Inspection on 24/05/06 for Brooklands Nursing & Residential Home

This inspection was carried out on 24th May 2006.

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

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

Other inspections for this house

Brooklands Nursing & Residential... 25/07/07

Brooklands Nursing & Residential... 26/10/05

Brooklands Nursing & Residential... 22/06/05

Brooklands Nursing & Residential... 25/02/05

Brooklands Nursing & Residential... 15/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Brooklands Nursing & Residential Home Costessey Lane Drayton Norwich Norfolk NR8 6HB Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 24th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000015620.V297347.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. DS0000015620.V297347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooklands Nursing & Residential Home Address Costessey Lane Drayton Norwich Norfolk NR8 6HB 01603 262666 01603 261155 jenny.sharp@carebase.org.uk 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) London & West Investments Limited Jennifer Carol Sharp Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54), Physical disability (2) of places DS0000015620.V297347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two Physical Disability (PD) service users must be over the age of 50 years. 26th October 2005 Date of last inspection Brief Description of the Service: Brooklands is situated in Drayton on the outskirts of Norwich and consists of a detached property built on three floors. A bus service is available to the village but does not run past the Home, the nearest train station is Norwich. There is a lawned area and a patio for Service Users use; this is accessible to wheelchair users. The Home is registered, as a Care Home with Nursing, which also accommodates Service Users without any nursing needs. There are a variety of activities in and outside the Home and an activity co-ordinator facilitates these and is employed to work every weekday afternoon. There is a hairdressing facility for all Service Users. The Home is suitably adapted to provide accommodation for people with handicaps and a range of appropriate equipment is available to meet the needs of the Service Users. Work has begun on an extension to the Home with the provision of further communal space a new kitchen and laundry room. DS0000015620.V297347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over nine and a half hours and during two visits to the home. The Manager was on leave from the Home and the deputy manager ably assisted the Inspector. Opportunity was taken to examine care and staff records and recruitment documentation. The Inspector spent some time observing staff working with the service users, speaking with staff members, service users and visitors to the home. Seventeen comment cards were received from service users and their relatives prior to the inspection. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. What the service does well: The Home is very good at offering a range of activities to satisfy service users social and recreational needs; a designated activity coordinator is employed who ensures that the activity programme is implemented. Meals are managed well. A friendly and approachable staff team ensure visitors are made welcome. Service users indicate that the staff are kind and caring. In house training for manual handling is good. The admission process is good. The building work for the new extension does not seem to have impeded on the service users at all. DS0000015620.V297347.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: In the past staffing has been an issue and the Home has not always deployed sufficient staff to meet the needs of the service users and this at times still remains an issue especially at weekends. Have better staffing arrangements in place especially for weekend cover. Adequate induction needs to be provided with appropriate records in place and available for inspection. Improve the response to the call bell system. Ensure that the process for recruitment is more robust. Monitor quality of care with evidence of this having taken place. Formal supervision of staff could be improved. DS0000015620.V297347.R01.S.doc Version 5.2 Page 7 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. DS0000015620.V297347.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 DS0000015620.V297347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The overall quality outcome for these standards is good. This Home does not provide intermediate care. The admission process remains good, is informative and enables prospective service users to make an informed choice. The process provides the opportunity for service users and their relatives to visit the Home where possible. EVIDENCE: The Home has an admission procedure that adequately guides the senior staff responsible for assessment as to actions to be taken to ensure service user’s needs are assessed prior to moving into the home: it also allows the home to ascertain if the individual’s need can be met. Evidence was seen in the files of new persons admitted to the Home, this included a full assessment of need in relation to the health care needs of the individual. DS0000015620.V297347.R01.S.doc Version 5.2 Page 10 These new admissions to the home indicated that they were given the opportunity to visit the Home prior to moving in. One service user indicated that they did not visit the Home prior to admission because they were very poorly, but their relatives had visited in their stead. The Inspector examined the service user’s guide and this was found to contain all information that is needed to make an informed choice about entry to the home. It is written in clear and easy to understand wording. DS0000015620.V297347.