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Inspection on 26/10/05 for Brooklands Nursing & Residential Home

Also see our care home review for Brooklands Nursing & Residential Home for more information

This inspection was carried out on 26th October 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a very good record for ensuring its staff members attend courses to enable them to improve their skills in relation to those persons in their care. The induction programme for new staff is good with all mandatory areas being covered. The home has its own manual handling instructor. New staff receive instruction and staff who have been in post are continually updated. The provision of activities and exercise is good and a designated person is employed to ensure that these take place.

What has improved since the last inspection?

There is some slight improvement in care planning. There is a better response to the call bells.

What the care home could do better:

Have better staffing arrangements in place especially at the weekends. Ensure that all qualified nurses are aware of the policy and procedure for handling medication. Improve communication skills of those employees from oversees. Continually monitor care and record on care plans and put risk assessments in place especially for those service users who have a tendency to fall. Better communication is required to ensure that all service users are aware of choices at meal times.

CARE HOMES FOR OLDER PEOPLE Brooklands Nursing & Residential Home Costessey Lane Drayton Norwich Norfolk NR8 6HB Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 25th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 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.V259945.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brooklands Nursing & Residential Home Address Costessey Lane Drayton Norwich Norfolk NR8 6HB 01603 262666 01603 261155 jenny.brooklands@tiscali.co.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 Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The two Physical Disability (PD) service users must be over the age of 50 years. 22nd June 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. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over five hours. Opportunity was taken to tour the premises, look at care records and speak at length with new members of staff, a number of service users and some relatives. Those standards not inspected during the last inspection were assessed, along with those standards that were not met previously. What the service does well: What has improved since the last inspection? There is some slight improvement in care planning. There is a better response to the call bells. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards assessed. EVIDENCE: Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 9 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 care planning system remains in part unclear and does not entirely provide staff with information they need to meet the health and care needs of service users. In many cases the health care needs of the service users are not identified or evaluated. These short falls have the potential to place service users at risk. Service users appear to be treated with dignity and respect. EVIDENCE: Individual care plans were reviewed; these did not always clearly set out the health care needs and in many cases lacked evidence of review. There still exists confusion amongst some members of the senior staff as to what constituted a need and where the review was itemised on the care plan. This confusion on the plans of care has the potential to place the residents at risk. As identified at the last inspection some service users who have been identified at risk of falls have not had this indicated in a plan of care to instruct carers what preventative action to take to prevent the risk of falling; it was also noted that no risk assessments were in place. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 10 The inspector noted once again that the incidence of falls took place mainly in residents’ rooms, and that they were mostly the same service users. It would appear after discussion with relatives and service users that their hygiene needs are not always tended to, as they should be. This could be due to the lack of staff on some shifts that was noted on examination of duty rotas. A number of drug errors have been made in the past and a separate pharmacy inspection was carried out to look at this. These were mainly due to the language skills of overseas trained staff, both of whom have since left the establishment. The manager has ensured that all new Registered General Nurses are familiar with the policies and procedures for the handling and administration of medication. Those residents whom the Inspector spoke with felt that they were treated with respect by the carers and that they “did their best, especially when they seemed short staffed”. One resident commented that she felt the carers were her friends. The Inspector noted whilst carrying out the inspection that call bells were being responded to quickly. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 11 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. The home offers a range of options to satisfy service users social and recreational needs. Visitors are made welcome. EVIDENCE: There is a published programme of activities provided each week and the home employs a specially designated activity organiser and promoter. It was noted on the day of inspection that the activity organiser was not on duty due to a family bereavement, however one of the service users sons was playing cards with those who chose to; it was also noted that large cards were being used to enable them to be held and seen without difficulty. Many visitors were visiting the home and the Inspector was able to speak with a number of them. They said that they were always made welcome and visited when they wished, they also said that they could see their relatives in their rooms or in the many small sitting areas dotted around the home. Those service users that the Inspector spoke with confirmed that they were enabled to make choices about their every day activities, where they ate their meals, what clothes they wore and if they wanted to join in any of the planned activities. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 12 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 Arrangements for dealing with complaints could be improved. Policies and procedures are in place to deal with instances of abuse. EVIDENCE: The home has a detailed complaints procedure that was examined by the inspector, it was clear to understand and gave clear guidelines to service users and their relatives: however after discussion with relatives it would appear that complaints are not always dealt with in a satisfactory manner. Those service users whose relatives had expressed concern over their care when spoken to by the Inspector were adamant that they themselves were well cared for and that the care met their expectations. These service users made comments such as the “girls are angels” and “get all the care I need, could not wish for any more” and “I am very content here”. Staff records and discussion with staff confirmed that they were knowledgeable about adult protection of vulnerable people. They also stated that they would report any incidents of abuse. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Appropriate fire and safety practices are not completely observed. The home is clean and tidy. EVIDENCE: On a tour of the home the inspector noted that a number of residents’ doors were being kept open with wooden door wedges, this is not an acceptable practice and constitutes a hazard in relation to fire safety. An immediate requirement was issued. The home was found to be very clean and tidy throughout. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 14 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 Deployment of staff is not always adequate to meet the assessed needs of the service users. Staff have the skills and are competent to do their jobs, although language can create a barrier. EVIDENCE: Examination of duty rosters indicated that the home did not always have sufficient staff on duty to furnish the assessed needs of the residents. The manager stated there is difficulty with recruitment for all grades of staff. On the day of inspection there were seven care staff on in the morning and six in the afternoon and evening providing a staffing level that is required for the number of service users in residence and sufficient to meet the their needs. However it was noted that this was not always the case and service users commented that they felt very much that the staffing situation was not always adequate and this certainly was reflected in the duty rosters. It was also noted by the Inspector that one day a carer was working a late shift then going on to do a night duty shift and other staff members were working very long shifts including the Registered Nurses. Consequently, it appeared that staff were stretched in their attempts to meet the service users needs and could ultimately have an impact on the quality of care given. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 15 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): 35,38 The financial interests and safety of service users are safeguarded by the home’s policy and practice. EVIDENCE: Policies and procedures for handling service users monies are in place, all financial the home’s administrator carries out transactions; records are maintained for this with duplicate signatures. The home seeks to promote the health, safety and welfare of service users, though the matter identified in this report concerning wedging open individual doors compromises this. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 16 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 x x 2 Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18 Requirement Timescale for action 26/10/05 2. OP7 15 3 OP19 13 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. The registered person shall 26/10/05 prepare a written plan (service users plan) as to how the service users needs in respect of his health and welfare are to be met and keep the plan under review. 26/10/05 The registered person shall ensure that all parts of the home which service users have access are so far as reasonably practicable free from hazards to their safety. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 18 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. Refer to Standard OP38 OP16 OP27 Good Practice Recommendations It is recommended that auditing of falls in residents rooms takes place to ensure that the incidence of falls might be decreased and preventative measures taken. It is recommended that relatives observations about care. are listened to and that they feel that their observations are listened to. 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. Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 19 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 Brooklands Nursing & Residential Home DS0000015620.V259945.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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