Inspection on 02/03/06 for Brookfield

This inspection was carried out on 2nd March 2006.

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

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

Other inspections for this house

Brookfield 12/06/08

Brookfield 31/05/07

Brookfield 24/08/06

Brookfield 30/05/06

Brookfield 18/08/05

Brookfield 29/03/05

Brookfield 28/09/04

Brookfield 08/03/04

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 Brookfield 7-9 Hayes Road Clacton on Sea Essex CO15 1TX Lead Inspector Tim Thornton-Jones Unannounced Inspection 2nd March 2006 10:00 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 Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 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 DS0000017783.V286273.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brookfield Address 7-9 Hayes Road Clacton on Sea Essex CO15 1TX 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) 01255 427993 01255 427993 Mr Jos Dorval Mrs Lystra Dorval Mrs Lystra Dorval Care Home 11 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (11) of places Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 11 persons) Three persons of either sex, aged 65 years and over, who require care by reason of dementia, whose names were provided to the Commission in March 2004 The total number of service users accommodated in the home must not exceed 11 persons 20th December 2005 (Additional Visit) Date of last inspection Brief Description of the Service: The residential service is primarily aimed at older people (over 65 years) who require personal care and assistance. The service is accommodating some service users who require care by way of mental frailty. Normally the home would not be permitted to care for persons with this level of need. A variation has been made to the current certificate of registration to enable named service users to remain at the home. The names of service users, to which this applies, have been submitted to the CSCI. The home is not registered to admit service users who are diagnosed with a dementia condition. The home has a passenger lift installed to reach the upper floor. Most of the accommodation is within single bedrooms, although one twin room remains in use. The home pre-existed at the time of National Minimum Standards coming into operation on 1.4.02, therefore the level of toilet and bathing facilities existing at that time remain available. There is one sitting room and one dining room. The front garden is laid to hard standing for vehicular parking. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to continue with ongoing monitoring of the service and to follow up the outcomes of the previous inspection undertaken on 20th December 2005. The informal report of this inspection (20.12.05) was notified to Mr and Mrs Dorval, the Persons in Control, and whilst not widely published, is nevertheless available upon request from CSCI. Resulting from the December 2005 visit, Mr and Mrs Dorval were asked to revise their action plan to achieve the short falls previously noted. This was done and a copy was sent to CSCI in January 06. This inspection mainly focussed upon those standards and practices that were highlighted previously as ‘carried forward,’ as the proportion of standards being subsequently carried forward was significant and an ongoing cause for concern. Further standards, however, have been reviewed at this inspection as they fell due to be inspected. Standards associated with assessment and care management were thoroughly reviewed on this occasion since this is an area that is of concern in relation to the frailty of service users accommodated. This inspection has concluded that although the Manager gave an assurance to inspectors that National Minimum Standards had been addressed, via the homes action plan, there continues to remain a substantial proportion of requirements outstanding, albeit that some have been ‘upgraded’ resulting from some progress. The service’s continued failure to make significant improvements over the preceding year is of serious concern to CSCI. Mr and Mrs Dorval will be contacted separately in regard to this with a view to resolving the ongoing situation. What the service does well: What has improved since the last inspection? • The bathroom that was previously unused due to unsuitability has been converted to a useful walk in shower. DS0000017783.V286273.R01.S.doc Version 5.1 Page 6 Brookfield • • Improvements to the decoration on the first floor, dining room and kitchen. Steps have been removed in favour of gradients from the first floor and lighting has been repaired. What they could do better: • • • • • Care management, assessment and monitoring remains an area for development. The laundry facilities would benefit from review and improvement, including the fitting of a sluice facility. Admission procedures require development to ensure the home has the full capacity to meet the needs of people admitted to the service. Development of improved strategies to ensure that people with more complex care needs receive appropriate social and emotional support. Evaluation of the regulatory requirements and National Minimum Standards, against the home’s practice, to formulate a clear and decisive plan for improvements to be made. Development of a functional, proactive approach to quality assurance and quality monitoring. Development of improved procedures for the protection of vulnerable adults. Complaint procedures require clarification to ensure only one approach is used, that meets with regulatory requirements. Ensure that the staff related notices are limited to areas within the home specific to staff. • • • • 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. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 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 DS0000017783.V286273.