Inspection on 08/06/06 for Brookes House Care Centre

This inspection was carried out on 8th June 2006.

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

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

Other inspections for this house

Brookes House Care Centre 14/10/08

Brookes House Care Centre 14/11/07

Brookes House Care Centre 07/06/07

Brookes House Care Centre 07/02/07

Brookes House Care Centre 23/01/06

Brookes House Care Centre 25/07/05

Brookes House Care Centre 02/03/05

Brookes House Care Centre 13/05/04

Brookes House Care Centre 05/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brookes House Care Centre 79-81 Western Road Brentwood Essex CM14 4ST Lead Inspector Michelle Love Key Unannounced Inspection 8th June 2006 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.V299471.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.V299471.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 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.V299471.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. 23rd January 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 £403.94 to £416.17 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.V299471.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 Bernadette Little, inspectors, over a period of approximately 11.5 hours. At this site visit both inspectors conducted the inspection with the acting manager. During the visit several residents, members of staff and visiting professionals i.e. District Nurses/Community Psychiatric Nurse were also spoken with. As part of the process a number of records relating to individual residents and care staff were examined i.e. care plans, staff employment files, nutritional records, accident records, training matrix etc. Additionally the homes medication systems were observed and records inspected. Following the site visit a number of letters were forwarded to resident’s next of kin, requesting their views as to their member of families experience in the care home. Comments received by the Commission for Social Care Inspection were positive and relatives were complimentary regarding care provided by staff and received by their member of family. One comment card was received from one of the home’s General Practitioners. This highlighted good practices carried out by the home/staff and no issues were featured. What the service does well: What has improved since the last inspection? The homes Statement of Purpose and Service Users Guide has been updated and reviewed to reflect the new registered provider and their policies and procedures. The manager’s office space has been altered and was observed to be much friendlier and welcoming for visitors. The office now has a designated area for relatives, residents and professionals to sit and discuss matters with the Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 6 manager in private. The administrator has her own office and designated record/filing system close to hand. What they could do better: It remains disappointing and of concern that at the last inspection there were 15 Statutory Requirements and 5 Recommendations highlighted and there appears to have been little improvement noted at this site visit, as 21 Statutory Requirements and 9 Recommendations have been identified, some of which are repeat requirements. The Commission recognises that since the last inspection to the home the acting manager has provided care planning training to staff, however it was very evident that staff’s understanding of the care planning processes still remains very poor. It is concerning that this was not picked up by the acting manager and that a random audit of the documentation was not undertaken on a regular basis. It was evident from inspection of the Operations Manager’s monthly audit for May 2006 that issues relating to care plan documentation had been highlighted as requiring `action`. It is essential that the homes care planning processes improve in line with regulatory requirements as detailed within the National Minimum Standards and Care Homes Regulations for Older People as continued non-compliance will result in an enforcement notice being issued. Additional improvement is still required pertaining to staff recruitment, ensuring staffing rosters/staffing levels are appropriate and that staff training is up to date and includes both mandatory and specialist training. Unfortunately on the day of the site visit it was evident that some records had not been updated and that filing systems were not being maintained. It is surprising and concerning that records relating to staff recruitment continue to not be in line with regulatory requirements as in May 06 and following the Operation Manager’s monthly audit it was highlighted as requiring `action` and only attained a score of 50 (poor). Again continued non- compliance will result in an enforcement notice being issued. The deployment of care staff within the home continues to need reviewing so as to meet the needs of residents. The registered provider must ensure that there are sufficient numbers of staff on duty at all times and that the home’s lounges are adequately staffed so as to ensure residents health and well being. It remains disappointing to witness poor interaction between some members of staff and residents and a lack of care and understanding of individual residents needs. This was especially prevalent during the lunchtime meal within two dining areas. This is unacceptable and must be addressed as a matter of priority and urgency. The Commission for Social Care Inspection must be assured that residents who live at Brooks House Care Centre are supported by care staff `who care`, that they are valued and have their basic core values met. