CARE HOMES FOR OLDER PEOPLE
Brookfield Brookfield 1 High Street Somersham Cambridgeshire PE28 3JA Lead Inspector
Dragan Cvejic Key Unannounced Inspection 19th April 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 DS0000069360.V337216.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 DS0000069360.V337216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brookfield Address Brookfield 1 High Street Somersham Cambridgeshire PE28 3JA 01487 840900 01487 840825 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) Brookfield Care Home Limited Mrs Linda Hodge Care Home 14 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (14) of places Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25/01/06 Brief Description of the Service: Brookfield provides personal care, support and accommodation for up to 14 older people, 7 of whom might suffer from dementia. The home is located in a quiet village location approximately 8 miles from Huntingdon and 15 miles from Cambridge; the village is well served with shops, pubs and other amenities. The home first opened in 1985 and consists of a two-storey building with a newer, purpose-built, ground-floor extension; the upper part of the building is accessed by a stair lift. The home has 12 single bedrooms (5 with en-suite facilities) and 1 double bedroom. Seven of the bedrooms are on the first floor of the older part of the building, the remaining 6 are on the ground floor. One of the bedrooms on the ground floor is shared. Residents have access to 3 communal sitting areas, two at the front of the house overlooking the end of the High Street, the third being to the rear of the building with views of the garden. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection with the site visit carried out in the morning hours and lasting 4 hours. This was the first inspection since a change of ownership. Monthly reports from the provider were used to inform this report in addition to the site visit. Case tracking was the main methodology used for the inspection and three service users were case tracked. Apart from these three, the other five service users were spoken to. A tour of the house and talking to the manager and a senior staff member were also used to inform this report. A visiting therapist provided comments too, helping to build a complete picture of the home for this report. What the service does well: What has improved since the last inspection?
The new owners had introduced updates to some policies without major changes, as indicated by the manager, in order to present current practice through policies. An example was the new format for care plans, based on
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 6 Person Centred Planning, which suggested one file for each user, and the manager considered this format to be better. Medication records were improved and MAR sheets were up to date, ensuring better protection for service users. Staff had attended POVA training since last inspection and the manager stated that all new staff would attend training within their inductions. Staff files for newer staff had been improved and contained the required work history information. Training was also improved as the new providers were trainers too and were able to ensure that all staff received appropriate training on time. Liquid soap and paper towels were introduced and reduced the risk of crosscontamination. The home also applied for and was granted an additional category in their registration, allowing them to care for up to 7 people with dementia. This variation covered some service users that were already users in the home and had deteriorated within that time. 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 DS0000069360.V337216.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service users were appropriately assessed prior to admission, ensuring that their needs would be met if they were admitted. The quality of the assessment exceeded minimum standards. EVIDENCE: The home’s statement of purpose was updated to present the change of ownership. Three service users’ files were checked and contained evidence of initial assessments for service users. The manager stated that she was assessing all potential users and shared the assessment process with the new deputy manager. The manager used an example of the refusal of a place from one of the referred people to explain that the home did not take people when they could
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 9 not care for them appropriately or meet their needs, or in this case where the referred user did not need residential care. The home did not offer intermediate care, but some users from the local community used the offer for respite care and were coming in almost regularly. One case tracked service user was first admitted on respite care and, after deterioration in her health, changed the status of her admission to permanent residence. She commented on the home: “I could not choose a better place to be in. It is a lovely place, with lovely views and we get on with staff so well. We live like a big family here.” Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Users benefited from an individual approach to their care, from good staff knowledge of their needs and from the respect shown to their abilities to remain as independent as possible. EVIDENCE: Three case tracked service users’ files were checked and all three were in order and up to date. Care plans contained detailed information about service users, but the manager stated that she had started organising the transfer of users’ care plans onto the form suggested by the new proprietors. This new format was based on Person Centred Planning and assumed one working file per user. The manager stated that it would take them about two months to create new files for all users. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 11 Risk assessments were related to care plans and were, also regularly reviewed and updated. The new plans would have risk assessments as a part of care plans and would provide easier access to information about each individual. Service users spoken to confirmed that they knew their care plans, but stated: “I am not actually interested in paperwork. They know me, I am fairly independent and they help me when I ask them.” Another user stated: “I use the stair lift to come down, it is much safer than the stairs.” The files contained records of optician’s visits and dental appointments. Medication and records for three service users were checked. A senior staff member was observed administering medication to service users. The process and records were accurate and appropriate, and ensured the protection of service users. The home arranged at least a once yearly review for each individual, with their GP when the medication review also took place. Privacy and dignity were respected and users were proud of the way they were treated in the home. A user was pleased that the staff member knew which newspapers she had every morning and her likes and dislikes. The user wanted to demonstrate how well staff knew her and, when asked what she wanted for breakfast, she responded: “As usual”. Staff brought her her favourite cereal. Another case tracked user answered: “Yes, we are respected here. We get on very well with staff and with others.” Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 12 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. Not only varied and interesting activities, but the satisfaction of service users with leisure activities, choices and quality of food determined the excellent scoring for this group of standards. EVIDENCE: “Oh, yes, we have a lot of activities. Something always happens here”, commented a case tracked service user. A few service users attended a day centre. The entertainer – a musician – had an inclusive programme for service users, who were able to use triangles and contribute to the music. The manager obtained a local magazine where one of the users was pictured and an article was written about her. The home planned to organise a garden party where relatives would be invited too. A particularly appealing activity, much loved by service users, was “Countdown”, where a pull down screen was used.
