Inspection on 18/11/09 for Brooklands Care Home

This inspection was carried out on 18th November 2009.

CQC found this care home to be providing an Good service.

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 19/11/08

Brooklands Care Home 12/07/07

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Brooklands Care Home Springfield Road Grimsby North East Lincs DN33 3LE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 1 8 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Brooklands Care Home Springfield Road Grimsby North East Lincs DN33 3LE 01472753108 01472278023 brooklands@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited care home 63 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 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 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. 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. Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 30 Over 65 24 31 0 0 0 11 1 9 1 1 2 0 0 8 Brief description of the care home The home has two floors and rooms are all single, access to the first floor is via stairs or passenger lift. There is a good range of communal facilities throughout the home. There is an attractive small rear garden and ample parking space available. The home is situated near to local shops and facilities, 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 361.00 pounds to 694.30 pounds 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. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 18th November 2009. This inspection report is based on information received by the Care Quality Commission (CQC)from the last twelve months including information gathered during a site visit to the home which took approximately nine and a half hours. During the visit we observed peoples experiences of living at Brooklands so that we could understand what it is like for people who live at this service. We spoke with the manager, relatives and staff members on duty on the day of the site visit, we also met many of the people who live there. Care Homes for Older People Page 6 of 30 We looked at the environment and checked maintenance records to make sure the home is safe and well maintained for the people who live there. We checked documents that relate to peoples care and safety. These included needs assessments, daily records, care plans, risk assessments and staff recruitment and training records. Before the visit the manager had completed an Annual Quality Assurance Assessment report (AQQA). This report provides information about how the service operates. We have used some of this information within the report. People who use the service were given surveys and thirteen were returned. Staff that work at the service were given surveys and four were returned. Placing social workers and health care professionals were given surveys and two were returned. Comments and views from everyone have been included in relevant parts of the report. We would like to thank the people who were staying at Brooklands, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use the service are not being put at significant risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Guidance provided by speech and language therapists to direct staff on how to support peoples nutritional needs should be included in the care plan. Care Homes for Older People Page 8 of 30 A number of the carpets in the home need to cleaned more regularly or replaced to provide a clean, pleasant and hygienic environment for the people who live there. Decorative improvements are needed in areas of the home to provide people who use the service with a more pleasant environment. The manager needs to produce an annual report as part of the quality monitoring programme, this report needs to describe the qualitative improvements made to the service, how the management team have addressed any shortfalls in the service and the planned improvements for the next year. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Proper pre- admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Evidence: We looked at a sample of files, which belong to people who are staying at the home, and we saw that these contained a range of assessments undertaken by the home. The assessments cover all aspects of health and personal care needs. In addition to this, information is also requested from the family and health and social care professionals where possible so that the home has as much information about the prospective individual prior to their admission. Wherever clients are referred through the Local Authority, the home has obtained copies of relevant assessment reports and care plans. The assessment process also takes account of peoples cultural and social needs. This information is recorded and Care Homes for Older People Page 11 of 30 Evidence: made available to carers so they have a good understanding and know how people wish to be addressed and their preferred lifestyle. People who are considering moving into the home and their relatives are invited for a visit before any decision is made about whether they move into the home on a permanent basis. People we spoke to during the visit told us that they were given information about the home and were able to visit beforehand, they also confirmed that a staff member had visited them to discuss their admission. One relative told us they had chosen the home due to the location and the friendly atmosphere. Surveys returned by people commented that they are always given enough information about the home. Completed pre- admission assessments show that admission procedures are being followed. The home accepts people through emergency admissions and records and discussions with staff evidenced that as much information was obtained prior to admission as possible to ensure peoples needs could be met. There was evidence to demonstrate that the care staff have accessed some service specific training courses over the last twelve months and that more courses are being arranged, this will help ensure that they have the skills to enable them to deliver up to date care methods and have a good understanding of the varied conditions common to elderly persons and those with physical