Inspection on 30/05/06 for Brookfield

This inspection was carried out on 30th May 2006.

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

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

Other inspections for this house

Brookfield 12/06/08

Brookfield 31/05/07

Brookfield 24/08/06

Brookfield 02/03/06

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 Key Inspection 30th May 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.V293884.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.V293884.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.V293884.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 11 persons) Date of last inspection 2nd March 2006 Brief Description of the Service: The residential service is primarily aimed at older people (over 65 years) who require personal care and assistance. 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 1st April 2002, therefore the level of toilet and bathing facilities existing at that time remain available. On this basis, these facilities comply with requirements of National Minimum Standards, although not necessarily with the presenting needs of service users. There is one sitting room and one dining room. There is a small garden to the rear. Brookfield DS0000017783.V293884.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 review a number of ‘key’ National Minimum Standards and to ascertain regulatory compliance. Policies and procedures were reviewed and the Manager and Proprietor contributed to the inspection. Various records were inspected. The overall result indicates that a high proportion of standards continue to remain unmet and have been carried forward to this report. Previous inspections of this service have concluded that improvements are needed in the way the service is managed and organised. The service has a number of policies and procedures available although inspections have concluded that the operation of the home on a day to day basis does not often reflect the policies and stated intended practice. Care staff had not had the benefit of well planned and structured care strategies, although inspections have highlighted that some senior staff are supporting service users positively. A proportion of staff had received some relevant training. Recruitment practice, supervision of staff and the maintaining of appropriate records, for both staff and service users, was generally poor. Recent reviews by Healthcare and Social Work professionals have highlighted concerns in a number of areas, particularly regarding the monitoring and review of healthcare. Reference to these visits and outcomes appear in this report. Observation of practice was made and service users were spoken with briefly, although due to frailty of some service users information collected via direct contact was limited. A protection of vulnerable adults alert was recently reported, by a visiting healthcare student, regarding a care related matter. This has now been investigated and upheld in part. A further matter of concern was received by a relative of a former service user. This matter is currently under consideration by a Protection of Vulnerable Adults (POVA) strategy group. Essex County Council is, at the time of writing this report, progressing a further concern under POVA procedures. Mrs Dorval and senior staff have been co-operative in assisting with these concerns. Mr and Mrs Dorval have advised they have recently engaged the services of a ‘consultant’ to assist with developments within the home to achieve improvements. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 6 Mr and Mrs Dorval have presented ‘action plans’ to the CSCI although in practice whilst the actions have made improvements to physical facilities and environment, little or no improvement to the quality of care outcomes have been achieved. The overall outcome of the fieldwork visit to Brookfield indicated that whilst care staff do continue to strive to provide the best support they can to service users, the day to day management of the service continues to fall below the requirements of a significant number of National Minimum Standards and regulatory requirements. The majority of standards assessed below the level of compliance have been carried forward from a number of previous inspections. This report concludes that 23 National Minimum Standards were unmet; 20 of those standards were carried forward from the previous inspection. CSCI inspectors have continued to monitor progress of the home in relation to required improvements for more than 12 months with relatively little improvement evidenced. On that basis, and taking into consideration other professional reviews of the service, CSCI are now considering enforcement action. What the service does well: What has improved since the last inspection? What they could do better: • • • Care planning, assessment and monitoring, in relation to health and social care. Management of service user admissions. Development of key policies and practice procedures. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 7 • • • Protection related practice, including Protection of Vulnerable Adults and complaints. Staff recruitment, induction, supervision and training and related practice. Maintaining statutory records and procedures both in relation to care practice and the operation of the home. 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.V293884.R01.S.doc Version 5.1 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 DS0000017783.V293884.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • • • Service users do not yet benefit from a Service Users Guide or access to a Statement of Purpose. Not all service users benefit from an agreed terms and conditions of residence or confirmation from the home that their needs can be met by the service. Service users benefit from a trial period, but pre-admission assessment was not routinely offered. EVIDENCE: At the fieldwork visit to the home on 30th May 2006 Mr Dorval advised Inspectors that the Statement of Purpose for Brookfield was in the final stage of completion, having been revised. The registered person is recommended to ensure that all of the required information is included in the document, and this data should include the relevant information, relating to the home’s Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 10 premises as a ‘pre-existing’ home, as detailed within National Minimum Standards document for older persons. Subsequent to the visit Mr Dorval forwarded a draft copy of the Statement of Purpose to CSCI for consideration. Whilst CSCI do not normally ‘approve’ such documents in this way, the document was briefly