Inspection on 24/04/06 for Brooklands House

This inspection was carried out on 24th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brooklands House 11/11/08

Brooklands House 30/07/07

Brooklands House 10/10/05

Brooklands House 24/05/05

Brooklands House 18/10/04

Brooklands House 13/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brooklands House 3 Woodville Terrace Lytham St Annes Lancashire FY8 5QB Lead Inspector Denise Upton Unannounced Inspection 24th April 2006 9:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brooklands House Address 3 Woodville Terrace Lytham St Annes Lancashire FY8 5QB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01253 736393 Mrs Carol Josephine Gilligan Mr Patrick Joseph Gilligan Mrs Carol Josephine Gilligan Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 25 service users in the category of OP (Older Persons over the age of 65 years). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 10th October 2005 Date of last inspection Brief Description of the Service: Brooklands House is situated in a quiet residential area of Lytham but in close proximity to Lowther Gardens, the promenade, the main shopping area of the town and community facilities and resources. The home is arranged over two floors with the majority of service users accommodated in single bedroom accommodation. Only one bedroom is for shared occupancy. The home is registered to accommodate up to 25 older people who do not require nursing care. Mr and Mrs Gilligan are the registered providers and a manager has been appointed although this person is not currently registered with the Commission For Social Care Inspection. Training is viewed as a positive tool to improve standards and to provide a high quality service. All staff are expected to undertake relevant training including nationally recognised N.V.Q. training and become accredited to a minimum of Level 2. Personal care is provided as required and specialised needs can be catered for. Any nursing needs are referred to the community district nursing team. Visitors are welcome at any time of the service users choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place during the morning, afternoon and early evening period of one day and the afternoon period of the following day. In total the visit spanned a period of thirteen and half hours. Twenty-three of the thirtyeight core standards identified in the National Minimum Standards-Care Homes For Older People were assessed during the course of the visit. The inspector spoke with homeowner, the home’s manager, three care staff and the domestic staff team member that were on duty during the course of the visit. A telephone discussion also took place with a recently appointed member of the care staff team. In addition, six residents ‘at home’ at the time of the inspection were spoken with individually and several other residents were also collectively spoken with informally during the course of the site visit. Discussion also took place four relatives of residents that were visiting the home and telephone contact was made with a further two relatives. A number of records and policies and procedures were also examined and a partial tour of the building took place that included communal areas and some bedroom accommodation. What the service does well: What has improved since the last inspection? Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 6 Since the last inspection in October 2005, the Commission for Social Care Pharmacist Inspector has visited Brooklands House on two occasions to provide guidance regarding medication issues. Following on from this, significant improvements have been noted regarding the recording and administration of medication. However further training is required for staff that has responsibility for the administration of medication. Improvements have also been made to the way staff are recruited. All references and clearances that are required had been obtained and found to be satisfactory before recently appointed staff started working at the home. All individual bedroom accommodation has now been provided with a lockable box fitted to the wall for the safe storage of personal items. Residents spoken with were pleased with their own bedroom accommodation and the shared accommodation at the home. It was clear that residents can take into the home personal belongings that are important to them including small pieces of furniture to make their bedroom how they would like it to be. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome group is good. The pre admission assessment enables an informed decision to be taken to make sure that the prospective residents current strengths and needs can be met at the home. EVIDENCE: Brooklands House undertake a structured pre admission assessment of all prospective residents to make sure that the staff team can provide the individual care and support required. This includes visiting the prospective resident in their current environment to undertake an initial assessment of current needs and requirements and to provide further information about the home. There was also evidence to confirm that other health and social care assessments had been obtained if the prospective resident had recently been assessed by a health or social care worker. This combined information then provided the basis for the initial care plan. Discussion with the relative of a recently admitted resident confirmed that his mother had been visited by a member of the management team prior to her admission to the home and further written information had also been provided. This resident and her son also both felt that the admission to the home had Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 9 gone well and that sufficient information had been obtained to ensure the residents needs could be met. Since the last inspection, the homes admission policy and emergency admission policy has been reviewed and amended. However although the amended policy makes it clear that referrals cannot be accept from people who are detained under the Mental Health Act or whos behaviour or mental state causes them to display anti social or aggressive behaviour, there is no reference to explain that the home is also not registered to accommodate people who are assessed as requiring specialist dementia care. It is important that this specific information be incorporated in the admission document to provide clear information for pospective residents and their family/advocate. Brooklands House is not registered to provide an intermediate care service. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome group is adequate. There is a consistent care planning process in operation but care plans should be developed further to identify individual strengths as well as needs to provide a holistic account for the staff team. Formal risk assessments should always be undertaken when a risk has been identified to help protect residents and staff. The systems for the administration and recording of medication has significantly improved however staff with responsibility for medication administration must undertake a more advanced course of medication training to ensure they have the required knowledge and skills. Privacy and dignity is well respected in this home that ensures residents are treated with respect. EVIDENCE: Six residents were case tracked during the course of the inspection that had differing needs and requirements. In the main, care plans are now reviewed on monthly basis and the resident sometimes signs the individual care plan. When a resident does not have mental capacity to understand or sign their care plan, it is recommended that where ever possible, the content of the care plan be discussed with the residents relatives who could then be invited to pass comment and to sign the care plan on the residents behalf. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 11 Care plans are developed from the initial assessment process and now provide some detail in respect of social and religious requirements. Care plans also give a good account of individual needs. However in order to provide a holistic care plan, it is essential that medication requirements are identified and what the resident can do independently is also made clear and taken into account during the formal review process. It was also noted that although moving and handling risk assessments are routinely undertaken on admission, other potential identified risks are frequently not formally risk assessed. It is essential that formal risk assessments are undertaken whenever a risk is identified with outcomes incorporated in the care plan and kept under regular review. When a care plan states that staff should spend some time talking or provide stimulation for a particular resident, the time spent in this activity should be clearly recorded on the daily record to ensure that this task is not intentionally neglected. Through direct observation at the time of inspection, discussion with staff and observation of documentation, there was clear evidence of good multi disciplinary working with health care professionals. A number of residents spoken with felt that their health care needs had been fully met while living at the home and a relative highly praised the support of the staff team during her mothers recent period of serious ill health. It was noted that although visits by health and social care professionals are well recorded, in order to maintain resident confidently, it is recommended that each resident has a individual record sheet to record professional visits rather that using a collective book as at present. Significant improvements to medication handling and administration have taken place following the recent involvement of the Commission for Social Care Inspection (CSCI) Pharmacist Inspector. The CSCI Pharmacist Inspector undertook the most recent assessments of the medication standard in January 2006 and March 2006. A number of requirements and recommendation were made at each inspection, the majority of which have now been addressed by the management team at Brooklands House. However there remains a significant requirement that has yet to be addressed. Although the majority of the care staff team have now received basic external medication training provided by the pharmacist who supplies the home with medication, a number of the more senior staff who have designated responsibility for the administration of medication have yet to undertake a more advanced course of study to ensure they are equipped with the required skills and knowledge. During the course of the inspection, the manager was advised of the type of training recommended and of an organisation that may be able to provide a suitable course of study. It is essential that staff with responsibility for medication administration receive the correct level of training in order to protect residents accommodated. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 12 It was recommended by the pharmacist inspector that all none monitored dosage system medication should be dated on opening to enable an meaningful audit trail to take place. Although this is now in place in respect of eye drop medication, the process should be extended to include all other none monitored dosage system medication received into the home. A regular medication audit has now been introduced to assess if medication administration and recording is completed correctly. From discussion with the manager, it is understood that the medication audit has been a useful tool. Written outcomes were observed that are also provided to all staff with responsibility for medication administration within 24 hours of the audit taking place. This has enabled any mistakes to be quickly identified and staff advised as to the correct procedure to be followed. It was observed that staff responded with care and sensitivity to resident’s needs and that resident’s privacy and dignity was well maintained. A number of residents spoken with were very clear that they felt their privacy and dignity were respected by the staff group that was also reinforced by the observations of two relatives spoken with who visit the home on a regular basis. Service users have access to a telephone that can be used in private and a personal telephone can be provided in individual bedroom accommodation although the resident is financially responsible for any associated costs in respect of the private line. The preferred term of address of the prospective resident is determined prior to admission and always respected. Staff spoken with confirmed that they were advised of the homes expectations in respect of maintaining residents privacy and dignity at commencement of their employment and these issues were also discussed during the period of induction training and reinforced through further training opportunities. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome group is adequate. Although formal activities are arranged on a limited basis throughout the year, activities provided ‘in-house’ or in the local community should be extended to enrich resident’s social opportunities. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. Dietary needs of residents are well met with a balanced and varied selection of foods served that residents enjoy. EVIDENCE: Although residents, relatives and staff spoken with were consistent in their comments regarding the high standards of health and personal care provided at the home, comments about social activities made available were more mixed. It is clear that occasional activities do take place that generally involve entertainment brought into the home or arranged visits to facilities in the community, for example a meal in a hotel at Christmas. However staff led structured ‘in house’ social and recreational activities on a regular basis are not normally provided. One resident spoken with explained that as she was able to go out either with friends or independently in the community, the limited social activities did not necessarily concern her however she did question “what happens to the people who cannot go out”. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 14 This concern was also expressed by another resident spoken with who said that “its alright for me as I can go out on my own but its not the same for some other people who are here and who do not have any anybody who can take them out” This same resident also commented that although all the staff are “very good, excellent” there were certain periods in the day when staff are busy doing other things and residents are left alone and “it’s not to brilliant at these times” A relative contacted also commented that the staff were excellent and had been “marvellous” with her mother during an illness, never the less this relative also felt that the home “should have a person to arrange regular activities and take residents out, I feel so sorry for some residents who never go out of the home”. A number of staff spoken also confirmed that activities are limited however those spoken with about this topic did have some suggestions as to how an activities programme could be arranged that included residents with particular needs and requirements. It is particularly important that some of the activities arranged are suitable for residents who experience cognitive impairment or who have mobility difficulties in order to improve their quality of life and to provide a stimulating social environment. The comments raised were discussed with the senior management team and it is understood that this is an area that is to be developed in the near future. Through observation and discussion it was clear that the routines of daily living remain flexible and varied to meet individually assessed needs. A number of residents spoken with confirmed that they are able to make decisions about their chosen daily routines. As evidenced during the course of the inspection, social relationships are encouraged either through family/friends visiting at a time of the resident’s choice or visits out with family/friends or independently in the wider community. Residents are free to entertain their guests either in the privacy of individual bedroom accommodation or any other communal area of the home. Residents are encouraged to maintain control of their own financial affairs for as long as they wish to and have capacity to do so. Leaflets in respect of local advocacy services are made available to residents and relatives in the entrance hall of the home and also referred to in the Service User Guide. Through discussion with residents and observation of some bedroom accommodation, it was confirmed that residents are encouraged to take personal possessions with them into the home to make their private accommodation more homely and comfortable. It is understood that residents are made aware that they can have access to their personal records and that confidential information in respect of themselves is maintained at the home. All residents spoken with stated that they very much enjoyed the meals at Brooklands House and confirmed that a choice of menu was always available and that they could make their choice of food before the meal was served. Several residents described the meals served as ‘very tasty’, ‘very good’ and Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 15 ‘excellent’ and a relative also commented that the meals always ‘smell very good’ when ever she was visiting. Residents are offered a varied, wholesome and nutritious diet and specialist diets in respect of religious, cultural or medical need can be accommodated. As observed, hot and cold drinks and snacks are also made available throughout the day. Although there is a rotating menu available, main meals are generally determined by what is in season and if there were anything that residents would particularly like to eat on a specific day. It was observed that the lunchtime meal being served was attractively presented and clearly enjoyed by residents. It was also noted that staff discreetly and sensitively offered assistance as required to ensure the dignity of the resident in both when assisting the resident to eat and in not drawing attention to the resident. It is however recommended that a record be maintained of the food each individual resident actually eat during the course of each meal. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome group is good. The home has developed a satisfactory complaints system and adult abuse policy and procedures for the protection of residents. The majority of staff have now undertaken formal adult abuse training that further helps to protect residents. EVIDENCE: During the course of the past year, the Commission For Social Care Inspection received one anonymous complaint in respect of Brooklands House. Two inspectors from the Commission For Social Care Inspection investigated this and the complaint was not upheld. Brooklands House had available a satisfactory complaints procedure that is displayed in the entrance hall and also incorporated in the Statement of Purpose and Service Users Guide to inform service users and their relatives of how to make a complaint. As recommended in the last inspection report, a structured complaint record form has now been developed to record in detail the issues and outcomes of any future complaint. A resident and relative spoken with confirmed that they were aware of the complaint procedure and of whom to make a complaint to if the need arose. Policies and procedures were evidenced for the protection of service users that included physical restraint, physical intervention by staff, aggression towards staff and a newly redeveloped service users monies and valuables policy, as well as a robust adult protection policy and staff whistle blowing policy. However it is suggested that the service users monies and valuables policy indicates that where ever possible, an external advocate would be approached Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 17 to assist the resident rather than the home taking on the financial responsibility for the resident. It was observed at the last inspection, that the policy in respect of aggression towards staff states that ‘staff should be trained to recognise early warning signs of potential aggression’. Although it was recommended that staff should receive this training, this has yet to be arranged. Since the last inspection the majority of staff have now undertaken adult abuse training. This training will help to ensure that all staff have a thorough understanding of adult abuse issues to protect both residents and themselves. However it is essential that the remaining staff that have not undertaken this training do so in the near future. Appropriate insurance cover is provided and all bedroom accommodation has now been provided with an appropriate locking facility to enable residents to maintain private and personal possessions securely. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome group is good. The standard of the environment within this home is good providing service users with an attractive and homely place to live. EVIDENCE: Residents at Brooklands House continue to live in well-maintained accommodation that is domestic in character and has been designed to meet the individual and collective needs of residents accommodated. All staff has responsibility for reporting any major or minor repairs that require attention and records are maintained in respect of all on-going maintenance requirements that also indicate when the task has been completed. It was however noted that in three individual communal toilets, a hand washbasin had not been provided. In order to prevent the risk of cross infection, it is recommended that the toilet facilities in question be provided with a hand wash basin to enable residents to wash their hands before leaving the toilet area. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 19 Brooklands House is conveniently situated in opposite Lowther Gardens and is close to the Promenade and within easy reach of local community facilities and resources. The home is well maintained and offers two alternative lounges, one of which includes the main dining area. There is a passenger lift for ease of access throughout the building. As identified in the last inspection report, policies and procedures are in place for the control of infection and a number of staff have undertaken infection control training. However as previously recommended, consideration should be given for all remaining staff to attend this training to ensure the staff group have sufficient understanding of the topic and a consistent approach is taken in respect of the control of infection. At the time of inspection the home was clean, hygienic and free from offensive odours. Discussion with a member of the domestic staff confirmed that adequate domestic cleaning equipment and materials are always available. Laundry facilities are sited on the ground floor of the building and do not intrude on residents accommodated. It is understood that as part of a planned extension to the building, a new laundry facility is to be provided. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome group is adequate. Although resident’s health and personal care needs are well met, care staff do not have sufficient time to ensure that social care needs are adequately addressed. This has resulted in residents not receiving a consistently high quality service that takes into account all personal, social and emotional and psychological care needs. Improvements to the staff recruitment process have been made that has help to protect residents from potential risk. EVIDENCE: From discussion with a number of staff, residents and relatives, it is clear that the current staff complement is stretched in providing a consistently high quality service that takes into account the personal, emotional and social care needs and requirements of each individual resident. This is especially so given the high level of dependency needs of some residents accommodated. A certain times of each day, a substantial number of residents are left unsupervised while care staff attend to residents who are heavily dependent and care staff are also required to undertake some catering duties that potentially leaves residents without sufficient support for extended periods especially during the late afternoon/evening period. Although the staff group were consistently highly praised by residents and relatives for their caring practices, concern was expressed about staff not having enough time to socially interact with residents on a one to one basis