Inspection on 07/11/06 for Brooklyn

This inspection was carried out on 7th November 2006.

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

The inspector 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 21/02/06

Brooklyn 13/06/05

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 Key Unannounced Inspection 11:30 7th November 2006 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.V311698.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. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 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 emorley@brooklyn22fsbusiness.co.uk Mrs Eileen Theresa Morley Mrs Eileen Theresa Morley Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 16 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 16 persons) The total number of residents accommodated in the home must not exceed 16 persons The registered person shall ensure that a continuing programme of development is provided for Managers and staff in relation to dementia care and good practice equivalent to the recommendations of the Alzheimer’s Society The registered person shall keep under review the environmental provision to meet the assessed needs of residents with dementia in relation to good practice guidance 21st February 2006 5. 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 residents 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. Residents 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. The range of fees charged by the service are between £367.15 and £450.03 per week. There are additional charges for hairdressing, chiropody and staff and some activities. The provider provided this information to the Commission in September 2006. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out over two days on the 7th and 16th November 2006. During these visits the inspector examined documents such as care plans, staff records and policy documents as well as observing staff interaction with residents and speaking to staff. The proprietor/Manager Mrs Eileen Morley was present on both occasions. What the service does well: What has improved since the last inspection? What they could do better: Now that staff have been provided with some large scale dementia training it has provided them with a basis from which to develop their practice and consider how their knowledge can improve the lives of residents with dementia living at the home. Particular areas that require such considerations are the way in which residents dignity is supported, how they spend their day, and the information provided to assist in this through care planning. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 6 A stronger commitment to staff induction and supervision must be given to provide a better sense of staff development in practice. 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. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 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 Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service determines whether it can provide the support prospective residents need prior to their admission. EVIDENCE: The inspector sampled a selection of resident’s files to determine how the service assessed their needs. The files seen contained an assessment format that covered the range of daily living activities such as mobility, continence, social interests. It also asked questions in respect of the prospective resident’s mental health and attitudes and determines a level of dependency from this. The information gathered from these questions would assist the service in understanding the level of support a prospective resident needs, but further detail about how the need manifests itself would provide a greater quality to the overall assessment tool. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 9 The service does not provide intermediate care. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 10 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): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are provide staff with the information to best support residents’ daily lives. Although residents’ health care is monitored the wider effects of health issues are not always recorded. EVIDENCE: The residents files sampled also contained their plan of care. These were set out in a table format with the headings for each of the areas of daily activity identified in the assessment. These areas would provide a holistic plan, however the quality of the completion determines how successful they would be in supporting the staff to assist residents. In the sample examined the plan is written to reflect the positive abilities of the resident at whatever level they were assessed, but the instructions to staff in how best to support these were general and could be improved upon. For example the plan of one resident who Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 11 was able to manage some areas of their personal care but required support stated “ needs assistance from one carer to maintain personal hygiene, It is important to explain all actions to them and do not rush…encourage and assist with bath weekly”. Whilst this information encourages staff to provide support to resident at a level they require, a plan with more specific detail would ensure that the way in which this is carried out gains the maximum benefit for residents independence. Residents health care is recorded and monitored by staff in the care planning Document. This includes weight, records of health visits and their outcomes. The changes in residents health needs are noted on care plans as additional issues, however the effect of some issues is not accounted for in all areas of daily living. So for example the daily records of a resident whose mental health had deteriorated, recorded the change in behaviours, and health care appointments noted the GP visit and the subsequent changes in medication were noted on the bottom of the existing care plan. However the way in which this had affected the individuals ability to communicate, participate in activities and how staff should best support the challenging behaviours was not changed in the appropriate areas of the care plan. The procedures for administration and management of medication were considered. The records of receiving, dispensing medication were in good order, and observation of staff administering the medication round at lunchtime demonstrated staff were aware of safe practice. The medication storage had been updated to a mobile lockable trolley that is moved around the home to where residents are located. There was evidence that generally residents are treated with dignity and respect by the service and staff delivering care. Staff spoken with were aware of the need to ensure they knocked on doors and spoke to residents with respect. However, observation of some areas of practice during the inspection identified that staff were not always conscious of residents’ rights in their daily interactions with residents. For example a number of residents sit with tables in front of them throughout the day, without any apparent reason for this. In another example at mealtimes staff stand next to the resident to assist them with their food and mashed the meal together on their plate. This issue was discussed with Mrs Morley at the time of the inspection. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service employs initiatives to offer residents with opportunities for occupation and activities in their daily routine. Opportunities for choice are offered by staff although due to residents communication issues this is limited. EVIDENCE: The service has appointed a member of staff as an activities co-ordinator. Their duties are to lead and organise the programme of activities for residents at the home, but does not exclude other staff from participating in activities with residents during their working day. The service maintains a record of the activities each individual resident takes part in and includes the time this takes, which is then totalled each week to audit that each resident receives a minimum level of staff interaction. The Manager felt this assisted staff to identify how they contributed to the overall occupation of residents. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 13 The personal interests of each resident are part of the recorded in their care plan, although this directs the staff member to the activities file where a list of activities on offer is held. This is a recent initiative and the skills of staff and effectiveness of the activities on offer will need ongoing development. The visiting policy and arrangements are unchanged from previous inspections at which time they were assessed as being appropriate to encourage visitors and respect residents right to refusal and privacy. Visitors frequently attend the home, in some cases on a daily basis, and are viewed by staff as a part of the residents support. The way in which the service gains resident’s opinions and views requires development. Particularly as the communication abilities of many of the residents are compromised by their dementias. The Manager has undertaken training in the use of dementia care mapping as a tool for this purpose and two sessions of mapping had taken place with the assistance of external mappers since the last inspection. However the Manager’s assessment of the exercise was that the lack of personal knowledge held by the mappers made the outcome less affective. She now intends that other staff members undertake the mapping course and that an internal group take on this role. In discussions with staff it was evident that they understood the need to offer choice to residents particularly in areas such as how they dressed and what they ate, and understood some techniques to assist residents with dementia to express their choices. This information should be included n the development of person centred care planning. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 14 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): 16 & 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ rights to complaint and protection are supported by the services policy, although access for residents with dementia is limited. EVIDENCE: The existing complaints policy fulfils the requirement of the NMS in that it contains reference to the processes, timescales and the opportunity to alert the CSCI to concerns. In order to provide additional communication options for those residents with dementia, the Manager has attended a dementia caremapping course developed by the Bradford University. This tool aims to chart how residents with cognitive impairment respond to their interactions with staff, and would add to the staffs understanding of residents satisfaction levels. The POVA policy and procedure is unchanged and meets the expectations of the NMS and the local guidance. Staff have received regularly updated POVA training as part of their annual training plan Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 15 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): 19 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Efforts are made to provide an environment that supports residents with dementia. EVIDENCE: The premise have undergone a redecoration in the preceding months and as discussed at the last inspection the principles of good practice in dementia care were considered by the Manager. The corridors and stairwells have been painted in strong contrasting colours, whilst doors leading to toilets have been coloured to stand out from the other doorways and signage is used to identify the use of the rooms. It is hoped that this easier identification of the purpose of areas of the building will support residents in moving around the home more independently. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 16 The communal space provided by the service is made up of a lounge at the front of the building and a separate lounge/diner at the rear. The majority of residents spend their day in the rear lounge/diner, and in particular those residents who are immobile spend all day in the room. The layout of this room presents some issues, as it is a T shape relatively slim room with a lot of furnishings that also provides an access route for other part of the home and is therefore the “hub” of the daily activity in the service. Whilst this creates a lively and active environment for residents, from observations on the day of inspection there are also health and safety issues that require consideration. This particularly relates to the tripping hazards posed by the furnishings and the mobility of residents with dementia who do not recognise the risks. Additionally there is another communal area that residents seem reluctant to spend time in. This was discussed with the Manager who recognised some of the issues and related the attempts made to encourage the use of the second lounge. It was agreed that further considerations should be made. There was not a noticeable odour in the home and the services policy in respect of infection control was in place and staff were issued with protective clothing including disposable gloves and aprons. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Sufficient skills and numbers of staff support the residents. These are selected by a robust recruitment system. EVIDENCE: The staffing numbers are monitored by the Manager in relation to the needs assessment of residents. The rota supplied to the inspector indicated that the daytime staff cover was set at 3 care staff with additional support provided by catering and laundry staff. At night there is one waking staff and one sleep-in staff member on call. The service has invested in a high level of training in dementia in the past 12 months and apart from the newest recruits all staff hold a certificate in dementia care qualification. Additionally the service has employed external trainers to provide staff with some mandatory training sessions such as moving and handling, first aid and protection of vulnerable adults training. Some staff had also undertaken a certificated medication training course. There were however some shortfall in mandatory training and those issues relating to the assessed needs of residents. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 18 The sample of staff files looked at during the course of the inspection indicated recruitment checks were undertaken prior to staff commencing employment and included an application for CRB and a POVA first response. It is not the intention of the Criminal Records Bureau that the POVA first application is routinely used as part of the employment checks on staff, and the Manager was directed to the CRB guidance on this. Staff spoken with during the inspection were asked to consider how their practice catered to the needs of residents. Although the selection of staff who met with the inspector were relatively new to working in the care field they gave a good account of how they tailored their practice to meet the needs of residents in their care, and were able to describe how they broke down tasks to assist residents in making choices. In particular a member of staff was aware from their previous experiences of the need to create a person centred approach to supporting people. These life experiences are invaluable to the diversity of the staff skill bank, and should be utilised as much as possible. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 19 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): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents benefit from positive management and a happy and caring atmosphere within the service. Staff would benefit from a greater understanding of quality in carrying out their induction and supervision. EVIDENCE: From observations of their interactions with residents and speaking to staff, it is apparent that the staff group exhibit sensitivity towards the residents in their care. The attitude within the staff group supports the Managers’ attempts Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 20 to develop an ethos of resident focused services and Ms Morley has invested in staff skills though training and development. There are continued developments needed in staff practice and the consistent application of good practice in promoting residents dignity and rights. For example staff assisting residents during meal times seemed unsure of the best way to support the individuals to eat. The Manager was directed to the SCIE published good practice guidance in delivering a respectful service. There is a continuing need to move the service forward and for staff to be secure in the knowledge that they carry out current good practice. There continues to be a happy and friendly atmosphere in the home, which both residents and staff enjoy. The quality assurance programme had not been developed since the last inspection and the proposed dementia care mapping exercise expected to add to the information gathered from residents had not been fully audited at eh time of the visit, although when carried out it would provide insight into residents assessment of wellbeing. The Manager confirmed that the home does not manage any finances on behalf of residents. Staff induction was carried out with the previous TOPPS standards used as a basis for the programme. The staff work through a workbook and these are signed off by the Deputy Manager on completion. From discussion with the Deputy and staff it was clear that there was not a full measure of competency carried out in determining if staff had completed their induction. The Manager advised that they were considering hiring a trainer to complete the induction standards, in a short standardised course. The Manager and deputy Manager were directed to the Skills for Care website for further guidance. There continues to be an issue with a consistent approach to formal staff supervision. During discussions with the Manager Mrs Morley and her deputy it was acknowledged that this was an area they were aware needed attention. Although they felt that issues were often dealt with informally during the course of the working day. Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 21 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 sCHOICE 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 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X N/A 2 3 3 Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 22 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 OP8 OP12 Regulation 12,13 Requirement The registered person must ensure that all aspects of residents’ identified needs and aspirations are set out in an individual care plan. This is a repeat requirement. 2. OP36 18 (2) The registered person must ensure that staff supervision is consistently provided. This is a repeat requirement 01/03/07 Timescale for action 01/03/07 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 OP8 Good Practice Recommendations The registered person should ensure that changes in residents needs are considered in all aspects of their care plan. The registered person should ensure that staff practice DS0000017784.V311698.R01.S.doc Version 5.2 Page 23 2 Brooklyn OP10 3. 4. OP12 OP14 OP16 OP33 OP15 OP10 supports the residents right to dignity. The registered person should continue to develop the staff skills in communication and understanding of individual preferences and choices in daily living. The registered person should ensure that there is a full assessment of residents’ needs in respect of meals and mealtimes, including specialist advice, provision of equipment and instructions to staff in care planning in relation to the support they should provide. The registered person should continue to give consideration to the layout, décor and signage of the home in accordance with established good practice guidance relating to dementia care. The registered person should ensure that training needs identified by staff through supervision processes are included in a training programme. 5. OP19 6. OP30 Brooklyn DS0000017784.V311698.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 © 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.V311698.R01.S.doc Version 5.2 Page 25 - 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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