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 7 A programme of meaningful and stimulating activities must be provided to all residents residing at the care home, irrespective of their needs. If staff require training in relation to activities this must be provided by the registered provider. This requirement has been highlighted many times and to date there has been no further progress. As stated at the last inspection it remains no longer acceptable to ignore this requirement. On many occasions residents have disclosed that they are bored and there is little to do at the care home except to sit and watch television. Activities must cater for both those residents whose needs are complex i.e. lack motivation/have physical disabilities and constraints, and for those who are mentally alert and independent. Care staff must recognise the value of spending `quality time` with a resident i.e. reading a newspaper with a resident rather than making a bed at a specific time. The home will not be penalised by the Commission if a resident’s bed is not made until later in the day. The acting manager must take ownership that some of the issues highlighted throughout the main text of the report have not been addressed/improved upon as a result of her poor management/poor monitoring of the home. It was felt by inspectors that the acting manager’s attitude was very defensive and that blame was apportioned to senior staff rather than being reflective of her own practice. Ultimately the line of responsibility on a day-to-day basis lies with the acting manager. 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. Brookes House Care Centre DS0000018120.V299471.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.V299471.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to admission. The homes Statement of Purpose and Service Users Guide, has been revised since the last inspection. EVIDENCE: Both the Statement of Purpose and Service Users Guide has been reviewed and updated since the last inspection. The acting manager advised that copies of both documents have been forwarded to the registered providers head office for approval. A copy of each document to be forwarded to the Commission for Social Care Inspection and to be made readily available within the home for existing and prospective residents and other agencies where applicable. Of ten individual care plans inspected, it was positive to note that all residents had been pre assessed prior to admission, as to their suitability to live at Brooks House Care Centre and to whether or not their needs could be met. The registered provider has implemented a new pre admission format, which also includes formal assessments relating to dependency, moving and handling, Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 10 pressure area risk assessments, nutrition and continence. In addition to the pre admission assessment documentation there was information from residents placing authority where pertinent. The acting manager or person undertaking the pre admission assessments should ensure that each assessment is signed and dated. Additionally the assessments should be audited to ensure that all elements as per the document are completed i.e. one persons pre admission assessment did not have the dementia/assessors summary completed and there was no evidence to indicate why this had not been completed i.e. not applicable. The acting manager/senior care staff must ensure that there is evidence to indicate whether or not the prospective resident and/or their representative were offered a trial visit to the care home and whether or not they received a copy of the homes Statement of Purpose etc. Feedback from relatives confirmed in two cases that they were not given any information on Brooks House Care Centre and were not asked to participate in the pre admission process. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 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 care plan detailing their individual care needs and how these are to be met by care staff. Information recorded within some care plans is incomplete and lacks detail. In general terms the homes systems for medication were observed to be satisfactory, however some issues were highlighted. EVIDENCE: Since the last inspection a new care plan format has been introduced to the care home. The acting manager advised inspectors that much effort has been undertaken to transfer information from the old care plans to the new care plan format. The Commission for Social Care Inspection recognises that the new care plan format is detailed and comprehensive and is more time consuming to complete than previous formats. At this site visit ten individual plans of care were requested. It is of concern and disappointing to note that no care plans were devised for five residents. There was no information depicting their individual care needs relating to physical, emotional, social and healthcare requirements. Additionally there was Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 12 no information detailing how staff were to provide/deliver care and no risk assessments had been devised. In some cases no formal assessments relating to dependency, moving and handling, pressure sores etc had been completed either. Other care plans inspected evidenced that these had been devised, however in most cases these lacked clarity and detail i.e. one care plan only made reference to falls and nothing else. Yet the pre admission assessment identified that the resident had Parkinson’s disease, recurring urinary tract infections, required support with their personal hygiene and had poor short term memory. No risk assessments were completed for this resident. Another care plan only documented that the resident needed their weight monitored. It was unclear as to the specific reason why, i.e. poor appetite/refuses food on occasions. No record of weight was recorded for this person within their care file. Daily care records and the pre admission assessment evidenced that the resident had poor mobility, needed assistance with personal care, was at risks of falls, suffered with confusion and at risk of pressure sores. No general risk assessments had been devised. It was very concerning to note that one resident had a formal diagnosis of paranoid schizophrenia. The care plan element related to mental health stated: “…is sometimes anxious and becomes very unsettled”. There was no information related to the resident’s formal diagnosis, professionals involved i.e. Consultant Psychiatrist/Community Psychiatrist Nurse, the specific nature of the resident’s unsettled behaviours, possible triggers and no guidelines for staff as to how to deal with