Inspection on 08/07/05 for Brookfields

This inspection was carried out on 8th 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.

Other inspections for this house

Brookfields 19/03/09

Brookfields 06/02/07

Brookfields 05/12/05

Brookfields 12/01/05

Brookfields 12/07/04

Brookfields 05/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Brookfields 488 Burton Road Derby DE23 6AL Lead Inspector Tony Barker Unannounced 8 July 2005 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. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brookfields Address 488 Burton Road Derby DE23 6AL 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) 01332 343840 01332 294558 Celeste@brookfieldspnh.fsnet.co.uk Brookfields PNH Ltd Susan Buxton Care Home with Nursing 34 Category(ies) of 34 - Older People registration, with number 5 - Physical Disability of places Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12/1/05 Brief Description of the Service: Brookfields is a detached house, which has been adapted and extended as a care home. It is situated in Littleover close to local shops and a bus route. The Registered Company is Brookfields Private Nursing Home Ltd.The home provides nursing and personal care for up to 34 persons aged 65 years and over with physical health needs. Service users facilities are on 2 floors. The home provides 26 single and 4 double bedrooms. 29 rooms have en suite facilities. Access to the first floor is by stairs and 2 passenger lifts. The home has a dining room and 2 lounges on the ground floor. The garden is accessible to service users. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The time spent on this inspection was 4.5 hours and was a routine unannounced inspection. The last inspection took place in January 2005 and was unannounced. Two residents, a visiting relative, the Home’s Administrator and three members of staff were spoken to and records were inspected. Case tracking was not undertaken on this occasion. The focus of this inspection was on progress made on the requirements and recommendations made, and those standards not assessed, at the last inspection. There was no tour of the premises at this inspection. What the service does well: What has improved since the last inspection? What they could do better: The Home’s assessment and care planning processes must take a more ‘whole person’ approach to residents’ needs, in addition to physical and nursing needs. A wider range of risks must be taken account of and the assessment and management of these must be recorded. Residents’ need for privacy in their bedrooms must be addressed through the provision of lockable doors. Please contact the provider for advice of actions taken in response to this Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfields C02 C52 S2113 Brookfields V236950 080705 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 Brookfields C02 C52 S2113 Brookfields V236950 080705 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 & 6 At the time of admission the needs of residents had been assessed giving staff information on which to base a plan of care. EVIDENCE: Two residents’ files were reviewed as part of the case tracking process. Completed assessments were fairly detailed, and included a pre-admission assessment. Information relating to residents’ social interests, religious and cultural needs was limited, as at the last two inspections - residents’ needs were, therefore, not being holistically assessed. The Manager’s stated plans to update the assessment forms, to include this information, had not materialised. One visiting relative stated that staff are “very friendly”. Residents also made positive comments about staff members’ caring attitudes. Other aspects of standard 4 were not assessed at this inspection. The Home does not provide intermediate care. Standard 6 therefore does not apply. Brookfields C02 C52 S2113 Brookfields V236950 080705 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 The residents’ health care needs were clearly set out in individual plans of care – though other needs were not so well recorded. Residents’ health was being promoted and maintained except that not all personal risks were being fully considered. Residents were not always being treated with dignity. EVIDENCE: Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 10 Two residents’ care plans were reviewed as part of the case tracking process. Care plans were clearly set out and showed how residents’ physical and nursing needs were being met - social, religious and cultural needs were less well identified. Regular reviews of all care plans were being recorded showing progress and outcomes of care and treatments. Care plans did not show residents’/relatives’ involvement in all stages of care planning. Periodic review meetings were still not being held for all residents who were privately funded. In this respect, residents without care managers had less opportunities for multi-professional discussions, including residents and relatives, of residents’ care. The Ancillary Service Record on residents’ files showed involvement of an optician, dentist and chiropodist. The Home had a range of pressure relieving equipment and staff had attended training on tissue viability. Residents’ continence was being promoted within the Home. The Home’s Administrator spoke of links with Derby University School of Occupational Therapy – OT students visit the Home on Tuesdays, which benefits both them and residents. The Administrator also spoke of residents’ involvement in exercises before lunch. The Home employs a part-time ‘Nursing Skills Co-ordinator’ to ensure that basic nursing skills are of a high standard. Qualified staff had completed various written health risk assessments. These were being signed and dated by staff. However, one resident’s file indicated she had bed rails to prevent her falling out of bed. The nurse-in-charge said a total of two residents had