Inspection on 19/07/05 for Brookfield Christian Care Home

This inspection was carried out on 19th July 2005.

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

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

Other inspections for this house

Brookfield Christian Care Home 28/10/08

Brookfield Christian Care Home 29/11/07

Brookfield Christian Care Home 17/05/06

Brookfield Christian Care Home 17/01/06

Brookfield Christian Care Home 09/06/04

Brookfield Christian Care Home 29/04/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Brookfield Christian Care Home Little Bury Oxford OX4 7UY Lead Inspector Annette Miller Announced 19 July 2005 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 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 Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brookfield Christian Care Home Address Little Bury, Oxford, OX4 7UY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01865 779888 01865 779444 Southern Cross Healthcare Services Limited Mr. Horace Grazette Care Home with Nursing 66 Category(ies) of DE(E); MD(E) registration, with number of places Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: On admission persons should be aged 60 years and over. The total number of persons that may be accommodated at any one time must not exceed 66, of which 33 may be in either the DE(E) or MD(E) category. Date of last inspection 09 June 2004 Brief Description of the Service: Brookfield is a purpose built home situated on the outskirts of the Greater Leys area of Oxford, overlooking open countryside. The home is registered to provide care for up to 66 residents aged 60 and over. Accommodation is provided on two floors. There are spacious lounges and dining rooms on both floors and all bedrooms are single with en-suite facilities consisting of a washbasin and toilet. Bathrooms are fitted with bathing facilities suitable for residents who need assistance. Gardens are provided, although the garden to the side of the home is open-plan and is only suitable for residents who are able to go out alone, or for residents who are accompanied. There is a small area of garden leading from one of the ground floor dining rooms that is enclosed with fencing and a locked gate. Garden furniture is provided. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by two inspectors over a period of seven hours. The inspection focused on talking to residents and staff to find out their views of the home. The availability of training was also discussed with staff and a tour of the building and inspection of documents took place. The Commission for Social Care Inspection (CSCI) received comment cards prior to the inspection from 22 residents, 28 relatives and five GPs. This was an extremely good response rate and the majority of respondents indicated they were satisfied with the care provided. Seven relatives considered the home had improved under the new manager and three specifically referred to the manager’s ‘effectiveness’. Some individual concerns were raised. For example, two residents said they did not like living in the home, one was dissatisfied with the food and 11 relatives considered staffing levels were inadequate. The responses from GPs showed that they were satisfied with the home, except that one GP thought that some staff members present during a GP visit were not always the staff who knew most about the residents. What the service does well: What has improved since the last inspection? Mr Grazette has introduced changes to the way in which the home is managed and these have met with general approval. Staff morale is improving and the number of staff leaving the home has decreased during 2005. The manager has set up weekly training sessions on a variety of topics and staff attendance is good. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 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 standard(s) 1 and 3. The home’s Statement of Purpose and Service Users’ Guide outline the services provided, enabling an informed decision to be made about admission to the home. EVIDENCE: The Statement of Purpose and Service Users’ Guide were examined and were found to provide comprehensive information about the services provided by the home. These document are sent to prospective residents and a copy of each document is kept in the information file in reception. The Service Users’ Guide is available, on request, in large print. The manager carries out an assessment on all prospective residents prior to admission, either in the resident’s own home or in hospital if that is their current situation, to determine whether or not the home can meet their health and social care needs. A pre-admission assessment form developed by the company is used to record the assessment. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 9 Assessment forms for two recently admitted residents were examined and, whilst all sections had been completed, the form did not cover all aspects of assessment listed in Standard 3.3 of the National Minimum Standards for Older People. Recommendation. An NHS nurse assesses residents who require nursing care to determine what contribution the NHS will make towards this care. The money is paid directly to the company, but it was not clear to the inspector how this money was being refunded to residents and clarification is being sought from the company. This matter will be reported on at the time of the next inspection. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 Every resident has a care plan in which his/her care needs are identified and where the action required is listed. The medication at this home is well managed, promoting good health. EVIDENCE: Overall, the computerised care plans examined reflected the residents’ care needs and how these needs were being met. There was evidence that psychological health was assessed and regularly monitored. On a few occasions, when changes had occurred in a resident’s condition, a record of the change was shown in the daily record, rather than on the care plan. Recommendation. A visiting GP commented, ‘Staff are very caring and any issues are dealt with, and the nurses are very good at communicating any concerns about the residents’. The nutritional needs of residents are assessed on admission and recorded on a nutritional assessment form. In order to provide greater information about how the level of risk is reached, it is recommended that the ‘MUST’ nutritional assessment tool is used. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 11 This tool has been developed by community dieticians and is a five-step screening tool to identify adults who are malnourished, at risk of malnutrition, or obese, and provides guidelines that can be used to develop a care plan. Recommendation. The medication system is in good order on both units and records are kept of all medicines received, administered and leaving the home. It was noted that a tick was entered on the administration record to show that a cream or lotion had been applied, but it was not clear who had applied it. A registered nurse confirmed that carers generally did this and that the nurse entered the tick, after checking with the carer that the medication for external use had been applied. The manager should review this procedure to ensure that the identity of the person applying creams and lotions can be identified, should a query arise. Recommendation. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. Recreational activities provide good opportunities for residents to be mentally stimulated. Visitors are made welcome to the home. EVIDENCE: Two activity organisers are employed to promote recreational activities and to organise trips to places of interest. They each work 20 hours per week. On 5 July 2005 a travelling theatre company visited the home and on the day of inspection a young musician was playing clarinet and piano music in one of the lounges, and it was clear that this entertainment was much appreciated by the residents. One-to-one activities are provided whenever possible. For example, a resident in a wheelchair is occasionally taken shopping by one of the activity organisers. A trip to a seaside resort is arranged twice a year and the next planned trip is on 21 August 2005. Out of the 22 comment cards received from residents, 15 thought the range of activities was good, four thought they were good ‘sometimes’ and one expressed dissatisfaction. Two did not respond to this question. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 13 There is ‘open’ visiting and residents can choose to see visitors in the privacy of their rooms or in one of the communal lounges. There are also four sun lounges that provide quiet areas at the end of each wing where residents and visitors can meet, as well as providing space for special occasions such as birthday parties. Meals are served in the spacious dining rooms, or in a resident’s room if this is requested. A relative commented during the inspection that she had enjoyed her lunch. Each day lunch consists of either a fish or a meat/chicken dish with potatoes and vegetables. Choice is offered at the time the meal is served. Pasta dishes are served occasionally and vegetarian options are always available. The use of frozen vegetables is kept to a minimum. Out of 22 comment cards received from residents, fourteen thought the food was good, four thought it was good ‘sometimes’ and two expressed dissatisfaction. One did not respond to the question and one was provided with liquid food via a feeding tube. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints system with evidence that complainants feel their views are listened to and acted upon. EVIDENCE: The complaints policy is referred to in the home’s Statement of Purpose and Service Users’ Guide, and a copy is displayed in reception. The company’s timescale for completing investigations is 28 days. The manager has dealt with six complaints since taking up appointment in January 2005. Comprehensive information about the nature of each complaint was provided in the home’s complaints file, as well as the action taken to resolve the matter, and the outcome. For example, a resident complained that his room was not warm enough. The manager arranged for supplementary heating to be provided enabling the complaint to be quickly resolved. New staff members receive training during induction about the protection of vulnerable adults, but regular updates are not planned into the training programme. Recommendation. There was a copy in the home of local guidelines on the protection of vulnerable adults (published by Oxfordshire County Council) and the company has provided its managers with a guide on matters relating to the protection of vulnerable adults to assist them in dealing with protection issues. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 26. Overall, the environment within this home is good and provides residents with an attractive and homely place to live. EVIDENCE: A full-time maintenance person is employed to undertake day-to-day maintenance and records are kept of work undertaken. There is an ongoing programme of redecoration and the bedrooms and communal rooms seen during the inspection were generally well decorated and furnished. The four sun lounges (one on each wing) are extremely pleasant rooms that provide quiet areas for residents and visitors. However, redecoration of these rooms should be considered, as wallpaper was loose and ripped in places. Recommendation. The home is purpose-built and is suitably equipped to maximise residents’ independence. All bedrooms have en-suite facilities consisting of toilets and washbasins, and grab rails are positioned appropriately to provide a safe environment. There are adequate baths and showers, of the appropriate type, for residents who need assistance. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 16 The main garden is open-plan and access is through the car park. It is not a secure area of garden and, therefore, is only suitable for residents who are independent, or who are accompanied. There is a small secure area of garden leading off one of the ground floor communal rooms. This provides safe open air space with a range of garden furniture. Three domestic staff and a laundry assistant were on duty to carry out cleaning and laundry tasks. The home looked clean and there were no odours. The housekeeper said that staff worked hard to eliminate odour by dealing immediately with spillages, as well as carrying out a regular carpet cleaning programme. Care staff said they were aware of the importance of dealing with incontinence as soon as it occurs and of emptying commodes promptly. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 After a period of high staff turnover and the frequent use of agency staff, this situation has now improved and has resulted in better continuity of care for residents. EVIDENCE: Over the past year the home has experienced a high level of staff turnover, as well as changes in key members of staff. The new registered manager was appointed in January 2005 but there is still a vacancy for a unit manager on the unit providing care for residents with mental health problems. The person recruited will need to have specialist knowledge in this area of care and, although the post has been advertised on several occasions, it is still vacant. As a result of staff leaving over the past year there are now only five carers (13 ) with NVQ Level 2 or above, although some new staff have recently registered to start this training. The national minimum standards for older people recommend that 50 of care staff should have a minimum of Level 2 NVQ by the end of 2005. Recommendation. The number of staff on duty on the day of inspection met the requirements of the home’s staffing notice. This notice sets out the minimum number of staff that must be on duty at all times. It is the responsibility of the manager to increase staffing above minimum levels to meet increased dependency levels. On the day of inspection there was a total of four registered nurses and nine carers for 61 residents and, from the inspectors’ observations, this level of staffing appeared appropriate for the present needs of residents. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 18 Staff files were randomly selected for inspection and those inspected were found to contain the information and checks required to ensure the protection of residents. An external trainer provides induction training to new staff, as well as giving updates on topics covered in induction to existing staff. A system of staff supervision has been implemented and copies of the documentation were seen within the individual staff files. A member of staff confirmed verbally that she receives one-to-one supervision with a senior member of staff on a regular basis and that a record of the issues discussed is kept. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 and 38 Attention to health and safety matters is generally good. The one exception to this is that the fire alarm system requires urgent work to ensure it is fully operational and capable of detecting fires. EVIDENCE: The inspector examined the records required by regulation and found them to be up to date, complete and stored appropriately. All members of staff receive mandatory training in moving and handling, fire safety and food hygiene. There are 20 members of staff who have a current first aid certificate. Training in infection control is included in the induction programme and further training is to be undertaken later in the year. The domestic and kitchen staff, and the care assistants have had training in hazardous substances and the use of these products. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 20 The written statement of the policy, organisation and arrangements for maintaining safe working practices is displayed in the staff rest room but the appointed person is the previous registered manager. The manager should identify a person to act as the home’s health and safety representative and to arrange for the required training to be provided. Recommendation. The service records, fire log, records of checks carried out on water temperatures and other safety checks within the building were examined and found to be in good order. During the course of this inspection the fire alarm sounded five times. On each occasion it was a false alarm and was activated from a faulty smoke detector in a resident’s bedroom. Each time the fire alarm sounded the staff immediately responded in accordance with the fire procedure. The manager said he had reported to the company the fact that the present smoke detectors were obsolete, but that action was still awaited. An immediate requirement was made for action to be taken regarding the faulty smoke detectors and, as a result, the company agreed for sections of the fire alarm system to be upgraded. Oxfordshire Fire Service was asked to provide advice to the company and a fire officer is monitoring the situation. There are close circuit security cameras placed around the outside of the building. The camera immediately outside the main entrance has an intermittent fault, which the manager has reported to the company, and a decision on appropriate action from head office is awaited. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x 2 Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? 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 38 Regulation 23(4) Requirement The manager must discuss with the fire officer the level of risk posed by the obsolete smoke detectors and inform the inspector of the outcome of this discussion, and the action taken to safeguard residents, visitors and staff. Timescale for action Within 48 hours of the date of inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 3 7 7 9 Good Practice Recommendations Update the pre-assessment form to include all aspects of assessment shown against Standard 3.3. Any changes in a residents care needs should be reflected in the care plan, rather than in the daily record. Implement the MUST nutritional assessment tool. Review the procedure for recording that creams and lotions have been applied. H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 23 Brookfield Christian Care Home 5. 6. 7. 8. 18 19 28 38 Arrange for staff to attend regular updates on the protection of vulnerable adults. Review the standard of decoration in the four sun lounges and redecorate as needed. Identify strategies that will encourage staff to undertake NVQ training. Identify a health and safety representative from within the workforce and provide the necessary training. Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brookfield Christian Care Home H57-H08 S27141 Brookfield V229976 190705 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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