CARE HOMES FOR OLDER PEOPLE
Brooklands Residential Home 16 Harper Lane Yeadon Leeds LS19 7RR Lead Inspector
Nadia Jejna Unannounced 18 October 2005 from 10:15
th 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 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 Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Brooklands Address 16 Harper Lane Leeds LS19 7RR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2508677 0113 2508677 Mrs Amanda Jowett Mrs Amanda Jowett Care home 27 Category(ies) of Old age (27) registration, with number Dementia (1) of places Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The place for DE is specifically for the service user named in the variation application dated 20.9.4 Date of last inspection 10th and 11th February 2005 Brief Description of the Service: Brooklands Residential Home is situated near Yeadon town centre, which is a suburb of Leeds. The home is situated within easy reach of local amenities, including the local supermarket, and is on a bus route. The building is an extended and converted detached property. There is a pleasant conservatory on the side of the building, which opens out into a secure and pleasant garden area. Accommodation for service users is provided in nineteen single rooms and four shared rooms. The ground floor has two lounge areas and a dining room in addition to the conservatory. The home provides residential care for up to twenty-seven older people of both sexes. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 18th October 2005. This inspection was unannounced; it started at 10:15am and ended at 3:30pm. The people who live in the home prefer the term residents, and this is the term that will be used throughout this report. The purpose of this inspection was to monitor the home’s progress and to assess whether the care given to residents meets minimum standards. During the inspection records were examined and care staff were seen carrying out their work. Discussions were held with members of staff, the manager, residents and visitors. Comment cards/questionnaires were left for residents and visitors so that they can share their views of the home with the CSCI. None had been returned when this report was written. What the service does well: What has improved since the last inspection?
The kitchen has been upgraded to a high standard. All units, worktops and appliances have been replaced. There are new floor coverings and the walls have been tiled.
Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 6 A new pre admission assessment document has been produced which will help the home to identify prospective residents needs. The medicine trolley is now secured to the wall in the dining room. The medicines cabinet in the manager’s office is kept locked at all time. A controlled drugs register is in use. Some of the staff are doing a certified course in the administration of medicines. It is intended that all staff who deal with medications will do this training. 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 Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 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 standard(s) 1, 3 and 4. Information is made available to people about the home so that they cam make an informed choice. Resident’s needs are identified before they are admitted. But there is a risk that needs would not be met if residents are admitted outside of the homes registration categories. EVIDENCE: The manager said that the Service User Guide has not been fully revised yet. Advice was given that this could be combined with the Statement of Purpose to make one comprehensive document. The pre admission assessment document has been revised and covers all areas of information needed to identify a prospective residents needs. Residents said that their needs were met and they were well looked after. It was clear that some of the residents have dementia. Advice was given to the manager that if this is the resident’s primary care need and the reason why they need 24 hour residential care, an application must be made for a variation in registration. The manager said that plans were in place to provide staff with training about dementia.
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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 standard(s) 7, 8, 9 and 10. Residents care needs are met, but this is not fully evidenced in the care plans. Staff treat residents with dignity, maintain their privacy and show an awareness of their needs. EVIDENCE: The manager and the matron are working together to produce new care plan formats that will : • Be clear and easy to follow for staff, residents and their representatives. • Show how residents health, personal and social care needs are to be met. When the new documents are produced they will be introduced to staff during meetings and training sessions before they are put in place. The care plans in use have been reviewed and updated. Two were seen. The information provided in the main care plan document is an overview of the residents needs. It asks if the need is a problem and will identify it with a number. Staff then complete detailed evaluations and updates on this particular need. The information in these evaluations is good.
Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 10 But guidance on how to meet individual needs for personal care, help with cutting up food and use of specialised cutlery was not documented in one case. A senior care assistant was able to state very clearly how all personal and social care needs were attended to for this resident and what help they needed. It was clear that she had a very good insight of all residents’ individual needs and strengths. This is good practice and must be evidenced so that all staff have this good level of insight. Residents remain with their own GP wherever possible or registered with a GP of their choice if they have to change. A resident said that the staff are very good at calling the GP in to see them if there is need. Regular health checks are made available to service users, including chiropody, sight and hearing tests, and dentists. Advice and support from the district nursing service is sought if needed for wound care, pressure area care and continence problems. The manager said that appropriate advice would be sought as needed for residents at risk of falling. The medicine trolley is now secured to the wall in the dining room. The medicines cabinet in the manager’s office is kept locked at all time. A controlled drugs register is in use. Some of the staff are doing a certified course in the administration of medicines. It is intended that all staff who deal with medications will complete this training. The policies about the administration have not yet been revised. A resident who had not been at the home very long said that they were settled and felt well looked after. They said that staff respected their privacy and knocked on the bedroom door before entering. The bedroom doors are lockable but they preferred to leave it unlocked. It was clear that there were good relationships between residents and staff. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 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 standard(s) 12, 13 and 14. Residents are encouraged to join in social and leisure activities, to maintain links with family, friends and other groups in the community. They are enabled to exercise choice and control over their lives. EVIDENCE: Residents said that they can choose when to get up, go to bed, where to spend their time and if they want to join in with planned activities. They said that they were able to go out with friends and family if they wanted to. Links with the community are kept up; one resident was waiting to go to a ladies group at the local church. There is a programme of planned activities, which includes in house sessions of bingo, dominoes and card games, alongside sessions, which combine music and movement by somebody who comes in at least once a month. The residents said that they really enjoyed these sessions. A quality assurance survey conducted by the home recently showed that the residents were happy with the activities arranged for them. Residents said that trips are planned and they were looking forward to one the following week where they would be going to a restaurant for lunch, an afternoon tea dance and entertainment. One of the visitors said that staff welcomed them to the home and that they could come at any time. They said that the atmosphere was warm and friendly and they were happy at how their friend had settler into the home.
