Inspection on 30/07/07 for Brooklands House

This inspection was carried out on 30th July 2007.

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

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

Other inspections for this house

Brooklands House 11/11/08

Brooklands House 24/04/06

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 09:00 30 & 31st July 2007 th 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.V343413.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 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.V343413.R01.S.doc Version 5.2 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. 24th April 2006 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 residents 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 Mrs Gilligan undertakes responsibility for the day-to-day management of the home including directing all professional issues and care practices. 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 National Vocational Qualification (N.V.Q) training in care 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. In house activities are arranged and residents can choose whether to participate or not. Visitors are welcome at any time of the resident’s choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of a mid-week day and a short period of time on the following day and in total spanned a period of approximately nine hours. Twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with a partial re-assessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the homeowner, deputy manager, a care assistant and informal brief discussion also took place with the cook. In addition, individual discussion took place with two people living at the home that were ‘case tracked’ and a relative and a friend that were visiting. Several other residents were also spoken with in a communal area of the home. A number of records were also examined and a tour of the building took place that included communal areas of the home and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the homeowners. In addition, a number of residents and relatives/friends also completed a Commission for Social Care Inspection survey forms that helped to form an opinion as to whether residents needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Currently the fees at Brooklands House range from £386.00 to £425 00 per week. What the service does well: Brooklands House has a group of staff that are well qualified and work well together. The standard of care provided is good and residents get on very well with members of staff. One resident said “I get all the help I need, I am very happy living here, they have been wonderful to me, I will be here for ever now, they have become good friends” (the staff). Another person wrote on a Commission for Social Care Inspection survey form, “My friend is looked after very well, I would never want him to leave, he is very happy living here”. Staff are well trained in order for them to do their job well. Newly appointed care staff receive induction training when they start working at the home to make sure that they have the right basic skills and understanding to fulfil Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 6 people’s needs and expectations. Staff are also encouraged to undertake nationally recognised, National Vocational Qualification (NVQ) training in care and a high number of staff have achieved this award at various levels. The home has good systems in place for residents and other interested people to have their say. This helps to make changes at the home. People were also please with their bedroom accommodation and the meals served. Residents spoken with described the meals as “very good”. One comment received from a relative stated that “The care home supplies an excellent service and are kind and considerate”. This statement was mirrored by another comment from another relative when answering the question ‘what do you feel the care home does well’ wrote, “Looking after my mother with kindness, care and compassion”. What has improved since the last inspection? What they could do better: The homeowners and staff at Brooklands House are keen to provide a good quality service and try hard to ensure that the needs of residents are well met and people feel comfortable living at the home. However there are a number of things that could be improved. The individual care plan that should tell staff exactly what assistance is required and what staff should be doing regarding each resident could be more detailed. This would make sure that staff always knew what they are expected to do and how to do it. This would also help to ensure that a consistent service is always provided. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 7 The Statement of Purpose and Service User Guide that tell residents, prospective residents and other interested people about the home should be reviewed in some places to make sure that the information provided is correct. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 in part & 3. Quality in this outcome area is good. The pre admission assessment information to identify what the prospective resident can do well and what help may be required is detailed in order to establish if current needs, wants and wishes could be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident and prospective resident is given a copy of the home’s Service User Guide that tells people about the home and the facilities and services provided. Residents also have access to the home’s Statement of Purpose that sets out the aims and objectives of the home, philosophy of care, terms and conditions as well as information about the facilities and services provided. The Statement of Purpose states that Brooklands House can accommodate people with a range of needs. It is important however to emphasis in the Statement of Purpose that Brooklands House is only registered to Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 10 accommodate people in the older age category. In practice this means that people who’s needs are associated with older ageing can be accommodated but younger people who’s needs are associated with a physical disability not related to older ageing process cannot be admitted and people who have already been assessed as requiring a specialist dementia care home cannot be admitted. It is recommended that the written information provided to residents, prospective residents