Inspection on 19/11/08 for Brooklands Care Home

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brooklands Care Home 18/11/09

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 06/02/2009.

Inspecting for better lives 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:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 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 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Home Properties Limited care home 63 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. The home has two floors and rooms are all single, access to the first floor is via stairs or passenger lift. There are a good range of communal facilities throughout the home. There is an attractive small rear garden and Care Homes for Older People Page 4 of 32 Over 65 24 31 0 0 0 11 Brief description of the care home 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 550.00 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. Information on the specific charges for these is available from the manager. Care Homes for Older People Page 5 of 32 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: one star adequate 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 one star. This means the people who use this service experience adequate quality outcomes. 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 services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 19th November 2008. Care Homes for Older People Page 6 of 32 During the visit we spoke with some of the people who live at the home, a number of relatives, care staff, registered nurse, the cook, the activity co-ordinator, visiting health care professionals, the manager and the operations manager. We looked around the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to do their job safely. We also checked records to make sure that the home and the things used in it were safe and checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI(Commission for Social care Inspection), which includes information about people who live at the home, the staff that work there, the service provided, complaints and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home and their relatives, staff who work there and health and social care professionals who visit the home regularly. Ten surveys were returned from people who live at the home, eleven from staff, eight from relatives and four from health/ social care professionals. Comments from surveys have been included in the summary and main body of this report. We would like to take this opportunity to thank everyone who participated in the inspection process. What the care home does well: What has improved since the last inspection? The home has appointed a Dignity at work champion to safeguard the rights of people who live and work in the home. More refurbishment and redecoration of the facilities has taken place, many people commented about the improvements especially to the Brooklyn Unit. Requirements made in the Fire Officers report have now been fully completed which better ensures the safety of those who work and live at the home. Improvements have been made to the way staff give out and administer the medication however staff need to make sure that when they hand write records they include all the instructions and the records are witnessed by a second person. This will make sure people receive the right medication at the right time. More up to date information has been provided to people about how much they have to pay to live at the home and how much extra services cost. Care Homes for Older People Page 8 of 32 What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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 followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Evidence: Pre- admission procedures are in place to make sure that the home only admits people whose needs can be met. Information about the persons care needs is collated from all available sources such as community care assessment from the persons social worker to support the home in their decision making about whether they have the skills and resources to meet the persons needs. The manager said she would then visit the person in their own home or in hospital to carry out an assessment of the persons needs before deciding on the persons suitability to live at the home. 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. Care Homes for Older People Page 11 of 32 Evidence: One person who has recently moved into the home said that they were given information about the home and was able to visit beforehand. Surveys returned by people commented that they are always given enough information about the home. Completed pre- admission assessments show that the admission procedures are being followed. The home accepts people through emergency admissions, records and discussions with staff evidenced that as much information as possible is obtained prior to admission to ensure peoples needs could be met. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel happy with the standards of care they receive and feel they are treated with respect, but some of the care documentation is not up to date or properly maintained and places them at risk of not receiving all the care they need. Improvements have been made to the management of the medication systems which better protects peoples health and welfare. 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. We found that there were some inconsistencies in the quality of recording; care plans for individuals in the dementia unit were found to be up to date, detailed and well maintained providing staff with clear directions in how to manage individuals care needs. However care plans for people residing in the young physically disabled unit and general unit had not been updated in all cases to clearly describe some peoples Care Homes for Older People Page 13 of 32 Evidence: current needs in relation to support with pressure area care and nutrition. For example one individual had developed a pressure sore yet the care plan had not been updated to reflect the current care provision as the individual was now cared for in bed. Following a recent visit by the speech and language therapist, specific new care directions had been recorded in detail by the therapist in the daily records however these had not been transferred to the care plan to ensure staff had clear direction in the changes in care support required and discussions with staff confirmed that they had not yet implemented all the new care support. Another care plan described more current needs around an individuals support with pressure damage however evaluation records described the persons reluctance to accept care in this area which had not been recorded on the care plan and although supplementary documentation to record care support for position changes had been put in place these were poorly completed by the staff and did not evidence clearly if support had been given or refused. Earlier in the year the home received a complaint about an individual developing a pressure sore; there is evidence that the management have taken some steps to ensure that the systems to prevent this happening have been improved however records checked confirm that the poor recording in some of the care documentation is still putting people at risk of not receiving all the care they need. 