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Inspection on 26/07/05 for Brookfield Nursing Home

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

This inspection was carried out on 26th July 2005.

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.

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 records held in the home provide evidence that a high level of staff training is being given and this is promoted by the home. Records continue to improve and the new format for assessments and care plans are informative and accessible to all staff. Regular reviews of service users are made to ensure that the staff have the necessary information to provide the appropriate level of care to each individual service user.

What has improved since the last inspection?

The care plans and general record keeping in relation to the service users has continued to improve through review and implementation of new formats.

What the care home could do better:

Some areas which require redecoration and improvement have been identified by the Registered Person and a plan for this work to be undertaken has been prepared. The carpets in the lounge and adjacent corridor are not on this plan and should be addressed as a priority. The system in place for holding service users finances is not sufficiently robust to protect them and appropriate measures should be put in place. Insufficient hours are allocated to the acting manager to enable her to review service users care needs, update care plans,ensure the health and safety of the service users and to supervise and support the staff team. Consideration should be given to increasing the number of management hours allocated.

CARE HOMES FOR OLDER PEOPLE Brookfield Nursing Home Grange Road West Kirby Wirral CH48 4EQ Lead Inspector Jeanette Fielding Unannounced Tuesday, 26 July 2005 9.30 am th 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 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 F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brookfield Nursing Home Address Grange Road, West Kirby, Wirral, CH48 4EQ Telephone number Fax number Email 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 enquiries@brookfieldcare.co.uk Brookfield Nursing Home (West Kirby) Limited Miss Catherine Tunley - acting manager Care Home with Nursing 25 Category(ies) of OP Old Age - 25 registration, with number of places Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 Date of last inspection 24th January 2005 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. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over a period of six hours in one day. The views of staff, service users and one visitor were sought to obtain their views of the care and service provided by the home. Service users care files were inspected and provided evidence that all service users are appropriately assessed and that their identified needs were being met. The records for staff were inspected, and despite the disorganisation of these, were found to contain all necessary information and evidence that appropriate checks had been made on them to ensure the protection of service users. The money held by the home on behalf of service users was inspected and found not to be sufficiently robust to ensure that the service users finances were protected. A tour of the building established that the carpets in the lounge and adjacent corridor were stained and worn and require to be replaced. A change has taken place of the manager of the home since the last inspection, however, the new acting manager is fully qualified and experienced to undertake this role. An application to register the manager is being processed by CSCI. What the service does well: What has improved since the last inspection? What they could do better: Some areas which require redecoration and improvement have been identified by the Registered Person and a plan for this work to be undertaken has been prepared. The carpets in the lounge and adjacent corridor are not on this plan and should be addressed as a priority. The system in place for holding service users finances is not sufficiently robust to protect them and appropriate measures should be put in place. Insufficient hours are allocated to the acting manager to enable her to review service users care needs, update care plans, Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 6 ensure the health and safety of the service users and to supervise and support the staff team. Consideration should be given to increasing the number of management hours allocated. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Pre-admission assessments are undertaken on all prospective service users to ensure that the home can meet their individual needs. EVIDENCE: Pre-admission assessments are undertaken on all prospective service users by the acting manager or one of the qualified nurses. The forms used for new service users admitted to the home have recently been reviewed and amended to allow more detailed information to be recorded. These forms ensure that prospective service users care needs are identified to enable a plan of care to be prepared. Specific equipment is identified as necessary to enable the home to arrange for this to be provided prior to admission. Information is gathered from the service user, their family and other professionals involved in their care. The home does not provide intermediate care. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The system for the administration of medication are good with clear and comprehensive arrangements being in place to ensure service users medication needs are met. EVIDENCE: Care plans have been prepared for each service user to give the staff full information regarding their care needs. The files are organised and all information is easily accessible to the staff. Full assessments have been undertaken on all service users and these are reviewed on a regular basis to ensure that the care plans can be updated as necessary. The care plans give information regarding the service users personal preferences such as, the name the wish to be called by, food likes and dislikes and the time they wish to go to bed and rise. Nutritional needs are identified to enable any special diets or requests to be provided. Information recorded by the staff on a daily basis gives details of the individual care given. Records are held of visits made to and by the GP or any other care professionals and gives information regarding any changes in care recommended by them. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 10 Medications were found to be ordered, stored, administered, recorded and disposed of as required. The storage area was seen to be clean and organised and it is evident that staff are following the home’s procedure for handling medications. All service users are accommodated in single bedrooms. Personal care is given to service users in their bedroom or in the bathroom as appropriate. Service users spoken to during the inspection confirmed that staff respected their privacy and dignity at all times. Service users may meet with their visitors in their bedroom or in one of the communal areas as they wish. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: The acting manager stated that the routines were flexible to suit the preferences of the individual service users. Service users spoken to during the inspection confirmed that they were free to choose the times that they got up or went to bed and that they could choose where they went within the home, and what they did during the day. Some service users go out with the family members or friends. Visitors are welcome at the home at any time, although it is preferred that visits early in the morning or late in the evening are discussed with the manager. Church services are held in the home on a regular basis and some service users choose to go to the church of their choosing. One service user is able to go out alone and risk assessments have been prepared to ensure their safety. The records held in the home, and discussion with service users, confirmed that choices are offered in all aspects of daily living. Risk assessments are undertaken on all service users and risk management systems are in place to reduce or remove risks to ensure their protection. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 12 Breakfast is served to service users when they risk or at a time of their choosing. A cooked breakfast is available from 8.00 am and two service users take a cooked breakfast each day. The main meal is served at 12 noon with a lighter meal in the evening. Snacks and drinks are provided throughout the day and all service users are offered supper. Changes have recently been made to the menu’s following consultation with service users. A choice of meals is offered and service users said that the catering staff did all they could do meet any special requests. Special diets can be provided on the advice of the GP or dietician or on the request of the service user. Meals can be taken in the dining room, lounge or in the service users bedroom as they wish. The kitchen was clean and organised and food supplies were good. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 Staff have a good knowledge and understanding of Adult Protection issues which protects service users from abuse. EVIDENCE: The home has a policy and a procedure to be followed in the event of a complaint being made against the home. Information on how to make a complaint is detailed in the statement of purpose and is also displayed within the home. No complaints have been made against the home since the last inspection. Policies and procedures are in place to give staff full information of the action to be taken in the event of abuse being suspected. The home holds a copy of the Wirral Adult Protection information booklet. Service users spoken to during the inspection said that they felt safe in the home. All staff are given full training on abuse which includes videos and reading material. The home has a copy of the No Secrets document and staff have been encouraged to read it. Staff spoken to were able to confirm that they were aware of the action to be taken and of the people to contact. Appropriate checks are made on staff prior to them commencing work at the home to ensure that service users are protected. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 26 Appropriate measures are in place to prevent infection within the home and thereby protect service users. EVIDENCE: Some redecoration has taken place since the last inspection. Bedrooms are decorated and furnished to a good standard. Rooms have been personalised and it is evident that the staff strive to provide a homely environment for the service users. The carpets in the lounge, and in the corridor outside the lounge, are in a poor condition. They are stained and worn and their replacement should be considered a priority. All service users are accommodated in single bedrooms to protect their privacy and dignity. The home is maintained in a good condition. The home was found to be clean throughout. Policies are in place for infection control and it was evident that staff follow the home’s procedure. Four staff have recently undertaken training on infection control and training is currently being given on MRSA and the action to be taken to prevent this. Appropriate Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 15 disposal systems are in place for both general and clinical waste. Staff are provided with protective aprons and gloves for added protection to service users. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: The home provides one registered nurse on duty at all times to care for the service users. The nurses are supported by four care assistants during the morning, three care assistants during the afternoon and early evening, and two care assistants at night. The acting manager is also holds responsibility for taking the role of the nurse on duty for most of the working week. Only six hours each week are allocated to the acting manager to enable management tasks to be undertaken. This is a low number of hours in view of the management role and the need to supervise staff. Consideration should be given to increasing the number of management hours. During the inspection, it was established that all staff have been appropriately vetted prior to them commencing work at the home. Personnel records are held separately from training records and supervision notes are kept separately again. The files for staff are held in the same cabinet as staff who work for the home’s sister home, and the care agency which is located on the same site. Discussion took place with the manager regarding the organisational difficulties that both she and the home’s administration staff have when trying to find or file information. It is strongly recommended that a reorganisation programme be undertaken to ensure that all information is held in a secure place that is accessible to both the acting manager and the administration staff. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 17 The staff files inspected were found to contain all the necessary documentation to ensure that staff held the appropriate qualifications and training to meet the needs of the service users. All new staff are required to complete a comprehensive TOPPS induction training programme and evidence of this is held on their file. All training was seen to be relevant to the needs of the service users. Each member of staff has a training file, providing evidence of training undertaken. A programme of training opportunities is held in the home. Training needs are identified during supervision and annual appraisals. Fifty percent of the care staff hold NVQ at level 2 and a further two staff are currently working towards this. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 38 The system for the banking of service users personal monies requires to be reviewed to ensure that they are protected from financial abuse. EVIDENCE: There has been a change in the manager of this home since the last inspection. The acting manager is a qualified nurse and an experienced manager. An application to register the acting manager has been submitted to the Commission for Social Care Inspection and is being processed. The home has developed its’ own quality assurance monitoring system. Service users and their representatives are surveyed on a regular basis to enable the manager and owner to identify with the positive aspect of the home and to develop those areas that would benefit from this. Monthly reports are now prepared each month by a representative of the owner and a copy is issued to the acting manager. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 19 Most service users have their finances dealt with by their family or representative. Small amounts of money are held in the home for service users at their request and detailed records are held of these. One service user does not have a bank account and so the personal allowance is placed in a separate account within the home’s bank account. This practice is not acceptable and arrangements must be made by the home to ensure that money belonging to service users is not held in any account belonging to the home. The acting manager is not aware of service users whose families have power of attorney. Policies and procedures are in place to ensure that all health and safety issues are addressed. Risk assessments are prepared for all service users as necessary. Health and safety training is given to all staff and records available in the home provide evidence that these issues are dealt with appropriately. Safety certificates inspected were found to be up to date. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 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 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 2 x x 3 Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 19 Regulation 23 Timescale for action The Registered Person must 20th ensure that the stained and worn November carpets in the lounge and 2005 adjacent corridor are replaced. The Registered Person must 31st August ensure that service users monies 2005 are held in an individual bank account in their own name. Requirement 2. 35 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 31 29 Good Practice Recommendations Sufficient hours should be designated for management duties to the acting manager. Consideration should be given to reorganising the information held on staff. Brookfield Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Liverpool Area Office 3rd Floor, 10 Duke Street Liverpool L1 5AS 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 Nursing Home F52 F02 S20903 Brookfield V244156 260705 Stage 4.doc Version 1.40 Page 23 - 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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