Inspection on 12/07/07 for Brooklands Care Home

This inspection was carried out on 12th July 2007.

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

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

Other inspections for this house

Brooklands Care Home 18/11/09

Brooklands Care Home 19/11/08

Brooklands Care Home 13/07/06

Brooklands Care Home 15/12/05

Brooklands Care Home 28/07/05

Brooklands Care Home 08/03/05

Brooklands Care Home 29/07/04

Brooklands Care Home 10/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Brooklands Care Home Springfield Road Grimsby North East Lincs DN33 3LE Lead Inspector Eileen Engelmann Key Unannounced Inspection 12th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000002776.V345483.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. DS0000002776.V345483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooklands Care Home Address Springfield Road Grimsby North East Lincs DN33 3LE 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) 01472 753108 01472 278023 brooklands@schealthcare.co.uk Southern Cross Home Properties Limited Mrs Dorothy Marfleet Care Home 63 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (31), of places Physical disability (11) DS0000002776.V345483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Three Physically Disabled service users to be accommodated in the main part of building until such time as a vacancy occurs in the designated unit. The Maximum number of service users to be accommodated in the home with a physical disability will remain at 11, and shall not be increased again. A new admission into any one of the three places in the main building shall not take place automatically, but only with the approval of the CSCI 13th July 2006 Date of last inspection Brief Description of the Service: Brooklands is a purpose built care home in a residential area of Grimsby, providing residential and nursing care to a maximum of 63 people, being of old age or having dementia or a physical disability. The home has two floors and rooms are all single. There are satisfactory communal facilities, a rear garden area and a passenger lift. Local facilities, shops, pubs, chemist, Grimsby Town Football Club, etc. are within walking distance and the centre of Grimsby or the Princess Diana General Hospital is only a bus ride away. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit indicates the home charges fees from £345.00 to £533.00 per week depending on the type of room required, the nursing input needed and the source of funding. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. DS0000002776.V345483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out with the manager, staff and people living at Brooklands Care Home. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files and records relating to the service. Two hours were spent observing the care being given to a small group of people. The care of four people was looked at in depth when comparisons with the observations were made with the homes records and the knowledge of the care staff. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to a selection of relatives, people using the service and staff and their written response to these was good. The inspector received 9 back from relatives (45 ), 4 from staff (20 ) and 14 from people using the service (66 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. Since the last key inspection in July 2006 the Commission has been notified of two formal complaints around cleanliness of the home and communication between staff and relatives, which were dealt with by the home and resolved. There has been one safeguarding of adults referral made in September 2006 around an injury to a person when staff omitted to put bed rail bumpers onto a set of bed rails; North East Lincolnshire Social Services and the provider investigated this. The outcome of the investigation was that two staff members underwent disciplinary procedures and the home re-instructed all staff in the safe use of bedrails and bumpers as a training exercise. An additional visit to the home took place in January 2007 to follow up progress of the home in meeting requirements and recommendations from the key visit in July 2006. This was very positive visit and only two requirements remained outstanding. What the service does well: The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. DS0000002776.V345483.R01.S.doc Version 5.2 Page 6 Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. What has improved since the last inspection? What they could do better: The person who owns the home must make the statement of purpose and service user guide better by putting more information into it. People living in the home said that the staff are very good at talking to them and they felt comfortable talking about the service and their needs. The person who owns the home must make sure that the contract given to people who pay for their own care has enough information in it to tell the people living in the home how much they have to pay to live there and how much extra services cost. People working in the home must make sure that the way they record and give out medication gets better. At the moment the way they do this is not safe and could put the people who live in the home at risk. People in the home who have dementia or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. The person who owns the home must make sure that action is taken to do any work asked for by the Fire Officer in his recent report, so that people living in the home have a safe environment to stay in. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. DS0000002776.V345483.R01.S.doc Version 5.2 Page 7 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. DS0000002776.V345483.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 DS0000002776.V345483.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): 1, 2, 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The Statement of Purpose and Service User Guide is on display in the entrance hall and copies are available from the manager. The information in the Statement of purpose needs updating around the categories of care provided in the home and the specialist training that staff receive to meet the needs of people using the service. The Service User Guide needs to include the price of fees and the statement of terms and conditions must include the costs of additional services. Both these documents are available in a tape format if required. DS0000002776.V345483.R01.S.doc Version 5.2 Page 10 Information from the surveys shows that the majority of people received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. A number of people within the home are self-funding and their files show that information about fees and fee increases is sent out to the person responsible for each individuals finances and sufficient notice of changes to the prices is given in writing. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Discussion with the manager indicated there is a formal, written process of offering placements to people who are interested in using the service. Those people at the home who receive nursing care have undergone an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of their specific problems/abilities and the care given on a daily basis. Discussion with people showed that they were satisfied with the care they receive and have a good relationship with the staff. Comments from the surveys said ‘ the staff help as much as they can and my relative is well looked after’, ‘the staff in the dementia unit are wonderful’. The home employs six staff from overseas including Poland, Philippines, Africa and India. People using the service are able to make a limited choice of staff gender when deciding whom they would like to deliver their care, as the home has 2 male care staff as well as the 34 female members. The manager said that she would discuss this with people wanting to use the service during the assessment process. The staff training files and the training matrix show that new staff go through an induction before starting work and that the home has a training programme in place. Information from the files and matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service, including dementia care. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. Information from the Pre-Inspection Questionnaire and discussion with the people living in the home indicates that all of the people are of white/British DS0000002776.V345483.R01.S.doc Version 5.2 Page 11 nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home does not accept intermediate care placements so standard six is not applicable to the service provided. DS0000002776.V345483.R01.S.doc Version 5.2 Page 12 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 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people using the service are clearly documented and are being met by the service and staff. Improvements to the staff performance around recording within the medication system must be made, to ensure the peoples’ health and welfare are protected. EVIDENCE: Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. One relative commented that ‘the staff have lots of patience with the people using the service, they are very caring and my relative always looks nice and is well fed’. The care of four people was looked at in depth during this visit and each person has their own care plan detailing what care is needed to meet their DS0000002776.V345483.R01.S.doc Version 5.2 Page 13 needs. The plans are kept up to date by the staff and individuals are able to input to these on a daily basis by talking to their key worker or during the review process with the funding authorities. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Relatives commented that ‘the staff show compassion and understanding when dealing with people’ and ‘staff always treat people as individuals’. One person told the inspector that she is looking forward to moving into her own flat in the community. She has made such good progress health wise that she is now able to move on after 13 years in care. Entries in the care plans specify where individuals have dietary needs, including PEG feeds, supplement drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Information from the Annual quality assurance assessment and discussion with the manager indicates that currently there is one person with a pressure sore, their wound is documented in their care plan and wound care is given as appropriate. Relatives commented that they are kept informed of their relative’s wellbeing by the staff; they are regularly consulted (where appropriate) on their care and feel involved in their lives. Overall there is a good level of satisfaction with the care being given to people using the service. At the last visit in January 2007 a requirement was made that ‘the Registered Provider must dispose of unwanted, unused medicines in a safe and responsible manner, making sure any contracted systems are used according to safety instructions. A new contractor and disposal bin has been acquired and the bin is now out of sight, but drugs are still accessible through the disposal bin lid. Suggest talks with ‘Cliniserve’ be carried out to look at a safer disposal bin’. Discussion with the manager and observation of the treatment room shows that the medication disposal bin is kept within a locked cupboard and only the nurses have access to this facility. The bin is the standard type issued by clinical waste companies and a record is kept of all medication being disposed of. The manager is following guidance from the waste disposal company and the local pharmacy and the requirement is now met. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. Observation DS0000002776.V345483.R01.S.doc Version 5.2 Page 14 of the medication records show that there are some areas of practice that need to improve and these include • Not all medication records have a photograph of the person receiving medication from the staff. The manager should make sure this is in place to aid new staff in recognising individual people and preventing medication being given to the wrong person. • There are a number of missing signatures where staff who have given out medication have not signed on the record sheet. • Not all medication has been signed into the medication record sheet and this makes auditing supplies difficult. • Antibiotics given for a seven-day course had too many signatures from staff to correspond to the amount dispensed by the pharmacy. This means that staff have been signing and not giving the medication, which is detrimental to the health of the person who should have received them. • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. It is recommended that the manager audit the medication records on a weekly basis to ensure that accurate records are kept and staff practice is improved. The staff are not recording fridge temperatures and the treatment room temperature. The manager should make sure these are recorded daily and that they are kept within the recommended temperature levels; this has impact on the usability of temperature sensitive medication. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Individual comments were ‘the staff treat people living in the home with kindness and respect, providing a warm, calm and person centred atmosphere. We feel safe here’. One relative said ‘ the people with dementia are treated with respect and professionalism. I am always made welcome and kept up to date with my relative’s well being’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. DS0000002776.V345483.R01.S.doc Version 5.2 Page 15 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 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals provided by the home. Individual wishes and needs are catered for and people have the option of when and how they participate in mealtimes. People with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. EVIDENCE: Discussion with a group of five people indicates that they enjoy the activities on offer within the home and have recently gone out to the cinema and shopping. One person said she particularly liked the singer who comes into the home on a regular basis and that she keeps herself busy with knitting, bingo and chatting to others living in the home. The home has an activities co-ordinator who organises and runs a weekly programme of social events; information about this is on display in the reception area. Meetings for people using the service and their relatives are held every 3-4 months; these are used as an opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Entertainers from outside to the DS0000002776.V345483.R01.S.doc Version 5.2 Page 16 home are booked on a regular basis to come in and perform for people and the home hires specialist transport when a trip out is organised. Discussion with the staff indicated that they would like to see the home have its own transport as people using the service get a lot of pleasure from going out into the community. Records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that people are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. Time was spent observing a small group of people during this visit and it was seen that a number of individuals spent time asleep in their chairs and others just sat watching the daily routines of the home. Staff did talk to individuals as they passed through the room, and one staff member sat with a person to discuss their family life for their care plan record. However, for those individuals who have communication difficulties there was little interaction other than when staff asked them a question at lunchtime around their choices of meal and drinks. One person commented that ‘ I am visually impaired and there is no provision for appropriate activities so I cannot join in’. The responsible person must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to the inspector showed a high level of satisfaction. Individuals said ‘my wife is well looked after, there is always a warm welcome when you come into the home and staff are always on hand if you need anything’, ‘staff have patience when giving care, I cannot praise too highly the staff looking after my relative’. Younger individuals on the physically disabled unit are more independent than most within the home and said they were happy with the way they can make choices and decisions about their lives. People on the dementia unit are less able to make their own decisions due to their mental frailty, but staff were seen to offer them choices around meals and drinks and take time to ask their preference around mobility and where they wished to sit in the dining room and communal spaces. Information about advocacy services is on display in the home and discussion with the manager indicated that no one at the home is currently using an advocacy service, although these have been accessed in the past. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. DS0000002776.V345483.R01.S.doc Version 5.2 Page 17 People spoken to are satisfied that they can access their personal allowances when needed. Observation of the lunch time meal on the dementia unit showed that people are offered a good choice of menu, staff are patient when feeding individuals and those who were reluctant to eat the hot meals provided were given a selection of sandwiches to choose from. Comments from relatives said that ‘catering is to a good standard, both in presentation and portioning for each person. Meals are served on time and drinks supplied during the day’. One person said ‘ the staff are good at understanding the needs of people with dementia, they allow them to walk around the unit and will adjust the meal times when people are sleeping or resting’. Staff did not respond immediately when one person complained that another at her table was ruining her mealtime due to poor personal habits. This lack of action resulted in the two people getting upset with each other and their argument also upset others in the dining room. Eventually staff moved one person to a table by herself and she then enjoyed the rest of her meal in peace and quiet. This was discussed with the manager who said she would talk to the staff about being more proactive in ensuring people are listened to and action taken to resolve problems. DS0000002776.V345483.R01.S.doc Version 5.2 Page 18 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 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. Staff have good knowledge and understanding of Safeguarding of Adults policies and procedures, which protects people from abuse. EVIDENCE: The Commission received two formal complaints around cleanliness of the home and poor communication between staff and relatives in August and September 2006. These were passed onto the provider for investigation and appropriate action was taken to resolve the issues. Checks of the complaints records in the home showed that the manager has dealt with six complaints since the last key visit in July 2006. The manager responded to each one and they are now all resolved. The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It is also on display within the home. People’s survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager comes round every day to see us and will discuss any problems at this time’. DS0000002776.V345483.R01.S.doc Version 5.2 Page 19 Relatives are aware of the complaints procedure and are confident of using it if needed. Those who responded to the surveys said that the manager was efficient and effective in answering queries and they were satisfied with her actions. The home has made one safeguarding of adults referral in the past 12 months. This was around the failure of staff to put a bumper pad onto a set of bed rails resulting in an injury to a person using the service. North East Lincolnshire Social Services investigated the referral, and the home assisted them with this. Disciplinary action was taken against two members of staff and the home reinstructed all staff in the safe use of bedrails and bumpers as a training exercise. The home has acted appropriately in referring issues and cooperating in the subsequent investigations. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Information in the staff training files showed that they all have received Safeguarding of Adults training. DS0000002776.V345483.R01.S.doc Version 5.2 Page 20 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, 22, 24 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: The inspector walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home is comprised of three units, one for dementia people, one for older people and one for younger disabled people. The home has an ongoing maintenance and refurbishment programme and the manager was able to show the inspector work that has been completed since the last visit in January 2007 and discuss work that is planned for this year. Main Home DS0000002776.V345483.R01.S.doc Version 5.2 Page 21 There is a large entrance foyer that has a nurse’s station here and a number of chairs and settees for people to sit on and watch the routines of the home. This is a popular communal space and well used by people living in the home. Four people were sat in the main lounge watching television and one person was sat in the separate smoking room, which meets the criteria of the new nosmoking laws for public places. Carpets in the downstairs corridors have been replaced since the last visit and this area of the home looked clean and tidy. The upstairs corridor carpets should be considered for replacement as they are stained despite regular cleaning. Paintwork in the corridors and doorways is in need of redecoration as people in wheelchairs have knocked the woodwork and caused damage to these areas. The maintenance man should check fans in the toilets and bathrooms as two were not working when tested by the inspector and a tap in the downstairs bathroom was constantly running and needs attention. Physically Disabled Unit Bedrooms in this area are spacious enough to get equipment needed for care into and out of the rooms. The lounge in this area (Parklands) has a dirty and stained carpet, which should be replaced as it affects the overall look of the home especially as the corridor carpets are new. Dementia Unit This area is clean and tidy and odour free. One room requires a new switch for the dimmer light and this was pointed out to the staff on duty. The fire officer visited the home on 22/06/07 and a report was issued with a number of requirements that need to be met. The manager said some work had already been completed regarding fire doors being closed but other issues still needed action. The responsible person must ensure the requirements of the Fire Report are dealt with in the given timescale. Inspection of the home showed that it has been designed and built to meet the needs of disabled individuals. Doorways to bedrooms, communal space and toilet/bathing facilities are wide enough for wheelchairs, and corridors are spacious enough for people in wheelchairs or with walking frames to move along comfortably. The home is built on three floors and the upper floors are accessible by two passenger lifts and/or stairs. There are flat walkways inside and out, providing safe and secure footing for people with limited mobility. Discussion with the staff and manager indicates that there is a wide range of equipment provided to help with the moving and handling of people and to encourage their independence within the home. This includes mobile hoists, stand aids and handrails. Bathrooms are fitted with rise and fall baths or fixed hoists and shower rooms are designed for disabled access. Specialist nursing beds and hospital beds are provided where people have an assessed need, and these aid staff in caring for these people and make life more comfortable for individuals who spend a lot of time in bed. Pressure relieving mattresses and DS0000002776.V345483.R01.S.doc Version 5.2 Page 22 cushions are provided by the community services and the home, where people are deemed at risk of developing pressure sores. People living in the home have access to a small, enclosed garden area and the manager said that the home is waiting for a council grant to improve the whole of the garden and make it enclosed and secure for everyone to enjoy. Bedrooms in the home are individually decorated and some are fitted with barrel locks. The manager said that she is waiting for all the rooms to be fitted with more suitable locks such as those using a master key system; this should be in place by the end of December 2007. The environment is warm and comfortable and no malodours were present. People spoken to on the day of this visit said that ‘ the domestic staff come round regularly to clean our rooms, they tidy up as they clean and do a good job’. People were also pleased with the laundry service at the home, two people commented that ‘the laundry is very good, our clothes come back clean and pressed and staff help us put things away’. One person said that ‘things in the laundry could be improved as clothes go missing even when labelled’, this was discussed with the manager who said she is aware of some issues and that staff are working hard to ensure the problem of missing clothing is minimised. DS0000002776.V345483.R01.S.doc Version 5.2 Page 23 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 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of recruitment, induction and training of staff are good with appropriate employment checks being carried out and staff demonstrating a clear understanding of their roles, ensuring that people are protected from risk and looked after by motivated and knowledgeable people. EVIDENCE: Comments from the people using the service and relatives are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. Survey responses said ‘the staff are warm, welcoming and friendly’. At the time of this visit there were 19 people in the dementia unit, 8 people in the younger physically disabled unit and 25 on the older persons unit. Staffing rotas show that there are three groups of staff during the day (one for each unit) and at night the home is staffed as two units (Dementia and the rest of the home). The home utilises a variety of different shift patterns to ensure cover is provided at peak activity times and on the whole there is one trained nurse in the building over the 24 hour period and the dementia unit has 4 care staff during the day and 2 care staff at night, the older person unit has 4 care staff during the day and the younger disabled unit has 2 care staff during the DS0000002776.V345483.R01.S.doc Version 5.2 Page 24 day. At night the latter two units have three care staff covering the floor. The manager’s hours are supernumerary to these. Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. There is an induction course for new members of staff, and 43 of the care staff have achieved an NVQ 2 or 3, with 8 working towards this award. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge around customer care, pressure care, care planning, dementia, safeguarding of adults and challenging behaviour. The manager said that training in Equality and Diversity issues is booked for September 2007 with an outside training company and it is hoped this will become part of the rolling programme of staff development. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The manager said that she has tried to recruit more male carers in the past as she is aware that the majority of staff are female, but this has proved difficult as there have been few suitable applicants. She is aware that this may affect people’s wishes regarding gender choice for giving of personal care, and this is discussed before an individual is offered a placement at the home. Comments from the manager indicate that the people living in the home are from a white British background, but the home is able to offer a range of services when they are approached from someone of another culture or ethnic group. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. DS0000002776.V345483.R01.S.doc Version 5.2 Page 25 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): People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: Dorothy Marfleet is the registered manager of Brooklands and has been in this post for 7 years. She has access to training and support from the Southern Cross Managers training programme and has regular contact with her operations manager. The manager is a trained nurse with an active registration with the Nursing and Midwifery Council and she has achieved her Registered Managers Award. DS0000002776.V345483.R01.S.doc Version 5.2 Page 26 The home has a system of Quality assurance and monitoring in place: the manager is responsible for completing monthly audits of staff practice and records within the home and the registered individual does spot checks and completes the regulation 26 visits. Meetings for the staff and people living in the home are taking place; minutes are kept and are available for any interested parties to read. Policies and procedures are up dated and reviewed as an ongoing practice and action is being taken to ensure the requirements of the inspection reports are met. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires, and the manager is in the process of producing an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Checks of the finance systems within the home found that computerised records are kept for people’s personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the person’s individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices or are due to attend later in the year, and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. A requirement was made at the last visit in January 2007 asking that the Registered Provider must ensure the health, safety and welfare of people using the service and staff in respect of safe disposal of medication. This has been met at this visit (See comments in standard 9). DS0000002776.V345483.R01.S.doc Version 5.2 Page 27 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 2 2 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 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 DS0000002776.V345483.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4, 5 Schedule 1 Requirement Timescale for action 01/11/07 2. OP2 5(b)(c) Amended regulations 2006 3. OP9 17 The responsible person must produce and make available to people an up to date statement of purpose and service user guide. So people receive enough information about the service and facilities to know if the home can meet their needs, before they decide to accept a placement. The responsible person must 01/11/07 ensure the homes statement of terms and conditions meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. This is so people know how much they have to pay for their care, what they are getting for their money and the cost of any additional extra services they may wish to purchase. Accurate records must be kept of 01/11/07 DS0000002776.V345483.R01.S.doc Version 5.2 Page 29 4. OP12 16(2)(m) (n) 5. OP19 23(4)(5) all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. The responsible person must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. To make sure people receive their medication correctly and their health and safety is not put at risk. The responsible person must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. The responsible person must ensure the requirements of the Fire Officer’s Report are dealt with in the given timescale. So people are able to live in a safe environment. 01/11/07 01/10/07 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 The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. DS0000002776.V345483.R01.S.doc Version 5.2 Page 30 2. OP9 The manager should audit the medication records on a weekly basis to ensure that accurate records are kept and staff practice is improved. The manager should make sure that the medication fridge temperature and the treatment room temperature are recorded daily and kept within the recommended guidelines. The responsible person should make sure the repairs and refurbishments asked for in this report are carried out. The responsible person should make sure bedroom doors are fitted with a suitable lock by the end of December 2007. 3. OP9 4. 5. OP19 OP24 DS0000002776.V345483.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000002776.V345483.R01.S.doc Version 5.2 Page 32 - 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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