Inspection on 13/07/06 for Brooklands Care Home

This inspection was carried out on 13th July 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

Brooklands Care Home 18/11/09

Brooklands Care Home 19/11/08

Brooklands Care Home 12/07/07

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 J M Lamb Key Unannounced Inspection 13th July 2006 10:30 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.V304254.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.V304254.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 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.V304254.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION 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 15/12/05 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 service users, being of old age or having dementia or a physical disability. The home has two floors and rooms are all single. The costs of staying in the home range from £329.00 to £520.00 per week. 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. Hairdressing and chiropody services can be accessed within the home if requested, and clothing can be purchased from visiting party plan suppliers two or three times a year, if service users are unable to get out of the home. DS0000002776.V304254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection of Brooklands Care Home began on the 19th April 2006 when a pre-inspection questionnaire was sent to the home requesting information about service users and their family members. The requested information was received by CSCI on 11th May 2006 and survey comment cards were then issued to a sample number of service users and their relatives, their GP and any other health care professional with an interest in their care. This information obtained from surveys and information already known from having had contact with a number of people over the last few months, was used to suggest what it must be like living in the home. A site visit was made to the home on 13th July 2006 to test these suggestions, and to interview service users, staff, visitors and the home manager. Some documents were viewed with permission from those people they concerned, and some records were also looked at. A total of eighteen people were spoken to or interviewed during the site visit and all of the information collected on that day was checked against the information already obtained through comment cards and details following complaints and concerns. What the service does well: What has improved since the last inspection? DS0000002776.V304254.R01.S.doc Version 5.2 Page 6 Cleanliness and odour control in the dementia unit has improved. 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. DS0000002776.V304254.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 DS0000002776.V304254.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): 3 and 6. Quality in this outcome area is good in respect of the home’s performance. This judgement has been made from evidence gathered both during and before the visit to this service. Brooklands undertakes good assessments of the diverse needs of individuals that are self-funding in a timely manner. EVIDENCE: Permission from one newly admitted service user and three admitted more than a year ago, was obtained to view their case files and care plans. Of the three files actually viewed, all contained assessment of needs documents completed by the home on admission of service users. Two contained social services’ assessment documents and showed either the service user or their family representative had signed it in agreement, although one was dated as being completed one month after the service user’s admission to the home. This was for the most recently admitted service user. All three files contained a care plan written in conjunction with the assessments. Documents show that consideration is given to service users’ DS0000002776.V304254.R01.S.doc Version 5.2 Page 9 equality and diversity needs, whether they are religious, cultural, racial, or disability, sexuality and gender related. Conversation with the four people concerned revealed one was aware of her assessment and care plan, though she said, “What good it does, no one ever follows it.” One service user could not remember having seen anyone or even being interviewed about his care before coming to the home. Another was certain he had not been involved in the assessment process, but knew about his care plan and stated he received the care he needed, according to his preferences. The fourth service user had been resident in the home for seven years, so the question was not asked. The Manager confirmed that the home tries to carry out its own assessment of need within the first week or two, but that sometimes social service assessments are not received before the arrival of the service user. Standard 6 is not applicable because the home does not take service users for intermediate care. Some do come into the home for continuing care after leaving hospital, but they are cared for within the main house along with everyone else, and do not have specially dedicated areas. DS0000002776.V304254.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 and 10. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Health and personal care support is adequate and could be better. Medication administration is good, but disposal of waste drugs is currently unsafe. Privacy and dignity are only adequately respected. EVIDENCE: Five service users were spoken to about the care they receive in the home and three of them had their care plans and risk assessment documents looked at, which showed there is good documenting of needs within care plans and risk assessments. One service user said, “I am not sure about a care plan, I haven’t seen one, but it would be a good idea. You can see it if you want to, though I don’t think there is one. It’s quite nice here, there is everything you want.” This service user had signed the copy of the care plan held on file. Discussion with another service user that said, “Staff are the main problem. They think they know what’s best for me. They don’t listen to me or do anything I ask,” revealed that not all service users are satisfied with the service they receive. This came from a service user with high physical DS0000002776.V304254.R01.S.doc Version 5.2 