CARE HOMES FOR OLDER PEOPLE
Brooklands Nursing & Residential Home Costessey Lane Drayton Norwich Norfolk NR8 6HB Lead Inspector
Mrs Marilyn Fellingham Unannounced Inspection 25th July 2007 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 Brooklands Nursing & Residential Home DS0000015620.V349283.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 Nursing & Residential Home DS0000015620.V349283.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 Ltd Jennifer Carol Sharp Mrs Helen Hill Care Home 70 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (54), Physical disability (2) of places Brooklands Nursing & Residential Home DS0000015620.V349283.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. 24th May 2006 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 finished on an extension to the Home with the provision of further communal space a new kitchen, laundry room and accommodation for sixteen service users with dementia. The fees charged by the home are from £453 to £700 per week. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector arrived unannounced and spent over eleven hours at the home during two visits. The views of the management, staff and a selection of service users and relatives were obtained. A tour of the home was made and records were also examined and have helped inform the judgements made. A selection of comment cards were received from service users, relatives and other professional agencies, these were used in the inspection process. The home has addressed the issues highlighted in the last key inspection report; however some of those issues are now a concern on the new unit that cares for those with dementia. This has resulted in the home overall not meeting all the criteria set out in the key standards. The focus of the inspection was to assess all the key standards for homes for the elderly and for those with dementia. What the service does well:
There are very positive relationships between staff and the service users. Service users are given many opportunities to take part in activities and outings. The management is always keen to address all issues raised by the Commission and meet the requirements and recommendations made. The home provides a well-maintained and well furnished environment for all its service users which is kept very clean and tidy. The service users are listened to and if possible their wishes are addressed. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Care plans need to be in place for those who have dementia with care being prescribed for all their assessed specialist needs; the assessment process for these service users also needs to be improved. This care must be informative and evaluated on a monthly basis. The home must ensure that appropriately trained and skilled staff are appointed to work with those who have dementia and that the unit for these service users is equipped to cater for their needs relating to dementia. Although staffing levels have improved the management must ensure that the home is always appropriately staffed with sufficient staff to meet the needs of the service users. The provider must ensure in the future that the home is managed appropriately in the absence of the manager. The home could provide more activities at the weekends. The response to call bells could be improved. Brooklands Nursing & Residential Home DS0000015620.V349283.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. The summary of this inspection report can be made available in other formats on request. Brooklands Nursing & Residential Home DS0000015620.V349283.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 Nursing & Residential Home DS0000015620.V349283.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means that peoples diverse needs are identified and planned for before they enter the home: however this is not so on the dementia unit and the assessment process needs to be greatly improved to ensure that peoples needs are identified before they move into the home. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 10 EVIDENCE: Case tracking of three service users records confirmed good practice; however the assessments for those people admitted on the dementia unit were not very informative and lacked clarification of needs related to the individuals. Some of the assessment material lacked detail in relation to their dementia needs as well as their social needs. The manager and acting manager had assessed prospective service users and the acting manager assessed those service users for the dementia unit whilst the manager was sick. Relatives and the service users if able visited the home prior to admission and one relative said that they felt the tour of the home was very informative and that all the staff seemed friendly and welcoming. The care services manager is leaving which could overall affect the already not very good assessment process for the people with dementia. Brooklands Nursing & Residential Home DS0000015620.V349283.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The variable practice regarding the planning and delivery of care for those with dementia means that all service users cannot be sure that their health and personal care needs will be fully met. EVIDENCE: Service user care plans on the main unit were detailed and had evidence of continued review and change of care when needs changed; the prescribed care was also in relation to assessed needs of all individuals. Risk assessments were in place along with additional risk assessments for moving and handling; there was also evidence to show that skin integrity was monitored and care prescribed accordingly. The care plans of service users with dementia were found not to be very detailed and in some cases lacked clear guidelines for care. Those care plans examined were muddled in part with “problems” being highlighted as “care”;
Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 12 this could lead to putting the service users at risk. The staff spoken to on the dementia unit seemed to lack clear understanding of care plan use and had not received particularly good informative advice about the care planning system. It was noted on the daily notes that one gentleman had complained about pain in his leg and left arm, no care plan was in place to continue to monitor this or evidence of a GP’s involvement. Another service user had pressure sores on their heels but no care plan was in place to give guidelines to the carers as to how to look after this residents needs in relation to this. . The care plans in most instances had not been evaluated and one resident had no care plans at all. The care plans did not evidence any activities that any of the residents with dementia had taken part in, although we noticed on the day of inspection some activities taking place. One relative commented that their relative had not always been given a bath although they were incontinent; the care plans for this resident did not indicate any guidelines for care in relation to the incontinence. It was not totally evident that the residents with dementia get the care they need. As mentioned in the previous standard the care services manager is leaving which could ultimately further affect the care for these people with dementia. The staff did not appear to have an overall understanding of the needs of people with dementia; we did however notice that the staff were seen to be kind and patient when interacting with them. The manager of the home having retuned from sick leave was eager to ensure that the residents with dementia were having their assessed needs met. We noticed on our return visit to the home some of the concerns shared with the manager had already started to be addressed. Following the incidents with medication it was noted that retraining for staff had taken place and an external audit of the handling and administration of medication had taken place. We found this to be a most extensive and thorough audit and the home has responded to the criteria suggested in the report. A random audit of the medication was carried out and found to be in order, however one residents eye drops did not have a date for opening them and this could place the residents at risk. Brooklands Nursing & Residential Home DS0000015620.V349283.