Inspection on 01/08/07 for Brookfield

This inspection was carried out on 1st August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brookfield 03/11/05

Brookfield 16/10/05

Brookfield 16/05/05

Brookfield 23/11/04

Brookfield 15/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Brookfield 1 Clayhall Road Alverstoke Gosport Hampshire PO12 2BY Lead Inspector Clare Hall Unannounced Inspection 1st August 2007 08:30 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 Brookfield DS0000011753.V342786.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. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookfield Address 1 Clayhall Road Alverstoke Gosport Hampshire PO12 2BY 023 9258 1103 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) Mrs J A Filsell Mrs J A Filsell Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (29), Old age, not falling within any other category (29) Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd November 2005 Brief Description of the Service: Brookfield is a twenty-nine bedded home, set in attractive grounds in a residential area of Alverstoke with local amenities close by. The home has been extended over the years to provide accommodation for twenty-nine older people, including those with dementia or mental health problem. Accommodation is arranged over three floors, with a passenger lift providing access between floors. Communal areas include a large comfortable lounge, pleasant dining room and two smaller conservatory lounges. Two communal assisted bathrooms are available, and many rooms benefit from an en-suite WC. The home is well screened from the road, and the grounds provide additional seating areas, including a sensory garden At the time of the inspection charges were from £395 -£430 per week. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit to Brookfield Residential Home took place on 1st August 2007 and was undertaken by one inspector over one day. Throughout the visit the Registered manager and provider / owner were available. The ancillary and care staff was also very supportive to the inspector. The judgements made in this report were made from information gathered pre-inspection from previous reports, the service history, Regulation 37 notices received and reports sent to the CSCI by the provider. Also considered were correspondence with the home, recorded contacts, reports and feedback relayed to the commission by staff. The management team completed the pre inspection evidence and this was also used to inform the inspection. The managers assisted the audit process by handing out relevant comment cards during the visit. A long discussion was held with the provider and manager at the beginning and end of the day clarifying the new process for regulation, the completion by the home of an annual quality assurance assessment and the findings of the visit. The inspector received feedback from service users, health and social care professionals and staff. Most of the environment was audited and a tour of the premises undertaken. The inspector had the opportunity to sit in the main lounge and dining areas and observe the routines and care practices in the home. As a result of this audit one requirement has been raised. What the service does well: Observing care delivery and talking with service users and care staff it is very clear that the principles on which the home’s philosophy of care is based ensure that residents are treated with respect, that their dignity is preserved at all times, and that their right to privacy is always observed. This is a home that is clearly run in the best interests of the service users. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 6 Observing the staff throughout the day communicating with service users it was identified that there is a very high commitment by the staff to treat all service users as individuals with desires, hopes and expectations. Clients were dealt with sympathetically, respectfully and with dignity. The choices of individuals led the care provided and senior staff knew every relevant detail of a clients social back ground down to the smallest of personal preference regarding their daily lives. This was considered to be exemplary. Observation and discussion identified that the home is very welcoming and any prospective service user with an interest to see how the home is run are welcome to visit regularly, stay for lunch and meet and develop a rapport with staff before under taking a commitment to stay. Staff reported by surveys and in discussion that they are provided with good training and support. All had received a contract of employment and felt informed regarding their job specification. Numerous comments from staff identified the homes commitment to the social needs of individuals. Service users and Relatives feedback was, • • • “We are very happy at the care and respect mum receives from all the staff at Brookfield. It is a homely home with a lovely atmosphere.” “I couldn’t wish for a better home, the staff are friendly, the home is clean and really beautiful. My room is nice and cosy.” “I have only got to ask if I need something and the staff are always asking how I am.” One healthcare professional reported that the home was always clean and that there were always activities taking place. She said it was an excellent home with very helpful, knowledgeable and caring staff. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brookfield DS0000011753.V342786.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 Brookfield DS0000011753.V342786.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): 3, Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users feel informed and in a home, which meets all their needs and expectations. EVIDENCE: The inspector joined groups of residents in the lounge and in the dining room. During these meetings it was established that all residents had either been visited by the manager or been to the home prior to moving in. They explained how the manager gave them all the information about the home so they could make a choice about whether to move in. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 10 It was unanimous that the service users felt informed. When walking around the home there were good and informative brochures and notices available on notice boards and in the main reception area. All records and residents care records case tracked identified a very detailed assessment is undertaken prior to any resident moving in. Contracts were completed and held on file. It was very clear that the residents currently living at Brookfield were very happy and felt the home met their expectations. All reported feedback was positive. Service users felt their needs were met in what was probably an excellent home of which they were lucky to get into. They stated categorically that the staff and owner delivered a high standard of service and care. Discussions with senior staff identified that the priority was for each and every residents quality of life to come first and that the care and support was driven by each and every individuals needs. This was evidenced through out the day. Brookfield DS0000011753.V342786.