Inspection on 13/06/05 for Brooklyn

This inspection was carried out on 13th June 2005.

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

Other inspections for this house

Brooklyn 02/09/09

Brooklyn 16/10/07

Brooklyn 07/11/06

Brooklyn 21/02/06

Brooklyn 02/12/04

Brooklyn 20/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brooklyn 22-24 Nelson Road Clacton On Sea Essex CO15 1LU Lead Inspector Sara Naylor-Wild Unannounced Inspection 12:00 13th June 2005 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 Brooklyn DS0000017784.V249757.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. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brooklyn Address 22-24 Nelson Road Clacton On Sea Essex CO15 1LU 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) 01255 430324 01255 688370 eileenmorley@btconnect.com Mrs Eileen Theresa Morley Mrs Eileen Theresa Morley Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of service users accommodated must not exceed 16 persons Date of last inspection Brief Description of the Service: Brooklyn is a converted premises, which is in walking distance of Clacton seafront, and local amenities. Mrs Morley is the registered owner and manager of the home. The home provides accommodation for 16 service users on two levels. Communal space is made up of two lounges and a dining room. Twelve of the fourteen bedrooms are single and all but one room have en suite facilities. Service users have access to a passenger lift. The home is well maintained throughout and there is a small garden area to the back of the premises. Parking can be found to the front of the home. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out in one day in June 2005, but was not considered completed until October 2005. This enabled the inspector to fully consider the information gathered during the inspection in relation to the final assessment regarding the approval of the application to vary the conditions of registration to include service users with dementia. The inspector was able to establish sufficient evidence of how the service will be developed to recommend the agreement to register. What the service does well: What has improved since the last inspection? 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. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 6 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 Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 7 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): 3 & 6. Assessment documentation contains sufficient information to determine a prospective service user’s needs. The home does not provide intermediate care. EVIDENCE: A sample of service users’ files contained assessments of needs, which included items listed in the National Minimum Standard (NMS). This would provide sufficient introductory information from which the home could determine whether they could meet the needs identified and commence a care plan. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 8 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 and 10. Care planning documents provide a person centred understanding of the individual service user. The new format was not in place for all service users. Health care needs of service users are monitored and action taken in response to identified need. Staff respect service users’ rights to dignity. EVIDENCE: A new format had been developed for the care planning documents, which provided evidence of person centred planning and risk assessment. The documents had not been introduced across all the service users’ documentation at the time of the inspection and the manager stated that she intended to replace the existing documents over a period of time. Records held on service users’ files demonstrated how service users’ health care needs were attended to by staff. These included visits by health professionals and their outcomes, nutrition records, etc. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 9 Observations of staff’s interaction with service users generally supported the statements in policy and procedure that upheld service users’ rights to dignity and respect. One staff member’s over zealous approach did not meet the expectations of dignity and confidentiality, and this was discussed with the manager on the day. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 10 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 & 15. The provision of suitable activities for service users with dementia requires development. Visitors are made welcome at the home. The meal provision was suitable and provided a balanced diet. EVIDENCE: Records show that staff are engaging service users in activities and identifying those tasks that, although are routinely carried out, form part of the occupational activities service users participate in. These include talking, reading papers, etc. Further development of activities plans, which are linked to individual needs and recorded, on care plans is required. From previous inspections it was evident that visitors to the home are aware of the home’s policy and feel welcomed by staff. During the inspection the midday meal was served, and whilst some of the service users commented on the quality of the preparation on that day, staff were proactive in offering choices and alternatives to service users. Feedback on the meal was readily given and received by staff. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 11 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): These standards were not fully assessed, although previous inspections have found that the correct policy and procedures for these standards were in place. EVIDENCE: Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 12 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. The environment generally provides sufficient facilities to meet the NMS. Further consideration is required in relation to the environmental provision in respect of dementia care. The home is well maintained and clean and hygienic. EVIDENCE: The building and décor had remained unchanged from previous inspections and within the natural limitations of the building provides sufficient space and facilities to meet the NMS. The building is well maintained and pleasantly decorated in a homely way. The additional provision of dementia care requires some consideration of how the environment enhances the lives of service users with degenerative cognitive impairments. Good practice includes use of colour and signage to promote independence. The manager was aware of the need to include this in any development of the maintenance programme for the home. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 13 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 & 29. The staffing numbers are calculated against service users’ assessed needs. The staff training programme includes specialist subjects relating to dementia care. EVIDENCE: The manager was able to demonstrate that staffing numbers and arrangements are arrived at following review, using the residential forum calculation. This provides indications of the numbers of care staff required at a basic level to meet the assessed needs of existing service users. The manager had developed a training programme that included mandatory health and safety subjects and specialist topics such as dementia care. This level of training is satisfactory as an induction level of training to support staff in provision of a specialist care service. However further development is required in the programme to ensure that the basic level of training is complemented by further initiatives in areas such as nutrition, activities and person centred planning, to enhance their understanding of dementia care. Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 14 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 & 38. The home is operated by a manager who is fit and competent to do so. The health and safety of service users is supported by the home’s policy and procedures. EVIDENCE: The Proprietor/manager Mrs Morley’s position is unchanged and in addition to her many years experience in caring for older people, she maintains her registration with the NMC, and had commenced the course for the Registered Managers Award NVQ level 4. Along with the rest of the staff group Mrs Morley is intending to develop her understanding and skills in meeting the needs of service users with dementia, in support of the variation application submitted, to enable the home to Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 15 continue to provide care for existing service users with dementia and accommodate further admissions in this category. The home’s policies and procedures support the health and safety of service users and staff supporting them. The certificates relating to equipment and services to the home were in place and updated as required. Brooklyn DS0000017784.V249757.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Brooklyn DS0000017784.V249757.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 OP7 Regulation 12,13 Requirement The registered person must ensure that all aspects of service users’ identified needs and aspirations are set out in an individual care plan. This is a repeat requirement. The registered person must ensure that staff uphold service users’ rights to dignity and respect in all their interactions with them. The registered person must ensure that service users are consulted in regard to the routines of daily living and activities made available. These preferences should be recorded in care plans. This is a repeat requirement. The registered person must ensure that staff recruitment policy and procedures are robust and that information required by Regulation 19, Schedule 2 is obtained prior to appointment. This standard was not assessed at this inspection and therefore is carried forward to the next visit. DS0000017784.V249757.R01.S.doc Timescale for action 31/01/06 2 OP10 12 31/01/06 3 OP12OP14 14,16 31/01/06 4 OP18OP29 OP36 19, Schedule 2 31/01/06 Brooklyn Version 5.0 Page 18 5 OP19 13 The registered person must ensure that consideration is given to the layout, décor and signage of the home in accordance with established good practice guidance relating to dementia care. 31/01/06 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 OP30 Good Practice Recommendations The registered person should ensure that training needs identified by staff through supervision processes are included in a training programme. This standard was not assessed at this inspection and therefore is carried forward to the next visit. The registered person should ensure that an assessment of the premises is conducted by a qualified Occupational Therapist or equivalent. This standard was not assessed at this inspection and therefore is carried forward to the next visit. The registered person should ensure that 50 of staff are qualified to NVQ level 2 by 2005. This standard was not assessed at this inspection and therefore is carried forward to the next visit. The registered manager should attain NVQ level 4 Registered Managers Award by April 2005. This standard was not assessed at this inspection and therefore is carried forward to the next visit. The registered person should ensure that the results from quality assurance questionnaires are evaluated and an action plan produced in response. This standard was not assessed at this inspection and therefore is carried forward to the next visit. 2 OP22 3 OP28 4 OP31 5 OP33 Brooklyn DS0000017784.V249757.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Brooklyn DS0000017784.V249757.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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