CARE HOMES FOR OLDER PEOPLE
Brooklands 6 Blackbull Lane Fulwood Preston Lancashire PR2 3PU Lead Inspector
Mrs Felicity Lacey Unannounced Inspection 9:30 1 November 2007
st 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 Brooklands DS0000009822.V346988.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. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brooklands Address 6 Blackbull Lane Fulwood Preston Lancashire PR2 3PU 01772 719078 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) J.T. Care Homes Limited Susan Williams Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (1) of places Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The registered provider should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The home is registered for a maximum of 24 service users to include up to 23 service users in the category OP and 1 service user in the category PD 28th November 2006 Date of last inspection Brief Description of the Service: Brooklands Residential Care home is registered with the Commission for Social Care Inspection to provide personal care for twenty-four older people. The home is situated in a residential area on the outskirts of the city of Preston. It is on a main road and is close to shops and local amenities and on a bus route. Brooklands is a detached home with a purpose built extension, with a small garden to the front of the home, a paved patio and a parking area at the side of the home. Accommodation is provided in twenty-four single rooms all with en-suite facilities. The bedrooms are individually decorated and furnished to a good standard. Rooms are situated on the ground and first floor and can be accessed by a lift. There are a variety of communal areas including a visitor’s lounge and there is a hairdressing room. Brooklands belongs to the J.T. Care Homes Limited group of care homes. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to Brooklands. During the visit the inspector was able to speak to people who lived at Oxford House, staff, a relatives and the manager. Case records and documentation kept at the home were looked at. A tour of the premises took place. As part of this inspection the manager provided written information about the running and administration of the home and an assessment of how they felt the home met the required standards of care. Comment cards were distributed to people living at the home, relatives and health and social care representatives. What the service does well:
All people who live at the home have had their needs assessed before being offered a place. People are able to spend time at Brooklands for a trial period before making a decision about moving in on a permanent basis. Care plans are concise and are reviewed regularly. Medical advise and consultations are arranged on request, or if a change in health needs develops. There are weekly trips out in the minibus. There are activities within the home, including Bingo, gentle exercise and quizzes. People who live at the home can decide if they wish to spend time alone or in company, and can take part in activities as they wish. The home is nicely decorated and clean. People are encouraged to make their bedrooms their own private space and can arrange their rooms as they wish. Staff respect the choices of people who live at the home. The comments received from residents, relatives and visiting professionals included: ‘I do as much as I can for myself, the staff help me when I ask.’ ‘The home is wonderful. Staff are very caring and kind.’ ‘Staff are very caring and interested. My room is nice. The food is good ’ ‘The staff are spot on. They seem to know before I do when I need the doctor to come out!’ ‘It is kept beautifully clean.’ ‘I feel happy and cared for here.’
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 6 ‘The care home staff are quick to get in touch with us if the need arises.’ ‘The whole staff at Brooklands are very supportive and caring of the residents.’ ‘(The staff) treat visitors with care and friendliness.’ ‘From my experience with the home individuals health care needs seem to be attended to in a caring, professional way.’ ‘The privacy and dignity of the residents has always been respected in my experience of involvement with the home.’ ‘The home seems to provide a wide variety of activities and trips and seems to encourage as much independence as possible.’ What has improved since the last inspection?
The manager has begun a regular audit of all care files and documentation kept at the home. This ensures that the records are relevant and are completed to the required standard. There has been an increase in activities on offer in the home. A record of activities is being kept and the activities co-ordinator has had an increase in hours. There have been improvements to the laundry system at the home to ensure that all clothing is in the correct room. Key workers have a checklist of duties including ensuring that clothes are labelled correctly, and bedroom wardrobes and drawers are kept tidy. Senior staff carry out weekly checks to make sure the system is working. There have been improvements and redecoration of the accommodation at The Brooklands. The hall, lounge and dining room have been recarpeted. There is a company training manager in place who has introduced a programme of Continuing Professional Development. Recent courses have related to the needs of the people at the home, and have included Dementia Awareness, Bi-polar disorder, Managing Challenging Behaviour and the Professional Use of Language. Staff continue to complete National Vocational Qualification training. 10 of the 16 care staff employed at the home have a NVQ in Care. The manager has achieved a National Vocational Qualification level 4 Registered Managers Award. She has also continued to add to her skills and update her knowledge.
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 7 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.
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 8 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 Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is good. The pre admission procedures of the home ensure that the needs of a person who would like to come to live at the home are assessed, and that the staff have the skills to meet these needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All files looked at contained records of the information gathered before a person was admitted to Brooklands. This included a record of the initial contact, copies of health and social services assessments if appropriate, and the record of the assessment made by the staff of Brooklands. A senior member of staff carries out a pre admission assessment, either with the prospective resident in their own home, or at Brooklands. People spoken with during the visit confirmed that prior to moving to Brooklands they had visited and had discussed their care needs with staff of the home. Information is provided in a Service User Guide and in the Terms and Conditions of residency. There was evidence on file that residents had contracts in place.