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 and continuity of care. A staff survey said The team leaders and nursing staff keep us up to date with information about the needs of people, we have handover meetings and reports where they tell us of any changes. 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 prior to and following their death is included in the care plan where people have chosen to discuss this aspect of their care. A range of risk assessments are carried out so that where risk has been identified a care plan is put in place to inform staff about what actions to take to meet the persons needs. Whilst there was good evidence that the risk assessments are regularly reviewed, the associate care plans must be updated when changes occur so Care Homes for Older People Page 14 of 32 Evidence: that staff can act on the changes in care support. 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. Health care 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. Those people spoken with during this visit said that the home always arranges the doctor when needed and relatives spoken to said that all the staff are good at letting them know if there have been any changes. One relatives survey commented Staff keep me very well informed , especially if there have been any falls. A survey returned by a G.P. commented Majority of staff are caring individuals who contact us appropriately. People looked clean, 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 support offered by the staff. Comments included The staff do a really good job, they know us all really well and how we like things done. People said they receive support in a way which respects their privacy and dignity and this could be observed during the visit. Observation of the service shows there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. In the main the medication systems were in good order; storage was safe, staff followed good administration procedures. The majority of recommendations from the last report had been fully actioned however some improvements are still needed where staff are hand writing medication on to the sheets (transcribing), as they are not following best practice guidance. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. There was evidence that the manager is auditing medication administration and recording procedures regularly and following up any issues. The nursing staff administer medications in the YPD and general units and senior care staff have this responsibility in the Dementia Unit; records showed that the care staff have completed an accredited medication training course. Care Homes for Older People Page 15 of 32 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 are involved in some social activities. To improve the frequency of activities and maintain interests the activity programme needs to be extended which should take place now the activity coordinators hours have been increased. Meals served at the home are of 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. One person said they they liked to sit in the entrance hall during the morning, watching the world go by, and then liked to rest in their bedroom for the afternoon and they also enjoyed going out with their relatives from time to time. People said that there were some activities planned such as Bingo, crafts, games, trips out and entertainers visiting the home. People said that they enjoyed these activities. An activity co-ordinator is employed at the home for 16 hours per week. We spoke to her about her role. She is enthusiastic and has developed a varied activity plan for all Care Homes for Older People Page 16 of 32 Evidence: units in the home, she has obtained new sensory equipment such as sensory balls and aromatherapy oils. It is clear that she has a very good understanding of peoples 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. However she said that she struggles to meet everyones social needs in the time she has. This was confirmed by comments received from staff during the visit and from their completed surveys, of the ten returned surveys, eight of the staff had made comments about more activity hours needed. Some of the comments included We need an activities person who can stay upstairs and spend more time with our dementia clients and I think that the clients should have activities daily and have more opportunities to go on outings. Surveys from health and social care professionals also commented on the limited social support at the home, these included Basic care needs are fully met however there is little or no social activity organised for the residents. Most spend their time alone in their rooms or sat around the television and Young clients are not supported to access pampering sessions. Discussions with the manager confirmed that senior management had increased the compliment of hours for the activity co-ordinator up to thirty hours per week at the recent budget review. The manager said she hopes to recruit a suitable person in the near future which will mean that all units will benefit from the increase in hours and support. Discussion with the people living in the home indicates that they have good contact with their family and friends. Everyone said they were able to see visitors in the lounge or in their own room, that they could go out of the home with family or staff would take them into town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. 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 said My wife is well looked after, there is always a warm welcome when you come into the home and staff are always on hand if you need anything and Staff have patience when giving care, I cannot praise too highly the staff looking after my relative. People said 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 Care Homes for Older People Page 17 of 32 Evidence: observed staff assisting people to eat in a sensitive and dignified way. The team leader on the unit told us that they now show individuals the selection of meals on offer and people find it much easier to make their choices. The breakfast meal in the main dining room was also observed, people told us how much they enjoyed the food at the home and some of the comments included The meals are lovely and I enjoy all my meals, there is always a good choice and they are very tasty. It was noted that the standard of cleaning of the dining room tables and place-mats was poor; the cook told us that there had been some staffing shortages in the kitchen the previous evening and the tables had not been cleaned since the tea time meal. Care Homes for Older People Page 18 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have a concern with their care, they or people close to them know how to complain. Inconsistent reporting of allegations to the safeguarding team may leave people at risk of harm. 