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Inspection on 29/11/07 for Brookfield Christian Care Home

Also see our care home review for Brookfield Christian Care Home for more information

This inspection was carried out on 29th November 2007.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a complaints procedure in place and this is displayed in the entrance hall. This is considered by the inspector to be good practice. In the last twelve months the home has received twenty-two complaints, and resolved within twenty-eight days. The home records all complaints whether received by letter or verbally. All complaints were seen to be appropriately recorded with action taken and outcomes clearly detailed. Service users stated that they knew how to make a complaint about the care provided. The home is purpose built and is maintained to a good standard. The location and layout of the home is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities and gardens. From a sample of staff files it was evident that the home has robust recruitment procedures in place. Two senior staff conduct all interviews and interview process is recorded.

What has improved since the last inspection?

The premises have benefited from a refurbishment programme. The manager has completed the Registered Managers Award. It is acknowledged that the manager is slowly improving the quality of care provided to service users.

What the care home could do better:

Standards associated with pre admission assessments, care planning and meeting service users assessed needs, service users privacy and dignity and staff supervision are subject to good practice recommendations and requirements.

CARE HOMES FOR OLDER PEOPLE Brookfield Christian Care Home Little Bury Oxford OX4 7UY Lead Inspector Marie Carvell Unannounced Inspection 29th & 30th November 2007 11.15 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 Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookfield Christian Care Home Address Little Bury Oxford OX4 7UY 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) 01865 779888 01865 779444 brookfield@schealthcare.co.uk Trinity Care (Brookfield) Ltd Mrs Susan Jane Chapman Care Home 66 Category(ies) of Dementia - over 65 years of age (33), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (33), Old age, not falling within any other category (33) Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 21st September 2007 –Thematic Inspection Date of last inspection Brief Description of the Service: Brookfield Christian Care Home 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. Spacious bathrooms with assisted baths are available. There is a small garden surrounded by fencing leading from one of the ground floor lounges. Ample parking is available at the front and side of the home. The range of fees for this home is £524.00 to £ 848.00 per week. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers, toiletries and physiotherapy. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’ carried out over two days. The inspector arrived at the service at 11.15 and was in the service until 17.00 on the first day and from 9.40 until 16.50 on the second day. It was a thorough look at how well the service is doing. It took into account detailed information provided by the registered manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to surveys that the Commission had sent out. Three relatives, two healthcare professionals and four members of staff responded to surveys sent out. In addition one relative requested to speak to the inspector by telephone and time was spent with one relative visiting during the first day of the inspection. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standards of the service. The inspector toured the building, examined records and met with service users individually and as a group. The inspector also spent time with the operations manager, manager, nursing, care and ancillary staff. In addition the inspector spent time observing how care was being delivered to service users and joined service users for lunch on both days of the inspection. At the (main) inspection carried out in May 2006, three good practice recommendations were made; these are referred to in the body of the report. An additional unannounced, thematic inspection was carried in September 2007. This was a short, focused inspection that looked in detail at the quality of care people with dementia receive in the home. At this inspection an additional five good practice recommendation were made, these are referred to in the body of this report. Feedback was given to the manager and operations manager, who were present throughout the two days. What the service does well: The home has a complaints procedure in place and this is displayed in the entrance hall. This is considered by the inspector to be good practice. In the last twelve months the home has received twenty-two complaints, and resolved within twenty-eight days. The home records all complaints whether Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 6 received by letter or verbally. All complaints were seen to be appropriately recorded with action taken and outcomes clearly detailed. Service users stated that they knew how to make a complaint about the care provided. The home is purpose built and is maintained to a good standard. The location and layout of the home is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities and gardens. From a sample of staff files it was evident that the home has robust recruitment procedures in place. Two senior staff conduct all interviews and interview process is recorded. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 and 5. Standard 6 is not applicable, as the home does not provide intermediate care. Quality in this outcome area is adequate. Service users are not always fully assessed prior to admission to ensure that their needs can be effectively met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of service user files were case tracked. It is not always evidenced that a full assessment of need is undertaken prior to admission. One service user file stated that the manager of another home had carried out the pre admission assessment. A copy of a service user’s contract, physical and social needs assessment, client social profile, pre-admission draft care plan, new Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 10 client admission checklist (to be completed within 24 hours of admission), body mapping on admission form, malnutrition universal screening tool (MUST) were all blank. Files seen either contained blank documentation as described or if in place were not dated and/ or signed. Files for some service users admitted to the dementia care unit included background information unusually provided by family members. None of the service user files seen evidenced that the service user had been able to visit the home before moving in on a trial period. Several files confirmed that the service users had not been offered the opportunity to visit the home. In discussion with some service users, the inspector was informed that relatives had been able to look around the home and had made the decision on behalf of the service user. The inspector discussed with the operations manager and manager the inappropriate manner in which a newly admitted service user to the dementia care unit was taken straight into the busy dining room. The manager agreed to address the issue with the staff concerned. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Standard 7 was subject to a good practice recommendation at the inspection carried out in May 2006 and standard 10 was subject to five good practice recommendations at the thematic inspection carried out in September 2007. Quality in this outcome area is adequate. Care plans need to contain sufficient information to demonstrate that the needs of the service users are being met. Medication storage, administration and recording were maintained to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Form examination of a sample of service user files, it was not evident that the service user/advocate is involved in the care planning process. Not all care Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 12 plans were signed and dated. Care plans were not in sufficient detail to ensure that all staff are familiar with the care needs of each service user, when care is to be provided or how. Care plans made no reference to cross gender care preferences, psychological health, nutritional screening or end of life care. Entries made in daily contact sheets did not consistently validate information recorded in care plans. The manager confirmed that there is a need to develop more person centred care plans and to develop life histories for all service users. Further care planning and record keeping training is to be provided to all nursing and care staff. A the last inspection in May 2006 a good practice recommendation was made that the manager should discuss the use of the short stay care documentation with the registered nurses. The manager confirmed that this had taken place. Nursing staff complete all entries in daily contact sheets, however care staff complete on a daily basis a personal hygiene record. It is not clear how nursing or senior staff in the home are monitoring that personal hygiene care needs are being met. From a sample of six personal hygiene records, completed for November, it was noted that none of the service users had, had an immersion bath, although this was not recorded on the care plan as to why one should not be undertaken. All records contained gaps in recordings, which implied that on some days no personal hygiene care had been provided. Records demonstrated that service users generally have an upper and lower body wash or occasionally a bed bath. Little regard to given to teeth/denture care, finger/toe nail care, self-image or spectacle/hearing aid care. Some service users require more attention being given to personal hygiene needs and the manager’s attention was drawn to many service users with fingernails, which were dirty, broken and long. The managers attention was also drawn to the fact that at least one service user urgently needed chiropody treatment for long toenails and a service user who needed to see a GP regarding a possible eye infection, drawn to the attention of a nurse the previous day. Service users were mixed in their views about life in the home; several service users said that the care and facilities were ‘excellent’ whilst others said that the care could be ‘better’. Feedback from surveys completed by relatives and discussion were mixed, comments included ‘ staff are always happy, caring, friendly and helpful’, ‘there can sometimes be problems with staff whose first language is not English (do not grasp idiomatic/colloquial English)’, ‘staff understand the needs of dementia patients and how to meet them’, ‘the staffing levels satisfy the legal requirements, but higher levels of staffing would permit staff to spend more time with residents. This would benefit both the residents and the staff, who genuinely want to interact with the residents’, ‘I am satisfied that the staff care for my X well, and I think they are genuinely fond of X’, ‘ I have been very disappointed recently’, ‘ my X cannot communicate because of a stroke and I have to ask staff to do ordinary everyday things for X, e.g. cut X finger nails, clean X hand that is always closed, put poligrip on X false teeth, and give X a plastic cup that is easier for X to hold. I have had to request these simple things many times’, ‘very Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 13 disappointed’, ‘some staff are very pleasant’, ‘it is the long wait for details/information that concern us’,’ and sometimes we have been very disillusioned lately’. The medical needs of service users are met by several GP practices. One survey completed by a healthcare professional stated that the home staff ‘always’ seek advice and act on it to manage and improve individual’s health care needs and individual’s health care needs ‘usually’ met by the home. Medication storage, administration and recording appeared to be satisfactory. The manager was carrying monthly medication audits. Service users