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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care the residents receive is based on the individual’s needs, and is provided by staff that are well informed. Residents feel their needs are met by caring and skilled staff that respects them. The homes processes for the safe management of medicines need improvement. EVIDENCE: Care records seen were up to date and clearly recorded the needs of individuals. Records illustrated the instructions on how care needs are met and records of the observations made. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 12 Visits from health and social care professionals are recorded. There are assessments completed in relation to falls, mobility, mental health and social needs. It was discussed with the manager that it would be good practice to incorporate a nutritional risk assessment especially as there are vulnerable persons who are nutritionally at risk. Residents preferences and choices were recorded from everything relation to sleep, food and wishes for end of life. Records also note resident’s wishes to have a key and/or additional lockable space. The medication records, receipts and storage were audited. The majority of records were clear and completed but there had been some tippex used in places on the MARS sheets. This is not considered to be best practice for record keeping. It was discussed with the manager that a number of creams and solutions had not been kept as directed by the manufacturer .The manager agreed to audit the state of medicine storage and handling. It was also agreed that the manager would to include the skills for care council knowledge sets for medication in staff training. This will improve safer outcomes for service users. The manager agreed to research what the legal requirements were for the installation of a controlled drugs cupboard as the homes cabinet was not secure. Guidance would suggest that the controlled drug cupboard requires a specified gauge, specified locking mechanism and be fixed to a solid wall or a wall that has a steel plate mounted behind it and that it should be fixed with either Rawl or Rag bolts. It would also be in the interests for best practice for the manager to purchase a controlled drug book, which conforms to the need for a number printed book which is not loose leaf. Currently this is a loose- leaf folder. The manager was directed to the guidance. One healthcare professional reported that the home responded appropriately to needs of individuals and always appropriately referred nursing issues to the district nurses. It was further reported that staff always discuss their concerns with community nurses and that their management of the skin and pressure relief is first rate. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users do feel the home meets their needs and expectations and the management philosophy of care promotes the core values. EVIDENCE: Service users informed the inspector that they were able to make decisions about what they do each day. They said the staff treat them well and act on what they say All residents spoken to reported complete satisfaction with the service provided. During the visit care staff showed insight and respect for the preferences of individuals regarding their social activities. Residents were observed being supported according to the individual needs. Individuals were supported when Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 14 engaging in the activities of daily life but were also able to undertake tasks for the promotion of independence. The inspector was able to meet with the home activities co-ordinators and observe a mealtime and join the service users at the table for lunch. Staff were observed seeking the preferences of services users and promoting choices and abilities sensitively. One care workers survey noted when asked what does the home do well? , Wrote, “Respecting residents choice.” and “the provision of activities.” Observation of the events of the day clearly indicated that service users are empowered to lead their lives as they choose .One service users was seen getting up close to lunchtime and they explained how they never like to get up early. The meal provided was of a very high standard. Service users complemented the food provided. The food served was of a high quality and the inspector noted that the service users were served at the table from dishes depending on their preferences. Throughout the day it was evident that the availability, quality and style of presentation of food, along with the way in which staff assist residents is excellent. Residents acknowledged they had choices and that their preferences were always considered. It was very apparent that the routines of the day and the activities made available to service users are flexible and varied to suit service users’ expectations, preferences and capacities. The inspector observed the functioning of the home directly and observed that service users had the opportunity to exercise their choice in relation to leisure and social activities, meals and mealtimes, the routines of daily living, and personal and social relationships. It was clear during the visit that service users are able to have visitors at any reasonable time and links with the local community have been developed and maintained in accordance with service users’ preferences. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel safe and staff have been trained in the safe guarding of vulnerable adults. The manager is taking the necessary steps to address issues or concerns raised. EVIDENCE: Surveys and discussions identify that service users are aware of the complaints procedure and what to do if they wish to make a complaint. One complaint has been received by the home since the last inspection and a record had been kept. Care staff explained to the inspector what her adult protection knowledge was and explained the types of abuse. She also stated she would report anything which looked abusive to the management and or the social services. There has been an immediate requirement made regarding the employment of staff and this will be discussed in staffing section of the report. Service users reported they felt safe, secure and would feel comfortable talking to staff should they have any concerns. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 16 One service user reported, ”Mrs. Filsell is always available to listen to any problem”. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 17 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): 19,23,24,25,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are supported in a nice environment, which is suited to their preferences and expectations. Service users live in a clean and well maintained premise. Despite this some staff are not confident with the principles behind the prevention of cross infection. EVIDENCE: Numerous comments were received in respect of the home stating it is always fresh and clean. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 18 A tour of part of the premises was undertaken. The internal and external areas of the home are well maintained and nicely furnished. The conditions demonstrate good financial investment and ongoing improvement. Service users were very happy with their accommodation and reported they could bring in and have their own personal items and furnishings. The standard of cleanliness around the home was exceptional and the home has been tastefully decorated in a very homely way. Despite this there was some confusion noted when talking to staff about good practices in relation to infection control. The manager confirmed she was working through new guidance from the Department of health regarding infection control in care homes. It was agreed with the manager that she would also look to the knowledge sets which the skills for care council now provide so to improve the staffs understanding for infection control and other best practice guidance. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 19 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are provided with good training. The recently recruited staff did not have all the necessary checks undertaken prior to employment. EVIDENCE: Of four staff files audited two lacked adequate references and the employment histories have not been completed in full. Through out the inspection the acting manager demonstrated a commitment to providing the highest care to all residents. Her philosophy of care is based on the best outcomes for the residents and it was very obviously she was very disappointed in herself that she had not met the minimum standard for recruitment. Staff reported they undertake good training opportunities, records indicate they undertake a good range of training and over 50 of staff hold a care qualification. Service users stated that they felt staff were skilled and well trained. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 20 All service users spoke highly of the care staff. One wrote, “I am very happy here and I do love the atmosphere. The staff do their very best, are friendly and caring.” When asked residents referred to staff as, lovely, friendly, helpful and willing. They also said that they felt the numbers of staff employed was suited to their needs. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,35,36,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The ethos of care in this home is based on ensuring good quality of life outcomes for service users. The management team are committed to a high standard of care and place valuing people as a priority. This shows through out the policies and practices within the home. EVIDENCE: Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 22 One care staff worker reported that the good points about the home were the friendliness of it and that it was so homely. She also stated that she felt she could go to the management with any problems; that they were supportive and provided good training. Two service users financial records were checked. Records in relation to monies managed were accurate and correct. The manager does undertake a number of quality assurance measures and questionnaires are given out to residents and their families. It was agreed that this could be developed by formally recording how and when this is undertaken, what the results of any audits identified have been and what actions were taken to address any issues. The staff did state they would like a more frequent opportunity to raise any issues they have more formally. It was established that formal staff meetings meeting may only take place once or twice a year. Staff also reported that they have annual appraisals undertaken but do not have regular formally recorded supervision. Staff did say that some processes for communication within the home could be improved by having more frequent formal consultation and meetings with management. During discussions with staff it was noted that there are concerns they have regarding practices of their peers/ colleagues, who would be best, dealt with through individual supervision. Staff reported that they felt the management of the home are approachable and supportive. Pre inspection information indicates all necessary checks are made on the homes equipments. It was very apparent that the manager and provider spend a lot of time in the home. They are at the forefront of the delivery of care and have ensured the standards remain high. During discussions with the manager and provider it was very apparent that they were aware of the recent changes in relation to fire regulation and the changes in relation to the mental health act, advocacy and infection control guidance. Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 23 Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 4 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 3 2 X 3 Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19(1) Requirement Staff must not be employed until all relevant checks stipulated in schedule 2 have been undertaken and deemed satisfactory. Timescale for action 01/09/07 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 Refer to Standard OP8 Good Practice Recommendations The manager could familiarise herself with the skills for care council knowledge sets and look to include these into the staff training and development. These include the knowledge sets in relation to the prevention of infection, dementia, nutrition and medicines. The manager could look at the CSCI professional intranet site and become familiar with the care home guidance log and also refer to the guidance on controlled drug management in care homes. 2 OP9 Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brookfield DS0000011753.V342786.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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