or to provide a stimulating environment that includes regular social activities. It is essential that in order to ensure a high quality service and a safe and stimulating environment for all Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 21 residents accommodated, that sufficient staff be on duty throughout the waking day. This issue was discussed at length during the course of the inspection and the senior management team have been asked to inform the Commission for Social Care Inspection of their proposals on how to address this matter. Since the last inspection, two new members of staff have been appointed. Through observation of the two staff files and discussion with the home’s manager and one of the recently appointed members of staff, it was evident that the staff recruitment practices required by regulation had been followed. Appropriate references and clearances had been obtained and deemed to be satisfactory before the applicants actually started working at the home. It was also confirmed that as recommended in the last inspection report, all staff have now been provided with a copy of the General Social Care Councils ‘Code of Conduct’ that advises staff and home owners of the council’s expectation with regard to a facility that provides care to venerable people. Although the recently appointed member of staff confirmed that she had been provided with some induction training, the manager confirmed that the current induction-training programme has yet to be evidenced against the ‘Skills for Care’ induction standards to ensure that newly appointed staff are provided with the National Occupational Induction Standards for care staff. It was also noted that although recommended in the last inspection report, the home’s application form in respect of care staff has still to be amended to ensure that the applicant is made aware that a satisfactory enhanced Criminal Records Bureau clearance is required and what this actually means in practice. All staff are encouraged and enabled to undertake a National Vocational Qualification in care. The majority of staff have now either obtained this qualification, or are currently working towards completing this course of study or are planning to commence this training in the near future. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome group is adequate. The homeowner and manager are well supported by the senior staff in providing clear leadership throughout the home with all staff spoken with demonstrating a clear awareness of their roles and responsibilities. Resident’s views are sought from time to time with a variety of evidence to indicate that resident’s views are acted upon. Systems are in place to protect service users monies held in safekeeping. The health, safety and welfare of residents and staff are promoted however a number of staff should undertake a variety of further health and safety training to ensure safe working practices are consistently applied. EVIDENCE: Although it is clearly evident that the home’s current manager has provided management responsibilities on a day-to-day basis in the home for some considerable period of time, the Commission for Social Care Inspection (CSCI) has not received an application to apply to register this person as registered manager. A registered manager is a requirement when the homeowner is not Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 23 undertaking full time management responsibility within the home. During the course of the inspection, it was arranged for a manager application pack to be sent to the manager for completion that should be submitted to CSCI in the near future. Only if all the requirements of registration, including satisfactory references and clearances are obtained and the prospective registered manager demonstrates at interview that she has the qualifications and experience to undertake the role of registered manager will the application be approved. Anonymous quality assurance questionnaires have recently been provided to residents to enable them to express their views and opinions on how the home is meeting their individual and collective needs. The inspector was shown seven completed questionnaires that had recently been returned. However, given that a number of residents accommodated may not have the mental capacity to complete the anonymous questionnaires, it is recommended that further anonymous questionnaires be developed for relatives/other stakeholders to complete to in order to provide opportunity to elicit their views. This would clearly assist the internal quality audit and provide a different quality assurance perspective to supplement the informal systems already in place. In addition, newly admitted residents are also provided with a separate questionnaire about three weeks after admission to find out their views on their admission to the home and the staff team also have opportunity to complete an anonymous questionnaire. Service user meetings have taken place in the past however residents have stated that they do not feel formal meetings are useful and do not want any more to take place. Residents spoken with during the course of the inspection were however clear that if they did have anything to say they would talk with the homeowner or the manager at any time. Brooklands House has achieved the professionally recognised ‘Investor In People’ award that also assists the internal quality assurance systems in place. Although in accordance with the home’s policy in respect of residents monies and valuables, all residents are encouraged to maintain control of their own financial affairs or assisted in this task by their family or an external advocate, appropriate systems are in place for the safe keeping if service users monies when required and structured records of financial transactions are maintained. It is recommended that where ever possible, the resident in question signs the financial expenditure record to acknowledge and agree the transaction or alternatively a second member of staff should witnesses and counter signs the transaction. As recommended at the last inspection, formal staff supervision has been reintroduced that was