Page 11 dependency on staff, but one very capable of representing oneself, and was observed interacting satisfactorily with staff. Another service user said of the help received from staff, “Three carers got me up this morning and they did chew me, I forgot to bring my shawl down, but …… went to get it.” Another three service users were asked about living at Brooklands, and several more were observed throughout the course of the day. No service user made any comments that gave cause for serious concern. Three staff members were interviewed and discussions followed on how they treat service users and how they meet health and personal care needs. Staff interviewed demonstrated a good understanding of service users’ needs and rights and one service user confirmed this by saying, “I get help in the morning from staff. It is done properly and how I like it, though there is sometimes a long time to wait. I am happy here and I like the staff. They sometimes knock before coming into my room.” Another said, “I am well cared for, I tell staff what to do for me. They respect my privacy.” Discussion about service users in the dementia unit did reveal there are some staff with a poor attitude and approach towards providing assistance, especially with using the toilet. One returned relative’s questionnaire spoke about this poor assistance and attitude within the dementia unit, stating they had been unhappy with a response from staff when they had asked them to attend to service users requests. It was discovered that the practice of refusing a service user the chance to go to the toilet when asking to, does take place. Staff explained they would only do this when a service user has recently been though, and anyone asking some time after a previous visit to the toilet would be assisted to go again. One staff member said it depended on who was on duty in the unit. The Manager was informed of the comments on the relative’s questionnaire and of the staff confirmation that some staff did not have a good attitude. She resolved to discuss this with seniors on the unit and to give clear instruction to all staff in the next staff meeting. Medication administration was discussed with the nurse on duty, staff and the manager. There is a dedicated medical and storeroom with lockable cupboards, a lockable fridge, oxygen etc. Medication Administration Record (MAR) sheets viewed showed medicines are given out according to instructions and prescribed times. In the main house only the five trained nurses administer medicines, and on the dementia unit there are only two senior staff trained to give out medication. At least a third one trained to do so would DS0000002776.V304254.R01.S.doc Version 5.2 Page 12 benefit the smooth running of the unit with regard to medication administration. The home now uses the Boots Monitored Dosage System instead of the Nomad system (change made three months ago), which involves pre-packed medicines in prescribed doses, that staff then give out to service users. Any short stay or respite service user is given medication straight from the bottles and packets they bring with them. For these service users a MAR sheet is written up by the nurse to show how much stock is brought in and when medicines are administered. Any such stock that is out of date and service users are encouraged to have it disposed of by the home and replaced through their GP. There is a new system of disposing of unwanted and unused medication, which involves a very large plastic dustbin with a sealable lid (showing only one quarter full and already containing at least four months of unused drugs.) These drugs are recorded on a sheet before being put into the dustbin but cannot then be identified once mixed together. In addition, the dustbin was being used wrongly, since the seal had been activated at the point where drugs should be put into the dustbin, and the whole lid, which should be sealed into position, was not. Anyone entering the medical room has access to any number of disposed of medicines, which cannot possibly be recounted for accuracy of the disposal record. Recounting would never be necessary if the dustbin seals were being properly used and access to retrieve them was impossible. Practices in disposing of unwanted and unused medication are currently unsafe and drugs cannot be properly accounted for. The Manager was informed and requested to have someone from the contracting disposal company attend to it as a matter of urgency. The home has policies and procedures on privacy and dignity, medication administration, and on giving personal care, and staff interviewed knew where they were kept and which they had read, but not all staff were following them. DS0000002776.V304254.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Outcomes for service users are adequate so service users do not always experience variety of activities, or food provision. EVIDENCE: The home displays an up to date activity programme on the notice board, and service users are aware of some of the regular pastimes held on set days, but these are not all to everyone’s liking. There is no activity coordinator employed to devise different entertainments, but the Manager explained all staff tend to help decide what could be offered, and each year at Christmas, the staff perform a pantomime with a script and costumes. When discussing activities with the service users, one service user explained he never looked at the activities board despite sitting under it, and supposed “a pub lunch would be alright if you have the money. Oh there’s bingo on Sundays I think, but I don’t play. Everyone seems to enjoy it though.” Bingo is held on a different day. Another said there were no activities in the home they liked doing. DS0000002776.V304254.R01.S.doc Version 5.2 Page 14 Three other service users spoken to expressed their dislike for bingo and wanted to do something different. They expressed a wish to have a glass of sherry or advocate of an evening and explained you could only have this if you purchased it yourself, but then you felt mean drinking it because there were too many other service users to share it with, though they’d like to. One said, “the reason I don’t buy my own is because you could be asking for a drink several nights before you actually managed to get staff to