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 • • • Service users do not fully benefit from all the information they need to make informed choices. Not all service users benefit from robust contractual arrangements. Service users have not benefited from a comprehensive pre-admission assessment procedure. EVIDENCE: The service user guide was unchanged since the previous inspection and remains in need of review to ensure that all the requirements of regulation are included. The Statement of Purpose was reviewed as this was stated by Mrs Dorval to be a revised document. Upon inspection, the document had indeed improved overall and whilst being mainly adequate in content, although minor shortfalls were found, was noted to have probably been copied from a document produced by another organisation since there were multiple references to the Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 9 organisation being referred to as ‘the society’ and an inappropriate reference to ‘Epping Primary Care Trust’. Mrs Dorval was unable to explain the purpose of these unusual references stating that a consultant acting on her behalf had developed the document. Terms and conditions were not individualised within the Service Users Guide and did not include all of the required information. Pre-admission assessment, regarding two recently admitted service users, was reviewed. In these instances the home did not fully operate a thorough pre admission assessment process, or give adequate attention to ensure the home was admitting individuals whose entire assessed needs could be fully met. Preadmission needs assessments were brief and generalised under broad statements and did not provide a ‘person centred’ approach; for example: ‘Personal Care Needs’ – ‘needs all personal care’. This type of statement is unhelpful and does not enable understanding of the person’s needs or help in delivering consistent and adequate care. A further example, a recently admitted person, also a wheelchair user, had not received written or verbal information about Brookfield prior to admission, although advised Inspectors they had now settled and wished to remain within the home, following the trial period. Following admission this service user discovered that the continued use of their own wheelchair at Brookfield was not possible due to the corridors and doorways being too narrow. This had not been taken into consideration prior to admission and an occupational or physiotherapy assessment had not been sought and no referral to the NHS wheelchair clinic had been made. The home supplied their own alternative wheelchair for the person, which was evidently too small; and in relation to other known risk factors, including immobility and diabetes, could potentially place the service user at risk of developing pressure ulcers and other physical health matters. Advice was given to Mrs Dorval on the potential difficulties this situation may cause. Needs assessments examined followed a rather outdated pre-printed format. It appeared to have originated from perhaps a large NHS establishment, being based on a ‘medical model’ requiring a professional nursing assessment. It included statements to be assessed in a closed question framework and not appropriate for the stated purpose of the home, therefore, the process is in need of improvement to ensure suitability. For example, under the heading of ‘Nutrition’ the following statements were to be assessed ‘Does resident look dehydrated and should fluids be encouraged?’ and ‘Any sign of fluid retention e.g. swelling of both legs or low urine output?’ An assessment such as this is inappropriate and can be misleading for the relatively inexperienced and untrained carer and could potentially place the service user at risk. There was no evidence available to ascertain whether the person evaluating this assessment was competent to do so. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 10 A need was identified by a tick in the ‘yes’ box alongside the corresponding statement and did not give a clear outline of the particular need identified or service user preference. The assessment format ‘disabled’ the process of gathering and analysing correct, meaningful and appropriate information about the individual and deflected from the way in which staff should carry out a person centred needs led assessment. It was unclear in some cases as to when the assessment was undertaken. Some of the responses were unclear within the assessment, for example, there were some ticks across both yes and no boxes, giving no indication as to whether there was a need or not. This indicated the inappropriateness of the method used. The development of a key working style approach is likely to benefit the development of practice, although it is inevitable that those involved with this approach will require some training and development. Overall, the information referred to above indicates an unsatisfactory level of professional practice and organisation that could potentially place service users at risk. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 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, 10 • Service users do not fully benefit from the arrangements in place to promote healthcare monitoring, personal and social needs and to preserve privacy and dignity. EVIDENCE: Care plans had received some attention since the previous inspection although, of those sampled, all lacked direction to ensure carers delivered consistent and informed care. The recorded information seen reflected a rather task-oriented approach, which tended to place service users with unnecessary dependence on care staff and the more detailed methodology was, at times, erratic and contradictory. Care plans continue to lack a clear detailed approach to attainable objectives and were not adequate to provide sufficient direction for carers. This was particularly evident for one individual who had recently been diagnosed as having had a stroke. The identified needs stated ‘needs to be washed, creamed, dressed, bathed and toileted.’ The desired intended outcome to meet the person’s identified need was to support and encourage Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 12 the person to maintain their independence. The care documentation did not give any indication of the type, frequency or method of support required and was reflective of ‘task related’ outcome. There was no indication of the service users ability or motivation to participate in meeting their own independence nor guidance for staff to provide care in the least intrusive and most supportive and consistent manner, observing dignity and self-respect. During discussion with the Manager, it was evident, in the opinion of the Inspector, that the rationale behind structured, clear and informative care plans, generated from an individualised assessment of need, was not fully understood. The care plans seen did not provide staff with appropriate guidance to good care practice and did not demonstrate or fully evidence the care being provided. Overall, the practice seen continues to be largely intuitive on the part of carers, who were mainly relying upon their individual experience and knowledge of service users. This approach places recently admitted service users and those with deteriorating or changing needs at most risk. Healthcare matters within the care plans had not progressed with regard to informing staff of individual needs. Brief entries relating to healthcare were found in the sampled records. Relevant information had not been transferred into care plans to ensure consistent and continued care. Appropriate monitoring and review for some examples, such as a skin condition requiring daily treatment, an x-ray of a wrist or increased anti depressant medication for a service user who had had a stroke, were poor. These are matters that must be addressed appropriately within care plans to ensure suitably constructed and appropriate care and support. Good practice associated with those having had a stroke, including depression associated with loss of function and ability, was discussed with the Manager. The Manager did not, in the opinion of the Inspector, demonstrate an adequate understanding of these matters, and had not sought additional specific professional advice, made links with voluntary organisations or support groups, such as The Stroke Association, or looked for guidance in line with the National Service Framework (DOH 2001) for Older People, to enable appropriate care and support delivery. This was also the case in relation to another service user, regarding diabetes management. There was no evidence of specialist guidance or follow up from a GP practice based Diabetic Nurse Specialist, or other monitoring, such as optometry or NHS chiropody, in line with the National Service Framework (DOH 2002) for Diabetes, or links with organisations such as Diabetes UK. Unhelpful statements were noted within a care plan for a service user with diabetes, controlled by tablet and diet, such as ‘ make her understand she is a diabetic, staff to be aware of mood swings, dizziness and any occurrences physically or mentally from diabetes’ did not reflect accurately the complexity and significance of the care support required for this individual. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 13 Discussion with this individual and review of related care planning arrangements indicated that staff had limited understanding of the dietary requirements and implications of diabetes. The service user said that, although the food was good, a choice was not offered and dietary needs related to diabetes was not catered for. The importance and rationale of a healthy eating plan incorporating a no sugar, low fat, high fibre balanced diet to effectively manage the disease and help to prevent further potential complications was absent in the care plan. Comments in the care plan such as ‘to make sure she still enjoys desserts, biscuits and cakes but only those that are diabetic friendly’ are not considered sufficiently informed to provide a safe diet without clear guidance and monitoring. There was an absence of the service user’s perspective on self-help and appropriate consultation. Risk assessment tools regarding identifying actual or potential health risks, in relation to falls, moving and handling, nutrition and potential pressure ulcer detection, were examined. With the exception of the Waterlow assessment tool, the tools used were not recognised as recommended assessment tools in line with current good practice. The assessment tools examined did not have an appropriate total risk score indicator reference associated with the degree to which the actual or potential risk factor was present. Therefore, any useful or critical information obtained did not form part of a proactive strategy in the prevention, detection or management of the risks identified. Put simply, the assessment was invalid and did not appropriately inform the care plan. An example of an unrecognised risk assessment tool, relating to nutrition with a numerical score rating for each statement, was included within this documentation. An assessment for statements such as ‘Gut Function’ was understandably omitted and the weight record was blank. This inevitably gave an inaccurate total score rating, which was, in any case, questionable, as there was no reference to total score rating indicators. In conclusion, this documentation, in the opinion of the Inspector, served little purpose with regard to information gathering to inform care planning and risk management strategies. The falls prevention risk assessment did not follow the appropriate specialist guidelines, taking into consideration any mental health needs, visual or sensory impairment, physical health or medication. The subsections included in the assessment, each with a numerical weighting associated to it, only referred to ‘disease’ or ‘injury to lower limb’ and ‘equipment’ required. Again this did not reflect a holistic, person centred approach and a total score indicator reference was not available. Moving and Handling risk assessments did not identify risks, or reflect appropriate management to promote safety and optimal independence, or provide guidance for staff in the level or type of support the service user Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 14 required, particularly with regard to a wheelchair user and one individual who recently had a stroke. A Waterlow pressure ulcer prevention risk assessment tool was evident in one care file, however, potential or actual risk identified to skin integrity was not generated into a proactive management strategy within the care plan, for the prevention of pressure damage. It was not evident that a risk assessment had been carried out, recorded or reviewed on a regular basis for those service users vulnerable to developing a pressure ulcer or that appropriate equipment was in place. Risk factors, such as immobility, loss of sensation, continence needs and chronic disease, were evident within the service user group. During discussion with the Manager it was not clear that the management of pressure damage was being taken in close collaboration with the Primary Health Care Team and the service user. In conclusion, the inspection continued to highlight significant concerns with regard to the health, safety and welfare of the service users accommodated within Brookfield. The lack of adequate assessment of the range and complexity of older peoples’ individual needs and prompt and appropriate delivery of planned care, in collaboration with other health professionals, places the service users at some risk. The inspection outcome consolidates the ongoing concern regarding the lack of professional development and expertise within the service in relation to the relatively high needs of service users. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 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, 14, 15 • Service users do not benefit from the home’s approach to meeting social and emotional needs and preferences. EVIDENCE: Care plans sampled did not fully evidence that individual social and emotional needs had been assessed or that service users had been fully consulted about their preferences and lifestyle choices. The Inspectors’ observations concluded that most service users were, on the whole, not communicative and generally disengaged from each other and from the carers. It is accepted that the majority of service users accommodated at the time of the inspection were physically and/or mentally frail. The Residential Forum assessment undertaken by the home shows that two of the nine service users were ‘high needs’ with the remainder described as ‘medium needs’. There was no clear evidence of how this conclusion was ascertained, however, Inspectors concluded that as a result of examining documentation, speaking with staff and from observation, the higher needs group was probably greater than two service users. On this basis, the assessment and evaluation of identifying emotional and ‘well being’ needs is more complex and it would be reasonable to expect the service to have developed more comprehensive strategies to Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 16 ascertain service users’ needs and preferences regarding social and emotional needs. Whilst the home has made increased effort to promote in-house activities, staff commented that it was difficult to motivate or engage service users, and this is probably accurate. In order to ensure that people with complex needs are provided with genuine and appropriate choices there needs to be a process in place to ensure that staff are confident that what they are offering is relevant, timely and meets the preference of individuals. The inspection concluded that no identifiable ‘tools’ or strategies were in place for staff to be guided in this task. Nevertheless, it is acknowledged that carers were doing their best within the resources at their disposal. The pre-inspection information provided by the home specifies a list of activities undertaken in the home and the wider community. The activities listed were not all evidenced at the time of inspection. In terms of simple choices such as ‘do you want a drink’ or ‘where do you want to sit’ these were being expressed by staff intuitively and, from observation, were being managed in a satisfactory way, however, the practice associated with lifestyle and choice will need to improve to meet National Minimum Standards since this will require a more strategic approach. The main meal was discreetly observed and was of good size and adequately presented. Service users who expressed a view were mixed in their opinion of the quality. The home states that a choice of meal is available, although the inspection concluded that an alternative is made available if service users do not like the meal rather than a proactive choice for all meals. Pre-inspection information submitted by the home did not list mealtimes and did not answer questions regarding special dietary needs or arrangements for snacks and drinks. One person spoken with stated they would need to wait for a drink to be served at mealtime. The Inspector clarified this with the person who insisted that a drink would not be offered. It was noted that during this time other service users did have drinks. The care plan of this person did not specify any arrangements associated with drinks and therefore this position may, or may not, be a perception on the part of the individual. The home will need to ensure that staff regularly make drinks available. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 • Service users do not fully benefit from robust complaints and protection procedures. EVIDENCE: The pre-inspection questionnaire, completed by the registered persons in January 2006, indicated that the service had not received any formal complaints. Mrs Dorval confirmed this was still the case at the inspection. The CSCI had received no complaints about the service during the previous 12 months. The complaints procedure, when asked to view it, was part of a package of policies and procedures that Mr and Mrs Dorval had purchased. The complaints summary within the Service Users Guide was a different version. The use of more than one complaints procedure was raised at the previous inspection and had not been resolved. Mrs Dorval confirmed that no matters under the Protection of Vulnerable Adults (POVA) procedures had been made in relation to the service. The CSCI were also unaware of any matters linked to POVA referrals. Upon inspection of the home’s practice, some staff had attended a training session regarding POVA issues and whilst certificates were not available at the time of inspection these were forwarded to CSCI received 7th March 2006. This is a positive development. The service procedure regarding POVA was contained within the purchased pack previously referred to and whilst this gave sound information on general issues, it did not provide specific advice to staff on what to do to Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 18 make a referral or link with the local lead body for adult protection referral. This was discussed at length with Mrs Dorval who was also advised to seek training in this area of practice. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25, 26 • Service users benefit from recent improvements to the environment, although further improvement is required. EVIDENCE: A bathroom has been refurbished and converted to a walk in shower room. Steps within the first floor corridor have been removed in favour of gradients and the fault previously noted with the first floor lighting has now been repaired and was working correctly, all of which are positive developments It was noted that the air extractor fan fitted within the shower room was noisy when operated and was noticed to be not flush with the ceiling. It is recommended, therefore, that a competent person inspect the fan to ensure it is fitted correctly and operating to manufacturer’s specification. On the day of inspection the rear room/lobby, where the lift is situated and visitors’ toilet located, was uncomfortably cold and it was noted that no central heating is installed in this area. This will need to be resolved to ensure that service users using the area have an adequate ambient temperature. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 20 Various improvements to the decoration of the first floor, dining room and kitchen had been completed. There were no odours noted to any parts of the home that were visited and all rooms were clean and tidy. The environment is not enhanced, in the opinion of Inspectors, by the various displays within the home of framed policies and procedures, such as Manual Handling instructions, indicators of adult abuse, GSCC Codes of Conduct and other policy and procedure documents associated with privacy and dignity etc. This was particularly poignant as on the shelf in the lounge was found a bank statement belonging to a service user and Criminal Record Bureau (CRB) declarations for some staff. This is a breach of confidentiality and privacy. The furniture and fittings seen were satisfactory although the Registered Persons are recommended to ensure that all furniture and fittings provided by the home are subject to periodic inspection to ensure fitness for purpose. The home does not have an appropriate sluicing facility, which is considered necessary since the service has stated that at least three service users require support with double continence management. The Registered Persons are recommended to consider ways in which the laundry arrangements may be improved since the laundry equipment is located in a lean-to arrangement within the rear outside courtyard. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 • • Skill mix is developing, although staff have not received all of the training required to do their job to an adequate level. Recruitment practice was satisfactory based upon the sample taken. EVIDENCE: Information provided by the home indicates that of the seven carers employed, five have attained NVQ at level 2. Some training had been undertaken, for example health and safety, first aid, and food hygiene, although other essential training such as moving and handling was out of date for some carers. The home was unable to produce information regarding an assessment of training and development needs for each staff member, although several staff did have a training list of courses attended, but not all. Recruitment practice is developing. The most recently recruited staff files were examined and initially showed gaps in compliance, but Mrs Dorval, the Manager, included further information later during the inspection. One carer had no Criminal Record Bureau (CRB) check, although had been checked against the POVA first record. Based upon the sample taken the arrangements were just compliant, but the overall practice and procedure will need to be improved if this outcome is to be sustained. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 22 Some staff were interviewed and all expressed a positive experience of working at the home. Care staff on the day of inspection demonstrated some sound intuitive caring and all had a caring disposition using positive tone and language. The management arrangements, professional support, supervision and training was not of an equitable level. The arrangement whereby care staff are rostered to undertake cooking duties must be clarified on the staff roster. Records seen continue to show care staff entered twice on the roster covering part of the both duties. Staff observed undertaking cooking duties continue to take part in supervising service users during rostered cooking hours. This has been previously discussed and should discontinue. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37, 38 • • • • Service users do not benefit from a home that is well run, with a positive ethos and management approach. Quality assurance and monitoring systems fail to safeguard the welfare of service users. Record keeping and policy and practice documents do not reflect the practice in several areas of the home’s operation. Health and safety standards have improved. EVIDENCE: Mrs L Dorval, who has been managing care homes for older people for several years, undertakes the management of Brookfield. CSCI has been advised that Mrs Dorval is currently working toward an NVQ award at level 4 in both care and management. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 24 Brookfield has been operating at a high level of non-compliance for approximately one year and this is, in the opinion of Inspectors, chiefly a management and leadership difficulty. It was noted that the last report sent to CSCI by Mr Dorval as part of his duties under Regulation 26 highlighted that the only concern found related to a need to ‘review of certain parts of the home’s documentation’. An action plan sent to CSCI in response to the inspection undertaken on 20th December 2005 gave a clear assurance that all of the requirements would be met by the latest date of 10th February 06. At the commencement of the current inspection Mrs Dorval was asked about the progress she had made in meeting the objective of the action plan. CSCI inspectors were told that all of the National Minimum Standards specified within the action plan had been achieved. On the basis that this inspection has concluded that, again, a very high proportion of