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. In the main the health and personal care needs of residents are recorded and reviewed, this ensures that support is provided in a consistent way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans seen included a personal information sheet, dependency checklist and from this the areas in which a more in-depth care plan is needed are identified. Common areas of need are covered by pre-written care plans, and staff identify which parts of the plan are relevant to the individual. Some files also included other care plans which had been written to address other needs identified, however in some case care plans had not been devised to provide guidance for staff inline with identified needs. For example, one assessment highlighted that a resident was prone to wandering and had limited sight, another identified a person had diabetes, and a further assessment highlighted that a times a person was agitated and demanding. However these needs were not included in the subsequent care plans. When using a system which provides pre written care plans to cover most common needs it is important to ensure when other needs are identified a care plan is
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 11 written. All care plans are reviewed monthly by the key worker. The manager monitors the care records to ensure that they are kept up to date. Care plans should be written in consultation with the person to whom the plan relates, or their representative when ever possible. Care plans are currently not signed by the person using the service, this should be done to show that they are in agreement with the care needs identified and the level of assistance required. Records of medical visits are kept and this showed that a range of health professionals are involved with the care provided at Brooklands. People spoken with during the visit confirmed that their health needs were met and that requests for visits from the G.P and health appointments are arranged promptly by staff. Health conditions are monitored. G.P visits were recorded, however the visits of other health professionals were recorded in the medication file and some on the daily notes, it is important that this information is easily accessible and that medical appointments, recommendations and treatment can be clearly identified and monitored from the records. In two cases in was unclear on the residents whether recommended medical consultation had taken place. The weight records kept by the staff were looked at. The records were up to date, however there was no evidence that any significant weight loss or gain was being acted upon. It is important that if staff register a significant change in weight that there is a system in place to ensure that this is reported and acted upon. The manager should ensure that regular monitoring of the weight record takes place to ensure that any patterns are quickly established and acted on. In the interests of accuracy and consistency it is advisable that weights are recorded consistently in either stones and pounds, or kilograms and that the same scales should be used whenever possible. The storage and administration of medication at the home is satisfactory. The people living at the home are able to decide whether they would like to selfadminister medication. Records seen were completed accurately. Staff who have responsibility for administering medication have received training, and evidence was seen on staff files of observation of practice. People spoken with during the visit confirmed that they felt that the staff were mindful of the importance of privacy and dignity. Assistance with personal care is offered in a discrete way and independence is promoted. Privacy is respected when visitors are present. Staff address people who live at the home in the way they wish. The induction programme of the home includes consideration of the values needed when providing quality care, including privacy and dignity. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 12 The manager is hoping to improve the way in which the wishes of people living at the home are recorded concerning terminal illness and arrangements after death. It is hoped that this will ensure that care and comfort is given to people in times of illness in accordance with their personal wishes, and the opportunity is given to discuss end of life care. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 13 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 good. Regular activities are on offer at The Brooklands, that reflect the interests and cultural preferences of the people living at the home, this provides the opportunity for an active social life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are a range of activities on offer at The Brooklands. Organised activities include gentle exercise, regular quizzes and drives out in the mini-bus. There are a number of organised social events that can be attended by resident’s families and friends, including a Bonfire Night Party and a Christmas Fair. The residents also have the opportunity to go out to functions if they wish; the next event is a Christmas dinner and entertainment at a hotel in Blackpool. The preferences of residents are respected, as some people do not wish to take part in organised activities. The residents spoken with felt that there was enough going on and that it was up to them if they wanted to take part. The religious interests of residents are recorded on admission. Some residents have maintained active links with the churches they attend and go out to services and functions. The home has regular visiting arrangements with local
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 14 Roman Catholic and Church of England clergy. Communion is held at the home on a weekly basis. Visitors spoken with during the visit to The Brooklands confirmed that they were always made welcome. The staff were friendly and ensured that they were kept informed of any important information. Residents are able to see visitors in the privacy of their own rooms or in the visitors lounge, or can join with other people in one of the communal areas. The independence of residents in managing their own financial affairs is promoted. The manager does administer some personal allowances and a form is signed by the resident or their representative to show their agreement for this. All transactions are documented and receipts kept. The meals at The Brooklands are of a good standard. Residents spoken with thought there was enough choice and variety. Residents are able to have what they like and can enjoy their own particular favourites prepared by the cook. Drinks and snacks are provided throughout the day and on request. Special diets are catered for. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 15 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, 18 Quality in this outcome area is good. The complaints and protection policies of the home are understood and safeguard the welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents and relatives spoken with and who completed surveys indicated that they knew how to make a complaint and who to make a complaint to. They also felt that their concerns would be listened to by the staff and acted upon. As identified at the previous inspection the current record of complaints should be improved, it should include the name of the person raising the complaint and should be kept in a way that respects confidentiality and in line with the requirements of Data Protection legislation. Staff spoken with understood their responsibilities under the Adult Safeguarding procedures. Staff have received training in Adult Protection through their NVQ studies and during induction. Brooklands DS0000009822.V346988.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. The home is well maintained, nicely decorated and clean and provides a pleasant place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents spoken with thought the home was lovely and clean. The rooms are nicely decorated and a new carpet has been laid through out the communal areas of the ground floor. The home offers a range of communal lounges and areas, and has two outdoor patio areas. There is a system in place to make sure that all maintenance jobs are reported and carried out. All areas of the home were clean. There have been improvements to the laundry systems, the key worker now keeps a check on resident’s clothes to ensure they are labelled correctly and clothes do not get mixed up. The laundry facilities of the home have been updated and there is now an industrial dryer installed. Infection control procedures are in place. Staff have undertaken training in infection control and the manager has identified the need for regular up dates for staff.
