage the care home. The manager is committed and keen to improve the home’s poor performance and to eradicate poor care practices from within the existing staff team. The acting manager has demonstrated a good understanding of the Care Homes Regulations and National Minimum Standards. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 6 The acting manager has confirmation from the registered provider that a new treatment room is to be created. What they could do better: The Commission recognises that since the last `key inspection`, the acting manager has undertaken a lot of work within a short time to try and address previous identified shortfalls. It is unfortunate that despite these efforts 18 Statutory Requirements and 6 Recommendations were highlighted at this inspection. Improvement is required in relation to the homes pre admission assessment processes and care planning/risk assessments. Although there is an assessment/care planning process in place, documentation is relatively poor and does not depict in most cases information pertaining to resident’s social, physical and healthcare needs. Records indicate that only a small number of staff have received training relating to care planning. Additionally there is little evidence to indicate that residents and/or their representatives are involved in the devising of care plans etc. The home has an activities programme however the recording of activities is relatively poor and in some cases is meaningless, as detailed within the main text of the report. Innovative and creative ideas need to be explored for residents, with particular those who have complex needs. The registered provider also needs to ensure that sufficient staffing hours are given for activities each week. As stated within the report, existing staffing levels do not meet resident’s needs and must be rectified with immediate effect. Throughout the report examples are highlighted as to the effects this deficit has on individual residents. Although no new members of staff have been recruited since the last inspection to the home, the registered provider must ensure that information pertaining to the recruitment of the acting manager is made readily available and any gaps in others recruitment files addressed. Limited staff training was evident in relation to both necessary training (fire awareness, manual handling, food hygiene, infection control, first aid, health and safety, protection of vulnerable adults, challenging behaviour, etc) and that which meets those conditions associated with the needs of older people. The major area of concern is in relation to some staff’s treatment of residents and to the lack of dignity and respect afforded residents. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 7 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.V329571.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered provider has developed a Statement of Purpose and Service Users Guide, which sets out the homes aims and objectives. Both documents need to be reviewed and updated. Prospective residents are assessed prior to admission, however there is evidence that the practice is not always consistent or well applied. EVIDENCE: The Statement of Purpose is displayed within the front foyer of the home and contains the latest inspection report. The document needs to be updated to reflect that the home has had a change of Operations Manager, that the numbers of staff who have attained an NVQ Level 2 qualification are actually lower than recorded and that currently the registered provider does not formally write to residents and/or their representatives confirming that the service can meet their needs. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 10 All residents are issued with a copy of the homes Service Users Guide. The acting manager was advised that additional information must be recorded relating to fees payable for services provided, arrangements for paying and additional costs incurred and whether or not there are different charges for people who have all or part of their care funded by a local authority or primary care trust. On inspection of four files for the newest residents, pre admission assessments were completed. In general terms assessments were seen to be satisfactory, however these varied in detail and comprehensiveness i.e. not all elements of the assessment were completed for one resident. In addition to the homes pre admission assessment format, the home had received information and/or assessments carried out through care management arrangements. There is little evidence to indicate that prospective residents and/or their representatives were encouraged to visit the home prior to admission and contributed to the assessment process. The home does not provide intermediate care. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all residents have a plan of care and in some cases these are incomplete and poorly completed. There is evidence that staff in the home do not respect resident’s wishes, choice or dignity. Medication discrepancies were highlighted at this inspection. EVIDENCE: On inspection of a random sample of five individual care plans, no care plan had been completed for one resident who was receiving respite/short term care at Brooks House Care Centre. This is of concern as staff do not have the necessary information to inform them about the individuals clinical and social care needs and there are no guidelines to advise them of how to support the individual resident. Formal assessments relating to manual handling, pressure area care, continence and nutrition were completed for this person. The acting manager was advised that the dependency assessment completed for this person seemed inaccurate and did not reflect the resident’s needs. Additionally Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 12 the nutritional assessment did not reflect the resident’s needs as information detailed on the pre admission assessment indicated the resident had a reduced appetite. This was not recorded within the formal nutritional assessment. Other care plans inspected varied in detail and