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. Relatives also commented that they knew how to complain, one person said that they had previously spoken to the manager about a concern and she had taken action straight away to sort things out, she would feel confident in future in discussing any issues if they arose. The records show that there is a complaints procedure that is clearly written and easy to understand. The records show that there is a full record of complaints and this includes details of the investigation and any actions taken. Regarding safeguarding adults, the homes safeguarding policies and procedures were available to the staff however the local multi- agency procedures were not in place, the manager confirmed that she would obtain a copy of these. There have been a number Care Homes for Older People Page 19 of 32 Evidence: of safeguarding referrals made at the home since the last inspection. There have been some inconsistencies in recent months with the reporting of allegations of abuse in the home to the local care trust plus; one allegation was reported to the manager who did not report the incident and more recently there were some delays in the reporting of an incident as the manager was made aware of the issue through a third party, the manager then reported the allegations to the CTP. Failure to report and delays in reporting allegations of abuse places people who use the service at risk. Records showed that the majority of staff have accessed safeguarding adults training within the last two years, all staff involved in safeguarding allegations had attended this course. Following investigations into some of the allegations raised, a small number of staff have been moved to work in different units. There were no records in place to support any formal systems which demonstrate that these staff members working practices or conduct had been monitored and was safe and satisfactory. Although the staff involved had received regular supervision with their manager, records showed that their working practices and conduct had not been discussed at these meetings. Care Homes for Older People Page 20 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a safe, comfortable and homely place to live. Specialist equipment is provided to promote peoples independence. Evidence: A walk round the home found that it is well maintained, pleasantly decorated and of suitable layout for the people living at the home. People living in the home said that they thought it was nicely decorated, and they said that they found it comfortable and homely. The home is comprised of three units, one for people with needs associated with dementia, one for older people and one for younger disabled people. The home has an ongoing maintenance and refurbishment programme and the manager was able to show the inspector work that has been completed since the last visit in July 2007 and discuss work that is planned for this year. The Brooklyn(dementia) Unit The unit has recently been redecorated with very positive results and many staff and visitors spoken to said how nice it looked. As part of the refurbishment programme people have been provided with new bedroom doors, they are painted in a range of colours with all front door furniture attached such as number, knocker and letter box Care Homes for Older People Page 21 of 32 Evidence: which works really well decoratively and provides some assistance for individuals with memory loss to recognise their room. The sitting areas in the unit are decorated in a very homely style with numerous pictures and ornaments, which complement this. One of the surveys returned from a relative commented that the people living on the unit would benefit from a large wall television, and staff said that the current T.V. had poor reception. These comments were passed on to the manager. There is a reminiscence room where the decor and furnishings reflect the style of the 1940s, the activity co-ordinator told us how much people enjoy this room and how it encourages people to talk about their experiences. The fire officer visited the home on the 22/06/07 and records showed that all the requirements made at that time had now been met. Young Physically Disabled Unit. Bedrooms in this area are spacious enough to get equipment needed for care into and out of the rooms. The communal areas are very light and airy, they have been decorated in a more modern style contemporary style which complements the younger people who reside there. One person told us that they have a lovely bedroom with views onto the garden where they can watch the birds. Main Unit There is a large entrance foyer that has a nurses station here and a number of chairs and settees for people to use and watch the routines of the home. This is a popular communal space and well used by people living in the home. Other communal rooms have been redecorated and are very pleasant; one staff member said that opportunities are created for relatives and friends in private. Many of the bedrooms and bathrooms have been redecorated. Surveys received from people and their relatives were very complimentary about the standard of facilities, some of the comments included The care home is currently subject to well planned redecoration/ refurbishment that has not interfered with day to day operations or the routines of residents and staff and The home is always kept clean, I find it very relaxing and comfortable when I visit. The manager explained that people who use the service are encouraged to personalise their bedrooms.This was supported by looking at peoples individual rooms, people living in the home spoke about this and said how nice it was that they could bring in small pieces of furniture, their pictures and ornaments. Discussion with the staff and manager indicates that there is a wide range or equipment provided to help with the moving and handling of people and to encourage their independence in 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 those people and make life more comfortable for individuals who Care Homes for Older People Page 22 of 32 Evidence: 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. A walk round the home found it to be well lit, clean , tidy and smelling fresh. Feedback from people who completed our survey indicated that they believed that the home is kept clean and hygienic. All people spoken to are very satisfied with the laundry service, although the manager told us that recent surveys returned have identified some issues which they are currently addressing. People living in the home have access to a small, enclosed garden area which has been made more secure with new fencing. Care Homes for Older People Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service feel that the staffing levels are appropriately maintained to meet their needs. Staff have received more training relevant to their role although the learning outcomes from some courses for some staff needs to be tested to demonstrate improvement in knowledge base and competence. Overall the recruitment practices are safe however closer scrutiny to the number of references received for new staff will help in making sure that people are not at risk from unsuitable workers. Evidence: The staff rotas show there are generally 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 unit). The home utilizes a variety of different shift patterns to ensure cover is provided at peak activity times and there is one trained and there is one trained nurse in the building over the 24 hour period. Surveys returned from two health professionals commented The home would benefit from more qualified staff, it is a very big home and another wroteBrooklands accepts clients with complex needs.There are not enough trained nurses for this complexity. Care Homes for Older People Page 24 of 32 Evidence: Nurses/ carers try hard to care for clients appropriately, particularly on the EMI unit, there are few nurses visible for nursing clients.These comments were passed on to the manager who confirmed she would discuss them with the homes senior management. All people spoken to during the day and comments on surveys were extremely complimentary about the staff at the home. Many people said how lovely and kind the staff are. One relative wrote The staff at Brooklands treat my relative with dignity and respect, whatever time I visit the staff are busy attending to everyones needs, they are amenable to constructive suggestions and always show patience and understanding with their care. 