disability. The home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 receive the care they need and the care plans generally provide sufficient information and guidance to staff on how to meet peoples needs. The medication systems at the home are well managed ensuring the promotion of good health. Evidence: Three peoples care plans were looked at in order to obtain a picture of what their needs are and how staff support them, care records were seen for individuals residing in each of the three units in the home. The information in care plans show that people staying in the home have their own preferred routines and discussions with staff and records show that people are assisted and supported by staff to make decisions and choices about all daily living needs. There was evidence in the care records seen that improvements have been made to the standard of recording, the care plans seen were clear, well written and set out the health and personal care needs identified for each person. They had been evaluated regularly and where peoples needs had changed, the care plans had been updated to reflect this. At the last visit we made a requirement to ensure that care plans were updated to reflect peoples current care Care Homes for Older People Page 13 of 30 Evidence: needs in relation to pressure care and nutrition support and this was seen to have been addressed in the main, although staff should ensure that any guidance received from speech and language therapists is incorporated into the relevant care plan. From sampling a selection of care plans we could see that some further improvements have been made in describing the care support in a more person centred way, however this has been applied somewhat inconsistently, the management are aware of this and told us they are working with staff to improve overall the quality of the care plans and daily records. A range of risk assessments are carried out so that where risk is identified a care plan is put in place to inform staff about what actions to take to meet the persons needs, these were seen to be reviewed regularly. At the last visit we made a requirement to ensure that where supplementary records are in use such as turn charts, food and fluid intake etc, that they must be completed appropriately to reflect the care that had been delivered. We saw evidence that in the main the staff had made improvements to the completion of the charts, however staff were completing a considerable number of charts for individuals whose needs were generally very stable and the manager will review the need for some of the charts. People did say that staff sit down and talk to them about their care and there was written evidence to support this. A key worker system is in place to enable people to receive one to one support. Relatives are asked to help complete the life history section of the care plan and this information is beneficial in terms of getting an insight into the kind of hobbies, leisure past times and significant events that make up this persons life. Having this information helps staff to see the person as an individual in their own right and to engage people in things they are interested in such as a past hobby or a particular talking point. Annual reviews take place to discuss peoples care with their family and others who are involved in their care. Information about peoples wishes around their end of life care is included in the care plan where people have chosen to discuss this aspect of their care. Care plans show that peoples health is monitored and people have access to health care facilities and any relevant specialists that are necessary, the staff support people in attending appointments. Healthcare information is recorded in the care plans about why people are attending appointments and outcomes from these. The records are well maintained, this helps in making sure that everyone is aware of the persons health needs and how these are to be met. A survey completed by a health care professional detailed under the section What does the home do well? Wound management, work well with other professionals, rehabilitate service users, seek Care Homes for Older People Page 14 of 30 Evidence: advice whenever possible and complete care plans appropriately. Other positive comments included in the survey detailed how the home had managed an individuals pressure damage very well and another persons mobility and rehabilitative support with very positive results. People looked well dressed and had received a good level of personal care. Comments received in surveys and during the visit from people and their relatives show that they are very satisfied with the care and support offered by the staff. Comments included: The home does well in providing all care needs and Good nursing care, friendly and kind. People said that they receive support in a way that respects their privacy and dignity and this could be observed during the visit. 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. At this visit we looked at how the home handles and stores medication. Checks on current medication administration records (MARS) showed that staff had signed for all medications administered or used appropriate codes to support why the medication had not been given. At the last visit we made a recommendation that staff should ensure transcribed records (handwritten) have been signed by two staff members to indicate they have both witnessed that the information on the sheet is correct. We saw evidence that three of the four transcribed records seen were completed properly, this said, there was good evidence that the manager carries out regular audits of the medication system and administration issues are followed up with individual staff members. This was the only issue of concern with medications identified at the visit. Observed medication practices during the day were safe. There was evidence that the staff are proactive in ensuring that individuals medication is reviewed by their G.P. where possible. Temperature recordings of the medication storage room and refrigerator are taken daily which were satisfactory. People who use the service are supported to self administer their medications where possible, risk assessments systems are in place to support the practice. All of the individuals chosen for case tracking prefer to have staff administer their medication. Storage of all medications was found to be satisfactory and stock control effectively managed. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are able to make choices about daily living and be involved in social activities. Meals served at the home are of a good quality and offer choice to ensure people receive a balanced diet Evidence: People spoke of how they are able to make their own choices such as when they get up and go to bed, the meals they eat and generally how they spend their time. This was observed during the visit. People said that there were activities arranged each day and that they enjoyed taking part. The home has a weekly activities programme displayed in the front entrance of the home, so visitors can see the type of activities available to people on a daily basis. An activity co-ordinator is employed at the home and since the last visit, her hours have been increased to 30 per week.This has resulted in improvements to the programme and views from people during the day and from comments in surveys were very positive about the activities and entertainment provided, some of these included: The activities co- ordinator is excellent, she is very busy and dedicated, Care Homes for Older People Page 16 of 30 Evidence: There are lots of activities and trips out for us to take part in. We did however receive one negative comment from a care manager who wrote in a survey, Recently a service user was admitted for respite care and he had expressed views that he would not return as he was left in his room for most of the time and felt isolated, there was no social interaction. We passed this comment onto the manager during the visit. We spoke to the activity co- ordinator about her about her role. She is enthusiastic and has developed a varied activity programme for each unit in the home. It is clear that she has a very good understanding of peoples social needs and has tailored the activity and sensory programme accordingly. She described some of the support she provides for the more dependent people and how individuals like to listen to her reading, enjoy manicures and also enjoy the time she spends with them talking about their families and their lives. Typical activities that take place in all units range from Bingo, quizzes, dominoes, skittles, darts, baking, watching DVDs, reminiscence, singa- longs, crafts, manicures, and gentle exercise programmes. The programme will be extended in the New Year to include pet therapy sessions, slide shows of local areas and reminiscence therapist visits. Records also show that entertainers regularly visit the home. The home now benefits from the shared use of a mini- bus, people told us about visits they have enjoyed to local places of interest, shops and cafes. The home is also involved in CHAT (Care Homes Activities Team) where people who use the service participate in activities at a local social club with people from other care homes in the area. There was evidence in the care documentation of personal profiles, social needs assessments and plans which identify peoples hobbies and leisure pastimes before they entered the home and what they enjoy doing now. Information from peoples files indicate that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. The staff confirmed that there are regular, monthly church services within the home and the Catholic priest visits to give communion to those who want to partake. Discussion with the people living in the home indicates that the staff support 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 out locally. 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. Brooklands has a welcoming and friendly atmosphere. 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 Care Homes for Older People Page 17 of 30 Evidence: said You are always made welcome and feel part of the family, staff always have time to talk and The staff are smashing, its a very happy home. The home now produces a quarterly newsletter, people we spoke with said they enjoyed reading them. Residents and relatives meetings are also held every three months, agenda items usually include menu choices, ideas for outings and activities, the environment and new projects. People said that they had a choice of food and that the quality of food served was generally very good. The menus are on display in the dining room. Observation of the lunchtime meal on the dementia unit showed that people were seen to have good appetites and enjoy the food on offer. The meal served was hot, nicely cooked and well presented. We observed staff assisting people to eat in a sensitive and dignified way. We also observed staff showing people the choice of meals on offer so they could make their choice at the meal time. The breakfast meal in the main dining room was also observed, this took place from 09:15, we noted that people had started to sit in the main entrance area waiting for breakfast to be ready from 08:15, we think that the manager should speak with individuals and check if they would like their breakfast earlier. Views from people spoken with and comments received in surveys evidenced that they were satisfied with the quality of the meals provided at the home, some of the comments included Good cooked food, The food is very good, menus are quite varied and The meals are great but there isnt enough time between breakfast and lunch. There is good evidence from residents meeting minutes that the manager has consulted regularly with people about the menus and the meal choices they would like, for instance some of the evening meal choices have been changed recently. Entries in the care files detail where individuals have specific nutritional needs and also note their likes and dislikes. Care records show that people are weighed regularly, nutritional needs are monitored, intake levels recorded and specialist advice is sought where necessary. The kitchen areas had been inspected by the Environmental Health Officer in September and the home was awarded a three star rating, the report shows that five recommendations were made, we saw evidence that four of these had been achieved, one of the fridges (which was not in use) needs to be repaired or replaced. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. There are suitable policies and practices within the home have improved to ensure people are better safeguarded from harm and abuse. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. Surveys returned by people living at the home confirmed that each one of them knew who to speak to if they were unhappy and knew how to make a complaint. The home has received nine complaints since the last inspection, records show that the complaints were dealt with in accordance with the homes procedures with details of the investigation and any actions taken held on file. Two of the complaints were upheld. When we visited the home last time we made a requirement that all safeguarding issues must be reported properly and we also made a recommendation that systems should be in place to formally monitor staff members working practices and conduct when they have been disciplined following any safeguarding investigations. We saw evidence at this visit that senior management at the home have taken the necessary action to improve safeguarding reporting procedures and to ensure that staff who Care Homes for Older People Page 19 of 30 Evidence: have been disciplined following safeguarding investigations have been provided with regular support, formal supervision and further training if necessary. This better protects the people living at the home. Records showed that the majority of staff have attended safeguarding training in the last twelve months, five new members of staff are scheduled to attend this training. When we spoke with the staff they were able to tell us what they would do if they witnessed any abuse within the home or if anyone made any allegation to them. Few of the staff have accessed any training on the legislation regarding mental capacity and deprivation of liberty, however the manager confirmed that courses would be provided over the next twelve months for the qualified and care staff. Staff were observed throughout the visit listening to what people said and treating them with dignity and responding to their wishes. The home has appointed Dignity at work champions, staff members attend workshops in the region and feedback to other staff. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 a safe, comfortable and homely place to live, however some areas are now looking tired and worn and in need of redecoration and refurbishment. Specialist equipment is provided to promote peoples independence. Evidence: The home provides and maintains comfortable facilities, people said they are happy living at Brooklands and they like their rooms. Bedrooms were seen to be comfortable and personalised to the individuals tastes. The home has an ongoing maintenance and refurbishment programme and works to replace the boiler, provide new fire doors and replace a number of carpets has taken place over the last year. We had a tour of the building and noted that a number of areas need attention, especially redecoration of the woodwork to the ground floor corridors, this work has been identified in the maintenance programme, but timescales need to be agreed. In the AQQA the manager detailed that planned improvements over the next twelve months include the provision of more profiling beds, redecoration, refurbishment and an upgrade to the bathrooms. We agree that this work should take place to improve the quality of the environment and a new maintenance programme should be developed with timescales for all the work to be completed. Surveys returned by people indicated that they were satisfied with the standard of Care Homes for Older People Page 21 of 30 Evidence: cleaning in the home. During our visit we observed that a number of carpets needed cleaning or replacement , these were identified to the manager, we also noted a stale odour of urine in the lounge in the main facility, the manager confirmed she would address this. 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. Specialist nursing 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 cushions are provided by the community services and the home, where people are deemed at risk of developing pressure sores. The atmosphere on the day of the visit was warm and friendly and people looked comfortable whilst sitting in various parts of the home. People spoken with said they are pleased with the home and the facilities available. The home has a good infection control policy and the manager explained that she would seek advice from external specialists, e.g. the Health Protection Agency if and when required. Feedback from people who completed our survey indicated that they believed that the home is kept clean and hygienic. In the AQQA the manager detailed the home will be involved in the local infection control initiative with the community health team over the next year. People living in the home have access to a small, secure, enclosed garden area. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient numbers to ensure people have their needs met. People can be confident that they are cared for by a skilled and competent staff group and improvements to the recruitment procedures provide more protection. Evidence: The staff rotas show there are enough staff planned to be on duty to meet peoples needs. On the day of the visit enough staff, were observed, to be available to meet peoples needs in a relaxed and unhurried manner. 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 there is one trained nurse in the building over the 24 hour period. Views from staff from discussions and from surveys indicated that they considered the home was usually well staffed, but covering short notice sickness and annual leave was sometimes problematic. All staff spoken to during the visit confirmed that staffing levels were satisfactory for the current occupancy. The home also employs a range of support staff including domestics, cooks, kitchen assistants, laundry and administration staff this enables care staff to concentrate on personal, physical and emotional care with people who use the service. Care Homes for Older People Page 23 of 30 Evidence: People spoken to during the day and comments on surveys were complimentary about the staff at the home. Many people said how lovely and kind the staff were. One person told us The staff are worth their weight in gold and another person wrote Staff work far beyond the call of duty, excellent in every way. 