Inspection on 26/05/06 for Brookfield House Nursing Home

This inspection was carried out on 26th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brookfield House Nursing Home 09/05/07

Brookfield House Nursing Home 03/10/06

Brookfield House Nursing Home 01/11/05

Brookfield House Nursing Home 20/12/04

Brookfield House Nursing Home 12/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Brookfield House Nursing Home Forton Road Newport Shropshire TF10 7JL Lead Inspector Janet Adams Announced Inspection 26th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brookfield House Nursing Home DS0000022238.V293800.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 Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brookfield House Nursing Home Address Forton Road Newport Shropshire TF10 7JL 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) 01952 810288 01952 810029 Mrs Margaret Jones Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 25 June 2001. The home may accommodate a maximum of 18 Elderly persons of whom 5 may be suffering with dementia. 1st November 2005 Date of last inspection Brief Description of the Service: Brookfield House is a Nursing Home situated in the market town of Newport, Shropshire. Being close to the Town Centre the Home benefits from a good range of shops and other facilities, and can be easily accessed from neighbouring towns and villages via public or private transport. The original Victorian building has been extended to provide additional ground floor accommodation, offering both single and double accommodation. A passenger lift provides access to the first floor bedrooms. There are two communal lounges, which are located on the ground floor. One has dining facilities. The front of the home has a secluded well-maintained garden that provides safe and accessible areas for all service users. The home owner makes services known to prospective service users in Brookfield House’s Statement of Purpose and Service User Guide. This information is on display in the entrance hall. The current fees charged vary between £338 and £450 per week depending on the care package required. The Home is owned, and managed, by Mrs Margaret Jones, who is supported by a team of qualified nurses, care staff, ancillary staff, a handyman, and a gardener. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by one inspector lasting seven hours. It included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, observing, talking and listening to nearly all of the 17 people living there, a few visitors, and the staff on duty at the time of the inspection. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share valid comments which are included in the main body of the report. They also made some written comments for the inspector, about what the home does well, what has improved and what could be done better. The Registered Manager Mrs Jones was on duty at the time of the inspection. Everyone, including residents and staff were very welcoming and helpful throughout. A total of 29 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. Feedback was given to the Registered Manager/ proprietor in the presence of the CSCI (Commission for Social Care Inspection) Regulation Manager. What the service does well: What has improved since the last inspection? A sluicing disinfector has been delivered to the home and is awaiting installation - this will improve infection control measures in the home. When residents were asked what had got better since the last inspection, many commented that they did not think much could be made better for them. One resident commented that the entertainment arrangements were getting to be more regular. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 6 What they could do better: The records kept at the home do not reflect the good standards of care delivery seen. Recordkeeping in care plans needs to be expanded to ensure all necessary information is kept up to date to realistically reflect the care the residents need and get. This includes nursing needs for equipment such as bedrails and the other equipment individuals use every day. Medication storage needs to be reorganised so it is all kept safe. As recorded at previous inspections, CSCI are becoming increasingly concerned about the location of the passenger lift which opens into a bedroom shared by two very frail residents. One of these individuals is on permanent bed rest. Priority must be given to ensure maximum privacy for these people. Some parts of the home that show signs of wear and tear need attention, including a communal toilet, bathroom and double bedroom. Hot water in one bathroom used by service users was tested to be running too hot at 50 Degrees Centigrade. An ‘Immediate Requirement Notice’ was issued on the inspection day about this to make sure it was remedied as a matter of urgency. Not all radiators have safety guards installed, and portable heaters were seen in bedrooms without guards or ways of keeping them secure. Over the past year CSCI have been aware of proposed management changes at Brookfields. Although the current Registered Manager/Proprietor will continue to play an active role at Brookfields, many responsibilities are to be delegated to other team members. It was reported that some of the following shortfalls of this inspection might be as a result of this changeover period. Management issues requiring remedial action include:• There appeared to be a lack of day to day activities organised for all residents. • The system to manage potential complaints needs further expansion. • Important information was not available when requested. A staff member had taken it home. • Although improvements in staff recruitment were reported in November 2005, the records of a nurse who started work at the home on the day of