Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 25/01/07 for Brookfield Nursing Home

Also see our care home review for Brookfield Nursing Home for more information

This inspection was carried out on 25th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

The recruitment policies and procedures are robust and all members of staff are supervised to help develop their knowledge and skills for the benefit of the residents. All routines are as flexible as possible and residents are positively encouraged to exercise their independence through promotion of choice.

What has improved since the last inspection?

The care planning process has improved significantly with the introduction of new documentation. Medication management has improved. A training programme is now in place, which will promote a well-trained and competent staff.

What the care home could do better:

There is a need to keep staffing levels under review to ensure that an appropriate number of staff are on duty at all times to meet the changing needs and dependency levels of residents. The home needs to make arrangements to put facilities and a system in place for the secure storage of patient`s valuables rather than using the controlled drugs cabinet as at present.

CARE HOMES FOR OLDER PEOPLE Brookfield Nursing Home Grange Road West Kirby Wirral CH48 4EQ Lead Inspector Les Smith Unannounced Inspection 25th January 2007 09:30 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 Nursing Home DS0000020903.V330840.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 Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookfield Nursing Home Address Grange Road West Kirby Wirral CH48 4EQ 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) 0151 625 5036 0151 625 2037 Brookfield Nursing Home (West Kirby) Limited Alison Bebu Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty Four (24) Older Persons (aged over 65) and one (1) named male person (aged under 65 years) within a total of 25 15th August 2006 Date of last inspection Brief Description of the Service: Brookfield is a medium sized care home providing care for older people requiring nursing care. It is located in a quiet residential area of West Kirby on the Wirral. Local amenities such as shops, library, cafes, restaurants, churches and pubs can be found nearby. The care home is also situated near to the local beach and Dee estuary. Accommodation is provided over two floors with all rooms offering single occupancy. There is a small enclosed, private garden to the rear of the home and a car park to the front. Wheelchair access is provided to the home and a lift to the first floor. Fees at Brookfield range from £477 to £518 per week depending upon the service required Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit lasted for a period of six hours in the presence of the registered manager. The home has complied with the requirements made at the previous visit and three new requirements have been made as a result of this visit. Records including care files and associated documentation were examined. Care delivery was observed throughout the visit and residents spoken to were positive in relation to the care they received. Staff were observed going about their duties in a cheerful and professional manner. What the service does well: 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 Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 6 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 Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 7 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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information to allow them to make an informed decision about accepting a place at the home and can be assured that the home is able to meet their needs. EVIDENCE: The home has a combined Statement of Purpose and Service User Guide. The document is well-presented, easy to read and contains all the required elements. All residents or their representatives have been provided with a copy of the revised document. A selection of files was examined and all contained an appropriate contract or Statement of Terms and Conditions. The standard of pre-admission assessment has improved with new documentation having been put in place and the assessments examined Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 8 showed that sufficient information was obtained to allow an initial care plan to be constructed. Evidence was seen that the resident or their representative and other relevant health care professionals had been involved in the assessment. The home has all the appropriate equipment and facilities to meet residents’ needs. Equipment and aids provided by the home include assisted baths, adaptions such as raised toilet seats and grab rails, hoists and slings and slide sheets for transferring and moving residents comfortably and safely. Wheelchair access is available to all areas of the home including the garden areas. Visitors and prospective residents are encouraged to visit the home at any time and as often and for as long as they as they wish when deciding whether to request or accept a place at the home. The home also offers trial stays with a view to permanent residency subject to availability. Brookfield is not registered for intermediate care Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 9 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): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are consistent care planning and medication management systems in place that support resident’s health, personal and social care needs. EVIDENCE: The new care planning documentation now provides a comprehensive and consistent care planning process. Care files examined showed that all required and appropriate risk assessments were in place with clear directions in relation as to how identified risks are to be managed. Care plans gave clear directions for staff to follow in relation to the care required. However one file was seen that showed that advice given by the dietician following a referral had not been included in the care plan. Care plans are reviewed regularly and the standard of the evaluations varied according to the member of staff who carried out the review. The regular evaluation of care plans is essential to monitor the effectiveness of the care delivered and therefore the evaluation must detail the effectiveness or Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 10 otherwise of care delivered thereby justifying any changes or no change to the plan. It is strongly recommended that the manager carry out regular, documented audits of all care files to check accuracy and content of all relevant paperwork. Accident records were examined and it was established that a total of 14 accidents have occurred since the beginning of January 2007. It is strongly recommended that regular audits of accidents to be carried out. The systems in place for medication management have improved significantly and are in accordance with good practice guidelines. There were no gaps in signatures for administration and MAR (Medication Administration Record) sheets now reflect the actual time of administration. Medications prescribed on a ‘as and when required’ basis should have guidelines in place to indicate the circumstances when the medication should be given. Controlled drugs were checked and found to be correct. The storage of patient’s monies and valuables in the controlled drug cupboard is not acceptable and must cease. Appropriate storage facilities provided for patients monies and valuables must be provided. All residents are accommodated in single rooms and it was observed that care was taken by staff to ensure that residents’ privacy and dignity was respected at all times. All personal care was carried out in personal rooms or the bathroom. Policies and Procedures are in place assure residents and their families that they will be treated with care, sensitivity and respect at the time of their death. There is a need to expand the policies and procedures to take account of different cultures and spiritual requirements. Care files showed that residents or their representatives had been consulted in relation to their personal wishes. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. As far as practicable residents have choice and flexibility in how they spend their day at the home and a limited range of social and recreational activities are available to promote individual independence and wellbeing. EVIDENCE: The home has two part-time activity co-ordinators who provide a total of 20 hours per week. Activities range from bingo, shopping trips, special themed teas and religious services supplemented by external entertainers. The programme for activities is very general and gives no details of specific activities for residents to choose from. The need to establish the personal preferences and interests of residents to provide a fully inclusive programme of activities remains. It is recommended that the documentation of participation in activities in the care files in a distinct ‘activity record’ be carried out on a daily basis. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 12 The local ministers of various faiths provide spiritual care. An ecumenical service is held at the home every other week and the various ministers visit regularly. Visitors are welcome at the home at any time and this was observed during the day of this visit. Residents take breakfast as and when they rise and a cooked breakfast is always available if required. Residents have the choice of taking their meals in their own room, the lounge or the dining room as they wish. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 13 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents or their representatives can be confident that any complaints will be taken seriously and that systems are in place to protect residents from abuse. EVIDENCE: The home has revised its recording of complaints and now includes details of actions taken and outcomes in relation to verbal and written complaints promoting an open and transparent approach to complaint management. There has been one complaint to the home since the previous visit which was addressed in an appropriate and timely manner. All residents are registered on the electoral roll and assistance is provided as required to enable residents to exercise their rights. The home has policies and procedures in place in relation to Protection of the vulnerable Adult including Whistle Blowing and the ‘No Secrets’ document. Staff training records showed that staff had received training in adult abuse, its various forms, recognition and procedures to follow. Discussions with members of the staff demonstrated an awareness of adult abuse and appropriate procedures. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 14 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Brookfield continues to improve and the continuing programme of decoration and refurbishment promotes a safe, homely and comfortable place to live. EVIDENCE: A tour of the home in the presence of the manager showed that continuing maintenance was in place and concerns found at the previous visit had been addressed. The fire doors identified at the previous visit as not closing have been repaired and now provide the required protection when closed. The windows at the rear of the home that were in a very poor condition have been replaced. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 15 There are sufficient and suitable toilets and washing facilities, which include walk-in showers and assisted bathrooms. The home has appropriate and relevant aids in place throughout the home to help maximise independence. Hand rails, a nurse call system, raised toilet seats and pressure relieving aids were all seen and a lift to all floors gives access to all areas of the home. Residents are positively encouraged to bring their own possessions and memorabilia into the home and personalisation of rooms was seen throughout the home. On the day of inspection the home appeared clean and hygienic and was free from any odours. Staff members have received training in infection control and were observed working in accordance with the homes policies. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 16 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): 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. Staff members are recruited via robust policies and procedures, are well trained and deployed in sufficient numbers and skill mix to support and protect the residents. EVIDENCE: Staffing levels were reviewed following the high incidence of accidents during January. The dependency profiles at Brookfield show that at the time of this visit 16 out of the 22 residents required the assistance of 2 care staff to support and meet their needs. Off-duty shows that the numbers of care staff on duty after 2pm is reduced from 5 to 3. It is known that the needs of residents and particularly those with dementia or confusion increase during the course of the day and a reduction of 2 staff during this period cannot be considered to be appropriate. This is supported by an analysis of the accident records that shows 50 of the accidents occurring between 2pm and 8pm. The home has attained the minimum level of NVQ trained staff with over 50 holding a minimum of the NVQ level 2 qualifications. In addition to mandatory training the home is providing specialist training in Parkinson’s disease, Elder abuse, nutrition and care of the dying. A selection of staff personnel files including most recent starters was examined. All required items with relevant certificates were seen to be present including two references, copies of Terms and Conditions, PovaFirst clearances Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 17 and Criminal Record Checks. Appropriate verification of ‘PIN’ numbers for trained members of staff were also seen. The home has reviewed the record keeping system and all appropriate and relevant records are accessible at all times for inspection as required. All new staff members undertake a ‘Skills for Care’ compliant induction using a commercially produced induction to care programme. There has been progress in ensuring that all staff members receive appropriate training. A training programme is in place and evidence was seen that this programme is ongoing and includes specialist areas in addition to the mandatory topics. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a home management that is focussed on the best interests of residents. EVIDENCE: The registered manager is a first level nurse with substantial experience of care of the elderly and is registered with the CSCI as a fit person to manage the home. The home has made arrangements for all relevant records to be available at all times for inspection in the care home by any person authorised by the CSCI to enter and inspect the home. The home is now notifying the CSCI of all events, which adversely affects the wellbeing of any resident to the CSCI via the regulation 37 procedures. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 19 The home monitors its own quality assurance programme and regularly surveys the residents and their representatives in relation to the service provided. The senior management have considered the feasibility of obtained an external quality award and intend to undertake and obtain ISO9000 with the British Standards Institute. Staff meetings are held regularly every three months. Records were seen to demonstrate that staff supervision is in place and carried out at appropriate intervals. All appropriate inspection and safety certificates including the gas safety and Loler certificates not available at the previous visit were seen and were valid. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 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 Timescale for action 31/03/07 2 OP27 18(1)(a) 3 OP35 1692)(l) The registered person must ensure that risks to residents are identified and eliminated as far as possible. (Refer specifically to number of falls) The registered person shall 31/03/07 ensure that staff members are working in such numbers as are appropriate to meet the assessed needs of the residents. (Refer specifically to the 2 to 8 shift period) The registered person must 31/03/07 provide a place where the money and valuables of service users may be deposited for safekeeping 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 OP7 Good Practice Recommendations It is strongly recommended that the accident records are DS0000020903.V330840.R01.S.doc Version 5.2 Page 22 Brookfield Nursing Home 2 OP9 audited regularly to identify patterns and trends It is recommended that clear guidelines for the administration of ‘As and when required medications’ be put in place. Brookfield Nursing Home DS0000020903.V330840.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Nursing Home DS0000020903.V330840.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!