are able to take responsibility for their own medication following a medication assessment and risk assessment. No service users currently manage their own medication. At the Thematic inspection undertaken in September, five good practice recommendations were made, primarily with reference to the dementia care unit, but also apply equally to the frail elderly unit. The good practice recommendation were in relation to providing training to look at ways of responding to the needs of all service users and engaging with each of them, improving the management of mealtimes to make sure that those service users needing assistance were not treated less favourably, ways of engaging service users in activities need to be explored to make sure that everyone is offered chances for stimulation, details of the persons background and preferences are to be obtained and added to the care plan, to ensure that important information is not lost and a care plan specifying a liquidised diet for a service user is amended to reflect that care needs have changed. Four of the recommendations have not been fully actioned. As in many other care homes, there is a wider range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the nurse on duty, the inspector considers that the home would be able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Standard 15 was subject to a good practice recommendation at the inspection carried out in May 2006. Quality in this outcome area is adequate. Arrangements are being put into place to provide a range of activities to meet the needs of the service users and food choices and meal times have improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two part time activity organisers are in post. One is employed to work on the dementia care unit for five hours per day from 8.30am until 1.30pm, Monday to Thursday. The second activity organiser is employed to work on the frail elderly unit and is also employed as a care assistant. During October 2007, an average of 16.25 hours per week was allocated to undertaking activity and recreational tasks on the frail elderly unit. Five hours being worked at week ends. One service user said she was very interested in knitting and handicrafts, which kept her busy and that lots of activities are planned for the Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 15 Christmas period with carol concerts, a party, outside entertainers and a raffle. During the inspection the activity organiser for the dementia unit was on leave and care staff were observed to be sitting, chatting with service users and reading magazines and newspapers together. On the frail elderly unit the activity organiser was on duty the first day of the inspection. No activities were observed, other than one service user being asked if she would like to be taken shopping in Cowley shopping centre. The service user later said that she had very much enjoyed her outing. However, although the needs of one service user was able to be met, this meant that the remaining fifty nine service users, received no input from the activity organiser. An activity programme is displayed in the entrance hall of the home and states that it is subject to change. Several service users said that they would like more activities such as bingo and games, other service users said that they did not wish to join in group activities and were happy to read their newspapers, books and watch television in their own bedroom. Care staff complete an recreational activities record when an activity has been completed. The manager confirmed that she intends to continue to develop and diversify activities within the home over the next twelve months. Relatives meetings take place; the minutes of the meetings held in January and September 2006, and September 2007 were seen. The next meeting is planned for January 2008. Many of the service users have friends and family who are able to visit on a regular basis. Service users are encouraged to maintain contact, as far as possible, with the local community. At the thematic inspection a good practice recommendation was made that consideration is given to improvement management of meal times. The inspector joined service users for lunch on the frail elderly unit over two days. On the first day the meal was adequate, and service users were given a choice of two main courses. In this dining six service users were seated for lunch. One service user was being assisted by her daughter and three service users needed staff assistance with eating their meal. Staff were seen to be busy and not able to assist all service users with eating their meal for some time. One service user with a visual impairment constantly shouted out ‘ have I done something wrong’ and was clearly struggling to eat the food placed in front of him/her. This continued until the relative asked staff to assist. Another service user had a broken arm and eventually staff assisted this service user to eat his/her meal. A third service user recently moved from the dementia care unit was said to require finger food, (food that can be handled by the service user). The nurse serving lunch was unclear as to what this service user was having for lunch and informed the inspector, that the service user would have vegetables. From a comment made by a member of staff it was implied that this service user is frequently given vegetables only. The inspector challenged this and the service user was given a plate of turkey casserole and vegetables. Service users told the inspector that it was disappointing that no gravy was Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 16 available, but that usually the food serviced was very good. It was unclear how the food intake of service users is monitored as no records are maintained. The manager agreed to address this. Time was spent with the chef on duty during the second day of the inspection. It was confirmed that the catering team were unaware of a service user requiring finger food and this was addressed during the inspection. On the second day the inspector joined service users in a second dining room on the frail elderly unit. The food was attractively service, staff were attentive and service users were assisted in a discreet manner. Tables were attractively laid with condiments and napkins. Since the thematic inspection “ protected mealtimes” have been introduced in the home, which means that all nursing staff are available in the dining rooms observing meals being served, rather than carrying out other tasks such as medication rounds. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good. The home has a satisfactory complaints process in place. Policies and procedures are in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and this is displayed in the entrance hall. This is considered by the inspector to be good practice. In the last twelve months the home has received twenty-two complaints, and resolved within twenty-eight days. The home records all complaints whether received by letter or verbally. All complaints were seen to be appropriately recorded with action taken and outcomes clearly detailed. Service users stated that they knew how to make a complaint about the care provided. Comments include ‘ Speak to the manager’, ‘ speak to the staff’ and my son/daughter would deal with this’, ‘ You only have to tell someone’, ‘ I would talk to the nurses’, ‘ My son/daughter gets in touch with head office’. Comments made on surveys completed by relatives to the question do you know how to make a complaint about the care provided included ‘I haven’t know who to make a complaint, but have spoken to the manager’, two relatives confirmed that they know how to make a complaint. In discussion with service users, most said Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 18 that they felt that their concerns were listened to, taken seriously and addressed. Since the last inspection in May 2006, the Commission has received information concerning five concerns and three complaints about the service. These have been referred to the organisation for action to be taken. All staff receive training in the home’s policies and procedures for protecting service users from abuse and the homes whistle blowing policy. Training is provided to all new staff as part of their induction course and then updated on a regular basis. The home has a copy of the Oxfordshire Safeguarding Adults procedures. Two safeguarding adults referrals have been made in the last year. One referral was not substantiated. One safeguarding adults investigation has taken place. No referrals have been made for inclusion on the POVA (Protection of Vulnerable Adults) list. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,21,22,23,24,25 and 26. Quality in this outcome area is good. The home provides safe, well-maintained and spacious accommodation for service users. The home was found to be clean, hygienic and free from unpleasant odours. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purpose built and is maintained to a good standard. The location and layout of the home is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities and gardens. Communal areas of the home are comfortable and well furnished. Hot water outlets in bedrooms and bathrooms are maintained at the recommended temperatures. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 20 All windows are fitted with window restrictors and radiators are covered. A call alarm system is fitted in all bedrooms, bathrooms and communal areas of the home. All bedrooms are for single occupancy and have en-suite shower, wash hand basin and toilet. Bedrooms are of a generous size and accommodate wheelchairs and aids with ease. Service users are encouraged to personalise their rooms Most have a television set and some have private telephones. Communal bathrooms and toilets are fitted with appropriate aid and adaptations to help maintain independence. All areas of the home were seen to be clean, well maintained and free from unpleasant odours. From discussion with a member of the housekeeping staff on duty, it was evident that staff take pride in maintaining high standards of cleanliness. There is an ongoing refurbishment programme in place. The laundry is well equipped. All housekeeping and laundry staff have received training in COSHH, infection control and health and safety. Policies and procedures are in place. Staff are provided with protective clothing, such as disposable aprons and gloves for use when carrying out personal care to service users. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30. Quality in this outcome area is good. Staff recruitment procedures are robust and protect service users from harm. Staffing levels are adequate to meet the needs of the service users. Staff are well trained and competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From discussion with the manager, deputy manager, staff on duty and examination of duty rosters, staffing levels appear to be sufficient to meet the care needs of the service users. Each of the two units has two registered nurses and five care assistants on duty from 8am until 8pm, supported by a team of catering, laundry and housekeeping staff. One registered nurse and three care assistants are on duty on each unit from 8pm until 8am. Duty rosters do not evidence that a handover period takes place at the start of each shift, the manager agreed to address this. In the last year seventeen full time and seven part time staff have left employment at the home, for a variety of reasons. Exit interviews do not always take place. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 22 Currently the home has a vacancy for a part time registered nurse and 110 hours care assistant hours to cover day and night duties. The home continues to be dependent on the use of agency staff and although most agency staff work in the home on a regular basis this does not allow for continuity of care to service users. The inspector was advised that three care staff are qualified to NVQ level II or above and nine care staff are working towards NVQ level II. All staff complete a detailed induction programme that meets Skills for Care standards. Each member of staff has a training and development programme. Training is well organised in the home with all staff completing mandatory training as well as specialist training as appropriate to meet the needs of the service users. Updates are provided as appropriate. From a sample of staff files it was evident that the home has robust recruitment procedures in place. Two senior staff conduct all interviews and interview process is recorded. The inspector discussed with the manager and operations manager that whilst staffing levels are satisfactory, there appears to be a lack of leadership and communication between the nursing and care staff on duty. This has already been identified and the manager and operations manager are considering action to be taken to improve this. Communication systems in the home need to be improved, it was unclear whether staff meetings are held on a regular basis. The inspector was given incomplete minutes of a trained staff meeting held at 1pm on the 12th October 2006 followed by a staff meeting held at 1.30pm. Surveys completed by staff confirmed that information passed about service users between staff ‘ usually’ worked well, that there is ‘usually’ enough staff to meet the needs of service users and ‘sometimes’ feel that they have the right support, experience and knowledge to meet the different needs of service users. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,36 and 38. Standard 31 was subject to a good practice recommendation at the inspection carried out in May 2006. Quality in this outcome area is adequate. The manager is working hard to improve the quality of care provided to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is an experienced nurse and manager and completed her Registered Managers Award, earlier this year. She is supported by a deputy manager, who in addition to carrying out some management task provides Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 24 care to service users on the dementia care unit as one of the two registered nurses. At the last inspection in May 2006 a good practice recommendation was made that the manager should make time in her busy schedule to get out of the office and meet the service users and staff each working day. The manager confirmed that this has been addressed. Several service users said that they don’t always see the manager each day. Quality Assurances systems are in place and the manager carries out monthly audits. It is not clear how the views of service users are sought to demonstrate that the home is being run in the best interests of the service users. In September 2007, surveys were sent out to 64 service users in the home, only 24 were returned. The information received has not as yet been collated, despite some of the responses received. The operations manager agreed to collate the responses and an action plan to address concerns expressed. Service user meetings do not take place and the manager is considering alternative ways of seeking the views and opinions of service users. Procedures are in place for dealing with service users monies, financial records are well maintained and receipts obtained for all expenditure s made on behalf of a service user. The manager advised the inspector that all staff receive formal 1-1 supervision at least six times per year. In discussion with staff this was disputed, several members of staff said that they did not receive any supervision and one member of staff said he/she remembered a senior member of staff observing her practice and ticking a checklist. This was discussed with the manager, who confirmed that this was the process. None of the nursing staff have received supervisory skills training. Previously staff were seen in private and a discussion took place, which did meet the National Minimum Standards. This is subject to requirement. All nursing staff receive bi-monthly clinical supervision. Reports written by a provider representative, following monthly visits to the home, were available for examination by the inspector. A sample of records relating to health, safety and welfare were examined and found to be up to date and well maintained. Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 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 X X 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 1 X 3 Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 30/01/08 2 OP7 15 Evidence must be available to demonstrate that all service users admitted to the home have been fully assessed Care plans must be in sufficient 30/01/08 detail to ensure that all staff are familiar with the specific care needs of each service user, when care is to be provided and how. Information recorded must include cross gender care preferences, how psychological healthcare needs are to be met and end of life care. All staff must receive formal supervision at least six times per year by an individual who has undertaken supervisory skills training. 30/01/08 3 OP36 18 Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 27 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 OP10 Good Practice Recommendations Training for all staff should be considered to look at ways of responding to the needs of all of the service users and engaging with each of them. This should then be monitored through one to one supervision. Ways of engaging service users in activities, needs to be explored to make sure that everyone is offered chances for stimulation. Details of the service users background and prefences should be obtained and added to the care plan, to make sure that no important information is lost. Consideration should be given to seeking the advice of a dietician or speech and language therapist about providing a varied diet to service users, who prefer to eat finger foods. Consideration should be given to improving communications between care and nursing staff on each shift, to ensure that the needs of service users are being met. Consideration should be given to how the views of service users are sought on a regular basis. 2 3 4 OP10 OP10 OP15 5 OP30 6 OP33 Brookfield Christian Care Home DS0000027141.V353213.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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