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 five staff files and the training matrix confirmed this. We discussed with the manager and operations manager the quality of staff training around safeguarding adults and pressure care given recent concerns identified in the home; the manager confirmed that the home was currently working with the local Care Trust Plus to introduce new risk management documentation for improving the management of pressure damage and that the staffs knowledge of safeguarding reporting procedures would be looked into and addressed. Staff files evidenced that an in- house induction programme was completed for new staff, however there was no evidence that they completed the more in depth induction programme allied to the National Training Standards- Skills for Care. During the visit the course documentation was accessed and the management confirmed that this would be in place for all new staff to complete. The majority of staff have either completed or are doing the National Vocational Qualification (NVQ). This helps to ensure that people are receiving care from staff with the right skills and knowledge.Staff spoken to said they felt they received good training to support them in providing care to people. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, health checks and past work history are all obtained and satisfactory before the person starts work. Two written references were in place in three of the files however one file contained only one reference.The manager is aware Care Homes for Older People Page 25 of 32 Evidence: that obtaining written references is important in ensuring the staff members suitability and in the protection of people who use the service; she confirmed that the outstanding reference would be followed up. 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 26 of 32 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 of 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 and has been in this post for eight years. She has access to training and support from 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. One survey from a relative said Brooklands is a well maintained, purpose built facility that is managed in a professional way. Everything appears to be done to support the needs of service users, relatives and carers. Care Homes for Older People Page 27 of 32 Evidence: 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 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 has produced an annual development report as part of this process to highlight where the service is going and/ or indicate how the management team are addressing any shortfalls within the service. The returned service and CSCI surveys show that people are more than happy with the service. All staff spoken to and from returned surveys said that they receive regular supervision and regularly meet up with their manager or senior to discuss ways of working and training, checks of records confirmed this. As detailed in an earlier section of the report, where staff have been disciplined due to conduct issues separate monitoring records should be in place or the supervision records should detail follow up discussions and observations of working practice. People are protected by the way their finances are dealt with as two peoples records were checked and found to be correct, safe and clear record kept. To keep people safe the information provided before the visit shows there are regular health and safety checks carried out throughout the home including fire and emergency equipment. The fire safety records and discussions with the manager confirmed this. Staff were up to date with mandatory courses in fire safety, moving/ handling, first aid and food hygiene. The home takes steps to ensure peoples safety when bed rails have been provided to support their care, records showed that detailed risk management, safety checks and staff training were in place. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 7 15 The registered person must ensure that all care plans are updated regularly to reflect individuals current care needs in relation to pressure care and nutrition support. This will make sure that staff are informed about peoples current care needs and that individuals receive the care they need. 14/01/2009 2 8 13 The registered person must 14/01/2009 ensure that where supplementary records such as position charts have been put in place that they are fully completed to reflect the care that has been given. This will better ensure that individuals have received the care that they need and the care support provided can be evaluated properly to identify where changes are needed. Care Homes for Older People Page 30 of 32 3 18 13 The registered person must make sure that all staff follow the multi-agency safeguarding reporting procedures when allegations of abuse have been made. This will better protect people who use the service from harm. 14/01/2009 4 29 19 The registered person must ensure that two written references are obtained for all new staff working at the home. This will make sure that only suitable workers are employed and this will protect the people who use the service from harm. 14/01/2009 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 15 The registered person should make sure that the dining tables and place-mats are cleaned after each meal which will ensure safer hygiene conditions for people to take their meals and better protect their dignity. The registered person should ensure that systems are fully in place to formally monitor staff members working practices and conduct if they have been subject to disciplinary action following any safeguarding investigations. The registered person should make sure that there is a copy of the multi agency safeguarding procedures in the home at all times. Although the staff have received safeguarding training, the registered person should ensure staff are fully aware of the multi- agency reporting procedures. 2 18 3 18 4 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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. 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