Inspection on 21/06/06 for Brookholme Croft Nursing Home

This inspection was carried out on 21st June 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brookholme Croft Nursing Home 22/10/08

Brookholme Croft Nursing Home 09/08/07

Brookholme Croft Nursing Home 06/02/06

Brookholme Croft Nursing Home 25/01/05

Brookholme Croft Nursing Home 30/06/04

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 Brookholme Croft Nursing Home Off Challands Way Hasland Chesterfield Derbyshire S41 0EU Lead Inspector Susan Richards Key Unannounced Inspection 21st June 2006 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 Brookholme Croft Nursing Home DS0000002045.V300432.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. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookholme Croft Nursing Home Address Off Challands Way Hasland Chesterfield Derbyshire S41 0EU 01246 230006 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) morverndax@aol.com Dr A P M Matthews Mrs A Matthews Angela Alice McInnes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That a named service user named on the Notice of Proposal may be accommodated at the home under the category of DE(E) - not transferable to any other service user. 6th February 2006 Date of last inspection Brief Description of the Service: Brookholme Croft is a purpose built care home, which opened in 1996. The home provides nursing and personal care and support for up to 40 older persons. It is situated at the head of a residential close and is located in the village of Hasland, within close proximity of Chesterfield town centre. There is level access to a well-kept garden to the rear of the building, with car parking spaces to the front of the home. Single room accommodation is provided for all residents. Nine of which, have en-suite toilet and wash hand basin facilities. There is an option for those who choose to share a room, as there are two sets of rooms which link via interconnecting doors. These doors are kept locked when the rooms are used as single accommodation. There is a choice of communal bathrooms and toilets, which are suitably located and equipped. The registered manager is a registered general nurse, who is supported by a team of nursing, care and hotel service staff. The home’s stated aims are to provide a friendly, safe and pleasant environment, together with high standards of care and support, delivered by a dedicated and professional staff team, who will promote individual’s rights to privacy, dignity and choice. The current scale of charges is as follows: Personal care only - £345.60 Nursing care - £426.80 - £479.80 These are as written information provided by the home on 12 May 2006. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a full key inspection of the service. As such all of the Department of Health’s key national minimum standards for older persons were inspected. Methodology included the use of case tracking, which provides closer inspection of national minimum standards relevant to the care and services provided to four residents, who were randomly sampled What the service does well: What has improved since the last inspection? What they could do better: Given the variable feedback obtained during the inspection regarding meals provided, the registered persons should continue to consult with residents on an ongoing basis about the quality of food they receive and the organisation and arrangements for meals and mealtimes, in order to measure their efficacy. The medicines policy should be further developed to ensure there is a clear process for individuals’ risk assessment and determination in respect of any potential resident that may wish to manage their own medicines by way of self-administration. The manager should ensure that the system of individual staff supervision, recently introduced is effectively rolled out to all staff and continued and that Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 6 records are properly maintained in respect of their recruitment, induction and training. 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. Brookholme Croft Nursing Home DS0000002045.V300432.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 Brookholme Croft Nursing Home DS0000002045.V300432.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Residents are provided with information about the home in suitable formats and do not move into the home without having their individual needs assessed and being assured that these would be met. Quality outcome in this area is good. This judgement has been made using evidence available, including a visit to the home. EVIDENCE: Discussions were held with residents’ case tracked about the arrangements for their admissions to the home and information provided to them and/or their representatives about the home. All had opportunity to visit and had been given relevant information about the home, including individual written terms and conditions. The recorded needs assessment information for each resident case tracked was examined. These were comprehensive and up to date, with the exception of Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 9 some two residents current religious needs, which were incomplete. Individual likes and dislikes and daily living preferences were detailed. Feedback from residents and their representatives was generally positive about their care. Discussions were also held with staff about the systems and arrangements for the organisation and delivery of care to individual residents, including those case tracked. Brookholme Croft Nursing Home DS0000002045.V300432.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Residents’ personal and health care needs were largely being met and the home’s philosophy of approach successfully underpinned the promotion of residents’ rights to dignity, privacy and respect. However, the home’s medicines policy did not fully provide for potential residents who may be responsible for their own medication and staff practises were not always in accordance with existing medicines policies and recognised practise in respect of medicines administration records. Quality outcome in this area is adequate. This judgement has been made using evidence available, including a site visit to the home. EVIDENCE: Discussions were held with residents’ case tracked about their care and comments were also received by way of residents comment cards. Satisfaction was expressed about the arrangements for individuals personal, social and healthcare. Discussions were also held with staff regarding the arrangements for care delivery and the provision of individual equipment. It was felt that additional Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 11 slings were required for the hoist in order to fit those of a slighter build. This was discussed with the manager, who advised that this was in hand. The written care plans of those residents case tracked were examined. These were formulated within a framework of risk assessment, were up to date and were reflective of recognised guidance concerned with the care of older persons. The arrangements for access to healthcare professionals was also discussed with residents