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Staff are competent and staffing levels are sufficient to meet the identified needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives considered the home to be sufficiently staffed, they felt that the staff work hard and are always busy. There were many positive comments about the friendliness and caring attitude of staff members. There has been a high turn over of staff since the last inspection; the manager explained that this had largely been night staff. At the time of the visit to The Brooklands there were two vacancies for night staff, and these were being covered by staff doing additional hours. The home has exceeded the recommended minimum ratios of trained staff. 62.5 of staff have achieve a National Vocational Qualification in Care at Level 2 or above. Staff spoken with confirmed that they were encouraged and expected to undertake training as part of their job. The company has employed a training manager who has made progress in ensuring that all staff have individual training and development assessments and profiles in place. These were seen on staff files and highlighted any statutory training that was needed, and also other training provided in particular topics, including Dementia Awareness, Managing Challenging Behaviour and Bi Polar Awareness. The training manager has devised a programme of regular training. The manager works with the training manager to identify training needs and provides some training in house.
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 18 The home has a recruitment procedure, which ensures that an application form and relevant checks are completed. In the main this had been followed, in one case a reference was outstanding and it is important that employment histories include months and years of employment, and in some case only years were listed and this allows for gaps in employment to go undisclosed. Staff spoken with confirmed that they had completed application forms. They had undergone a period of induction when joining the home and this included regular oversight from a senior member of staff. There is an induction programme which covers information that is needed from day one and that continues for up to 12 weeks. The induction includes practical information and covers areas of good practice including the principles and values of care. Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. The Brooklands is well managed, residents feel their views are taken account of and are pleased with the standard of care. The health and safety of residents and staff are promoted through the policies and practice of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager continues to add to her knowledge and skills. She has achieved a Registered Managers Award and is undertaking further training to become an NVQ assessor. She is experienced and provides good support for the staff of the home. There is regular contact between the manager and people living at the home. People spoken with felt that their views were sought and listened to. The home has an ISO quality award in place. The responsible individual visits the home
Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 20 regularly and a monthly report inline with regulation 26 is produced. There is also a new system called a ‘Management Review’, this is a monthly visit by the proprietor in which all aspects of the running of the home are discussed with the registered manager. During these visits areas for improvement are identified and planning takes place to ensure the continual development of the service. The monies kept on behalf of people living at the home are stored securely. Any transactions undertaken are receipted and entries are double signed. The Annual Quality Assurance Assessment completed by the manager as part of this inspection indicates that health and safety checks are up to date. Policies and procedures are reviewed periodically. An annual review of policies should take place to ensure that all guidance is up to date and relevant. Training is given in health and safety topics. Staff spoken with confirmed they had completed mandatory training in safe working practices, including Moving and Handling, Basic Food Hygiene and Fire Safety. Brooklands DS0000009822.V346988.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Brooklands DS0000009822.V346988.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. Standard Regulation Requirement Timescale for action 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. 3. 4 Refer to Standard OP7 OP7 OP8 OP8 Good Practice Recommendations Care plans should provide relevant guidance to ensure that all identified needs are met in a consistent and appropriate way. Care plans should be signed by the service user or their representative. The record of weight gain or loss should be monitored, and appropriate action taken in the case of a significant change. Consistent records should be kept which allow the monitoring of recommended medical treatments. All visits and consultations with health professionals should be recorded. As recommended at the last inspection the record of complaints should record details of the complainant and should be kept in such a way as to ensure that confidentiality is protected.
DS0000009822.V346988.R01.S.doc Version 5.2 Page 23 5 OP16 Brooklands Brooklands DS0000009822.V346988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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