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The overall quality outcome for these standards is good. The care planning system has improved and clearly gives the staff clear information they need in order to meet the health care needs of the service users. Service users health and personal care needs are well attended to. The system for handling and administering medication has improved. The administration and handling of medication appears to be satisfactory with no untoward incidents being reported. Service users ere treated with respect and dignity, however shared rooms do inhibit privacy at times. EVIDENCE: Five individual care plans were reviewed, these were clearly set out with evidence of regular review. A care plan for a service user who had a history of falls showed evidence of preventative care and risk assessments for falls; DS0000015620.V297347.R01.S.doc Version 5.2 Page 12 this information also tallied with records for untoward occurrences involving service users. Another service user’s care plan reflected a good pre assessment that was then used to formulate an informative care plan. In general the five care plans reflected good assessment and attention to clear guidelines for care with appropriate referral to risk assessments and attention given to the service user’s health care needs. These care plans also indicated where there had been service user involvement. A random check of medication tallied with that on the MAR charts and related to the five care plans, daily notes and notes from the GP’s visits. Those service users spoken to by the Inspector including relatives confirmed that the service users were treated with respect; observation during the inspection process showed that staff had an understanding of how to promote service users privacy and dignity. Two comment cards noted that there was not enough room in shared rooms where two service users used wheel chairs. This was also noted by the Inspector on her tour of the Home that those service users who shared rooms needed more space when using the hoist or wheelchairs in order that their privacy could be promoted and a recommendation is made. DS0000015620.V297347.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The overall quality outcome for these standards is excellent. The Home manages activities very well. Service users have access to family and friends, visitors are made welcome. Service users feel that the lifestyle experienced in the Home matches their expectations and they encouraged to make choices about their daily lives are. EVIDENCE: Those service users and the newly admitted persons to the Home that the Inspector spoke with were very positive about their lifestyle and felt that it matched their expectations and one stated they wanted for nothing. Another service user said they had enjoyed the celebrations that were put on for the Queens birthday. One service user stated that they chose not to join in any of the activities and that her decision was respected. Another service user stated that they enjoyed the outings and also the flower arranging. It was also noted that those service users who had suffered strokes were encouraged to have hand massages. DS0000015620.V297347.R01.S.doc Version 5.2 Page 14 It was pleasing to note that the building work had not disrupted any of the activity programme. Discussion with the activity coordinator revealed that she is very aware of the service user’s abilities and plans the activity programme around those abilities and what individuals like doing. Good records are kept of the activities and quite often recorded in photographic form. Seven service users commented that they thought the activities provided by the Home were good and varied. A number of the service users spoken to were happy about the presentation and quality of the food. The Inspector observed lunch being served and the menus reflected that the meals were well balanced and nutritious. During the course of the inspection, relatives and friends were noted as coming and going freely. Service users confirm that they have visits and receive their visitors wherever they wish. DS0000015620.V297347.R01.S.doc Version 5.2 Page 15 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. The overall quality outcome for these standards is adequate. Arrangements for dealing with complaints appear to be handled well. Service users could be better protected from abuse. EVIDENCE: Those service users and relatives spoken with were aware of whom to go to, to lodge a concern or complaint. The Home has a detailed complaints procedure and records were in place of past complaints how they were dealt with and the outcome. The comment cards that were received reflected that generally everyone was aware of how to make a complaint and whom to go to if they needed to raise any concerns. Discussion with service users and their relatives leads the Inspector to believe that there is improvement for dealing with complaints and that they feel that they are listened to. The service users stated that they felt that there concerns were listened to and a record for these concerns was seen and the action taken in response. Service users made comments such as nothing wrong with Home, very well cared for, another stated that they were well looked after and had no complaints. DS0000015620.V297347.R01.S.doc Version 5.2 Page 16 Policies and procedures are in place for dealing with abuse and staff stated that they would be quite happy to ‘blow the whistle’ if they felt someone was being abused. Discussion with staff and the management revealed that no abuse training had taken place and a requirement is made to ensure that service users are better protected against abuse. DS0000015620.V297347.R01.S.doc Version 5.2 Page 17 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): 19,20,23,26. The overall quality outcome for these standards is poor. ` Despite the building work the Home remains clean and tidy. The Home also appeared safe in relation to the building work and not impacted on the safety of the residents and visitors. EVIDENCE: A tour of the home took place and already the new lounge was almost ready to use; it is very light and airy and offers a lot of communal space with new chairs and carpet in place. The new kitchen is also almost ready to be occupied, as is the new laundry. DS0000015620.V297347.R01.S.doc Version 5.2 Page 18 Those service users spoken with stated that the building work had not disrupted their daily lives and that they still felt comfortable in their surroundings. It was noted during the tour that four service users who have shared accommodation require more room in relation to their wheelchairs and use of hoists and consideration must be given to providing adequate accommodation for these service users. A number of service users have been moved from their rooms into other rooms to facilitate the easy development of the new extension. However this has meant that one service user who is confused has been moved and is quite disruptive to other service users. This information was shared with the Inspector by one of the service users who feels unsafe in their room when the confused service user visits her, especially in the night. The care plan for the confused service user did not contain guidelines for care in relation to this or a risk assessment. A requirement is made to ensure the safety and comfort of all persons living in the Home. DS0000015620.V297347.R01.S.doc Version 5.2 Page 19 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. The overall quality outcome for these standards is poor. The deployment of staff is not always sufficient to meet the needs of the service users. Training and induction could be better. The procedures for