the resident should they have a relapse. No risk assessments were devised. It was unclear as to this person’s primary care needs, and no discussion undertaken between the home and the Commission as to whether or not an application to vary the homes registration should have been undertaken. The care home is not registered to admit people who have a mental disorder. Records relating to personal hygiene were inconsistently completed and many had gaps. In some cases it appeared that individual residents had not had a bath/shower/strip wash for many days/weeks. Records did not tally with individual care plan requirements. The acting manager advised both inspectors that `in house` training had been provided to care staff/senior carers in relation to care planning. It is clear that staff’s understanding of the care planning processes is poor and somewhat limited, however this cannot continue as this lack of knowledge has a severe impact on resident’s needs and how these are to be met. Following the site visit the Operations Director undertook a care file audit, this confirmed the inspector’s findings at the time of the visit to the care home. The registered provider has implemented care plan training for all staff working at Brooks House Care Centre. This is seen to be positive. Daily care records for residents were inconsistently documented i.e. some records were detailed and informative whilst others were basic. In some cases daily care records were not written daily or after every shift. The acting Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 13 manager was advised that this is not good practice and should be addressed as soon as possible. Some but not all those care plans/risk assessments inspected had been reviewed and updated. It was unclear as to whether or not the care plans had been devised with the individual resident and/or their representative. Additionally in the majority of documentation submitted it was unclear as to whether or not information relating to funeral arrangements/terminal care had been sought. As a result of the Commissions findings and concerns an Immediate Requirement Notice was issued pertaining to care planning and risk assessments. The recording of accident/incident documentation for residents was observed to be well organised and in general satisfactory. Some entries need to record specific outcomes following treatment/injuries sustained. The homes medication storage systems were seen to be appropriate, however on the day of the site visit the treatment room where medication is stored was observed to be very warm and the temperature in excess of 80° degrees. The acting manager was advised that better ventilation is required to ensure that medication does not become ruined. The list of staff names/initials of those people able to administer medication to residents was not up to date and needs to be amended. Of all Medication Administration Records (MAR) inspected, only two omissions were noted whereby records had not been signed by senior staff to indicate that medication had been administered to and received by residents. The MAR records for some residents indicated `F` (other/define), however no further information was recorded. A self-medication assessment for one resident was observed to have been not updated since 3.3.04. There was no evidence to indicate that the resident was still deemed capable and competent to administer their own medication. PRN (as and when required medication) protocols were seen to be appropriate. Currently two residents require controlled drug medication. An audit of medication records/actual medication was undertaken and seen to be satisfactory. The home was observed to have policies and procedures relating to medication, however no copy of the Royal Pharmaceutical Guidelines for the Safe Administration of Medication in care homes was readily available. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 14 During the site visit the inspector noted that a resident’s medication was left on a table for the resident to take, however the senior member of staff administering medication did not wait to observe them taking the medication. This is an unsafe practice and must be addressed with immediate effect. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recording of activities is poor and limited evidence is available to indicate that a programme of activities is provided for both complex and independent/mentally alert residents. Mealtimes are hurried and assistance by some staff for individual residents is very poor and inappropriate. EVIDENCE: The home operates a two weekly activity programme (exercises, board games, manicures and nail painting, quizzes etc). 37 hours per week are provided for activities and a new activities person is due to start employment at the home for 25 hours per week. Recording is poor and there is limited evidence to indicate that all residents residing at the care home receive/participate within a programme of activities, which meet individual needs. One resident advised that they have exhausted the homes library and would like more access to books for the future. On the day of the site visit several residents were noted to participate in a quiz out on the patio. As highlighted at previous inspections it appears that the same people tend to participate within the homes activity programme. The care home must ensure that it meets the needs of those residents who have complex needs and those who are mentally alert and independent. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 16 Both inspectors observed the lunchtime meal within the homes three dining areas. Residents were noted to have a choice of two meals and alternatives. The menu’s displayed did not depict the actual menu provided to residents i.e. on the day residents were noted to be offered either faggots/mash potato/cauliflower/green beans or beef curry and rice. The menu stated that gammon/parsley sauce or meatballs in gravy were the option of the day. It was concerning to observe within one dining area that some residents were not supported appropriately by care/senior staff i.e. one resident had their food placed in front of them however they were not prompted or encouraged by staff. The meal was left untouched for at least 10-15 minutes before the senior member of care staff tried to intervene/provide support. Doubly concerning was that the senior carer interrupted the administration of medication to residents and the medication trolley was left exposed and unattended, with medication available to any person passing by the trolley. This occurrence happened on more than one occasion throughout the lunchtime period. Another resident was given their meal but left this untouched. Staff were observed to take the plate away without talking to the resident and without offering an alternative meal. It was equally distressing to observe that care staff were accepting residents decisions not to eat and to not explore the reasoning behind their decision i.e. had changed their mind and unable to express an alternative choice, could not eat their meal without staff assistance/encouragement. Another resident did not receive their meal and it was only when the inspector pointed this out that staff retrieved a meal from the main kitchen. Residents within one dining area are not supported to maintain their independence i.e. jugs of juice were on the table on the day of the site visit, however it was stated to inspectors that this is unusual and does not happen generally. Comments relating to food were very inconsistent i.e. “menu is repetitive”, “portions are sometimes overwhelming”, “something is always missing, yesterday there was no marmalade and only bread/margarine”, “no Weetabix, often only cornflakes”. Residents comment books located within each dining area are not kept up to date. All tables were observed to have tablecloths and condiments readily available. However residents stated that salt/pepper pots are often empty. Support provided to residents within the conservatory dining area was much more positive. Staff appeared more interested and interaction between staff and individual residents was observed to be good. It was positive to note that residents were asked if the portions were satisfactory i.e. adequate/too big and salad was offered as an alternative to the menu. Food was presented attractively and the meal in this area was unhurried. Unfortunately the lunchtime meal was hurried in the two other dining areas and interaction between staff and residents very poor. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 17 It was evident that the menu on the day should have been altered to reflect the weather as it was very hot. As a result of the Commissions findings and concerns relating to resident’s meals/supervision of individual residents, an Immediate Requirement Notice was issued. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 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 policy and procedure relating to complaints and protection of vulnerable adults. Records indicate that not all staff have protection of vulnerable adults training. EVIDENCE: The homes complaints procedure was observed to be displayed however it was noted to be in very small print. Since the last inspection the home has received one complaint. The Commission for Social Care Inspection has been made aware of the situation by the complainant. Records relating to the nature of the complaint, investigation and action taken were readily available. Although the home has a protection of vulnerable adults policy and procedure, this does not include `in-house` procedures or identify that there will be no repercussions for staff. The inspector advised the acting manager that staff need to have a simple and staff friendly version of the procedure available. Staff spoken with demonstrated a general understanding and awareness of protection of vulnerable adults procedures. The home were noted to have local adult protection guidelines for Essex, and Barking and Dagenham. On inspection of the homes training matrix it was evident that not all staff working within the care home have attained resident welfare training. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 19 The acting manager advised the inspector that postal voting has been arranged for individual residents, however there was no evidence in individual care plans to indicate this is happening in practice. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 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: It was positive to note that no health and safety issues were highlighted at this visit. The home continues to be well maintained and decorated for residents. All bedrooms remain personalised and individualised. Issues were highlighted at the inspection pertaining to one of the home’s assistant bath’s/hoist not in operational use. This was confirmed by both the acting manager and operations manager, however there was no documented evidence within the home to indicate what steps had been undertaken to rectify the situation. The registered provider must ensure that all equipment utilised at the care home is fully maintained and working and that where equipment/adaptations fail, these are serviced/parts got as speedily as possible. The registered provider must Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 21 confirm to the Commission for Social Care Inspection within 7 days of receiving this report that all works have been completed. Prior to the site visit the Commission received written notification from Essex County Fire and Rescue Service highlighting their findings following a routine inspection of the care home. This underlined issues relating to the effectiveness of the homes fire doors and that the matter required urgent attention. The acting manager advised that enquiries had been made and quotes received to get outstanding works completed, however the final decision as to when works would be undertaken/completed had not yet been finalised. The Commission must be notified within 7 days following receipt of this report that works have either been completed or have a start/completion date. The Commission will liaise closely with the fire authority. On the day of the site visit the homes laundry was observed to be well maintained and managed. One resident advised the inspector that their personal laundry is often missing and that the homes drier is often out of order. Additionally residents stated that often there is a lack of flannels and towels and in some instances have had to request these in the evening as they have not automatically been placed in their room. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 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. Staff deployment within the home is at times inadequate to meet the needs of residents. Staff recruitment procedures are not robust and do not protect residents. Some gaps relating to both mandatory and specialist training were observed. EVIDENCE: Not all staff rosters requested were given to the inspector on the day of the site visit. The acting manager advised that minimum staffing levels should be 2x senior staff and 6x care staff (a.m.) and 2x senior staff and 5x care staff (p.m.) each day. The minimum staffing levels at night are 4x waking night staff. The rosters indicate on occasions that minimum staffing levels are not being met i.e. 24.5.06, 27.5.06 and 3.6.06 indicates only 5x staff on the a.m. shift. Additionally the staff rosters show that some regular shifts by individual members of staff are 6.25 hours instead of 7 hours, therefore leaving the minimum staffing levels short. The day shifts are recorded as being 7.15 a.m. to 2.15 p.m. and 2.15 p.m. to 9.15 p.m. (both 7 hour shifts). No agency staff have been utilised at the home for some time. The manager’s hours are supernumerary, however the manager’s specific hours worked are not detailed on the statutory roster. On inspection of four staff recruitment files for the newest members of staff to be employed at Brooks House Care Centre, it was disappointing to observe Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 23 that following some improvements highlighted at the last inspection, recruitment procedures have lapsed and the acting manager is not adopting robust recruitment procedures which protect residents. Gaps were noted pertaining to no photographs, employment histories not fully explored, no job description and for one person only one written reference was evident. No original Criminal Record Bureau checks/POVA 1st were available, only a disclosure tracking form was evident. The Commission for Social Care Inspection was advised by the registered providers Operations Director that this has been formally agreed by CSCI. Records of induction were completed for newly appointed staff, however in all cases they were inducted within one day. This is seen as bad practice and not in line with TOPSS/Skills for Care. The registered provider must also devise a comprehensive induction format for those newly appointed members of staff who do not have a previous background in care. An updated training matrix was given to the inspector on the day of the site visit. Records show that out of 31 members of care staff, 9 have achieved NVQ Level 2, 1 has NVQ Level 3, 4 staff had registered to undertake NVQ Level 3 and 6 staff are planned to register for NVQ Level 2 in June 2006. Currently 32.6 of staff have NVQ 2 or above. It was frustrating to see that on inspection of a random sample of staff training records, some files did not have confirmation of training undertaken by staff. The acting manager advised inspectors that there were a large number of records, which had not been filed depicting training attained by individual staff. The training matrix indicates that the majority of staff have attained mandatory training (Moving and Handling, Health and Safety, Food Hygiene, Resident Welfare and Fire Awareness), however some refresher training is required. Records indicate that no staff have Basic First Aid or Infection Control and in relation to specialist training which meets those conditions associated with older people, there is little evidence to indicate that this has happened. The pre inspection questionnaire submitted to the Commission details that some staff had received Dementia Awareness, Death, Dying and Bereavement, Effective Communication, Diabetes and Continence. It was unclear as to when senior members of staff had last received medication training and this was not detailed on the staff matrix submitted. No monthly audit has been completed by the acting manager to ensure that staff training records are recorded accurately and kept up to date. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is evidence to indicate that the acting manager is struggling to run the home in line with the Care Homes Regulations for Older People and with Southern Cross Healthcares policies and procedures. Not all records as required by regulation were available. Resident’s financial interests are safeguarded. It is unclear as to whether or not staff are receiving formal supervision in line with recommendations and regulatory requirements. EVIDENCE: It is recognised as positive that the acting manager has attained the Registered Manager’s Award/NVQ Level 4 in Care. The inspector was advised that she has as yet to complete the management element of the Registered Manager’s Award. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 25 Despite a recent reminder the acting manager has still not submitted her application to be formally registered with the Commission for Social Care Inspection. The registered provider must ensure that the CSCI receive this application within the next 14 days upon receipt of this report, as the home cannot continue to be without a registered manager. As detailed within the main text of the report it is concerning and somewhat surprising to see that the acting manager has made little progress to make improvements and address previous identified shortfalls. It is evident that the scoring of outcomes following this site visit will reflect a significant increase in those standards not met and the number of statutory requirements. It is clear that the acting manager is popular and well respected by staff working at the care home, however she has a lot to accomplish if she wants to raise the homes profile. The Commission for Social Care Inspection believes that the acting manager will require much support and additional training from the registered provider to enable her to succeed for the future. Financial records for a random sample of