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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 standard(s) 18 Residents feel safe living at the home. EVIDENCE: Residents said that they felt safe living in the home and that if they had any concerns they would raise them with the staff. Staff were aware of the homes polices around abuse and said that they would not hesitate to report suspected or actual abuse to the manager. One care worker was aware that they could report to social services as well. The manager has not yet obtained a copy of the local authority adult protection procedures. She said that she would do this as well as looking at arranging training for staff. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 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 standard(s) 26 Residents live in a clean and tidy home. EVIDENCE: The home was clean, tidy and odour free. Residents said that this was one of the things that they liked about the home. The manager has not yet revised the infection control policies. She said that this would be done in the near future. The infection control nurse should be contacted for advice. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 Trained and competent staff meet residents needs. The recruitment procedures must be made more robust in order to protect residents. EVIDENCE: Induction training has been provided for staff via a local college. The manager said that new staff complete an in house new starters induction and are given a copy of the homes staff handbook. Over • • • • • • • the last 18 months training provided to staff has included: Food hygiene Fire safety Health and safety First aid Administration of medicines Diabetes Parkinson’s disease The manager said that there are plans to provide further training including infection control, abuse and adult protection, and dementia. Two staff files were seen. In one case employment had started before references were returned and there was no evidence to show that the POVA and CRB had been carried out. The manager said that verbal references were taken and was advised that records must be kept to evidence this. The
Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 15 manager said that the CRB and POVA had been requested from an umbrella body and that these had been confirmed as satisfactory. But evidence of this could not be found. The second staff file also did not evidence that CRB and POVA had been checked. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 and 33 The home is well managed. The interests of the residents are seen as very important to the manager and staff. EVIDENCE: The manager and matron have carried out a quality assurance survey and are in the process of collecting and collating the results. Questionnaires were sent out to residents, relatives, GP’s and district nurses. Responses have been received from all the different groups surveyed and have included very positive comments. Comments from district nurses said that they found the home to be clean and odour free, the staff made them welcome and they could see residents in the privacy of their own rooms. Relatives said that they knew who to speak to if they had any concerns and were happy with the care and kindness shown to residents. Staff meetings are held and records kept. The most recent had taken place in September 2005. A senior care worker said that the meetings were used to discuss any issues or problems in the home and to discuss residents’ needs,
Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 17 care plans and if any changes needed to be made. Staff said that the management team are supportive and approachable and that they can go to them at any time. They said that the manager works ‘hands on’ and is very involved with all aspects of care provided to the residents. The last resident meeting was held in September 2005. The minutes of the meeting showed that discussions about activities in the home had taken place and that residents were happy with the arrangements in place. Residents said that they could speak to the manager at any time. Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 2 x x 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 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 3 3 x x x x x Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 19 YES 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 4 Regulation Registrati on Regulation s 8 (2) Schedule 7 15 Requirement The manager must make sure that if a residents main reason for needing 24 hour care in a residential home is because they have some form of dementia, an application for a variation in registration is made to the CSCI. A plan of care must be put in place for each resident. This must show clearly how all assessed health, personal and social care needs will be met. The resident and or their representatives must be involved in this process. (Work is under way to meet this requirement and it was agreed to extend the timescale.) The registered person must make sure that recruitment procedures are robust and that satisfactory written references and enhanced CRB and POVA checks are in place before offering employment to staff. POVA first checks can be used in exceptional circumstances while waiting for confirmation of satisfactory enhanced CRB disclosure. The registered person must Timescale for action Immediate as discussed with the manager. 30.7.06 2. 7 3. 29 19 Immediate as discussed with the manager. 4. 30 18 Ongoing
Page 20 Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 continue to implement and develop the staff training programme. This must make sure that it is appropriate to the work they are to perform and to the assessed and identifed needs of the residents. Records must be kept. 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. Refer to Standard 1 2 Good Practice Recommendations The Service User Guide should be revised to include all the required information. It should be available in different formats to suit the needs of the residents. A formal contract (or terms and conditions of residence for funded residents) should be given to residents. These documents should be signed by all involved parties. (This standard was not assessed on this inspection and has been carried forward.) The homes policies and procedures around the ordering, storing, administration and disposal of medications should be revised in line with the Royal Pharmaceutical Guidelines. The registered person should obtain a copy of the local adult protection procedures and make sure that this is available to all staff. The infection control policy should be revised in line with current good practice guidelines and implemented within the home. The infection control nurse should be contacted for advice. (This recommendation was first made In Februaury 2005.) The registered person should make sure that 50 of the care staff are qualified to at least NVQ level 2 by 31st December 2005. The registered person should ensure that accident records contain all the relevant information about the incident, including who last saw the service user prior to the accident and at what time, and details of all actions taken and any follow up information as a result of the accident. The fire safety risk assessment should include information
Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 21 3. 9 4. 5. 18 26 6. 7. 28 38 that the fire doors to the kitchen and communal lounge are wedged open at certain times of the day and that they must be closed at night. The fire safety officer should be consulted for advice on safe, suitable alternatives for keeping these doors open at key times during the day. (This standard was not assessed on this inspection and has been carried forward.) Brooklands Residential Home J52 S1429 Brooklands V192919 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1 HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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