give it to you.” The Manager explained that the home provides sherry and other alcoholic drinks for service user to drink in the evenings and some have sherry with their dinner. These three service users said it was “boring” living in Brooklands. The Inspector offered some suggestions to the service users to do something else and they agreed a quiz or theme night, or a cinema night would be different, but they rejected other suggestions, crochet or needlepoint, despite talking about having done these pastimes as younger women. When the Inspector asked service users what they would like to do to, they could not think of any suggestions of their own. One younger person from the physical disability unit was seen leaving the building quite independently to join in with activities in the community. Staff explained she often goes out and leads her own social life in wider circles than those in the home. Such independence and enthusiasm is encouraged. Several service users were observed having a manicure and nail painting done by a volunteer that visits the home every Thursday. The volunteer used to work in the home until she retired and still enjoys providing materials for the manicures and chatting one-to-one with service users. Clearly there are activities to be enjoyed, but not everyone finds them suitable or to their liking. The home needs to make greater efforts to offer more variety and a more extensive number of pastimes if a larger number of service users are to be satisfied and fulfilled. Service users have a level of autonomy and choice that is acceptable to them, but not entirely satisfactory. Some routines are present throughout the day and sometimes service users have to wait for ‘their turn’. Where possible they deal with their own finances or family members do. This area was not explored and needs to be looked at, at the next inspection. Lunchtime was observed on the dementia unit and everyone looked calm and relaxed and looked to be enjoying their food. Discussions with staff later in the day revealed they were of the opinion that meals are not as varied in the dementia unit as for the rest of the home, choices are restricted. Most days the cook will only send up one of the meals DS0000002776.V304254.R01.S.doc Version 5.2 Page 15 on the menu, in both main meal and pudding. They felt that the quality of food depended on the cook on duty. For those service users needing a soft diet, one cook blends the whole meal together, making it unappetising and bland, but another blends the meat separately to the vegetables, making food a little more interesting, colourful and with different flavours to it. Two relative comment cards made comments that meals do not provide enough fresh vegetables. One service user felt there were too many cakes at teatime and that they are often too hard to eat. A seven day menu sample provided shows cakes are offered every day. Menu samples also showed assorted vegetables or peas are provided for each lunchtime meal, but that there is only an alternative choice of meal on five days of the week. There is a choice of dessert at lunchtime and a choice of tea selections, but there is a distinct lack of fresh fruit for any meal and the home does not provide a special vegetarian option. When discussing food with service users, one said, “The food is alright, if you don’t like it you leave it. You can have something else. I shall enjoy my lunch today if there are plenty of peas with it.” Another said, “The food is nice.” There was no indication that service users take part in compiling menus or suggesting meal options. The cook had gone off duty before the Inspector had the chance to speak to her. Staff explained the cook prepares and serves breakfast and lunch, but only prepares tea. Clearly the implications from service users and relatives are that the meals are adequate but do not generate a lot of interest or pleasure. There was some discussion with the Manager about service users having relationships and although no personal information was discussed with the Manager or the service users, it was concluded that relationships are evident and the Manager and staff only take responsibility to intervene where a service user may be considered to be vulnerable. Situations are dealt with sensitively. What transpires from the evidence gathered on social contact and activities, community contact, autonomy and choice and meals, is that service users receive an adequate service, sometimes causing them individual frustrations and dissatisfaction, but an adequate service that meets their collective needs. A large number of people living in one establishment may not always have every individual need met at the same time, but staff recognise this and try to achieve it as much as possible. DS0000002776.V304254.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Complaint management and protection of service users are adequate. EVIDENCE: Of the service users and relatives spoken to several indicated they would complain if they felt it was necessary, but mostly there were no reasons to complain. One said if they had a problem they would “only tell those in authority behind the desk.” Another felt complaining got them nowhere. Another expressed the view that she was afraid to complain in case of repercussions, and another said, “I don’t think anyone would listen if we did complain, though there’s nothing to complain about.” Again there is a feeling of indifference within the service user group when it comes to making complaints, and one person clearly feels unable to complain. The company and the Manager must undertake work to change the culture within the home and to encourage service users to speak up more and make changes for themselves. Complaints over the last twelve months have come from relatives or health care professionals and the company has dealt with these appropriately. Staff spoken to understand what constitutes abuse, what whistle blowing involves, and that service users have rights and responsibilities. They have DS0000002776.V304254.R01.S.doc Version 5.2 Page 17 done Protection Of Vulnerable Adults (POVA) training and evidence was held in their files. They were comfortable with having permission to take time out whenever necessary, and said they did use this arrangement. Whistle blowing has taken