content. Some assessments of need contained up to twelve elements, whilst others only recorded six or less. Areas relating to communication and mental well being were consistently not recorded. The care plan for one person made basic reference to them neglecting their personal care and to their past/present issues pertaining to alcohol. No information was recorded in relation to how the lack of alcohol and/or consumption of alcohol would affect the person’s appetite, their general well being/behaviour and moods. No risk assessment was completed pertaining to the above issue i.e. if they should arrive back to the care home when under the influence of alcohol and how this situation would be managed by care staff. The care plan detailed that the resident “must not drink while out”, however this was not recorded as a restriction on the persons choice and freedom. No evidence was available to indicate that this had been formally agreed or discussed with the resident. Not all care plans were observed to have been reviewed and updated i.e. the care plan for one resident had not been reviewed since 29.12.06. Risk assessments were not completed for all areas of assessed risk i.e. the pre admission assessment for the resident receiving respite care advised that they suffered with depression, anxiety, could neglect personal care and had poor nutrition/poor appetite. No risk assessments were devised for these areas, however a risk assessment relating to falls was completed. It was unclear as to why this was detailed when the person’s mobility was seen to be satisfactory. One care plan relating to a resident with pressure sores was inspected. The care plan made reference to the resident needing to be hoisted by two carers and to be `turned` in bed. The care plan did not include details of how frequently the resident should be `turned` and no `turn charts` were available to evidence care provided by care staff. The frequency of visits by healthcare professionals and specialist equipment utilised were not recorded. Daily care records for residents were inconsistently documented i.e. some records were detailed and informative whilst others were basic. The acting manager was advised that daily records are a good source of evidence to show that care is being provided, as detailed in the care plan. Daily records when well written, help ensure a consistent approach and good quality of care for service users. Detailed daily records will help ensure the acting manager to audit the care being provided to residents, and ensure that staff are following the guidelines in the care plans. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review and to record that they are following the assessment of needs i.e. the day care records for one resident indicated that they displayed Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 13 challenging/inappropriate behaviours on occasions. No records depicting staff interventions/support to the resident were available. On inspection of the homes training matrix, this details 7 of staff have undertaken care planning training. No evidence was available to indicate that individual care plans had been devised with the resident and/or their representative. The homes medication storage systems remain appropriate. The acting manager advised inspectors that he now has confirmation from the registered provider to convert a vacant ground floor bedroom into a treatment room. On inspection of Medication Administration Records (MAR), only one omission were noted whereby records had not been signed by senior staff to indicate that medication had been administered to and received by residents. There was good evidence to indicate that one resident who has oxygen has a detailed care plan/risk assessment in place. The home also had a detailed policy for the safe administration of oxygen. The Commission is concerned that following inspection/audit of four residents medication, records and actual medication available did not concur i.e. 30x 10 mg Nicorandil tablets were received on 21.1.07. Records indicated that since 21.1.07, 17x tablets had been administered, however on checking the remaining medication, only 12x tablets were observed to be left, (1x tablet short) and this shortage could not be accounted for. 56x Adcal tablets were received on 21.1.07. Since 25.1.07 records indicated that 28x tablets had been administered to residents, however only 14x tablets remained (14x tablets short). 56x Adcal tablets were received on 21.1.07. Since this date records indicated that 34x tablets had been administered to residents, however 24x tablets remained instead of 22. According to the homes staff training matrix 81 of staff have received medication training. However this only details the names of 3x staff as having completed medication training. The homes pre inspection questionnaire submitted to the Commission lists 10x staff as being able to administer medication to residents. It is unclear as to whether or not 7x member of staff have up to date medication training. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. Residents are not consulted or listened to and residents are compliant with the routine of the home. Residents have the opportunity to participate within a programme of activities. Residents are provided with a varied diet, however the experiences at mealtimes for residents vary and in some cases it is not a happy experience. EVIDENCE: The home has both a written and pictorial activity programme. This is displayed within the main reception area for all to see. Activities for residents include sing a long, netball, quiz, table top games, cooking, bingo, music, nail care, cream tea, 1-1 discussion, taste/touch and smell etc. Recording of activities undertaken by residents are located within two files and a notice is pinned to boards around the home, advising residents of forthcoming events. The activities co-ordinator is contracted to work 25 hours per week. Currently there are 10 additional vacant hours for activities, however recruitment to this post has proved problematic. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 15 Records depicting actual activities undertaken by residents was observed to be poorly completed and inappropriate in some cases i.e. “Chat with Tosca” (Tosca is the homes activities co-ordinator), “tasted biscuit from cooking session”, “declined bingo” and “…said hello to Tosca as he walked the corridor and also sat in lounge one…had a friendly smile”. No recording sheets were available for some residents. On inspection of a number of surveys received from relatives, comments relating to activities were mixed i.e. “more activities perhaps ?” and “more staff for activities”. Routines within the home are rigid and not in the best interests of residents i.e. some residents do not have a choice about the time they get up and go to bed, residents do not have a choice about which lounge they can sit in, residents do not have a choice about what they watch on television etc. The home operates an open visiting policy, which enables residents to see their member of family/friend at any reasonable time. Menus were displayed within the home and offered residents the choice of two main courses at lunchtime and one hot/cold at teatime. Alternatives to the menu were available i.e. soup/omelette/salad etc. Inspectors observed both the lunchtime and teatime meals. It was positive to note that meals served to residents within the conservatory were unrushed and staff interacted well with residents. This was in contrast to the lunchtime meal served to residents within the other ground floor dining room. Residents were observed to be seated at 12.10 p.m. and the first person to receive their meal did not get this until 12.50 p.m. The dining area was very congested (13x residents and 5x staff) and there was little manoeuvrability for both residents and staff. It was positive to note that the lunchtime meal provided to residents looked appealing and portions provided to residents were appropriate. Not all of the tables had a table cloth laid, however condiments were readily available. During the lunchtime meal it was very evident that one resident was very distressed as a result of being given another person’s clothing to wear. The resident was adamant that the trousers were not theirs and they were ill-fitting and were causing them discomfort. It was concerning to note that staff including one senior carer dismissed the resident’s comments and pleas for their clothes to be changed. The senior carer was overheard to say “they’re not half-way up your legs” and “we’ll take them off this evening”. No action was taken by staff to alleviate the resident’s discomfort, and the resident was overheard to say “I know they’re not mine”, “they’re up my legs” and “no one believes me”. It was the housekeeper who confirmed to the resident, staff and the inspector that the clothes the resident were wearing did belong to someone else. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 16 Comments relating to food were in general positive, however some negative comments were noted relating to the quality of food. Interaction between the majority of staff and residents was observed to be limited and very poor. The lunchtime meal was rushed and residents were not consulted as to whether or not they wanted gravy with their meal and plates were removed without asking residents if they had finished their meal. Brookes House Care Centre DS0000018120.V329571.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 home has a complaints and adult abuse policy and procedure. Some staff have attained training pertaining to protection of vulnerable adults. EVIDENCE: Since the last key inspection the home has received 21 complaints, however not all records of complaint include clear evidence of the specific outcome. Despite this the acting manager was able to demonstrate a good understanding of the homes complaints procedure and evidence appropriate processes for investigating complaints. Inspectors noted that 5 out of 9 complaints have involved members of night staff. Additionally several of the complaints highlighted, made reference to poor care practices by staff. The acting manager is proactive in trying to eradicate poor performance by some staff members. No protection of vulnerable adults issues have been highlighted since the last key inspection. On inspection of the homes training matrix 60 of staff have attained protection of vulnerable adults training and only 19 of staff have received training pertaining to challenging behaviour/dealing with aggressive and/or inappropriate behaviours. The latter is poor as on observation of staff interventions with individual residents, it was clear that staff did not demonstrate a good understanding of residents needs and were unable to Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 18 initiate appropriate support for residents i.e. for most of the afternoon one resident was observed to be distressed and continually requesting to “go home” and wandering up and down the corridor. The majority of staff were noted to either ignore the resident or to tell them to “sit down”. Gradually as the afternoon wore on the resident became more distressed becoming both verbally and physically aggressive. Eventually staff made the decision to allow the resident to speak on the telephone to their member of family to see if this would have any effect. It was only after a member of the family visited the home that the resident became untroubled. The resident’s care plan did not clearly identify guidelines for staff detailing how best to support the resident at times of distress. Brookes House Care Centre DS0000018120.V329571.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 good. This judgement has been made using available evidence including a visit to this service. Resident’s live in a safe and homely environment. No health and safety issues were highlighted at this site visit. EVIDENCE: The home continues to be well maintained and decorated for residents. Of those resident’s bedrooms inspected, all were seen to be personalised and individualised. The pre inspection questionnaire submitted to the Commission details that some changes to the premises have been undertaken since the last key inspection. A number of resident’s bedrooms have been re-carpeted and redecorated, a new lounge area has been created on the ground floor, a smaller lounge area has been re-carpeted, some items of equipment have been purchased for the kitchen and the homes main dining area carpet has been replaced with vinyl flooring. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 20 On the day of the inspection some odours were detected throughout the home and some carpets were very stained. Brookes House Care Centre DS0000018120.V329571.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 poor. This judgement has been made using available evidence including a visit to this service. Staffing levels have been reduced and do not meet resident’s needs. Recruitment procedures within the home appear generally satisfactory. Training provided is limited. EVIDENCE: On inspection of two weeks staff rosters it is evident that minimum staffing levels have been reduced from 2x senior staff and 6x care staff (a.m.) each day to 2x senior staff and 5x care staff. The minimum staffing levels in the afternoon remain at 2x senior staff and 5x care staff and at night are 4x waking night staff. Although there were only 62 residents at the home on the day of the inspection, it is evident that current staffing levels are inadequate and insufficient to meet resident’s needs i.e. call alarms were not answered promptly and in some instances residents had to wait up to 3 or 4 minutes to be attended to by care staff and lounge areas were left unattended for up to 10/15 minutes at a time. Some staff members were seen to be complacent and unresponsive to residents needs. The rosters indicate that on 3.2.07, there were only three waking night staff instead of 4. No rationale was recorded as to why this happened or what efforts were made by the person in charge to deploy additional staff. The Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 22 rosters also indicate that some staff are working in excess of 60 hours per week. The acting manager was advised that this places both staff and residents at potential risk. On inspection of several staff employment files, records indicated that some staff are employed whilst on a student visa. This means that staff can only work up to 20 hours per week during term time, however staff rosters indicate that some staff are working in excess of these hours. Inspectors were advised that no new staff have been recruited to the home since the last key inspection. The acting managers employment file was requested. Inspectors were advised that this file is held centrally at the registered providers HR department. The acting manager was advised that to comply with Schedule 4 of the Care Homes Regulations, the relevant details must be recorded on a proforma to allow the inspector to assess the robustness of the provider’s practice in the recruitment, selection and retention of staff. Inspectors were advised that one member of staff had transferred from another `sister home` to Brooks House Care Centre. On inspection of their employment file not all records as required by regulation had been sought i.e. no evidence of qualifications/experience, no proof of identification and no evidence of eligibility to work in the UK was available. As a result of issues highlighted pertaining to the conduct of some members of night staff, five staff files were inspected. It is unclear as to whether some issues have been addressed by the acting manager i.e. one record indicated “white staff won’t answer the buzzer when some residents call but ask her and some of the other staff to go” and one member of staff had recorded that a resident was asleep when actually the resident was in hospital following an accident earlier in the evening and staff absences and lateness are prevalent. Comments from relatives pertaining to the conduct of staff were varied i.e. one relative advised inspectors “some of the night staff are unwilling to assist my relative at night and help them to the toilet and are rude and verbally abusive”. Additionally the relative advised inspectors that their member of family felt frightened to call for assistance too often during the night. Relatives also advised that some call alarm cords are often tied up and out of reach. Records indicate that 8x staff have attained NVQ Level 2 and 6x staff are currently undertaking NVQ Level 2. Limited training has been undertaken and attained by staff. The training matrix presented to inspectors details that 33 of staff have undertaken Health and Safety, 2 have attained Food Hygiene, 40 of staff have undertaken infection control, 19 of staff have attained training relating to challenging behaviour, 8 have undertaken first aid and 19 have attained training relating to effective communication. There was no evidence to indicate that staff have received training which relates to the needs of older people i.e. sensory impairment, Parkinsons disease, diabetes etc. Brookes House Care Centre DS0000018120.V329571.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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is clear that the acting manager is trying to address the issues of poor care practices and poor staff attitudes and is aware of the areas where they need to make improvements. EVIDENCE: The acting manager is qualified and has the necessary experience to run the home. He appears committed and keen to deal with issues highlighted and was able to demonstrate a good understanding of the Care Homes Regulations and National Minimum Standards. From discussion with the acting manager it is evident that he has vast experience in working with older people, both within a hospital and residential care setting since 1975 to the present. The acting Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 24 manager is a qualified RMN (Registered Mental Nurse) and has also undertaken a variety of other courses i.e. ENB 941/Care of the Elderly, Teaching and Assessing, Stress Management etc. It is clearly evident that the acting manager is very aware of previous identified shortfalls, which need to be