Inspection on 23/05/06 for Brookfield House Care Home

This inspection was carried out on 23rd May 2006.

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

The inspector 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 House Care Home 11/09/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brookfield House Care Home Brookfield Park Shrewbridge Road Nantwich Cheshire CW5 7AD Lead Inspector Ms Julie Porter Key Unannounced Inspection 10:00 23 & 25th May 2006 rd 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 House Care Home DS0000066254.V290708.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 House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brookfield House Care Home Address Brookfield Park Shrewbridge Road Nantwich Cheshire CW5 7AD 01270 624951 01270 624951 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) Mr Jayantilal James Bhikhabhal Patel Mrs June Jones Care Home 35 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (35) Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home is registered for a maximum of 35 service users in the category OP (Old age, not falling within any other category) One (1) service user in the category MD(E) (Mental disorder, excluding learning disability or dementia - over 65) may be accommodated within the maximum of 35 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 09/02/06 Date of last inspection Brief Description of the Service: Brookfield House provides care for thirty-five older people. It is located in Brookfield Park about one mile from Nantwich town centre, which has a range of shops, pubs and other amenities. It is within walking distance of the River Weaver and Nantwich Lake. The home is a two-storey building with a passenger lift providing access between the ground and the first floor. A variety of lifting aids, hoists and grab rails are provided for residents with mobility problems. All bedrooms are single and contain hand-washing facilities; some of the bedrooms also have en-suite toilets. Staff are on duty twenty-four hours a day to deliver care to residents. The home charges between £400 and £410 per week for residential care. This information was provided on the pre-inspection questionnaire completed by the manager and submitted to CSCI on 04 May 2006. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 23 May 2006. Five residents, five relatives and seven staff were spoken with during the inspection. Three residents’ care plans were inspected; three members of staff and a number of the homes records were seen. The visit also included a tour of the premises. Feedback on the findings of the inspection was given to the manager and a representative from the owner on 25 May 2006. What the service does well: What has improved since the last inspection? What they could do better: Risk assessments relating to daily living, in particular when someone has been identified as being at risk from falls, must be produced to identify what the risks are and what is required to minimise them. All residents must receive care/treatment in private to maintain privacy and dignity. A record must be kept in the home of all complaints made, with the details of complaint, the investigation and the outcome. Staffing rotas need to ensure that supervisors work directly with the people they supervise to ensure their care practices can be monitored. Accident records must accurately reflect all accidents that happen in the home. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 6 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 House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. There are processes in place to enable potential residents and their relatives to find out about the home but improvements are needed so that residents have all the information they need about the home. EVIDENCE: There is written information about the services the home can offer, so potential residents and their families can make a choice regarding their move to the home. This information was provided in one document that was overly complicated in the content and lay out. See recommendation 1 Two residents spoken with confirmed that they either knew or visited the home before they moved there. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 9 A new owner took over the home in March 2006 and is currently reviewing all the documents and contracts to ensure they provide up-to-date information. See recommendation 2 Before the change of ownership, the previous owner assessed new residents before they moved into the home. This will now be done by the manager and there is new assessment documentation available. However, as no new residents have moved in since March, the new system has not yet been used. See recommendation 3 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Records in relation to care were not always sufficiently accurate to ensure that residents needs were being met appropriately and safely. EVIDENCE: During the visit, the care plans for three residents were inspected. They were being reviewed regularly and contained basic information regarding the practical support needed for the residents. Staff were observed providing good support for residents with confusion, using prompts such as favourite songs or memories, and this should be recorded to enable all staff to work in the same way. One care plan contained conflicting information regarding the level of support one resident needed in relation to personal hygiene i.e. “one carer to support” was identified in one document but “independent” was noted in another. Two care plans identified that the residents were at risk from falls but there was no record how the home was managing this. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 11 See requirement 1 Evidence was seen that the residents have access to community health services and a record is kept of visits made by doctors, nurses and other health care professionals. On the day of this visit, the chiropodist was at the home and residents were receiving treatment in one of the lounges. Arrangements need to be made to ensure the residents can receive care in private. See requirement 2 Medication records were reviewed for the three residents and on the whole the storage and recording was good. There was a discrepancy of 3 soluble pain relief tablets and so full audit trail could not be traced. See recommendation 4 The daily record for one resident identified that she had received a recent injury; however no accident form had been completed. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 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 the following standard(s): 12 - 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Improvements need to be made to the activities programme and to involving advocates to help residents make appropriate choices. EVIDENCE: Visitors were seen coming and going throughout the day of this visit. Five relatives were spoken with and commented positively about the home and its staff. They confirmed they could visit at any time of the day and were always made to feel welcome. The home has a designated activities coordinator who involves the residents with board games, music, videos etc. A number of residents said they would like to do more exercise and this should be explored. Residents spoken with said they didn’t know which activities would take place so they didn’t know if they would like to be involved or not. Residents’ views and interests should be sought to develop a structured activities timetable to include their likes, hobbies and interests. See recommendation 5 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 13 Residents’ religious preferences are recorded and one resident said that she goes to church when well enough. Alternatively she has visitors from the church, which is a “great comfort” to her. A number of situations are ongoing in the home that are outside the expertise or responsibility of the staff. The manager should actively promote the use of external agencies and independent advocacy services for e.g. Age Concern who will support residents in making choices. See recommendation 6 Residents said that they could choose when they get up and when they went to bed. On the day of the visit, residents were seen taking lunch either in the dining room or in their own rooms. Lunch was well presented and the food sampled was tasty and hot. However one resident commented that the standard and quality of the food was not to her taste. Some improvements have been made to the décor. Access to the manager’s office and to the staff break area is through the dining room and this can be disruptive to residents when taking meals. See recommendations 7 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 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 the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Residents and relatives are confident that they are listened to so that their concerns are responded to promptly. Staff have received training so that residents are protected from harm. EVIDENCE: The complaints procedure was readily available in the home but had not been updated to provide information about who to complain to since ownership of the home had changed. See requirement 3 Relatives spoken with said they had reported a concern directly to the new owner and had received a timely response from him. Other family members and residents were unclear about making a formal complaint although they felt confident to express their concerns and confirmed that verbal complaints were responded to appropriately. The information provided by the manager on the pre-inspection questionnaire stated that the home had not received any complaints. See requirement 4 and recommendation 8 All staff have recently completed training in relation to Adult Protection. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 24, 25 & 26. Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The environment of the home is safe and comfortable for the residents and the refurbishment programme will improve it further. EVIDENCE: The visit included a tour of the building and meeting with residents in their rooms, with their agreement. It was evident that maintenance and refurbishment work is being carried out in the home. The homeowner has provided an action plan dated 20 April 2006 relating to proposed refurbishment of the home, showing that the majority of the work will be completed by October 2006. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 16 The layout of the home remains unchanged with residents having access to all the communal areas. Some bedrooms have en-suite facilities. Brookfield Park, which is open to the public, is at the front of the home. At the rear there is a large secure well maintained garden, accessible to residents and their visitors. The home was clean and fresh throughout. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Robust recruitment processes are in place to ensure the residents are safe and staff received training so that they can meet the needs of the residents appropriately. EVIDENCE: The home has developed a continuing programme of training which covers mandatory training. Following a requirement made at the last inspection the programme now covers training on dementia care and NVQ training for staff. Information provided by the home before the visit identifies that 50 of care staff have achieved NVQ at level 2 on above. Three staff personnel files were inspected and were satisfactory. Residents and visitors were very complimentary about the staff commenting; “staff are very nice”, “staff are lovely”, “oh they are very good, dad only has to ask” Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 18 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The manager is aware of her responsibilities in respect the day-to-day running of the home to ensure the residents are well cared for. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and has recently completed the Registered Managers Award NVQ level 4. The staff structure is such that the staff are supervised daily by senior staff; the manager supervises the senior staff. The staffing rota identified that the manager generally works with the same people each week and therefore cannot appropriately supervise the whole of the senior team’s practice. See requirement 5 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 19 The home holds small amounts of money for residents who are unable to do so for themselves; the records for these were satisfactory. Information provided by the manager before the this visit indicated that up to date safety certificates were in place for the following: • • • • • • Fire equipment Gas installation Electrical wiring Passenger lift Emergency call systems Bath hoists Accident records were inspected. One accident recorded on the resident’s care plan had not been recorded. See requirement 6 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 20 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 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 2 X 2 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 13 Requirement A risk assessment must be in place for all residents identified as being at risk from falls which identifies the action to be taken to minimise those risks. Treatment and care of residents must be provided in a way that promotes privacy and dignity Treatment and care of residents must be provided in a way that promotes privacy and dignity The complaints procedure must include correct information about who to complain to. All complaints must be recorded and fully investigated All staff must receive appropriate supervision The accident record must reflect all accidents that occur in the home Timescale for action 31/07/06 2 3 4 5 6 7 OP10 OP8 OP16 OP16 OP36 OP38 12 12 22 22 18 17 30/06/06 30/06/06 31/07/06 31/07/06 31/07/06 31/07/06 Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 22 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 5 6 7 Refer to Standard OP1 OP2 OP9 OP12 OP14 OP15 OP16 Good Practice Recommendations The home’s Statement of Purpose and Service Users guide should be reviewed with a view to simplifying it. The review of all documentation should be undertaken within an appropriate timescale to ensure the residents are provided with accurate information. A full audit trail for all medication received in the home should be available Residents’ interests and hobbies should be taken into account and incorporated into a structured activities programme. Advocates and advocacy services should be available for those residents who need them. Consideration should be given to relocating the managers’ office and staff break area. Once the complaints procedure has been up-dated it should be re-issued to all interested parties. Brookfield House Care Home DS0000066254.V290708.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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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