place and the company has handled it appropriately. One recent vulnerable adult investigation has been implemented because of an allegation that a staff member abused a service user. This was investigated by the vulnerable adults team and was unsubstantiated. Senior management in the company handles all investigations, takes them seriously, and that conclusions are made about the quality of care received. Documentation was seen to back this up. Feedback to complainants is in a timely manner. In January 2006 the CSCI received correspondence from two complainants that had had their complaints investigated by the company, but they were not satisfied. The CSCI made a visit to the home to examine information gathered as a result of the investigations and this confirmed the original findings that the complaints were unsubstantiated. Discussion with staff highlighted there is a small element of “us and them” amongst the staff team and care staff are not given the responsibility and accountability their roles suggest they have. In addition to this the nursing staff may not be fully supportive towards the carers seeking advice and assistance when caring for the non-nursing service users, but as the nurses point out, they cannot attend to service users that are not in receipt of nursing care. Roles and responsibilities may need re-defining, but emphasis on team working should not be lost, and staff need to be able to find the reporting of any poor practice or abuse a natural part of their role. As well as maintaining complaint records the home has a ring-binder file dedicated to compliments and thank you cards. Many have been received over the last twelve months. DS0000002776.V304254.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home is suitable for its stated purpose, but despite improvements in the dementia unit service users live in an environment where cleanliness and maintenance are only adequate. EVIDENCE: The opportunity to view parts of the building whilst interviewing service users revealed that bedrooms are satisfactory, but bathrooms and toilets now look unwelcoming. They have paint spills on the floor surfaces, which are also dirty in places, have no aesthetic features, and toilet bowls are very stained. The Inspector observed staff using the smoke room and not the service users. Some areas of the home, corridors and service users’ bedrooms required vacuuming. Cleaners were present in the home, but the information contained in the returned questionnaire, that there are 4 cleaners, 2 laundry assistants DS0000002776.V304254.R01.S.doc Version 5.2 Page 19 and 1 housekeeper employed, is not indicative of the actual equivalent number of full time posts in place; only 4 to cover the whole of the house and do the laundry. This may not be sufficient for the size of the home and to cover the volume of cleaning and laundry work to be done. On the day of the site visit a cleaning trolley was left unattended for at least 20 minutes in the corridor on the physical disability unit, and it contained bottles of cleaning fluid, which could not be identified because of the worn labelling. These are two bad and unsafe practices, which required urgent attention. The Manager was informed. Many service users’ rooms are comfortable and personalised, and those on the physical disability unit are spacious and appropriately equipped. There are sufficient lounge, dining room and garden areas for service users’ use. The medical room is extremely untidy, but the nurse on duty explained that with the recent change over from Nomad to Boots Monitored Dosage System, the cupboard and storage space has proven to be insufficient. New storage is being built, but is not complete yet. The whole of the medical room facility, equipment and supplies needs to be tidied and stored more efficiently. The medical room looks dirty and does not present as a sterile area. There is a very noticeable improvement in the cleanliness of the dementia unit, with malodour now being under control. Toilet bowls are also very stained, and bathrooms are unwelcoming in this area too. The unit office is extremely sparse, containing a broken desk and only one chair. The Manager explained new carpets are to be fitted to communal areas in the next few months. Carpet fitters were already in the process of fitting new carpets down corridors on the upper floor. There is room for improvement in the maintaining of the safety and cleanliness of the environment. DS0000002776.V304254.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staffing levels only allow basic care needs to be met and service users do not have time invested in them. Although staff have good training opportunities there is an insufficient number of them with the required qualification, and so service users do not always receive care from nationally recognised competent staff. EVIDENCE: The staffing complement of 1 manager, 1 administrator, 5 trained nurses, 41 care staff, 11 ancillary staff and 1 maintenance person, = 60, appears to be sufficient for the smooth running of the home, but many staff work part time or a maximum of 33 hours. Seniors nurses and care staff work 38 or 39 hours, but they number only 10 in total. This results in there being only the very minimum number of staff on duty at any one time. The residential staffing forum hours have been calculated according to the information provided on the returned questionnaire and shows there was a shortfall in hours at the time it was completed, but the nature of the home is such that there are always service users coming and going for respite, for end of life nursing care, etc. and therefore the numbers are never stable for long. Dependency levels fluctuate so very much and it is difficult to ensure sufficient staffing is always provided on the roster. DS0000002776.V304254.R01.S.doc Version 5.2 Page 21 The Manager must be constantly aware of the needs of new and existing service users and must adjust rosters and staffing figures to ensure everyone’s needs are met. For the home to be providing a good service of care all needs must be met and service users must feel they are being invested in, in respect of staff time spent with them for socialising, entertainment and for assisting with those little extras. Comments on survey comment cards are that the staff always