and staff, including that relating to routine health care screening and records in respect of these were also examined and were properly maintained. A number of healthcare professionals visits named residents during the inspection, including GP, district nurse and physiotherapist. The arrangements for the management and administration of medicines were also examined, with particular scrutiny placed on those residents case tracked. For one resident case tracked one of their medicines had been omitted on two occasions, although this was not properly recorded on their medicines administration record (MAR) sheet, including the reason for this omission. Another resident case tracked had hand written instructions on their MAR sheet as to a particular medicines prescribed, which was not clear and was not signed or dated by the person writing these or countersigned by a witnessing staff member. There were also two omissions of recording on the MAR sheet in relation to another prescribed medication for this resident. A further resident also had omissions of recording on their MAR sheet regarding medicines administered. The previous two inspection reports dated 150605 and 060206 detailed the need to develop the medicines policy in relation to self-administration of medicines ensuring that residents should be able to take responsibility for their own medicines if they wish, within a risk management framework. This had not been developed by this inspection. The manager confirmed that there was no residents who were able to self medicate at the time of the site visit for this key inspection. The home’s written care philosophy was examined and discussions held with staff in relation to this and its promotion. Brookholme Croft Nursing Home DS0000002045.V300432.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 There are excellent arrangements to enable residents to engage in occupational, social and recreational activities of their choice and in consultation with them. However, continued and close monitoring of residents views as to the quality and choice of food should be ensured in order to properly ascertain their satisfaction with these. Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. EVIDENCE: The home employs a half time activities co-ordinator. Discussions were held with residents and staff about the arrangements for residents to engage in occupational, social and recreational activities and to receive visitors. Feedback about these arrangements was also received via residents comment cards as forwarded by the Commission. High levels of satisfaction were expressed in respect of these, which residents felt to be well organised and in accordance with their individual choices. Records and details of activities displayed were reflective of this. On the day of the site visit for the inspection a group of residents went out on a pre-planned trip to a country pub for lunch. On their return, all said they had very much enjoyed this. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 13 Since the previous inspection, the registered manager had introduced regular residents meetings and relative meetings. These had been well received and the minutes of the meetings were posted on the residents’ notice board. Details of consultation and discussions about the arrangements for activities and also meals were included, including a very recent review of menus as a result of the meetings. The revised menus were displayed on the notice board also. However, lunches served on the day of the site visit for the inspection were not as recorded on the menu. Residents had not been notified before hand of this change. They were advised at the dining table as to the food to be served, which consisted of a main cooked meal or a lighter alternative choice. Feedback obtained from residents about meals served in the home was variable and it was felt that the promotion of quality and choice was not consistent. This was discussed with the manager during the site visit. Two of the residents’ case tracked did not have their religious needs recorded on their individual needs assessment documentation. During discussions with them, those residents advised that they did not practise their religion. However, discussions with other residents and staff detailed suitable arrangements in respect of religious activities. Brookholme Croft Nursing Home DS0000002045.V300432.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents knew how to complain. Complaints were effectively dealt with in accordance with the home’s complaints procedure and there were suitable systems and procedures in place to promote the protection of residents from abuse and staff understood their responsibilities in relation to these. Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. EVIDENCE: Details of complaints received by the home over the preceding 12 months were provided in the pre-inspection questionnaire as completed by the registered manager. There had been two in total. These were discussed with the manager at the site visit for the inspection, including action taken and outcomes and records were examined in relation to these, which from the information provided were satisfactory. Effective information is provided for residents and their representatives as to how to complain by way of the home’s complaints procedure, which is openly displayed in the home and also provided in the service user guide and statement of purpose. Residents spoken with knew how to complain. Feedback from residents/representatives indicated that the manager and staff listened to them and dealt with concerns raised promptly. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 15 Staff spoken with was conversant with the appropriate procedures to follow in the event of any suspicion or witnessing of the abuse of any resident. Residents spoken with said that they felt safe in the home and that staff treated them with kindness and respect. The arrangements for the management and handling of residents monies in the home were discussed with the manager and examined more closely for the four residents case tracked. These were satisfactory. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Residents live in a safe and well-maintained environment, which meets their needs and is homely and comfortable. Quality outcome in this area is good. This judgement has been made using available evidence, including a site visit to the home. EVIDENCE: The communal and private accommodation of residents’ case tracked was inspected. All areas seen were clean, odour free and free from hazards. They were also well lit and ventilated and were furnished and decorated to a good standard. Equipment was provided in accordance with residents’ assessed needs (see comments made in relation to hoist slings in the Healthcare section of this report). There is an ongoing programme for the routine maintenance and renewal of the fabric and decoration of the home. Residents’ rooms were personalised, some having their own furniture and residents spoken with expressed satisfaction with their environment. Brookholme Croft Nursing Home DS0000002045.V300432.