viewed to provide further advice on compliance. As a result the draft document was returned to Mr Dorval with a number of recommendations and some requirements to ensure compliance with regulatory requirement. The Service Users Guide was also incomplete and had yet to be given to all service users. Mr Dorval confirmed that the document was in need of revision to ensure regulatory compliance prior to giving each service user a copy. Mr Dorval was advised about the regulatory requirements regarding this document. Part of the Service Users Guide is the service terms and conditions. The fieldwork visit concluded that this document was not in the possession of each service user, signed and dated, and specific to each person where such individual matters are relevant, for example method and payment of fees. Three service users’ files were examined as part of a case tracking approach. Initial inspection of the information held indicated than none of the sample had a pre-admission needs assessment undertaken by a trained person. The registered person submitted two further local authority assessment documents that had been produced, although one remained as not having a pre-admission assessment. None of the files were able to show that the home had consulted service users about the care they were to receive or confirmed in writing, from the home to service users, that their needs could be met. (This is a regulatory requirement.) No information was available in the service user files to indicate that service users were able to visit the home and make an informed judgement as to whether the home was suitable prior to their admission. Brookfield DS0000017783.V293884.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, 9 and 10. The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • • Service users do not benefit from a robust and comprehensive delivery of personal care and healthcare. Not all service users are satisfied with the respect they have received whilst resident in the home. EVIDENCE: Standards associated with practice within this group of standards were not directly assessed at this inspection, although information has been received from both Essex County Council (ECC) and the Tendring Primary Care Trust (PCT) following their recent separate visits to the home. This information has been considered in relation to the home’s performance in relation to National Minimum Standards and adherence to regulatory requirements. A Specialist Practitioner Nurse accompanied by a Student District Nurse from the PCT undertook a review of service users living at Brookfield during May Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 12 2006. As a result they concluded that some concerns were evident. One service user had a risk assessment undertaken by the home, although no action plan had been made as a result. Mrs Dorval had agreed to purchase some pressure relieving equipment for this service user. It was noted that the care plan for this service user did not address all known needs to assist staff in the delivery of safe and appropriate care. This service user has subsequently been admitted to hospital following a fall and it is understood will not be returning to Brookfield and will move to an alternative care setting. A further service user was noted to have had a risk assessment undertaken, but with no written action response by the home. A review of a medical condition is now to take place. This service user had reported a theft to Mrs Dorval with inadequate response, in that the home did not follow its own procedures regarding complaints. CSCI were not informed of the complaint within a reasonable timescale, in accordance with regulatory requirements. It is understood that the service user has since requested to move from Brookfield and this is being arranged by their Social Worker. One service user was noted to not have received a medical review for more than a year. Mrs Dorval had advised that a medical review had been undertaken on a six-monthly basis, however, no presenting evidence was found. A further frail service user was assessed by the PCT as requiring pressure relieving equipment. The PCT Healthcare professional had noted that no referral was evident to have been made by the home in relation to this service user. Equipment has now been ordered for this person. One frail service user was noted to have a serious illness. Pressure ulcers were identified. The service user was stated by PCT healthcare professionals to be in a great deal of pain at the time of the visit. PCT staff, in response, had made an urgent referral to a specialist, GP and Macmillan Nurse. Mrs Dorval advised that Prime Care doctors were aware of the service user’s condition and medicines had been prescribed. The Specialist Nurse employed by the PCT confirmed that she had spoken to the GP surgery and confirmation was obtained that the information held by the surgery and the home’s explanation of the medical care received by the service user was not consistent. The PCT are to make further enquiries. Subsequent, however, to these arrangements the service user in question died. Enquiries relating to the care arrangements are to continue. Reviews of service users placed by Essex County Council were also recently undertaken. The care arrangements for four service users were undertaken and the overall conclusion reached was that service users had expressed satisfaction with the home and where families had expressed a view, they too Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 13 were satisfied. The Social Work professional undertaking the review stated that care plans were basic but pertinent to the care of the individuals. Further reviews are to take place. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • • Service users did not fully benefit from assessment and delivery of their social and recreational needs. Service users do not fully benefit from appropriate choices in their life at the home. EVIDENCE: The care records were examined to find out if the home had improved the way in which assessment and identification of service users’ interests and recreational needs had developed. No information was included within the care files examined to indicate the home’s approach. No further development had been made since the previous inspection. There was information, obtained via healthcare reviews and social care reviews, that one service user had expressed feelings of isolation within the home and that their emotional and social needs were being ignored. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 15 Service users who are frail both mentally and/or physically require varying approaches to meet their needs from a social, recreational and emotional perspective. At the time of inspection staff were observed to communicate appropriately at various times and in response to varying circumstances. The inspection concluded that, on an unplanned basis, staff were at the time of inspection demonstrating a friendly and positive approach to service users. Care planning, consultation and assessment regarding social, emotional and communication matters will need to be improved to ensure that the home has a clear direction in meeting the needs of service users, particularly those with illness or other conditions that prevent fluent communication. The wider involvement of advocate services, where available and appropriate, should be considered. There was evidence to indicate that families visit at various times of the day and that the home’s approach to quality monitoring takes account of relatives’ views. Resulting from recent reviews of service users, by Essex Social Services, families spoken with were satisfied with the support they receive from the home. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 16 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 The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • Service users were not protected by the home’s arrangements regarding complaints or protection from abuse. EVIDENCE: The home has a complaints procedure. One service user recently made a complaint to Mrs Dorval that some property belonging to them had been allegedly stolen. Whilst the home did make some enquiries, the complaint procedure produced by the home was not followed. The matter was unsatisfactory in that the outcome and investigation process was unclear. No report of the investigation was produced and the CSCI was not informed at the time as required by Regulation 37 of the Care Homes Regulations 2001. The service user’s Social Worker advised the CSCI that their client had told them that Mrs Dorval had asked the service user to change the statement regarding the matter, which the service user stated to the social worker that they had refused to do. Theft is a serious matter and as such should have been considered by the home as a protection of vulnerable adults (POVA) referral since the alleged person was a staff member. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 17 The home has recently been subject to a POVA investigation based upon an alleged assault and verbal abuse by a staff member toward a service user. This matter was found to be partly upheld in that the alleged assault was unproven. The verbal abuse was upheld. Resulting from enquiries relating to this investigation Essex County Council has begun a further POVA investigation based upon their view that the overall management of the home has been poor and that as a result the outcome, in part, for some service users has been reflective of ‘institutional abuse’ as defined within the Essex County Council policy for protection of vulnerable adults. This matter was being investigated at the time of this report, involving Essex County Council, CSCI and Tendring Primary Care Trust. The local authority has stopped service user referrals under the existing contractual arrangements until they are confident that the home is able to consistently offer safe and appropriate care. CSCI continue to be concerned regarding the arrangements for the protection of vulnerable adults at Brookfield, however, it is noted that some staff, including the Manager, have now attended POVA training, which is positive. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 18 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, 23 & 26. The quality rating for this group of standards has been judged to be good in that there were no significant areas for improvement relating to health and safety of people using the service or issues of poor management. The environment meets the needs of service users notwithstanding comments made within this report. • • • The environment meets requirements for the number of toilet and bathing facilities. Service users have not benefited from assessment of the environment. The home was adequately clean and hygienic. EVIDENCE: The environment was domestic in appearance and reflective of a comfortable home setting. Not all of the rooms occupied or used by service users were visited, although all communal areas were seen. Of the individual rooms viewed, these appeared comfortable and adequate to meet service users’ Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 19 needs. The rooms seen were not part of a case tracking approach on this occasion. There were no obvious health and safety concerns found. area was not visited. The outside rear The building was formerly two semi-detached dwellings, which has created additional corridors and stairways. It was noted that service users, who were also wheelchair users and had brought their own equipment suited to their needs to the home with them, could not use it as the doorways and corridors were restrictive, resulting in the service users being unable to use their own equipment at all times. The number of toilets and bathing facilities were being maintained in accordance with the levels required of a ‘pre-existing’ care home. This means that the care home was in existence prior to the current National Minimum Standards. At the time of this inspection the facilities met with the needs of service users being accommodated. The registered persons have not advised the CSCI that a person qualified to do so in relation to older people accommodated has assessed the home. The home does have a passenger lift and various adaptations to the building to assist service users. Of the areas within the home that were visited, all were clean and tidy with no unpleasant odours. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 20 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 The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • Service users have not benefited from the home’s approach to meeting this group of standards. EVIDENCE: The registered person has not ensured that employees who provide personal care have received all of the training that is required to inform their knowledge and understanding of service users’ needs. Based upon information held in the home’s records, discussion with the Manager, Registered Person and from observation, Inspectors noted a range of presenting needs, by service users, that staff would need to fully understand or at least have adequate training in. These include; moving and handling, food hygiene, first aid, dementia, care of older people, safe handling and administration of prescribed medication, protection of vulnerable adults from abuse, continence management, diabetes, challenging behaviour, supervisory skills (for senior staff) and 50 of staff are recommended to achieve NVQ qualification at level 2 or higher. Five staff files were sampled, although one staff member had only been in post less than a week, there was no evidence available of experience or training in care work. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 21 The remaining four files sampled showed that two had adequate levels of training. The remaining two showed infrequent and underdeveloped training and development. It is recommended that senior staff, who take charge of the home in the absence of the manager, be trained in supervisory skills, commensurate with the level of responsibility they take for the support of staff. The registered person’s practice regarding recruitment of staff remains poor and non-compliant with regard to regulatory requirements, in that staff recruited must be subject to various checks before they are able to work in the care home. The files of the same five staff members were used as part of the case tracking method. The files indicated that one of the five staff had the required information available. Two of the five carers did not have an available Criminal Record Bureau (CRB) certificate. The most recently recruited carer, who was on duty at the time of the fieldwork visit (inspection), had not been checked against the POVA 1st register nor had the CRB certificate been applied for. Mrs Dorval was reminded that it is unlawful for persons to be employed without the required checks having been made and that such practice potentially places service users at risk. When Mrs Dorval was asked why this member of staff had been allowed to start work, she stated that the home was short staffed and whilst she was aware that it was a regulatory breach she stated that she knew the person and felt confident to commence her employment at the home. Mrs Dorval went on to say that she was aware that the new carer had a CRB check undertaken ten months earlier. Mrs Dorval was advised by the Inspector about the requirements regarding portability of CRB checks, in that all new staff must be checked, as previous CRB certificates were not transferable. Mrs Dorval stated she understood this requirement. There was no evidence available to show that the most recently recruited carer had been subject to any ‘service specific’ induction process. There was no identifiable arrangement in place for the new carer to be supported and supervised by an appropriately qualified and experienced staff member. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 37. The quality rating for this group of standards has been judged to be poor in that the outcomes had significantly more weaknesses than strengths and that the overall poor service quality outcomes have been sustained. • • • • • Service users did not benefit from a home that is well managed or has sound leadership. The home is not run in the best interest of service users. Financial interests are not fully protected. Staff were not all adequately supervised. Service users are not fully protected by the home’s practices regarding record keeping and policy/procedures. EVIDENCE: Mrs Dorval is the registered manager and has a number of years experience in that capacity. She is also the Registered Person in partnership with Mr Dorval. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 23 Mrs Dorval has advised CSCI that she is currently working toward the Registered Managers Award. Mrs Dorval had recently attended a training course on the protection of vulnerable adults from abuse. CSCI have continued to encourage Mr and Mrs Dorval over a period of time to enable essential improvements to be made. At the time of this inspection a significant number of National Minimum Standards remain unmet and new concern regarding the welfare of service users has emerged resulting from reviews undertaken by partnership agencies and from protection of vulnerable adults alerts. On this basis, this report concludes that the home is not always being well managed or operated in accordance with good professional practice. The quality assurance and quality monitoring of the service remains largely as that noted at the previous inspection. The outcomes of the approach are questionable since this has not resulted in satisfactory improvements to the way in which the service is delivered or experienced by service users. The system would benefit from a more robust stakeholder approach to the quality setting and monitoring to include service users, relatives and visiting professionals, and must be based upon a comprehensive consultation exercise to ensure that the service delivery meets the needs of service users and is reflective of both National Minimum Standards and regulatory requirements. Mr and Mrs Dorval have produced ‘action plans’ following inspections of the home, although subsequent inspections show that whilst the plans were stated by Mr and Mrs Dorval to have been completed successfully, the care outcomes were assessed by CSCI to remain poor for the most part. Financial arrangements regarding the safe custody of service users’ monies have not previously featured very highly since the home had adopted a policy of not maintaining cash on the premises in this way. One service user, however, had recently been admitted to hospital and had requested the home, at short notice, to hold in safe custody a wallet containing cash and other personal items. The manner in which this was undertaken was reviewed at this fieldwork visit to ensure accountability and security. Staff made a note of the cash within the wallet on a piece of paper, however, the cash and valuables were not subject to the issuing of a receipt to the service user detailing the amount of cash and other valuables so deposited. It is accepted, however, that the request was made by the service user at the hospital and facilities were not readily available to provide a receipt at that time. It is important, however, that valuables and cash left in safe custody are subject to accounting procedures as soon as is practicable to ensure appropriate safekeeping of service users’ possessions. The registered person is recommended to ensure that such procedures are in place. The same sample group of care staff files mentioned earlier within this report were viewed regarding the quality and frequency of formal supervision. The Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 24 carer who was recently recruited during the previous week was discounted for the purpose of the sample. Two staff had