seem to be “run off their feet,” and that staff are “always on the go.” Staff were observed providing care to service users and aiding them in their mobility, etc., but none of them were seen sitting and chatting or passing the time of day with service users, or sharing an activity. Of the 41 care staff employed in the home only 5 have achieved NVQ Level 2 or 3, but another 13 doing the courses. This gives a figure of 37 with the award. Standards 27 and 28 are not met. The company maintains recruitment and selection policy, procedure and systems for taking on new staff. These meet the requirements of schedule 2 and two staff files seen confirmed this. Discussion with the Manager also confirmed the policy, procedure and practice for recruiting new staff. Standard 29 is met. Staff undertake statutory training and in interview confirmed there are plenty of opportunities for outside courses if they need them. There are certificates and copy certificates in their files to confirm the training they have done. Service users and comment cards received made no adverse comments about the ability of staff because of training. Standard 30 is met. DS0000002776.V304254.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The Manager is a qualified Registered Manager that usually maintains a consistent approach to the role. Some areas concerning health, safety and welfare of service users and staff are not as well managed as they have been. EVIDENCE: The Manager is registered with the CSCI, has the required nursing and management qualifications, and has worked at Brooklands for many years now. Information throughout the rest of the report indicates there is a need to complete a review of the management in the dementia unit to focus care at the level of the individual. The standard on quality assurance was not met at the last inspection, and no other evidence has come to light to suggest the systems for quality assuring DS0000002776.V304254.R01.S.doc Version 5.2 Page 23 the service of care in the home have changed. The standard has not been assessed. The standard on safeguarding service users’ finances was met at the last inspection, but was not assessed on this inspection. Discussions with staff, viewing of their training files and observation of their practice with such as moving service users around in wheelchairs, assisting them to stand etc. revealed that the moving and handling area of standard 38 was sampled. One service user said that the hoists in the home were all broken and she could therefore not get out of bed today. Staff also thought one of the hoists in the main house was out of action and the one in the dementia unit was also broken. The Manager refuted that any hoists were broken. One hoist was seen to be in use. Later in the afternoon an engineer arrived to attend to hoists and lifting equipment and it transpired that the problem had been with batteries not holding their charge. Another area sampled, that of safe handling and disposal of hazardous material, revealed cleaning products are left unattended and disposal of unwanted medication is not satisfactory. Both of these have been discussed in previous sections of the report. DS0000002776.V304254.R01.S.doc Version 5.2 Page 24 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 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 DS0000002776.V304254.R01.S.doc Version 5.2 Page 25 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP28 Regulation 18 and 19 Requirement The Registered Provider must ensure 50 of care staff achieves NVQ level 2 by the end of 2005. This deadline has now expired. The Registered Provider must provide a better quality of health care within the home, for all service users, which meets their wishes and expectations. Experiences of service users relayed to the Inspector show that not all personal care needs are met. 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. The Registered Provider must treat service users with respect and maintain their dignity at all times, especially within the dementia unit. The Registered Provider must encourage service users to experience a lifestyle, which DS0000002776.V304254.R01.S.doc Timescale for action 30/11/06 2. OP8 12 31/08/06 3 OP9 13(2) 31/08/06 4. OP10 12 and especially 12(4)(a) 12 & 16(2)(m) (n) 31/08/06 5. OP12 30/11/06 Version 5.2 Page 26 6. OP14 7. OP15 8. OP16 9. OP18 10. OP26 11. OP27 12. OP38 matches their expectations and preferences, and provide a wider variety of pastimes, which meets more service users’ needs. 12(3) The Registered Provider must encourage service users to exercise autonomy and choice in their daily lives. 16(2)(i) The Registered Provider must provide nutritious food, which is varied and properly prepared, and available at such times as may reasonably be required by service users. Service users must also be consulted about compiling menus. 22(8) The Registered Provider must review the complaints within the home in the last twelve months and supply the CSCI with a summary statement of the complaints and the action taken. 13(6) The Registered Provider must ensure all staff behave according to clearly defined codes of good practice, especially in the dementia unit. 23(2)(d) The Registered Provider must keep the home clean at all times, and therefore an increase in the cleaning hours is required. The medical room must be tidied up, thoroughly cleaned and all items stored efficiently. 18(1)(a) The Registered Provider must provide care staff in such numbers as are appropriate for the health and welfare of service users. 12, 13, 16 The Registered Provider must and 23 ensure the health, safety and welfare of service users and staff in respect of lifting equipment, safe storage and handling of materials under COSHH, and safe disposal of medication. 30/11/06 30/11/06 30/11/06 31/08/06 30/11/06 30/11/06 31/08/06 DS0000002776.V304254.R01.S.doc Version 5.2 Page 27 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 OP31 Good Practice Recommendations The Manager should review the management in the dementia unit to focus care at the level of the individual. DS0000002776.V304254.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000002776.V304254.R01.S.doc Version 5.2 Page 29 - 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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