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, equality and diversity, nutrition, infection control, safeguarding of adults and challenging behaviour. A sample of four staff files and the training matrix confirmed this. Comments received in staff surveys included Training is always on going to keep us updated with any new changes. The majority of training is provided corporately although the manager has accessed courses for staff from the workforce development team at the CTP and some distance learning courses over the last year. The home has an induction programme which all new staff undertake, this ensures that they know the home and their responsibilities. We saw records to confirm this training was completed, however the manager should ensure that records are held in the home to support staff having completed the more in- depth induction and foundation programme allied to the National Training Standards -Skills for Care. All new staff work alongside more experienced staff as part of their induction which was confirmed in discussions. The home has exceeded the target for the number of care staff who should gain a National Vocational Qualification (NVQ). The home has 70 of the care staff qualified at this level. This helps to ensure that people are receiving care from staff with the right skills and knowledge. People who use the service are protected through robust recruitment procedures. Staff records sampled during the visit show that face to face interviews take place and formal questions and responses are noted. Recruitment records are well maintained and up to date. Safe vetting procedures are followed: these include taking up written references and carrying out checks through the Criminal Records Bureau before appointment. All staff files contain a photograph, proof of identification, a contract and terms and conditions of employment. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 have confidence in the management at the home. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: Dorothy Marfleet is the registered manager of Brooklands and has been in this post for nine 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. People, staff and relatives said they were all happy to approach the manager at any time for advice, guidance or to look at any issues. The manager provided us with information about the home in their Annual Quality Care Homes for Older People Page 25 of 30 Evidence: Assurance Assessment (AQQA). This information let us know about the service and what they are doing to improve the outcomes for people who use this service and about improvements they intend to make to continue with this. The homes quality assurance and monitoring systems are well developed. 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. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires. The manager needs to produce an annual report as part of this process to describe the qualitative improvements made to the service and how the management team has addressed any shortfalls in the service. The returned service and CQC surveys show that people are happy with the service. All staff said that they receive regular supervision and regularly meet up with their manager to discuss ways of working and training, checks of records confirmed this. Improvements have been made to the quality of the staff supervision records, they now more clearly describe where shortfalls of practice or conduct have been followed up. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The records show the individual balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two peoples finances were checked during the visit and were found to be correct. The AQQA confirmed that regular safety checks are made of the facilities and equipment to make sure the home is a safe place to live and work. The staff are trained in safe working practices and are updated on a regular basis. We looked at some of the records of safety checks, like fire safety, and these were found to be up to date. Maintenance records such as checks on equipment and hot water were also looked and found to be up to date and satisfactory. Accident records were also seen and these are audited by the manager to see if measures can be taken to reduce the risk of accidents. The environmental health officer had visited the home in September and inspected the kitchen facilities, a number of recommendations were made and we saw evidence that these had been actioned with the exception of the repairs / replacement of one of the fridges. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Guidance provided by speech and language therapists to direct staff on how to support peoples nutritional needs should be included in the care plan. The management should review the number of supplementary records in use such as food charts, fluid charts, turn charts, personal care charts. Those records which remain in use should be completed and maintained appropropriately. Review the times for the breakfast meal, people should have a choice of times and be able to take their meal early if they wish. Develop a comprehensive maintenenance plan which details all the redecoration and refurbishment works needed in the home. Appropriate timescales should be set and agreed to ensure the work is carried out promptly so people can reside in a home which is attractive and well maintained. Identified carpets should be cleaned or replaced to ensure people live in an environment which is hygienic and without mal odours. Page 28 of 30 2 8 3 15 4 19 5 26 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 33 The manager needs to produce an annual report as part of the quality monitoring programme which will describe the qualitative improvements made to the service and how the management team have addressed any shortfalls in the service. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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