and other interested people be reviewed to ensure the information provided is clear. Residents are only admitted to the home if their individual needs and requirements can be addressed. It is routine policy at Brooklands House that all prospective residents are visited in their current environment in order to undertake an initial assessment of individual strengths and needs and to provide further information in respect of the home and facilities and services provided. This is coupled with an invitation to undertake an introductory visit to the home to assess the accommodation for themselves, meet staff and existing residents in order to make informed choice. The pre admission assessment carried out by the homeowner is in some instances, further supplemented by information made available from professional assessments undertaken by Care Managers or through hospital discharge information. This combined information is then collated and provides the basis of the initial care plan. A number of pre admission assessments were viewed. In the main these were satisfactory however in some instances, although a risk had been identified, there was not always a formal risk assessment in place to direct how the risk could be eliminated or minimised. A formal risk assessment should always be undertaken when a risk has been identified even if this needs to be amended once the resident has been admitted to the home. The significant outcome of any risk assessment undertaken should be clearly incorporated in the care plan to guide and advise staff how to minimise the risk. A friend of a resident was individually spoken with. This person, who had helped the resident when he was admitted to Brooklands House, confirmed that a wide variety of written information had been provided and that the pre admission assessment had taken place. This same person also said that his friend, his friends brother and himself visited the home and were invited to stay for lunch prior to admission to see what the home was like and to help his friend make an informed decision about living there. “My friend is looked after very well, I would never want him to leave, he is very happy living here”. Brooklands House is not registered to provide an intermediate care service. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. There is a clear and consistent care planning system in place that provides guidance to staff in order for them to meet resident’s needs and requirements. However the information provided could be more detailed. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect resident’s privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 12 Since the last inspection the development of individual care plans has significantly improved. The care plans evidenced now provide a more rounded account of the individual including what the resident can do independently and what interests and requirements the individual resident has. However, although care plans are more comprehensive, sometimes the detail is missing as to how an objective is to be achieved. The care plan should provide sufficient information to direct staff what they need to do/the actual assistance required to achieve the stated objective. Whilst in general terms there is no suggestion that resident’s needs and requirements are not been addressed, a more detailed care plan would help to ensure that a consistent service is provided. In addition, by ensuring that the action required is detailed on how to address a specific personal objective, care plans would very much be personalised rather than the same general aims on a variety of care plans. It is also recommended that when there has been a significant change in the care plan following a review, the whole care plan could be updated. It was noted that on a number of the care plans evidenced, the actual care plan had not been updated following a significant change with the recent changes only briefly identified on the review sheet. This changed information following the review could easily be missed by care staff if it is not clearly identified on the current care plan. There was clear evidence of monthly reviews taking place. The monthly review and the care plan are now both signed by the resident or their representative and the member of staff who has undertaken the review. Since the last inspection, a system has been developed whereby every six months invitations are sent out to a resident’s family/friends, General Practitioner, Social Worker or any other significant person involved, inviting them to attend the formal review of care. At this meeting the resident and their representatives are provided with opportunity to comment on the care provided and to suggest ideas or views for improvement. This development appears to be working really well. Relatives spoken with all considered this to be a good thing and were looking forward to their invitation to attend. As previously stated in this report, even when a risk has been identified a formal risk assessment is not always in place. A formal risk assessment would clearly show when and why certain actions are being taken in order to minimise risk and provide clear written guidance to staff. A formal risk assessment should always be undertaken when ever a risk has been identified. The outcome of the risk assessment and of any risk management strategies devised as a result of the risk assessment should be clearly highlighted in the care plan. All risk assessments should be formally reviewed at the same time as the monthly care plan review. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 13 It is understood the homeowner has approached an outside agency that is to provide guidance in developing more professional care plans and risk assessments. It is anticipated that the involvement of this agency will assist the existing care planning and the risk assessment process to ensure that care plans will be very personalised to the individual and formal risk assessment will routinely be in place when required. A number of residents have lived at the home for a considerable period of time and are now quite frail. The majority of these people are less interested in discussing the content of their individual care plan. However the remaining residents are being encouraged to get more involved in care planning. This is especially true for residents who are in the main self-caring and who in the past have shown little interest in becoming involved. Residents and relatives spoken with held high regard for the level of care and support provided by the management team and staff group at Brooklands House. One relative/friend wrote on a Commission for Social Care Inspection survey form, “In my opinion, I believe Brooklands to be an excellent home. They take their duties very seriously and I have been quite touched by the gentle care, quite young girls exercise”. Another relative who lives some distance away and just turns up at the home unannounced commented that “my aunt is very well cared for, always clean, hair done” this same person also said that she liked the “banter between residents/staff/relatives” and was “quite confident with the place”. The daily records of the residents case tracked were also viewed. The homeowner had already self-identified on the Annual Quality Assurance Assessment that this was an area for future development. The homeowner wants to ensure that the daily record for each resident is written in more detail. For example how residents plan they day and what they have actually done throughout the day. This would provide a clearer picture of daily living and assist future planning. Through discussion with residents and staff and observation of documentation, it was confirmed that the health care needs of people living at the home are fully met. There is a good relationship with health and social care professionals in order to maintain health and social well being. Comments on the Commission for Social Care Inspection, comment cards confirmed that residents felt that they always receive the medical support that they needed. Residents spoken with felt their privacy and dignity was well respected and that staff were sensitive when they needed help with personal care. Staff had a good overall understanding of the needs of people who lived at the home and were seen to be patient, kind and respectful when interacting with residents. All staff receive training in respect of maintaining privacy and dignity during Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 14 induction training, National Vocational Qualification (NVQ) training and through regular supervision. Through direct observation at the time of inspection, discussion with residents and observation of documentation, there was clear evidence of good multi disciplinary working with health care professionals. It was noted that visits by health care professionals are individually recorded and residents spoken with felt that their health care needs had been fully met whilst they had been living at the home. There are good systems in place for the administration of medication. The medication administration records of the residents that were ‘case tracked’ were examined and found to be well recorded and accurate. Medication is now stored in a medication storage cabinet chained to the wall in a locked room. Residents are enabled to self-administer their own prescribed medication within a risk assessment framework. Appropriate storage facilities are provided in individual bedrooms. The medication audit trail is clear and the homeowner undertakes a review of medication practices every few months that includes monitoring staff when undertaking a drug medication round and checking the drug systems in place. The findings of the review are recorded in a report format and a copy is given to all senior staff. In addition, the local pharmacist who supplies medication to the home also undertakes an annual drug audit and advises staff on any drug related matters. Senior staff that have responsibility for the administration of medication have all completed a medication awareness course and a more advanced ‘Safe Handling of Medication’ course provided in-house by an external agency. This ensures that all staff with responsibility for the administration of medication are competent to undertake the task. A relative spoken with commented that she felt she could speak with the homeowner at any time and that the home always kept in touch about important issues. This relative went on to say that, “Decisions taken always reflect individual needs- I trust them”. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Improvements have been made to the availability of staff led social activities in order to provide a more socially stimulating environment for people to enjoy. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection concern was raised about the availability of staff lead activities in the home that would promote well being and social stimulation. Since this time a programme of weekly activities has been introduced mainly in the afternoon period although reading, television and music are available throughout the remainder of the day. The activity programme is displayed in a communal area of the home. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 16 Staff are also escorting some residents out to the park or a walk along the promenade in fine weather. Members of staff are also giving more one to one time with residents who choose mainly to remain in their bedrooms, often just for a chat and a cup of coffee. One or two events are planned either in-house’ or the wider community each month and forthcoming events include a summer fair and coffee morning. Entertainers and trips out are also now arranged approximately every eight weeks. All activities undertaken are recorded whether they are one to one contact or a group activity. This helps to plan further activities and also highlights what residents have enjoyed. The homeowner is intending that the task of planning and organizing individual interests and activities be deployed to certain staff on certain days of the week. The activity programme developed is intended to be “flexible to meet individual expectations, preferences and capacities” One recently admitted gentleman who chooses to remain in his bedroom accommodation was individually spoken with. This resident stated that he was very comfortable but explained that he was not interested in joining in with others. Nor does he like music or television. However this gentleman is supported to engage with friends from his Polish community and members of the church who visit him regularly. Two members of the care staff team are also Polish. Although all three speak very good English, this resident benefits by being in close contact with others who share the same culture and by being able to speak with the two carers in his native