addressed and dealt with. On inspection of staff meeting and management meeting minutes, there was evidence to indicate that the acting manager is trying his best to eradicate and `stamp out` poor care practices and poor staff attitudes, which have been highlighted throughout the main text of the report. The Commission recognises that to improve staff attitudes and poor staff practice, this may take some considerable time. The acting manager advised inspectors that monthly surveys are conducted with residents. The results/collation of these surveys had not been completed. The acting manager is not aware of the registered providers quality assurance systems. The acting manager has instigated a programme of supervision for staff. On inspection of a random sample of staff files, there was sufficient evidence to indicate that the majority of staff have received formal supervision, however these remain not in line with National Minimum Standards recommendations i.e. minimum of 6x supervisions annually. Monetary systems and records for resident’s finances were seen to be appropriate. A random sample of records as required by regulation were inspected. All were seen to be satisfactory. Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 3 Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 and 5 Requirement Ensure that the homes Statement of Purpose and Service Users Guide is reviewed and updated to contain accurate information. Ensure that all pre admission assessments are detailed and that there is evidence depicting the home can meet the needs of prospective residents. Previous timescale of 21.7.06 not met. Ensure that comprehensive and detailed care plans are devised for all residents detailing all of their care needs. Previous timescale of 1.11.05, 1.6.06 and 1.1.07 not met. Ensure that risks are identified and as far as possible eliminated. Previous timescale of 1.4.06, 1.8.06 and 1.1.07 not met. Ensure that individual resident’s care plans are regularly kept under review. DS0000018120.V329571.R01.S.doc Timescale for action 01/06/07 2. OP3 14 14/04/07 3. OP7 15(1) 14/04/07 4. OP7 13(4) 14/04/07 5. OP7 15(2)(b) 14/04/07 Brookes House Care Centre Version 5.2 Page 27 6. OP7 17(1)(a), Sch 3(n) 7. OP9 13(2) 8. OP9 18(1)(c) and (i) Previous timescale of 1.4.06, 1.8.06 and 1.1.07 not met. Ensure that those residents who 14/04/07 have pressure sores have a care plan depicting the incidence of pressure sores and of treatment/professionals involved. Ensure that suitable 14/04/07 arrangements are made for the recording, handling, safekeeping and safe administration of medicines. This refers specifically to the records of medication and actual medication available tallying. Ensure that all staff who 14/04/07 administer medication to residents are appropriately trained. Previous timescale of 1.9.06 not met. Ensure that staff maintain good relationships with residents. This refers specifically to a lack of verbal interaction between staff and residents. Previous timescale of 1.4.06, 21.7.06 and 14.12.06 not met. Ensure that all residents receive an appropriate programme of activities, which meet individual needs. Ensure that there is clear evidence to depict activities undertaken. Previous timescale of 01.10.05, 1.5.06, 1.9.06 and 1.1.07 not met. Ensure that residents are empowered to exercise real choice and control wherever possible about their lives. Previous timescale of 21.7.06 9. OP10 12(5)(b) 14/04/07 10. OP12 16(2)(m) (n) 14/04/07 11. OP14 12(2) 14/04/07 Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 28 12. OP15 12(1)(a) not met. Ensure that residents are appropriately supervised and supported at all times. This refers specifically to mealtimes. Previous timescale of 14.12.06 not met. All staff within the home must receive training relating to dealing with residents inappropriate and aggressive behaviours and resident welfare. Previous timescale of 01.01.06, 01.07.06 and 1.10.06 not met. Ensure that there are adequate numbers of staff on duty at all times to meet resident’s needs. Previous timescale of 01.10.05, 14.4.06, 21.7.06 and 14.12.06 not met. Ensure that all staff are competent to do their job. This refers specifically to some staff working in excess of 60 hours per week. Ensure that robust recruitment procedures are adhered to in line with regulatory requirements. This refers specifically to the acting managers file being available for inspection and all records as required by regulation being available. Previous timescale of 01.09.05, 01.4.06, 1.8.06, 14.12.06 not met. Ensure that all staff working at the care home receive appropriate training to the work they perform. Previous timescale of 1.6.06 and 1.11.06 not met. 14/04/07 13. OP18 13(6) 01/08/07 14. OP27 18(1)(a) 21/04/07 15. OP27 18(1)(a) 21/04/07 16. OP29 17(2),19, Sch2&4 21/04/07 17. OP30 18(1)(c) and(i) 01/08/07 Brookes House Care Centre DS0000018120.V329571.R01.S.doc Version 5.2 Page 29 18. OP36 18(2) Ensure that all staff are appropriately supervised and records are readily available. Previous timescale of 1.9.06 and 14.12.06 not met. 01/05/07 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. 4. 5. Refer to Standard OP7 OP7 OP28 OP5 OP30 Good Practice Recommendations Residents daily care records should be detailed and include an account of the resident’s day, outcomes and staff interventions. These should be written after every shift. Ensure that care plans are devised in consultation with the resident and/or their representative. A minimum of 50 of care staff should be trained to NVQ Level 2. Ensure that prospective residents and/or their representatives are invited to visit the home prior to admission and that this is recorded. The homes induction procedures should be reviewed to take into account those newly appointed staff who have no previous care experience. In addition the induction period should be extended. The homes quality assurance outcomes should be made readily available within the home. 6. OP33 Brookes House Care Centre DS0000018120.V329571.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. 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