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Although residents’ care and support needs is met by staff, the home’s record keeping in respect of staff recruitment, induction and training did not evidence this. Quality outcome in this area is adequate. This judgement has been made using evidence available, including a site visit to the home. EVIDENCE: Details of staff employed, together with the arrangements for their deployment, recruitment, induction and training were discussed with the manager and staff and records were request and examined in respect of these. Information was also provided by way of the pre-inspection questionnaire completed by the registered manager with regard to staff employed and their recruitment and training. A total of 9 care staff have achieved at least NVQ level 2, being 50 of the total number of care staff employed with further undertaking. Staff confirmed there had been a variety of training over the preceding 12 months, including Positive Dementia Care, adult protection, oral health care and safe handling of medicines as detailed on the pre-inspection questionnaire. The manager also advised that further training was planned over the coming weeks for first aid, food hygiene, ‘End of Life’ programmes and care and ongoing NVQ training. Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 18 The personal files for four of the most recent staff starters were examined. Discussions were held with the manager about the storage and retention of records in respect of criminal records checks for staff in line with data protection. One of the staff files did not contain two personal references in respect of their recruitment and another contained only one, although the checklist at the front of their file was signed to indicate that these had been received. The manager stated that they had been received. There was no properly completed induction record for the four staff, whose records were examined and no clear and consistent record as to training undertaken by them to date or training needs analysis information. Discussions with the manager and staff indicated that appropriate staff training and induction was being provided, including core health and safety training. Some of the staff files contained specific certificates relating to some aspects of training undertaken by them. (At the previous inspection for this service in February 2006 all records were in place in respect of these areas). Residents felt that staff was mostly available when they needed them and that they received the care and support they needed. Brookholme Croft Nursing Home DS0000002045.V300432.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Positive measures have been introduced to promote residents’ rights and best interests in respect of formal mechanisms for increased consultation with them. The home is generally well managed and run, although inconsistencies and omissions relating to some aspects of record keeping, procedures and practise (staff records/training, individual supervision and medicines records) do not always serve to underpin the safeguarding of their rights and best interests. Quality outcome in this area is adequate. This judgement has been made using evidence available, including a site visit to the home. EVIDENCE: Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 20 The registered manager has been employed at the home for many years. She is a Registered General Nurse and has completed the Registered Managers Award. Discussions were held with her about training and development undertaken by her. She also acts as a link nurse for wound care. Since the previous inspection for this service, she has introduced regular meetings with residents and also with relatives. Records of these meetings were provided and minutes were displayed on the residents’ notice board. The home has Investors in People Award and an internal quality assurance audit system. Records of these, together with the aims and objectives of the home were examined and discussed with the manager, together the home’s care philosophy. The arrangements for the management and handling of residents’ monies were examined, with closer scrutiny for those residents case tracked. These were satisfactory. At the previous inspection for this service a programme for individual staff supervision had been developed. However, examination of records and discussions with the manager and staff indicated that this had not been fully rolled out to all staff. A number of records were examined during the inspection, which are required to be kept in the home, including residents care records, accident records and staff records. (Comments are made in respect of omissions in staff records under the Staffing section of this report and also medicines records under the Health Care section of this report). Details of the required maintenance of equipment were provided within the pre-inspection questionnaire, which were up to date and also relating to staff core health and safety training. Although staff training records in the home did not accurately reflect training said to have been undertaken by staff in this respect. Brookholme Croft Nursing Home DS0000002045.V300432.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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13, 17 Requirement Staff administering medicines must properly maintained records of these. Staff must sign to indicate that medicines have been administrated or where these have been omitted, use the appropriate code to indicate the reason for this. Hand written medicines instructions on the medicines administration record (MAR) sheet must be signed and dated by the person writing them and countersigned and dated by a staff member witnessing this. (NMS OP 38 also applies here). There must be a safe system for moving and handling residents – in this instance a review of sling sizes available for use with the hoist must be undertaken and equipment provided in accordance with individual needs. A copy of each reference (x2) obtained for each staff member for the purposes of their recruitment must be kept. A record of induction and DS0000002045.V300432.R01.S.doc Timescale for action 31/07/06 2. OP9 13 31/07/06 3. OP22 13, 23 31/07/06 4. OP29 17, S4 31/07/06 5. OP30 17, S4 31/07/06 Page 23 Brookholme Croft Nursing Home Version 5.2 training must be provided for each staff member and be properly maintained. 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 OP9 Good Practice Recommendations Residents should be able to take responsibility for their own medicines if they wish, within a risk management framework and the home’s medicines policy should be developed to reflect this. The manager should ensure that effective consultation with residents is maintained in respect of their satisfaction as to the food/meals provided. The registered manager should ensure that the system for individual staff supervision is effectively rolled out to all staff and undertaken in a timely manner. 2. 3. OP15 OP36 Brookholme Croft Nursing Home DS0000002045.V300432.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office 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. 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