residents were seen to be appropriate. Written documentation, receipts and monetary totals were correct on the day of the site visit. A quality assurance system has been implemented at the care home. The acting manager advised the inspector that surveys once completed are forwarded to the registered providers head office, information collated and then the outcomes forwarded back to the home. Surveys are conducted 6th monthly and the last one completed was in December 2005. A few staff supervision records were inspected nonetheless it was unclear as to whether or not these were being conducted in line with regulatory requirements/recommendations as the homes filing systems were poorly maintained. A random sample of records as required by regulation were inspected in relation to the following: The record of hot and cold water temperatures were only available for April and May 06. The record of fire drills indicated that the last two drills were undertaken in January and May 06. Fire equipment within the home was last serviced February 06. No records were available relating to emergency lighting and fire alarms. Records should be maintained monthly. The homes gas safety inspection certificate was observed to be in date and satisfactory. No electrical certificate was available and the last test conducted was February 2000. A copy of the homes certificate must be forwarded to the Commission within 7 days upon receipt of this report. The homes passenger lift Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 26 certificate was dated 11.5.06 and deemed appropriate. The homes hoists were last serviced in January 06. Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X 1 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 2 2 X 3 X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 X 3 2 2 2 Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 Requirement Ensure that all pre admission assessments are detailed and that there is evidence depicting the home can meet the needs of prospective residents. Ensure that comprehensive and detailed care plans are devised for all residents. Previous timescale of 01.11.05 and 01/06/06 not met. Ensure that risks are identified and as far as possible eliminated. Previous timescale of 01.11.05 and 01/05/06 not met. Ensure that residents care plans are regularly kept under review. Timescale for action 21/07/06 2. OP7 15(1) 21/07/06 3. OP7 13(4) 21/07/06 4. OP7 15(2)(b) 01/08/06 5. OP7 6. OP9 Previous timescale of 01.04.06 not met. 17(1a)Sch Ensure that care plans detail 3,3(m) information relating to medication, healthcare and nutrition. 13(2) Ensure that suitable arrangements are made for the recording, handling, safekeeping DS0000018120.V299471.R01.S.doc 21/07/06 21/07/06 Brookes House Care Centre Version 5.2 Page 29 7. OP9 18(1)(c) and(i) 8. OP10 12(5)(b) and safe administration of medication. Ensure that all staff who administer medication to residents are appropriately trained and receive regular updated training. 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 not met. Ensure that information is recorded for each resident relating to funeral arrangements and terminal care needs. Ensure that all residents receive an appropriate programme of activities. Previous timescale of 01.10.05 and 1.5.06 not met. Ensure that residents are empowered to exercise real choice and control wherever possible about their lives. Ensure that residents are appropriately supervised and supported at all times. This refers specifically to mealtimes. 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 and 01/07/06 not met. 01/09/06 21/07/06 9. OP11 12(3) 21/07/06 10. OP12 16(2)(m) (n) 01/09/06 11. OP14 12(2) 21/07/06 12. OP15 12(1)(a) 21/07/06 13. OP18 13(6) 01/10/06 14. OP19 23(4)(a)& (c) 15. OP27 18(1)(a) Ensure that adequate precautions and/or arrangements against the risk of fire are undertaken. This refers to the recent fire report. Ensure that there are adequate DS0000018120.V299471.R01.S.doc 01/08/06 21/07/06 Page 30 Brookes House Care Centre Version 5.2 numbers of staff on duty at all times. Previous timescale of 01.10.05 and 14.4.06 not met. 16. OP27 18(1)(a) Ensure that the numbers of hours provided for activities is reviewed and increased to meet resident’s needs. Previous timescale of 01.5.06 not met Ensure that robust recruitment procedures are adhered to in line with regulatory requirements. Previous timescale of 01.09.05 and 01.4.06 not met. Ensure that all staff working at the care home receive appropriate training to the work they perform. Previous timescale of 01.6.06 not met. The registered person must ensure that the manager has the skills, experience and competence to run the care home on a day-to-day basis. Ensure that all staff are appropriately supervised and records are readily available. Ensure that all equipment provided at the care home is maintained in good working order. This refers specifically to the homes electrical certificate. 01/09/06 17. OP29 17(2),19, Sch2&4 01/08/06 18. OP30 18(1)(c) &(i) 01/11/06 19. OP31 9 21/07/06 20. 21. OP36 OP38 18(2) 23(2)(c) 01/09/06 01/08/06 Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 31 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 OP5 OP7 OP16 OP17 OP18 Good Practice Recommendations Ensure that prospective residents and/or their representatives are invited to visit the home prior to admission and that this is recorded. 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. The complaints procedure should be written in larger print. Systems pertaining to voting at parliamentary elections should be recorded within individual care plan documentation. The homes POVA procedures should be simplified/bullet pointed for staff and there should be guidance pertaining to there being no repercussions for staff should they whistleblow. A minimum of 50 of care staff should be trained to NVQ Level 2. 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. The homes emergency lighting/alarms should be tested monthly. 6. 7. OP28 OP30 8. 9. OP33 OP37 Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brookes House Care Centre DS0000018120.V299471.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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