evidence of having received two supervisory sessions, one in February 2006, the other April 2006. The remaining two carers had no evidence of having been supervised. The supervisory records seen did not provide clear indication that working codes of practice and/or the home’s aims and objectives were included as part of the process. Good practice suggests that structured supervision will include the home’s objectives and aspirations, together with methods of working for this to be achieved. The home’s approach to record keeping remains below that required by National Minimum Standards and regulation. Three service user files were reviewed which showed a number of omissions to the required information. One file seen, that should have contained at least eleven separate items of information, contained two. All three files indicated significant gaps. The registered person will need to review these documents to ensure that all information is being maintained. Various statutory records were sampled. The following were found to be incomplete or not available for inspection: • • • • • • • • A copy of the Statement of Purpose. A copy of the Service Users Guide. Incomplete records of persons employed. Staff supervisory records. Staff duty roster. Record of whether the roster was actually worked. A record of money or valuables deposited for safekeeping. A record of reportable occurrences in the home. This includes reports of theft, incidents detrimental to the welfare of service users and accidents/injury. Various policies and procedures within the home were not being adequately followed. This includes, for example, the complaint procedure, supervisory procedure, recruitment procedure, disciplinary procedure and reporting of statutory occurrences. Brookfield DS0000017783.V293884.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 1 2 1 2 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X 3 2 3 X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 2 2 1 X Brookfield DS0000017783.V293884.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 30/06/06 review and update the Statement of Purpose and Service User Guide. This is a repeat requirement. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must 30/06/06 ensure that each service user has a contract or terms and conditions at the point of moving into the home. No service user should move into 30/06/06 the home without having his/her needs assessed and being assured that these will be met. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must be 30/06/06 able to demonstrate that the home has the capacity to meet the assessed needs of service users. This is a repeat requirement. Previous action date was 10/02/06. The registered person must 30/06/06 ensure that prospective service users are invited to visit the DS0000017783.V293884.R01.S.doc Version 5.1 Page 27 Requirement 2. OP2 5(1) 3. OP3 14 4. OP4 12,14,15 5. OP5 14 Brookfield 6 OP7 7 OP8 8 OP10 9 OP12 10 OP14 11 OP16 home and ascertain the suitability of the admission. 15 The Registered Person must ensure that service users’ health, personal and social care needs are set out in an individual plan of care. This is a repeat requirement. Previous action date was 10/02/06. 13 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. Previous action date was 10/02/06. 13, 14, 15 The Registered Person must ensure that service users’ dignity is respected at all times. This is a repeat requirement. Previous action date was 10/02/06. 13, 15 The Registered Person must ensure that service users’ lifestyle within the home matches their expectations, preferences, needs and aspirations. This is a repeat requirement. Previous action date was 10/02/06. 15, 16 The Registered Person must ensure that service users are assisted to exercise choice and control over their lives. This is a repeat requirement. Previous action date was 10/02/06. 22 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. Previous action date was 10/02/06. DS0000017783.V293884.R01.S.doc 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Brookfield Version 5.1 Page 28 12. OP18 13,16,18, 19 13 OP19 23(2) 14. OP22 16 15. OP27 18 16. OP28 18, 19 17. OP29 19 18. OP30 18 The Registered Person must ensure that the service follows a clear procedure that will prevent service users from abuse. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that the homes layout is suitable for the needs of service users. This is in relation to wheelchair users. 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. Previous action date was 10/02/06. The Registered Person must ensure that the numbers and skill mix of staff meets service users’ needs. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that service users are in safe hands at all times. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that a thorough recruitment procedure is operated which ensures the protection of service users. This is a repeat requirement. Previous action date was 10/02/06. 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. Previous action date was 10/02/06. 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 29 19 OP31 9 20 OP32 9, 10 21 OP33 9,10, 24, 26 22. OP36 18 23. OP37 17, 26 The Registered Person must ensure that the home is managed in a competent manner. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that service users benefit from the ethos, leadership and management approach of the home. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that the home is run in the best interest of service users. This is a repeat requirement. Previous action date was 10/02/06. The Registered Person must ensure that the staff are appropriately supervised. This is a repeat requirement. Previous action date was 10/02/06. 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. Previous action date was 10/02/06. 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 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 OP24 Good Practice Recommendations It is recommended the Registered Person undertake regular reviews of the home’s furniture and fittings to ensure that it is fit for purpose. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 30 2. 3. OP28 OP35 It is recommended the Registered Person ensure that at least 50 of care workers are qualified to NVQ level 2 or equivalent by December 2005. The registered person is recommended to ensure that adequate accounting procedures are adopted when accepting cash and valuables from service users to be held in safe custody in the home. Brookfield DS0000017783.V293884.R01.S.doc Version 5.1 Page 31 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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