the inspection lacked important information. • Similar shortfalls in staff training records meant it was not clear if all staff had received the mandatory training they should have. • Some maintenance and service records such as water temperature records, and hoist service records were not available to show the home was being fully maintained. As a result of this inspection a total of 24 Requirements have been made – which indicate a significant change in this service. Please contact the provider for advice of actions taken in response to this Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: From the four sets of resident’s records looked at it was noteworthy to see that appropriate assessments had been carried out in enough detail to assure residents, their relatives and staff that the home could meet their needs. Observations and discussions with nearly all of the residents confirmed they were very happy living at Brookfield House. A comment written by one of the residents which reflects the other residents and relatives opinions as well as inspection observations states:‘It is a wonderful atmosphere – highly skilled staff help us and keep us happy.’ Brookfield House Nursing Home DS0000022238.V293800.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 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. The care planning and medication management systems need extra details to mirror the entire professional, individual, standards of care resident’s receive and need to get. EVIDENCE: As recorded earlier good standards of care were seen to be carried out. One resident commented: ‘If you’re looking for a good care home – then look no further!’ However – it seems the written records of the good care seen delivered is not all covered in the recordkeeping. A review of care planning documentation, relating to four residents, showed them to be clearly written and met most of the needs of each resident but also showed they needed to be reviewed and updated in one way or another. For instance, in the records of a person with diabetes it was stated that a ‘blood sugar test’ needed to be carried out daily. When the results of these tests were looked for, a staff member confirmed that the person had not had this test done on a daily basis for some time. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 11 Another person’s records showed that although the individual had experienced two falls, there was no falls risk assessment tool in use, and the moving and handling information did not have details how to safely lift the person in the event of another fall. When the care records for a resident who has wandersome behaviour was looked at, there was not enough information in his risk assessment for this matter. It was good to see the home had obtained a pressure alarm pad to alert staff the person was up and around at night, although the information about this and how to use it was not included in the care information. It was positive to see the care records also show the home has been using a risk assessment tool for bedrail safety for some time. Again this needs to be further expanded to make sure it meets the guidance of the Health and Safety Executive for this matter. Some beds with overlay pressure relief mattresses on top of their normal mattresses did not have bedrails in place, which were the right height. Upon requesting the care records for one individual, it was confirmed that a staff member had taken them home to be updated. These were returned during the inspection. When the way the home manages its medication was looked at, it was seen that some medications including oxygen were not stored appropriately. The majority of medication is kept enclosed in the ‘bar’ area of one of the lounges. It is mostly locked in a drug trolley located in this area. An overspill of medication including inhalers and painkillers was seen stored in a metal tray on the floor under the trolley. Throughout the day the drug fridge, also in this area was seen to be unlocked – the key was in the lock itself. Free standing oxygen cylinders awaiting return to the chemist were also seen located in a communal area under the stairs accessed frequently by residents to use the toilet beside that area. Relationships between residents and staff were observed to be friendly and respectful, and residents and visitors confirmed this impression by being very complimentary about the warmth and friendliness of the staff. On the tour of the home it was seen that the bathrooms have bath lists with residents names on – this needs to be addressed more discretely. Furthermore, two very frail individuals occupy the bedroom where the lift opens out. Although consultation with these people about this matter has involved their relatives , CSCI remain concerned about the intrusion of privacy these people experience, especially as one person is on permanent bed rest. Consideration of care arrangements including ‘end of life care’ needs to be reorganised in order to ensure maximum privacy as well as achieving ground floor access for the other four people who regularly use the lift. Brookfield House Nursing Home DS0000022238.V293800.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): 12,13,14, & 15 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff enable residents to promote choice and control over their lives wherever possible within a homely atmosphere, there is a limited range of leisure opportunities, consistent with residents’ capabilities, provided. EVIDENCE: Observations on the inspection day showed that the staff encourage and welcome residents to make choices about their daily lifestyle, and the home has long established links with the local community of Newport. One person takes advantage of the day centre provided in town, and the local clergy are regular acquaintances of the home. The home team were seen to meet and greet a stream of visitors with a knowledgeable rapport. Two residents were taken out for lunch by relatives. Discussion with residents reflected their appreciation of the quality, quantity and choice of food provided through a four-week cycle menu. A group discussion with residents confirmed they agreed that the lunch had been ‘beautiful’, and they appreciated the homemade cakes and puddings they were regularly offered. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 13 Discussion on a 1:1 with staff members confirmed there was no formal activity programme planned and there wasn’t anything booked up for the near future. It appears that when group activities are arranged most residents enjoy them. However, these do not occur on a very regular basis. Five residents spoken to in a group said they enjoyed the visit by the ‘exercise lady’ when she came every few months. One resident commented that the frequency of entertainment in the home had improved. Furthermore, many residents were seen to be cared for full time in bed due to their medical conditions. It was not clear what regular activities they enjoyed as several care plan records looked at had not had their activity records completed since last October. Brookfield House Nursing Home DS0000022238.V293800.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 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Residents well being is not fully protected through the home’s complaints procedure and available information relating to protecting residents from abuse. EVIDENCE: It is noteworthy to comment that the home has not received any complaints in the past year. It was seen that the home use a corporate range of policies and procedures known at Brookfield House as ‘The Blue Cross’ policy book. When the policy for complaints was looked at, it referred to a specific form people have to fill in should they wish to make a complaint. There was not a copy of the form in the policy file. When a sample of this form was asked for there was none available. When the complaints log was looked at it was seen that the home uses a hardback book entitled ‘Comments’. This was empty, and appeared to have pages torn out. The complaints system needs to be updated so that it reflects the other good processes seen at the inspection. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 15 Although policies relating to the protection of residents from abuse were observed to be in place and training files indicated that staff had received training in respect of these policies, it was seen that the local authority Multi Agency Adult Protection policy was not in the home. A staff member who had taken it home with her had loaned it. This was discussed at the end of the inspection. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 16 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): 19,20,21,22, 23,25 & 26. The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Although most parts of the home are attractive and a homely place to live, improvements are needed to ensure the health and safety of people living, visiting and working at the home. EVIDENCE: The home is decorated to a good standard, with furnishings and fittings that create a comfortable and ‘homely’ atmosphere. The designated dining room also provides an additional lounge area seen in use by residents and staff. However many residents have opted to have their meals served in their rooms or at their chairside. Brookfields has well tended gardens, which are accessible, and appropriate in design to the needs of most residents. Residents are encouraged to bring their own possessions into the home. Many residents spoken to commented they were happy with their personal accommodation, and observations on the home tour confirmed the home has Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 17 most of the equipment it needs to safely care for them. It was reported that the necessary sluicing disinfector had been delivered and was awaiting installation. It was seen that some parts of the home were beginning to show signs of wear and tear. For example: • Wear to the laminate flooring in the downstairs communal toilet meant it was badly split and a challenge to clean. • A double bedroom had an offensive odour of stale urine. It was seen that the toilet area of this room was carpeted, and a commode in this room had worn paintwork near the seat. • There was only one bath thermometer in the home, which was old and difficult to read – testing of the hot water bath tap confirmed this was in excess of 50 Degrees Centigrade. – An ‘Immediate Requirement’ notice to correct this was issued at the inspection. • The bath surround in the upstairs bathroom looked grubby around the bath itself, and a stainless steel jug and bowl were badly stained. The above issues were discussed with the manager at the end of the inspection as well as with the nurse showing the inspector round the home. In addition, an unguarded radiator was seen in another double bedroom. This was partly protected by a chest of drawers, however, this room is occupied by a resident with wander some behaviour, so needs a protective guard as priority. Furthermore. two portable heaters were seen in people’s bedrooms. They were also without guards or safe means of securing them in place when in use. CSCI remain concerned about the location of the shaft lift posing an intrusion of privacy to the people living in the bedroom it opens out into. This is an increasing concern as one of the residents is very frail and cared for in bed all of the time. A CSCI Regulation Manager attended the home at the end of the inspection to look at this and discuss the issue with the manager. Proposals how this is to be improved are required to be submitted to CSCI as a matter of priority. In April 2006, the home had its first infection control audit by the Health Protection Agency infection control nurse. This report highlights good practice in systems in the kitchen, and describes several issues for improvement in management of infection control within the home, including clinical equipment use. This will be explored in full at the next key inspection when the home management team have had the opportunity to carry out its recommendations. Meanwhile, some practices of concern seen on the home tour requiring early improvement include: • • Storage of communal toiletries in bathrooms and ‘nursing trolley.’ The use of communal cleansing foam for people with continence challenges- two canisters which clearly were in use, did not have their DS0000022238.V293800.R01.S.doc Version 5.1 Page 18 Brookfield House Nursing Home • • lids on, were not named for the person it was used for, and had visible signs of stains on the sides of the can. Washing bowls with visible scum/ sediment in need of cleaning. Sterile equipment for clinical use was stored in a tray on the floor under the medicine trolley. In balance of this, it is noteworthy to comment that the home does use alcohol gel for staff to use between hand washing. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, & 30 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Lack of necessary detail in staff records mean systems to manage recruitment and training are not robust, potentially leaving service users at risk. EVIDENCE: Examination of the rotas for two weeks before the inspection as well as the forthcoming fortnight shows the home is adequately staffed. During that period of time it was seen that the home had only had to use agency staff for four hours. The core of the staff team have worked at the home for a very long time which provides consistency in care delivery. In addition, the results of low staff turnover means that the home still has 50 of its carers NVQ qualified. All residents spoken to were full of praise about the staff. One commented. ‘All staff are very helpful at times, from the top to the bottom’ However, shortfalls in recruitment of the home’s latest new starters are not as robust as the last inspection. A new nurse who started her first shift at the Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 20 home did not have all the necessary information in her records. This person was to be on duty in charge of the home the following weekend. Similar shortfalls were seen at an earlier inspection in June 2005 when it was written: ‘Newly recruited bank staff must have the necessary checks in place as required by the standards and legislation.’ Although discussions with staff and the manager confirmed that many individuals had attended external training events as well as ‘in house’ training, this could not be confirmed. Upon examination of three sets of staff records it was seen that the home only held training records of the care team. Some nursing staff records were not available with sufficient evidence to confirm what training they had undertaken. It was therefore not possible to check whether the staff team members had received all of the mandatory training they are required to. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 21 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. The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Operationally, the home is organised with the central purpose being ‘the best interests of Residents’. Changes in management in the home means some of the safe working systems need to be reviewed to meet the changing needs as well as necessary legislation to maximise the health, safety and welfare of residents, staff and visitors. EVIDENCE: For over a year it has been the intention of the Registered Manager/Owner to hand over more of the day-to-day, and strategic, management of the Home to her deputy who is in the process of making an application to CSCI. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 22 In preparation for this, some of the responsibilities of the home’s management have already been delegated, and the manager confirmed that some of the shortfalls seen at the inspection might be as a result of this period of change. Inspection findings show that there are currently some challenges to safe working systems: • The moving and handling hoists in the home have not been serviced since February 2005, and there are no staff training records to show they are trained in the safe use of this equipment. • The five yearly electrical wiring certificate was not available, and the information the manager submitted about the home in September 2005 showed that it was last carried out in May 2000.The manager could not recall whether this had been carried out lately. • The lock was not in place on the well-stocked linen cupboard – posing a fire safety hazard. • Although the passenger lift has been fully serviced, the light was not working. • Accident recording systems need to be improved so they can be audited effectively. • Bedrail risk assessments need to be reviewed and updated so that records can confirm they are installed maintained and checked in line with Medical Device Agency guidelines and the Health and Safety Executive Guidance. • Hot water temperatures were not being recorded as they should, on a weekly basis. However, it is clear that many of the systems are set up to focus on a homely atmosphere for the 17 people living there. • The minutes of the last resident and relatives meeting confirm the people at the home are welcomed to be involved and ‘have their say’ about the home. • Following discussion with the manager residents and staff it was confirmed all residents or their relatives have control over their own finances. The home does not keep monies on residents’ behalf. As recorded earlier, important information requested during this inspection was not available, as staff had taken it home. Systems in the home must be improved to ensure all information necessary for inspection is available at all times. The inspector would like to convey appreciation and gratitude for the welcoming cooperation from the team during the course of this inspection. This was much appreciated. Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 23 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 2 1 3 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes – both. 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 15 Requirement Risk assessments for all equipment used for residents must have the necessary details so staff know how to use it appropriately. Care plans must be kept up to date so that they meet the current needs of the individuals. Care plans must show details that resident’s health needs are monitored, as they should be, including the frequency of blood glucose tests. Storage arrangements for all medication including tablets and oxygen must comply with the Royal Pharmaceutical Society guidelines of Great Britain. Evidence that a regular range of activities suited to residents abilities and interests must be provided The home’s complaint procedure must be further developed to be robust and reflect the guidance in the home complaint policy. The local authority multi agency adult protection policy must be available at all times in the DS0000022238.V293800.R01.S.doc Timescale for action 10/08/06 2 3 OP7 OP8 15 12 10/08/06 10/08/06 4 OP9 13 (2) 10/07/06 5 OP12 16(2) (m. N) 22 (1)(2) 10/07/06 6 OP16 10/08/06 7 OP18 13(6) 10/07/06 Brookfield House Nursing Home Version 5.1 Page 25 8 9 OP21 OP21 16(1) 23 (2)(j) 16(1) 23 (2)(j) 16(1) 23 (2)(j) 10 OP21OP38 11 OP21 16(1) 23 (2)(j) 12 OP23 12(4)(a) 13 OP23 16 (1) 23 (2)(f) 14 OP25 23 (2)(p) 15 OP26 16 (2) (c, home. The flooring of all toilets in the home must be easy to clean and in good repair. All commodes and equipment used to promote continence must be kept clean and in good repair. Systems to monitor hot water temperature testing must be improved to ensure there are plenty of thermometers in the home, and records of this practice are carried out weekly. All hot water outlets in areas accessible by services users must be approximately 43 Degrees Centigrade maximum. (Immediate Requirement made 26/05/06) The ‘double occupancy’ room, containing the shaft lift door, is to be retained as ‘single occupancy,’ should residency change and is subject to direct agreement with CSCI and following appropriate ‘risk assessment’. This arrangement is to remain in place subject to/and pending the lift replacement. ( Requirement made June 2006) The registered provider must provide plans to convert the passenger lift arrangements to ensure it does not need access from residents bedrooms. All radiators and heaters must be guarded. Portable heaters must not be used without a relevant risk assessment to ensure they are secured in place and guarded when in use. (Ongoing timescale requirement made 26/11/03.) All parts of the home including DS0000022238.V293800.R01.S.doc 10/08/06 10/08/06 10/07/06 10/07/06 10/09/06 10/08/06 10/07/06 10/07/06 Page 26 Brookfield House Nursing Home Version 5.1 j) 23 (2)(b, d) 16 OP26 17 OP26 23(2)(k) 13 (3) residents bedrooms and communal bathrooms must be kept clean, in good repair and free from offensive odours. To provide a sluicing disinfector. (Previous timescales of 27/1/06 not met) The home must implement an action plan to implement changes to infection control management in the home in line with the report of the Health protection Agency audit on 05/04/06. The practice of communal use and storage of residents’ toiletries must cease. The registered manager must provide required evidence of having taken steps to recruit suitable people to work with vulnerable adults. All staff training records must contain necessary information to evidence manadatory training , including hoist training has taken place. All records must be available for inspection at all times. 10/09/06 10/09/06 18 19 OP26 OP29 13 (3) 19(4) 10/07/06 10/07/06 20 OP30OP38 18(1) (c) 13(5) 10/08/06 21 22 OP37 OP38 17, Schedule3 ,4 13 (4) 10/08/06 23 OP38 Schedule 3 3(j) 24 OP38 13 (4)(6) The registered person must 10/08/06 ensure appropriate servicing and maintenance of alll essential services and equipment in line with necessary health and safety legislation, including six monthly hoist servicing , and 5 yearly electrical wiring installation checks. Recordkeeping for accidents 10/08/06 must be kept in a format which can be audited in line with Health and safety as well as Care Homes legislation. Bedrail risk assessments must be 10/08/06 reviewed and updated so that records can confirm they are DS0000022238.V293800.R01.S.doc Version 5.1 Page 27 Brookfield House Nursing Home installed maintained and checked in line with Medical Device Agency guidelines and the Health and Safety Executive Guidance. 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 12(4)(a) Privacy and the end of life care arrangements for residents currently occupying the bedroom where the lift is must be prioritised, including ground floor access for other residents during such times All clinical equipment must have suitable storage that promotes good infection control practice. The home fire safety risk assessment must ensure that a lock is installed on the linen cupboard to ensure it is secure at all times. 2 3 OP26 OP38 Brookfield House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 House Nursing Home DS0000022238.V293800.R01.S.doc Version 5.1 Page 29 - 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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