bed rails but confirmed there were no records of an assessment for these or multiprofessional agreement for their use. This lack of records may indicate that bed rails were not being used as a last resort and the risks involved with their use had not been fully understood. The nurse-in-charge confirmed that residents who were unable to walk to the toilet were still being transferred there on toilet chair frames without seat covers. This did not look altogether dignified. Other aspects of Standard 10 were not assessed at this inspection. Brookfields C02 C52 S2113 Brookfields V236950 080705 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 & 15 Residents found a flexible lifestyle within the Home that met their preferences and recreational interests. They received a varied and nutritious diet in pleasing surroundings. EVIDENCE: Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 12 Residents and staff considered that the atmosphere at the Home is friendly and relaxed and that daily routines are generally flexible. This was apparent on this inspection. Residents can eat in their rooms if they choose, go to bed and rise each morning according to their preferences. The Administrator added that medication and other health needs will sometimes affect the rising time for residents. This was said in response to a concern expressed by an exmember of staff to the Commission (see the next section - ‘Complaints’). The Home’s Liaison Nurse described a professional approach being taken to decisions over who, of the more mentally confused residents, is enabled to go to bed and when. The Home had a ‘motivator’, employed for 9/10 hours a week, to provide stimulating activities for residents. This member of staff was seen and her records included details of activities held and planned and she had made constructive notes on care plans about individual residents. Residents reported that they enjoyed these activities. The Administrator reported that outings were provided on a one to one basis, where requested and links with a local stroke club and a dysphasia group have been developed. Meals were planned around a rolling 4-week menu with seasonal variations. These were varied and nutritious and included homemade products. Two residents, when asked, commented that they were happy with the quality of food provided at the Home. One main lunch menu was available each day together with cooked alternatives or a snack. When residents eat alternatives to the main menu these are appropriately recorded. The Administrator said that food is bought daily. Fresh and home cooked foods were provided. The Inspector observed that dining room tables, and individual trays, were attractively set out. Replacement dining chairs and tables had been provided. Mealtimes were unhurried and residents were given time to eat their meal. Staff were in the parlour assisting residents who required feeding. Brookfields C02 C52 S2113 Brookfields V236950 080705 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 Residents’ and relatives’ complaints were handled professionally. The Home’s systems ensured that residents were being protected from abuse. EVIDENCE: The complaints procedure was still not displayed in the Home although the Administrator said that it will displayed in the Atrium within the following few days. The Home held a record of complaints received. This record was well set out and showed that the Home had taken appropriate action following the receipt of complaints. A discussion took place with the Administrator about a recent complaint received by the Commission. The Home’s Adult Protection policy & procedures were displayed in the staff room, including one on ‘whistle blowing’. The Administrator said that the Home considers staff training on Adult Protection to be mandatory and all staff had attended Derby City Social Services training. She was unclear whether the Home’s policy and procedures on prevention of aggression had been amended to include residents. Brookfields C02 C52 S2113 Brookfields V236950 080705 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) These standards were not assessed. EVIDENCE: These environmental standards were not assessed at this inspection. However, there was evidence that approved privacy locks had not been fitted to bedroom doors and an assessment of disability equipment and environmental adaptations had not taken place. The Administrator said that approximately ten bedrooms now had lockable storage facilities and there was an ongoing programme of fitting. A suitable bolt was seen to have been fitted to the staff/visitors’ WC door to prevent risks to residents. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 15 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) 29 Residents were being protected by the Home’s recruitment policy and procedures. EVIDENCE: The Administrator said that staffing levels on the late shift have been reviewed. She added that additional staff are provided at particularly busy times – 8 to 10.30am and 3 to 5pm for feeding residents. Other aspects of the staffing standard 27 were not assessed at this inspection. The Administrator explained that new, inexperienced staff are ‘supernumerary’ until the Home’s Nursing Skills Co-ordinator assesses them as suitable to work in an unsupervised capacity. She added that no staff member works unsupervised until a CRB check is received. Staff files indicated that thorough recruitment procedures were being followed. However, the Administrator was not aware of changes to the Regulations in 2004 resulting in further information and documents being required in respect of persons working at a care home (Schedule 2 of the Regulations). She was advised to view the new Regulations on the Department of Health web site. Discussion with the Administrator identified that the Home provides appropriate mandatory training to its staff group as well as other relevant training courses. The Home employs a training officer. Other aspects of the training standard 30 were not assessed at this inspection. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 16 Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 17 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) These standards were not assessed. EVIDENCE: The Administrator spoke of improvements being made to the Home’s ‘Comments, Suggestions and Complaints’ procedure. This included displaying the complaints procedure and placing a suggestion box in the Atrium in the near future. Residents meetings were being held periodically and minutes of the 31 May 2005 meeting were seen. These confirmed that residents were being consulted on various matters regarding the running of the Home. Other aspects of the Home’s quality assurance measures, as detailed in standard 33, were not assessed at this inspection. Health and Safety matters (Standard 38) were not assessed at this inspection. However, the Administrator said that the Home had had an inspection yesterday by Severn Trent Water Authority when the risks of Legionella, and the Home’s washing machines, had been assessed. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 18 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 2 x x STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 19 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 3 Regulation 14(1)(a) Requirement The registered persons must ensure that a full assessment of a prospective residents needs is carried out and recorded prior to admission - as detailed in Standard 3.3 Care plans must show involvement of service users/relatives in all stages of care planning. Service users care plans must include all risks. Service users care plans must include all needs.(Previous timescale was 30/6/04) Carry out a programme to fit approved locks to bedroom doors. (Previous timescale was 31/10/04) The manager must establish formal supervision for all staff. Care staff must receive supervision at least 6 times a year.(This requirement from 5 March 2004 had a timescale of 31 October 2004. It was not assessed at this inspection) Wheelchairs must contain footrests for service users assessed as needing them.(This requirement from 12 January 2005 had a timescale of 30 Timescale for action 1 September 2005 2. 7 13(4)(c) 15(1)&(2) (c) 1 September 2005 3. 24 12(4)(a) 1 February 2006 1 October 2005 4. 36 18(2) 5. 38 13(4)(c) 1 September 2005 Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 20 6. 38 15(1) November 2005. It was not assessed at this inspection) Service users moving and handling assessments and care plans must clearly show how staff are assisting them to move/transfer. (This requirement from 12 January 2005 had a timescale of 28 February 2005. It was not assessed at this inspection) 1 October 2005 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 2 Good Practice Recommendations A signed copy of service users contract (or terms and conditions if care managed) should be kept within their care plan. (This recommendation from 5 March 2004 was not assessed at this inspection) Periodic, multi-professional review meetings should be held for all residents who are privately funded.(This was a recommendation from 12 July 2004) The practice of transferring service users through the lounge areas on a toilet chair frame, without a seat cover, should be reviewed. (This was a recommendation from 12 January 2005) Written information on external advocacy groups should be made available to service users, relatives and visitors. (This recommendation from 12 January 2005 was not assessed at this inspection) The Complaints Procedure should be clearly displayed in the home.(This was a recommendation from 12 July 2004) The Home’s policy and procedures on prevention of aggression should include service users in line with current guidance.(This recommendation from 5 March 2004 was not assessed at this inspection) Update the home’s policy and procedure on the use of restraint in line with current guidance. (This recommendation from 5 March 2004 was not assessed at this inspection) The Registered Persons should demonstrate that a suitably qualified person, in consultation with service users, has C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 21 2. 3. 4 10 4. 14 5. 6. 16 18 7. 18 8. 22 Brookfields 9. 24 10. 11. 32 33 12. 35 13. 36 carried out an assessment of the premises and equipment. The report should demonstrate that the home provides the required disability equipment and environmental adaptations to meet service users needs. (This was a recommendation from 5 March 2004) The Home’s statement of purpose, service users guide and service users care plans should clearly show that service users are given the option of having a lockable storage space provided. (This recommendation from 12 January 2005 was not assessed at this inspection) The home should establish regular staff meetings.(This recommendation from 5 March 2004 was not assessed at this inspection) The Registered Person should use a standard form to record monthly un-announced visits as required in Regulation 26.(This recommendation from 5 March 2004 was not assessed at this inspection) Qualified staff should determine and record whether service users are subject to power of attorney or guardianship orders on admission.(This recommendation from 5 March 2004 was not assessed at this inspection) The home should provide a written policy on staff supervision. All staff should be made aware of this.(This recommendation from 5 March 2004 was not assessed at this inspection) 14. Brookfields C02 C52 S2113 Brookfields V236950 080705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT 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 Brookfields C02 C52 S2113 Brookfields V236950 080705 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. 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. 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