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 13 Service users filled in crosswords with the male gardener, and this activity gave them the opportunity to communicate with a man, as there were no male users or staff. Another chance was through a local clergyman who visited the home for religious service. Service users’ interests were recorded in their files. Service users were independent and could do many things themselves, and the activities were appropriate for users capabilities. Some users wanted the home to keep their personal allowances in a safe. They were aware of their balances and controlled their expenditure. Two records of money were checked and compared with the balances; this demonstrated that the home kept accurate financial records. Mealtimes were relaxed and used as a social gathering, too. Service users were able to communicate, and enjoy not only a quality and nutritious diet, but social aspects of mealtimes too. Menus showed the choices that service users appreciated and were proud of. A user was especially proud of the fact that staff knew her likes and dislikes and remembered her usual choices. The home exceeded standards in this area. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 14 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): 18,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had policies and procedures that ensured the protection of service users. They felt capable of protecting their rights and of complaining in case they had any complaints. EVIDENCE: The complaints procedure was included in the statement of purpose. It was updated when ownership changed. It gave a clear timescale for responding and instructions on how to pursue the complaint further if the outcome was not acceptable for the complainant. The procedure was displayed on the board and accessible to users, staff and visitors. The home had not received any complaints since the last inspection, but a concern was received by the CSCI after the site visit, related to the management of the home. Service users spoken to did not know details of the complaints procedure, but stated that they would complain to the staff, the manager, the owner or the CSCI, if they had anything to complain about. Records of service users’ money, staff POVA training and other policies and procedures demonstrated how the protection of service users was ensured. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 15 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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The users enjoyed a homely and clean environment with a wonderful position in relation to the open countryside soothingly visible through the main dining room window. EVIDENCE: Service users were predominantly mobile and independent and the home’s environment was appropriate to their needs. A stair lift was used independently, as a service user was observed using it on her own to access the ground floor from her bedroom located upstairs. A tour through the house demonstrated a homely environment and users’ bedrooms contained their personal memorable items. A notice board in the middle foyer contained relevant information, certificates from other inspecting authorities, and the fire and complaints procedures.
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 16 The home was clean and bright. A recent Environmental Health visit praised the home for using just one food supplier – Sainsbury’s. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Staff complement was appropriate for the service users and home’s needs. Staff were knowledgeable, trained, open, and reflected the gender structure of the service users, making them more comfortable. EVIDENCE: Three staff files were checked. Although the files were in order, some older files did not have all required documents: one did not have an application form for a worker that had worked in the home for more than 11 years; the other did not have two written references, again for a worker who had worked there for more than 10 years. The file of a newer worker contained all documents and demonstrated that the home had improved their recruitment procedure. A new induction programme was also introduced and covered an in-depth induction, as seen in the latest file. Despite the change of ownership the home retained the principle to pay staff weekly, which was important for many part time staff and was preferred by all of them. Having mainly part time staff reduced the need for the use of agency staff, resulting in only one agency shift in a year and better continuity of care offered to service users. Nine of the 14 staff members had their NVQ qualifications, exceeding the standards. Three further staff were currently doing their NVQ.
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 18 Staff training was also significantly improved by the change of ownership. The new owners were trainers too and a new training programme was devised covering all mandatory subjects. Extra training was provided covering challenging behaviour, dementia and nutrition. New records for staff training had just been introduced, whereby individual and computerised records were kept for all individual staff members. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users welfare and wellbeing were ensured by safe working practices and principles of the home’s provision of service. Service users could influence the management of the home and make decisions. However, service users were not fully in charge of audits of their money. EVIDENCE: The manager was experienced and had worked in this home for more than 11 years. Her skills and knowledge ensured that service users were offered appropriate care without taking away their independence. The manager stated that the home’s philosophy and aims had not changed with the change of ownership.
Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 20 A further improvement was planned and suggested to the new proprietor to restructure staffing by adding an assistant manager position. New survey questionnaires were just sent to external professionals involved in the care process here. The manager explained that there was a plan to distribute users’ questionnaires. Families’ comments were received. Policies were reviewed. The home had recently been inspected by Environmental Health and the manager was preparing her response. The home was helping service users who needed help with their finances. Two checked records were accurate, but did not have users’ signatures. An audit was carried out, but users were not involved in auditing records of their money. Staff were regularly supervised. In relation to the suggested staffing restructure and introduction of an assistant manager, a new supervision plan was made, allowing shared responsibility for supervision between the manager and assistant manager. However, the manager and the cleaner were not supervised. Safe working policies and practices were in place. The health and safety policy was displayed on the notice board, giving service users direct access to it. All staff received mandatory training. New POVA training was also attended by staff. The new providers planned to deliver training, as they were trainers for mandatory subjects and for expanded training covering users’ specific conditions. The home complied with fire and environmental health legislations. The new staff induction programme was based on TOPSS and National Minimum Standards. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 21 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 4 X 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 22 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 OP35 Regulation 16 (l) Requirement Service users must be involved in the management of their personal allowances kept in the home when the audit of these accounts is carried out, and must be offered the chance to sign for the recorded transactions. Timescale for action 15/06/07 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 OP36 Good Practice Recommendations The manager and the cleaner should be included in the supervision programme and receive regular supervision. Brookfield DS0000069360.V337216.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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