National Minimum Standards remain below the minimum requirement, CSCI must inevitably question the professional practice and integrity of the home’s management. Supervision of care staff continues to require development to meet with National Minimum Standards in terms of practice and frequency. Supervision records were requested, but not produced. Quality assurance and quality monitoring records were stated to have been unchanged since the previous inspection and therefore the standard rating remains. Inspectors discussed quality issues with Mrs Dorval. A number of policies and procedures were not being followed in practice, for example, care management, POVA, staff training and supervision. Various statutory records did not meet requirements of regulation. Details of these requirements are contained in various parts of this report, however, a full professional audit of compliance, by the home or a competent person on their behalf, is strongly recommended. It is noted and commented upon within this report that the Registered Persons were of the view that the action plan had, in fact, been met in terms of compliance. For this reason Inspectors recommend that the Registered Persons seek assistance externally to assist them in ensuring that practice is compliant with both regulatory requirements and National Minimum Standards. Various checks were examined in terms of the fire, electrical and gas safety, lift and other equipment, portable appliances etc and these were satisfactory. Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 2 2 2 X HEALTH AND PERSONAL2 CARE Standard No Score 7 1 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 3 1 3 2 1 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 1 3 Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4,5,6 Timescale for action The Registered Person must 30/05/06 review and update the Statement of Purpose and Service User Guide. This is a repeat requirement. No service user should move into 30/05/06 the home without having his/her needs assessed and being assured that these will be met. This is a repeat requirement. The Registered Person must be 30/05/06 able to demonstrate that the home has the capacity to meet the assessed needs of service users. This is a repeat requirement. The Registered Person must 30/05/06 ensure that service users receive an appropriate admission procedure and assessment. The Registered Person must 30/05/06 ensure that service users’ health, personal and social care needs are set out in an individual plan of care. This is a repeat requirement. Requirement 2. OP3 14 3. OP4 12,14,15 4 OP5 14 5. OP7 15 Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 27 6. OP8 13 7. OP12 13, 15 8. OP14 15, 16 9. OP16 22 10. OP18 13,16,18, 19 11. OP22 16 12 OP25 23(2)(p) 13 OP26 13(3) The Registered Person must promote and maintain service users health and ensure access to health care services to meet assessed needs. This is a repeat requirement. The Registered Person must ensure that service users’ lifestyle within the home matches their expectations, preferences, needs and aspirations. This is a repeat requirement. The Registered Person must ensure that service users are assisted to exercise choice and control over their lives. This is a repeat requirement. The Registered Person must ensure that service users and their representatives have access to a complaints procedure that includes the stages and timescales for the process, and that the complaint is dealt with promptly and effectively. This is a repeat requirement. The Registered Person must ensure that the service follows a clear procedure that will prevent service users from abuse. This is a repeat requirement. The Registered Person must ensure that service users have access to all specialist equipment they require to maximise their independence. This is a repeat requirement. The Registered Person must ensure that all parts of the home used by service users are suitably heated. The Registered Person must ensure that practices prevent and control the spread of infection. This refers to the practice of staff undertaking cooking and personal care tasks DS0000017783.V286273.R01.S.doc 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 Brookfield Version 5.1 Page 28 14. OP27 18 15. OP28 18, 19 16. OP29 19 17. OP30 18 18. OP31 9 19. OP32 9, 10 20. OP33 9,10, 24, 26 21. OP36 18 22. OP37 17, 26 The Registered Person must ensure that the numbers and skill mix of staff meets service users’ needs. This is a repeat requirement. The Registered Person must ensure that service users are in safe hands at all times. This is a repeat requirement. The Registered Person must ensure that a thorough recruitment procedure is operated which ensures the protection of service users. This is a repeat requirement. The Registered Person must ensure that a staff training and development programme is operated in accordance with National Minimum Standards. This is a repeat requirement. The Registered Person must ensure that the home is managed in a competent manner. This is a repeat requirement. The Registered Person must ensure that service users benefit from the ethos, leadership and management approach of the home. This is a repeat requirement. The Registered Person must ensure that the home is run in the best interest of service users. This is a repeat requirement. The Registered Person must ensure that the staff are appropriately supervised. This is a repeat requirement. The Registered Person must ensure that all records required to be kept are maintained accurately and are available for inspection. This is a repeat requirement. DS0000017783.V286273.R01.S.doc 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 Brookfield Version 5.1 Page 29 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 OP25 Good Practice Recommendations It is recommended that the fan installed within the shower room be checked by a competent person to ensure correct installation as a result of operational noise and appropriate fitting. It is recommended the Registered Person ensure that adequate financial support is available to ensure that staff have access to suitable training. 2. OP30 Brookfield DS0000017783.V286273.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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