recruitment are not robust enough and do not totally provide any safeguard for the protection of persons living in the Home. EVIDENCE: Examination of the duty rosters indicate that the Home is not always sufficiently staffed in order to furnish the needs of the service users; this would appear to be particularly so at the weekends. On the day of inspection there were seven care staff on duty in the morning and six on duty for the afternoon and evening shift providing a staffing level that is not adequate for the number of service users in residence and sufficient to meet their needs. Service users and relatives commented that they felt that the staffing levels were not always adequate and this is reflected in the duty rosters and especially at weekends. It is also noted that many staff members including the Registered Nurses are working very long shifts. DS0000015620.V297347.R01.S.doc Version 5.2 Page 20 On inspection of the duty roster, week beginning 15th May 2006, it was noted that there were lots of “crossings out”, making the duty roster very unclear as to what shifts had actually been worked by various staff members. However, it was noted that, during the week beginning 29th May 2006, one carer worked an early shift followed by a night shift on 4th June and two carers worked an early shift, immediately followed by a late shift, on 5th and 6th June. This naturally leads to the stretching of staff in their attempt to meet the service users needs and could have an impact on the quality of care given. A number of service users commented that their call bells were not always answered in good time and this could be a reflection on too few staff on duty. The training of carers has been somewhat negligent since the last inspection although the Registered Nurses have attended some courses including advanced medicine management, palliative care and wound care. Discussion with staff members show that they have an understanding of the service users needs, however there was no evidence available on staff files to indicate that rigorous induction and foundation with assessment of competence had taken place. It is recommended that these records are made available for inspection purposes and kept up to date and monitored by the manager. The manager was made aware that she should be able to comment on what induction methods had taken place. The status of carers with NVQ qualifications is low with only eight carers with NVQ 2 and three with level 3,out of twenty-six in post at the time of inspection giving a figure of only 30 of care staff with NVQ level 2. This is well below the expected 50 to be achieved by 2005. No training has taken place in relation to the Protection of Vulnerable adults and a requirement is made within this report. Recruitment records were examined and although the policies and procedures for recruitment are good the actual management of the process needs to be more robust. In three cases of newly appointed staff, they have been employed with no or just one reference, one overseas member of staff has only one reference and no obligatory checks in place; a requirement is made within this report. DS0000015620.V297347.R01.S.doc Version 5.2 Page 21 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): 31,33,35,38. The overall quality outcome for these standards is poor. There are some management areas that do not promote or safeguard the welfare and safety of the service users; improvements are needed to show that the home is run in the best interests of the service users. Formal supervision could be improved. The promotion and protection of service users and staff’s health, safety and welfare needs improving. EVIDENCE: The inspector gained the impression after discussion with senior staff that they are unclear of their roles within the structure of the Home and there are some areas that lack clear direction; an example of this is that the manager was not DS0000015620.V297347.R01.S.doc Version 5.2 Page 22 able to produce induction records and could not state how much mandatory training had been given. Discussion with the deputy manager revealed that she seems to have a lot of administration duties whilst also having to work in the clinical area and take responsibility for the clinical area and care. Recruitment needs to be managed by the manager more effectively in order to protect the service users and all checks and references in place. Comment has been made previously in this report regarding shortfalls arising from poor record keeping for staff. There are very few formal supervision records in place and it would appear after discussion with staff that it does not always happen and the records certainly reflect this. There is no formal process for monitoring and improving the quality of care and service in the home. DS0000015620.V297347.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 10 11 3 X X X 3 X X 3 STAFFING Standard No Score 27 28 29 30 3 3 x 2 2 2 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 X 2 DS0000015620.V297347.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no DS0000015620.V297347.R01.S.doc Version 5.2 Page 25 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 OP27 Regulation 18 Requirement The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified and experienced persons are working at the care home in such numbers as are appropriate for health and welfare of the service users. Timescale for action 24/05/06 2. OP18 13(6) It is required that the Home shall 24/05/06 make arrangements by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm. It is required that the Home shall 24/05/06 not employ a person to work at the care home unless subject to paragraph (6) he has obtained of that person information and documents specified in (1) paragraphs 1-7 of Schedule 2 It is required that the home protects service users from disruptive residents and ensure that all service user’s needs can be met 24/05/06 3. OP29 19 (1) (b) 4. OP38 12 (1) (a) DS0000015620.V297347.R01.S.doc Version 5.2 Page 26 5. OP27 37 and 18 It is required that the registered person must ensure that the Commission is notified when staffing levels fall below expected levels. 24/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations It is recommended that consideration be given to the deployment of more staff and in sufficient numbers to ensure needs are met in a safe manner. It is recommended that the manager monitor induction and mandatory training. It is recommended that consideration be given to shared room accommodation where wheelchairs and hoists are used and that privacy and dignity may be maintained. 2. 3. OP30 OP25 DS0000015620.V297347.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 DS0000015620.V297347.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!