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a wide range of activities within the home, although not always extended into the weekend. More consideration needs to be given to the type of activities offered to those with dementia. Meals are managed well. The manager has shown a good understanding of the areas of weakness in relation to activities and there is capacity for improvement. EVIDENCE: The activity programme remains varied and records kept in care plans of activities taken part in; however this was not so for those residents with dementia. We noticed activities taking place with those with dementia but the residents participation was not recorded in a plan of care. We also noted that the activities for those with dementia needed to be more orientated to their special needs. The manager recognises the shortfall in this area and also the need for more activities at the weekends. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 14 Those service users who were spoken to stated that they felt that there were quite a lot of activities that they could be involved with if they so wished and that they had had the opportunity to go on numerous outings during the nice weather. Throughout the day we noted visitors and relatives coming and going and those service users spoken to said that they could receive visitors any time and that they were always made welcome, those visitors spoken to confirmed this. Menus were varied and nutritious. The mealtime appeared to be relaxed and those that needed assistance were treated with dignity and respect. Brooklands Nursing & Residential Home DS0000015620.V349283.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel safe and listened to. The staff have been given the knowledge to recognise all aspects of abuse. EVIDENCE: A complaints procedure is available to all service users and significant others. The service users felt that they were listened to and one comment made in the survey said that the manager was always available to listen to them. Those staff spoken to were knowledgeable about the complaints procedure and the residents seen by us stated that they would feel happy about airing their concerns. One complaint from a relative was being investigated at the time of inspection and we were happy about the way it was being fully investigated. The training records evidenced that staff continue to have training related to safeguarding adults and those staff members spoken to were knowledgeable about all areas relating to abuse Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The new and existing accommodation appears safe and well maintained. The external environment is equipped to allow maximum use by the residents. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 17 EVIDENCE: The home has dedicated domestic staff led by a housekeeper. It was found to be very clean and tidy; it is very light and airy and the extension has provided some very homely accommodation which has been decorated most tastefully. The existing garden requires some attention, the patio garden that has been created in the new extension provides a pleasant area for residents to sit in. Those residents and visitors that we spoke to commented most favourably on the extension and the new patio facilities. The manager is aware of what improvements need to be carried out in the existing garden and a part time gardener has recently been employed. All those service users spoken with were pleased with their accommodation. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is showing improvement in training and induction, this capacity to improve will result in better outcomes for people using this service. EVIDENCE: Some comments on the surveys suggested that the call bells were not always answered and that there was some delay in relation to the staff meeting the residents personal needs. This was discussed with some service users and some relatives. We noted that on our visit it took some time for the front door bell to be acknowledged; the manager is aware of this and is waiting for a new system to be put in place. She is also aware that sometimes the call bells are not answered promptly and is monitoring the situation. The rotas showed that for the majority of shifts there were sufficient staff on duty except at times of sickness and annual leave. This does cause some anxiety amongst the staff as they do not always feel they spend as much time with the residents as they would like. New staff members have been recruited with the hope of being able to more adequately meet the assessed needs of the individuals.
Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 19 An induction programme is in place that covers all mandatory training; a training plan is also in place so that staff have the knowledge to be carry out their jobs well. It was noted that the staff looking after those residents with dementia have not had sufficient training to carry out their roles adequately and therefore are not totally able to ensure that these residents receive the care appropriate to their specialised needs. Those staff spoken with were clear about their roles and stated that their training had improved, however those members of staff who are caring for people with dementia were less knowledgeable about their role. In general the staff had noted the increased commitment to training. Records of all new recruits were examined and were in order except for one member who had been employed (by the acting manager whilst the manager was on sick leave) without a” POVAfirst” check in place. The manager is aware of this although it happened in her absence. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Temporary management arrangements did not always fully meet the needs of the service, however they have greatly improved since the return of the registered manager. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 21 EVIDENCE: Surveys commented on how they had missed the registered manager and glad that she was back. They felt that the manager was contactable and willing to listen to their concerns, the service users and relatives felt that the improvements had certainly enhanced the home. One visitor to the home felt that the home was very good and appreciated the management style. Records evidenced that supervision was now taking place and those staff spoken to confirmed this and that they felt well supported by the management. Views of the service users and relatives are actively sought on how the home could be improved. There were some issues relating to the running of the home in the absence of the registered manager, such as employment of a member of staff before a POVA was in place; the registered manager is aware of this and is ensuring that this will not happen again. All residents are now appropriately placed in suitable accommodation to support their assessed needs Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 22 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 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 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 3 3 x 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 3 3 Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 25/11/07 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 especially on the unit for those service users with dementia. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 24 2. 3. OP31 OP12 It is recommended that consideration be given to ensure that the home is appropriately run in the absence of the registered manager. It is recommended that consideration be given to enhancing the unit for those with dementia in relation to their special needs. Brooklands Nursing & Residential Home DS0000015620.V349283.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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
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