evidenced through discussion and observation of individual supervision records. However the quality of the supervision records Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 24 were variable. It is important that the each supervisor has received training on how to formally supervise staff and understands the concept of supervision and the intended outcomes and how this is recorded. At minimum, staff supervision should cover all aspects of practice, philosophy of care in the home and career development needs and should be provided at least six times a year. Brooklands House has a number of policies and procedures in place to ensure the health, welfare and safety of service users, relatives and staff. These include policies in respect of COSHH requirements, accidents, fire safety, first aid and a health and safety policy. Through discussion with the homeowner, it was identified that a new company has recently been employed that will provide updated policies and procedures for the home. The same company will also carry out an annual health and safety inspection of the home and provide a report. Systems are in place to protect residents and staff from the risk of Legionella. Routine weekly fire equipment tests are also carry out. However it was noted that the last recorded fire drill took place in July 2005 and a further fire drill should take place as a matter of urgency to ensure that residents and staff know what to do in the event of an actual fire occurring. A staff-training matrix has recently been developed that identified that a number of staff have still to undertake basic moving and handling training and first aid training. This training is a requirement and must be provide to all staff that have not already undertaken the training. As previously recommended, all staff that prepare, cook or serve food should also undertake food hygiene training. Whilst it is acknowledged that some members of staff have already undertaken this training, the remaining staff should be provided with food hygiene training. At inspection the training matrix identified that only a small number of staff had received specific health and safety training however it is understood a further course of this training has been arranged to take place in May 2006. There was however no evidence to suggest that staff had received formal fire safety training and this important training should also be arranged as soon as possible. It was pleasing to note that risk assessments are in place in relation to the home’s fire procedures and other environment issues and that all equipment is regularly serviced and maintained with appropriate certificates available for inspection. Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be further developed to provide a holistic account of current strengths and needs and identify how these are to be addressed. Formal risk assessments must be undertaken as required with outcomes incorporated in the care plan. (Timescale of (28/02/06 not met in full) The current programme of staff training in respect of adult abuse must continue until all staff has received appropriate adult abuse training. (Timescale of 31/03/06 not met) The manager must ensure all staff that administers medication is competent to do so. (Not fully met, on going) Timescale for action 30/06/06 2. OP18 13 31/07/06 3. OP9 18(1)(a) 06/07/06 4 OP27 18(1)(a) Staff should be employed in 30/06/06 sufficient numbers to ensure that residents individual health, personal, social & emotional DS0000009800.V286551.R01.S.doc Version 5.1 Page 27 Brooklands House needs are well met. Please advise CSCI of your proposals and timescale to address this matter in the Action Plan. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 5 Refer to Standard OP3 OP7 OP8 OP9 OP12 Good Practice Recommendations The admission policy should indicate that Brooklands House is not registered to provide a service to people who require specialist dementia care. If a resident cannot understand or sign their care plan, where ever possible the care plan could be discussed with relatives and signed by them on behalf of the resident. To maintain confidently, each resident should have an individual record of professional visits rather than a record being maintained in a collective book as at present. All non-monitored dosage system medication should be dated upon opening. An ‘in-house’ activities programme should be developed and all residents who wish to, should be provided with opportunity to go out on a regular basis with staff assistance as required. It is recommended that a record be maintained of the food each individual resident eats during the course of each meal. As indicated in the home’s policy document, staff should receive training in respect of aggressive behaviour. The policy in respect of resident’s monies should indicate that in the first instance, an external advocate would be approached to assist the resident rather than the home assisting the resident. The three communal toilets that are not provided with a hand washbasin should be provided with one. All staff that have not done so should receive infection control training. Current induction training should be evidenced against ‘Skills for Care’ induction training specifications to ensure compliance. Anonymous questionnaires should be provided to other DS0000009800.V286551.R01.S.doc Version 5.1 Page 28 6 7 OP15 OP18 8 9 10. 11 OP19 OP26 OP30 OP33 Brooklands House 12 OP35 13. 14. OP36 OP38 stakeholders to assist with the internal quality audit. Where possible, the resident should sign any financial transaction or if a resident does not have mental capacity to do so, the transaction should be witnessed and countersigned by a second member of staff. Senior staff that provides supervision to should receive adequate training to perform the task. A fire drill should be arranged as soon as possible. Staff that have not done so should undertake the health and safety training as identified in this Standard Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brooklands House DS0000009800.V286551.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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