Inspection on 09/05/07 for Brookfield House Nursing Home

This inspection was carried out on 9th May 2007.

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

The inspector 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 03/10/06

Brookfield House Nursing Home 26/05/06

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 Joy Hoelzel Key Unannounced Inspection 9th May 2007 09:45 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.V339028.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 House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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 Mrs Irene Elizabeth Palmer 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.V339028.R01.S.doc Version 5.2 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. 19th December 2006 Date of last inspection Brief Description of the Service: Brookfield House is a nursing home situated in the market town of Newport, Shropshire. As it is 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 and offers both single and double accommodation for older people, of whom 5 may have dementia related illness. A passenger lift provides access to the first floor bedrooms. However, the current layout of the home means that access to the lift is via a bedroom occupied by two residents. There are two communal lounges one of which has dining facilities. Externally, the front of the home has a secluded well-maintained garden that provides safe and accessible areas for all service users. The current fees charged vary between £338 and £450 per week depending on the care package required. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection is the first of key inspections for 2007/08 and took place over four and a half hours on Wednesday 9th May 2007. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty five of the thirty eight National Minimum Standards for Older People were inspected. Thirteen people are currently living at the home. The deputy manager was on the premises supported by three care staff, ancillary personnel were additional. Three case files were selected for case tracking, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and deputy manager. Observation was made of the various daily activities and a tour of the premises was conducted. Four visitors, two members of staff and one person residing at the home completed comment cards on the day of the inspection, their comments have been included in this report. A thematic inspection ‘ A fair contract for Older People’ was conducted in December 2006 and focused on the information of the service including the contracts, assessment process and complaints information. A separate report for this inspection has been prepared and available upon request. What the service does well: The home provides a comfortable environment in which to live. People commented that ‘ the home is a lovely place in which to live, ‘ its nice and peaceful’, ‘ the gardens are lovely’ and ‘ staff look after us well’. The cleanliness of the home is maintained to a high standard. The staff demonstrated a good in-depth knowledge of the resident group and the conditions and dilemmas associated with the ageing process. The management team are highly aware of equality and diversity and its implications even when there are few people in residence with recognised diversity issues in receipt of the service. Social, leisure and recreational activities are arranged on a regular basis, based on the individual requirements and are age appropriate. Visitors and relatives commented ‘satisfied with the care provided’, ‘ my relative is looked after very well’. People living at the home stated that they are ‘ cared for and very well looked after’, ‘have no complaints’, ‘very happy to be here’. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 6 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. 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 House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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 Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken by a senior member of the staff team, this ensures that the home is confident that all assessed care needs of the individual can be fully met. EVIDENCE: The statements of purpose, service user guide and terms and conditions have all been reviewed and contain specific information as set out in the regulations and national minimum standards. The terms and conditions are at the final draft stage with planned discussions with the provider and manager later this week. Each person and/or representative will then be issued with a copy. Three case files were selected for inspection each contained a pre admission assessment conducted by a member of staff together with information from the previous placements i.e. other care home, local hospital. One file contained an assessment and review from the social worker. The home does not offer an intermediate care service. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 9 Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service involves individuals and/or representatives whenever possible in the planning of care that affects their lifestyle and quality of life. The care plan is a working document that is reviewed and updated on a regular basis this ensures that all care needs can be met. EVIDENCE: The three case files were selected for inspection, all contained a full plan of care based on the activities of daily living, with additional monitoring and assessment tools and risk assessments. The plans are based on the problem, the aim/ goals, the action to be taken and the next planned review date. The documentation is divided into two files with the plan of care being kept in the individual bedrooms, personal and contact details and the daily reports are kept in the main office. The care plans cover all areas of healthcare including mobility, pressure area care, maintaining a safe environment, continence, and nutrition. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 11 Where a risk has been identified, following assessment, a specific plan of care has been formulated offering full details for the action to be taken by staff to reduce the risk. For example one person had an assessment carried out for maintaining his/her safety whilst in a wheelchair, specific instructions had been made to ensure that footrests are on the wheelchair at all times and are used appropriately. Another plan identified a person with hearing and sight impairment; a plan had been developed for maintaining effective communication. One person had a plan for dealing with diabetes, the plan detailed the diet and fluids required but stated that the blood sugar monitoring ‘ to be as directed by the GP’. There were no specific details of when the testing was to be carried out or the factors that may trigger the monitoring. Discussions were held with the deputy manager who stated that the plan would be reviewed to include this additional information. The home uses the monitored dosage system for the administration of medication with the additional use of boxes and bottles. The Primary Care Trust pharmacy technician visited the home (March 2007) to review the procedures and recommended that the policy and procedure be reviewed and recording of the temperature of the room where medications are stored. Insulin that is in use is being stored in the fridge contrary to the manufactures instructions. This was discussed with the deputy manager at the time and an alternative storage procedure was implemented. The care staff were observed to be assisting service users with personal care discreetly and in a manner which promotes service users’ dignity. Privacy curtains are provided in the twin occupancy bedrooms. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily living and social activities arranged for service users takes into account the differing expectations, preferences, lifestyle and capacities of each individual. EVIDENCE: The care staff organise the in house activities and a monthly programme is arranged, the details are displayed at the entrance of the home. The deputy manager stated that the current group of people are somewhat frail and the recent experience of bringing in entertainers to the home has not been successful. In house musical evenings, movement to music and massage etc are arranged each month. Staff gave a good account of the activities arranged and included a recent Easter bonnet parade. One lady confirmed that this was ‘great fun’. One lady stated that she would like to see a religious minister occasionally and would like the opportunity to have Holy Communion as she felt that faith was very important ‘as you get older’. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 13 This was communicated to the nurse in charge who assured that this would be actioned. Many people visited the home during the day, all observed to be made welcome and were offered tea or coffee on arrival. Two visitors stated ‘we can come anytime- nothing is ever any different, the home has to be good as we wouldn’t let our mother stay here. Never any smells, staff are very friendly, mother is very well cared for’. Staffs gave a good account of the preferences of people living at the home and were observed to be very busy but appeared kind, considerate and offering choices. Meals can either be taken at the dining table, or private rooms to suit the individual’s preference. One lady was being assisted with the midday meal this had all been blended together, staff explained the reasoning behind this but it was recommended that the food be blended separately to offer the different tastes. One lady spoke of her satisfaction with the meals and said the ‘ food is good, fruit juice and cereals for breakfast, lovely lunch with dessert and for supper sandwiches and cake’. A glass of sherry was offered to people prior to lunch and appeared to be greatly enjoyed. The Environmental Health Officer visited in November 2006 and made three recommendations, the deputy manager confirmed compliance. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand, people living and visiting the home say they are happy with the service provision and feel well supported. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. EVIDENCE: The complaints procedure has been amended to include the contact details of Commission for Social Care Inspection. It is included in the statement of purpose and a copy is displayed at the entrance to the home. One person and visitors stated if they had any concerns they would not hesitate but to see a member of staff who would ‘sort it out’. The deputy manager stated no complaints have been made. A copy of the multi agency adult protection procedures is available for staff reference. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. All transactions are recorded on individual balance sheets and the cash is accounted for a separately named envelopes. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: During the tour of the premises bedrooms were observed to be personalised with the occupants own belongings. Three people stated that they were satisfied with the bedroom and had many home comforts. The ground floor room containing the lift shaft is now a sitting room and not a bedroom, the previous occupants have been allocated alternative accommodation. The first floor room with the lift shaft is currently being redecorated and refurbished into a quiet lounge area. The radiators have been fitted with covers to protect people from injury, with the exception of one in the new first floor sitting room. This is due to be covered shortly. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 16 Some doors continue to be wedged open with either wooden blocks or other items. The gardens are well maintained and accessible. People stated that they liked to sit in the gardens when the weather permits. All areas of the home were spotlessly clean; the staff responsible for the household cleaning must be commended on maintaining such high standards. Additional hand wash facilities have been provided in all areas at the point of the delivery of care. The bathroom on the first floor is carpeted, it was agreed that a more easily cleanable floor covering would be beneficial. The deputy manager confirmed on 14th May 2007 that the carpet fitter had been contacted, has visited the home and arrangements are being made for an alternative flooring to be laid. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using services are generally satisfied that the care they receive to meet their needs, but there are times when they may need to wait a short time for staff support and attention. EVIDENCE: A staffing rota is completed each week, indicating which people were on each shift. The deputy manager confirmed the usual staffing levels as for the morning shift, one registered nurse, and three care staff reducing to one registered nurse and two care staff for the evening shift further reducing to one registered nurse and one care staff during the night. Ancillary staff additional and are at the home during the day. The deputy manager stated that sometimes agency nurses and carers are required and that a request is made for an agency person who has been at the home previously. There is a stable staff group with many staff working at the home for long periods of time. The staff appeared to be very busy; the completed surveys at the time of the inspection had additional comments of ‘like to spend more time with the residents’. During the afternoon a person was heard shouting in a first floor bedroom. On observation, the room was occupied with two people, one of whom was asleep, the other appeared to be quite distressed and calling out. The deputy Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 18 manager offered an explanation of the situation. The care staff on duty were busy downstairs with the other residents, additional staff would be beneficial to allow for one to one care and to assist with situations such as this. It was evident that the care staff provide high standards of physical care as most people appeared to be well groomed, nevertheless the numbers of staff should be determined by the dependency needs of all people living at the home. Two staff personnel files inspected and contained criminal record bureau disclosures, references and previous experience. Each person has an individual training, supervision and appraisal file Certificates and accreditations of training are included. Staff have received training opportunities in induction, to caring, dementia care, moving and handling, fire drills and safety, health and safety, food hygiene, and adult protection. The statement of purpose contains details of the current staff group and their qualifications and experience. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team has a clear understanding of the key principles and focus of the service, based on organisational values and priorities and are supported by the providers of the home. There is a strong ethos of being open and transparent in all areas of running of the home this is encouraging and positive for people living, working and visiting the home. EVIDENCE: The registered manager Irene Palmer was not on duty at time of inspection but called in to collect documents for a pre admission assessment of a person in hospital who had expressed a wish to come into the home. Chris Parton the deputy manager was in charge of the building Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 20 She demonstrated a good knowledge of service users group and the challenges and dilemmas associated with the ageing process. People living, visiting and working at the home commented of the management team and their accessibility and commitment to providing a good service. Quality assurance and monitoring of the service continues. Monthly visits by the provider/owner are recorded and resident and staff meetings continue. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Health and safety checks continue weekly, monthly annually with records kept. The fire safety officer visited the premises in February 2007 the risk assessments for the premises have been completed. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 17. Standard OP19 Regulation 13 (4) Requirement All parts of the home must be kept safe. Residents’ bedroom doors must not be wedged open Previous timescale 30/11/06 not met. Timescale for action 30/06/07 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 OP27 Good Practice Recommendations The staffing levels should be based on the dependency needs of all people living at the home and be in sufficient numbers to ensure that care needs are fully met. Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. Extracts may not be used or reproduced without the express permission of CSCI Brookfield House Nursing Home DS0000022238.V339028.R01.S.doc Version 5.2 Page 24 - 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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