language. The deputy manager stated that staff attitudes are changing towards providing social stimulation and staff are now more proactive in providing or arranging social activities. However a relative spoken with pointed out that no matter what social activities the home arrange, some residents will remain very resistant and choose not to participate. The homeowner is planning to develop a questionnaire for residents and families in order to gain feedback regarding community contact. It is understood that Age Concern has also shown an interest and are willing to support Brooklands House in providing services and entertainment. As observed at the time of inspection, it was clearly evident that residents can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. Residents are always asked if they would like to see their visitor before introducing the visitor to the resident. Occasionally residents do reject meeting their visitor. The friend of a resident spoken with during the course of the inspection who visits on a very regular basis, stated that he is always made welcome and confirmed his satisfaction with the level of care provided and that he is kept informed about the resident’s well being. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 17 All residents wherever possible are encouraged and enabled to retain independence in respect of financial affairs for as long as they wish to and as long as they are able to. However in reality a substantial number of people living at the home have assistance from family/friends or an independent advocate. Information regarding local advocacy services is available for residents or their family to access independently. Through discussion with a number of residents and observation of some bedroom accommodation it was clearly evident that residents are encouraged to take personal possessions with them into the home to make their individual bedroom accommodation more homely and comfortable. Meals and mealtimes at Brooklands House are given high priority with a varied and balanced menu provided that is designed around the known likes and dislikes of people living at the home. Residents spoken with were all very pleased with the variety and quality of the meals served. People described the meals as “very good”. During the course of the inspection the mid day meal was observed. Residents were very comfortable and ‘chatty’ sitting at the table waiting for their meal to arrive. The atmosphere was relaxed and staff were encouraging, sensitive and discrete when assisting individual residents to eat their meal. The meal in itself was a social event and the food well cooked and presented. There is a four weekly rotating menu that was devised following consultation with residents. The menu is changed periodically to reflect seasonal availability and there was good evidence of fresh fruit and vegetables being served on a daily basis. There is a choice of menu at each meal or residents can request an alternative of their choice. There are good systems in place to ensure that the needs and requirements of residents with specific dietary restrictions can be adequately addressed. This includes medical, religious or cultural dietary needs in addition to specific preferences. Blended meals are served in a way that ensures that the resident can experience the taste of each element of the meal and there was evidence that the instruction regarding dietary intake identified in the care plan was carried out by staff. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have a good knowledge and understanding of adult protection issues, which helps to protect people who live at the home from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brooklands House has a comprehensive complaint policy and procedures, which outlines the home’s commitment to resolving complaints within 28 days. The complaints procedure is incorporated in the Statement of Purpose and Service Users Guide and displayed in a communal area of the home to inform residents and their relatives how to make a complaint should the need arise. Several residents and the relative and friend of a resident spoken with stated they were aware of how to make a complaint. All confirmed that they would have no hesitation about speaking with the homeowner if they had a concern and felt confident that any concern would be taken seriously and acted upon. Since the last inspection one verbal concern was received. There was written evidence to confirm that this concern was thoroughly investigated by the Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 19 homeowner and the complainant informed of the outcome. The concern was not upheld. Policies and procedures were again evidenced for the protection of residents that included physical restraint, physical intervention by staff, aggression towards staff and a monies and valuables policy, as well as a robust adult protection policy and staff-whistle blowing policy. Since the last inspection, the policy in respect of aggression towards staff has been amended to reflect current needs. All staff have recently undertaken refresher adult protection training. Training in this topic also forms part of the induction training programme and NVQ training. This helps to protect residents. Through the training provided staff are made more aware of legislation regarding adult protection issues and the protection of resident’s rights. It is understood that training in the protection, detection and response to abuse it to be arranged to take place twice yearly. This will ensure that all staff are provided with updated training. Discussion with a member of the care staff team confirmed their knowledge of the Home’s adult abuse procedures and their individual responsibility in reporting any incident of alleged adult abuse. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Standard 24 in part. Quality in this outcome area is good. The standard of the environment within this home is good providing people living there with safe, comfortable and homely surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Brooklands House continue to live in comfortable, well maintained and homely accommodation. Bedrooms are comfortably furnished and personalised to reflect the needs and wishes of the occupant. Communal space is spacious and welcoming consisting of a large combined lounge/dining room and a second lounge. There is a passenger lift for ease of access throughout the building. All staff has responsibility for reporting any major or minor repairs that require attention and records are maintained in respect of all ongoing maintenance requirements that also indicate when the task has been completed. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 21 The homeowners are planning an extension to the home to provide more bedroom accommodation. In conjunction with this new build accommodation the existing accommodation will be improved so that it ‘matches in’ with the new extension. Currently a small number of single toilets are without a hand washbasin. From discussion with one of the homeowners, it is understood that although these toilet facilities are situated in a communal corridor, each is only used by the resident occupying the adjacent bedroom and not by other residents. It is planned that as part of the refurbishment of the existing accommodation, these toilets will be enclosed within the bedroom accommodation and not accessed from a communal corridor. It was also noted that a small minority of bedroom accommodation is not provided with a door lock. All bedroom doors should be provided with an appropriate lock to ensure privacy for the occupant. If a resident refuses a lock on their bedroom door this should be clearly recorded. Once the bedroom accommodation becomes vacant an appropriate lock should automatically be provided before a new occupant moves in. Brooklands House is conveniently situated opposite Lowther Gardens and is close to the Promenade and within easy reach of local community facilities and resources. A new patio seating area is planned for the coming year and consideration is being given to providing a second seating area at the front of the home. The home remains clean, pleasant and hygienic with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are sited in away from resident accommodation and do not intrude on people living at the home. All staff have now received infection control training that will become a mandatory annual training topic. The industrial washing machine has the capacity to meet disinfection standards and floor finishes are easily cleanable. As part of the planned new build and refurbishment programme a new laundry facility and kitchen will be provided. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30. Quality in this outcome area is good. There is a good mix of staff offering consistency of care within the home. The arrangements for the induction and more advanced National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff within the first six weeks of employment. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels and skills mix at Brooklands House is determined in accordance with the individually assessed needs of residents accommodated. Additional staff are on duty at peak times of activity and all night staff have ‘waking watch’ responsibility. There is sufficient ancillary staff employed to ensure standards in respect of domestic and catering are maintained. Since the Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 23 last inspection staffing levels have been increased. This has enabled a high quality service to be maintained that takes into account the social/emotional/psychological needs of people living at the home in addition to personal care needs. A resident spoken with and a member of the care staff team spoken with both felt that sufficient staff are now on duty to make sure that people’s needs were being met. One resident said “I get all the help I need, I am very happy living here, they have been wonderful to me, I will be here for ever now, they have become good friends” (the staff). Training of staff is given high priority at Brooklands House and there is a clear commitment to the training and development of all the people working at the home. All care staff are encouraged and enabled to undertake a National Vocational Qualification (NVQ) in care. The vast majority of the care staff team have achieved this recognised qualification at level 2, which is commendable. The remaining care staff are currently undertaking this course of study. In addition, a further number of care staff are either pursuing or have achieved an NVQ award at more advanced levels. This shows that people working at Brookland House are appropriately and sufficiently trained to do the job expected of them. A member of staff spoken was able to give good examples of recent training which she had undertaken or which is planned, included mandatory courses, such as moving and handling, food hygiene, fire training, health and safety and safe guarding adults. This ensures that staff are aware of the important aspects of looking after people within a care setting. Induction training that is compliant with ‘Skills for Care’ nationally recognised induction training standards for care staff is provided to all new members of the care staff team. This follows the home’s induction training programme that is specific to the needs of Brooklands House. Staff spoken with felt that the training provided was very valuable and enabled a good quality of care to be provided as well as allowing them to develop their skills and knowledge. One member of staff spoken with had just learnt that she had successfully achieved an NVQ qualification and was clearly very proud of her achievements. Brooklands House has in place a structured recruitment policy and procedure that helps to protect residents. Since the last inspection, some new members of staff have been appointed. From observation of two recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) clearance had been obtained prior to the applicant actually taking up post at the home. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 24 A recently appointed member of staff confirmed that procedures had been followed and she was not allowed to take up post at the home until satisfactory references and a CRB clearance had been received. All people spoken with were very positive in their comments regarding the staff group. The interaction observed between staff and those living at the home was warm, friendly and comfortable which helped to make residents feel happy, safe and secure. One relative wrote on a Commission for Social Care inspection survey form that, “(the care home) gives me peace of mind. I know that my mother is well fed, clean and has twenty-four care. She seems happy and contented”. A friend of a resident also commented that, “The home maintains a happy spirit. They arrange occasional outings and the staff are dedicated carers. The rooms are clean and the food quite good. I have recommended three of my friends to live their later years at Brooklands and all have been perfectly happy”. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. The homeowner/manager is well qualified and well supported by the senior staff in providing clear leadership throughout the home. The systems for consultation with residents/family are good with a variety of evidence that indicates views and opinions are sought and acted upon. Financial procedures in respect of resident’s monies and the safekeeping of valuables are robust to protect the interests of people living at the home. Systems are in place to ensure as far as possible the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered homeowner/manager has recently returned to managing the home in a full time capacity and is experienced in working with older people. The homeowner/manager is competent to run the home and meet its stated purpose and has almost completed the Registered Managers Award. This is a qualification that all managers of care home are expected to achieve. The registered homeowner/manager has also undertaken a variety of other training courses that includes all mandatory health and safety training courses and a number of other ‘in-house’ training courses to update or increase her skills and knowledge. Comments from staff were positive one person saying, “definitely a good standard of care provided. “Carole (homeowner/manager) is very good and approachable and will ‘muck in’. She will always make somebody available as mentor for a long as required even if you have been working here for some time.” Effective quality assurance systems are in place and the home has achieved the ‘Investors In People’ award that has recently being renewed. The home regularly reviews aspects of its performance through a good programme of self-review and consultation, which includes seeking the views of people living at the home, staff, relatives and other interested people such as medical personal. This is achieved through quality assurance questionnaires, regular staff meetings, staff supervision and daily dialogue between residents and staff. In the past, residents meetings have not been very successful however it is understood that consideration is being given to reintroducing these. This would provide another formal platform for residents to air their views and opinions and influence change. The outcomes of questionnaires are made known to all residents and staff and discussions take place on how to address any issues raised. However it is understood that comments made were very positive and complementary. The home has introduced a quality assurance folder to record quality assurance information in order to provide a structured response to quality assurance issues. Resident’s financial interests are safeguarded by the financial procedures adopted by the home. People living at Brooklands House are, wherever possible, encouraged to remain financially independent or assisted in this task by a family member or independent advocate. When the home does retain any monies or valuables in respect of a resident, this is appropriately recorded and secure facilities are provided for the safe keeping of monies and valuables held on behalf of the individual. As recommended at the last inspection, if a resident is unable to sign the form detailing the transaction undertaken, a second Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 27 member of staff countersigns the transaction in order to protect the interests of the resident. A member of the care staff team spoken with confirmed that formal supervision takes place on a regular basis. Observation of recent supervision records showed that formal supervision takes place at bi-monthly intervals with staff appraisals taking place every six months. These forums provide opportunity for the management team to support staff members on an individual basis and also to discuss career development needs and how they can be met. Daily informal supervision is a routine feature at the home to ensure that all staff are sufficiently competent to undertake their roles and responsibilities. The registered homeowner/manager ensures the health, safety and welfare of residents, staff and visitors through the development of a variety of policies and procedures and staff training initiatives. All staff now undertake a variety of mandatory health and safety training. Equipment in the home is regularly serviced. It is understood that water temperatures from hot water outlets in resident accommodation is tested on a regular basis. In addition measures are in place to protect people at the home from Legionalla. A policy is in place that deals with issues of safe working practices and environmental and fire risk assessments were in place. Health and safety issues are also addressed through the induction training standards and NVQ training. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 6 Refer to Standard OP1 OP3 OP7 OP7 OP7 OP19 Good Practice Recommendations The Statement of Purpose and Service User Guide should provide clear details as to the category of resident the home is registered to accommodate. A risk assessment should always be undertaken when a risk is identified during the pre admission assessment process. All care plans should provide sufficient detail to direct staff as to the actual assistance required to fulfil an identified objective. It is recommended that when a care plan has been significantly changed following a review the whole care plan should be amended. A formal risk assessment should always be in place when a risk has been identified with significant outcomes incorporated in the care plan. As part of the planned refurbishment programme to the DS0000009800.V343413.R01.S.doc Version 5.2 Page 30 Brooklands House 7 OP24 existing building, the toilets without a hand washbasin should be incorporated into the designated individual bedroom accommodation. All bedroom doors should be provided with an appropriate lock. This should be provided as a matter of course when a bedroom without a lock becomes vacant. Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brooklands House DS0000009800.V343413.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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