Inspection on 26/10/05 for Brooklyn House Nursing Home

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 Poor. 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 House Nursing Home 22/05/07

Brooklyn House Nursing Home 25/04/06

Brooklyn House Nursing Home 16/11/04

Brooklyn House Nursing Home 08/06/04

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 House Nursing Home Queen`s Road Attleborough Norfolk NR17 2AE Lead Inspector Mrs Judith Huggins Unannounced Inspection 26th October 2005 12:00 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 Brooklyn House Nursing Home DS0000015621.V260628.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 House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brooklyn House Nursing Home Address Queen`s Road Attleborough Norfolk NR17 2AE 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) 01953 455789 01953 455789 Brooklyn House Limited Mrs Elizabeth Carlton Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: The home is purpose built, close to the centre of the town of Attleborough and is registered to provide nursing care, including long term and short term respite care, for up to 31 elderly people. There is parking on the adjacent supermarket car park. Accommodation is arranged over two floors, with communal areas predominantly on the ground floor. There is one first floor sitting area. A shaft passenger lift is provided. Information for service users outlines services available, such as hairdressing, chiropody, and activities organised during the week. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted over four and a half hours. During the inspection, three members of the care team, four ancillary staff, and four residents were spoken to. The registered manager has recently resigned, and in the absence of the temporary manager, a manager from another home owned by the company was supporting staff. A selection of records including care plans was inspected. What the service does well: What has improved since the last inspection? What they could do better: The company urgently need to recruit and retain a manager for this home. The owners have again arranged for temporary management input following the departure of the last registered manager. The providers have made arrangements to ensure that there is management cover for the home. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 6 However, this represents the 9th change in three and a half years and presents concerns for staff morale, continuity of care and sustained development of the home. In addition staffing levels do not take into account the assessed dependency of residents, with minimum staffing levels only being provided. This represents a shortfall from those identified as necessary following the work undertaken by the previous manager. She felt that the home required five full time equivalent carers to meet the identified needs – using the Residential Forum tool, which is the adopted method of the Commission for assessing staffing needs. At the time of doing this work there was only one more resident in placement in the home than at the time of this inspection. Staff are frustrated in that they feel they are not able to undertake care tasks to the standard they expect and as is set out in care plans. In view of the number of changes of manager, the way staff are deployed in the home may be an issue. Many of the following areas which need improvement should not be seen as any reflection on the staff group who work hard to provide care to the service users placed at the home. Many result from a lack of consistent management and working to minimum staffing levels as well as a failure by the company to work to agreed timescales. They have therefore been split between things the management of the home need to do and things the company need to do. Management and Staffing: • • • Care plans need to be more detailed on all aspects of service users care; The care home needs to respect the choice of times service users wish to get up; Service users must be offered real choices for main meals. Owners of the home: • • • Maintain the environment and to work to agreed timescales; Ensure the safety of the residents by covering all heaters, and ensure they work properly; Ensure that all equipment in the home is installed and maintained to a satisfactory standard, e.g. lifting aids and washing machine. 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 House Nursing Home DS0000015621.V260628.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 Brooklyn House Nursing Home DS0000015621.V260628.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): 3 and 6 Residents have their needs assessed before moving into the home. Residents are not referred solely for intermediate or rehabilitative care. The standard is not therefore applicable. EVIDENCE: At the last inspection it was found that assessments did not cover the range of information specified in standards and designed to see that the full range of needs of residents is assessed before they move in. A care plan for one person recently admitted showed that this information had been either collected from other agencies or obtained by the previous manager, before admission. This is to be commended. Brooklyn House Nursing Home DS0000015621.V260628.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 There has been significant improvement in the setting out of residents’ health, personal and social care needs, and this is to be commended, although there remains a need for more detail. Records of personal care delivered could be improved. Health care needs are not fully met. EVIDENCE: Care plans are showing evidence of review on a regular basis, and when needs change. One person had changed skin condition and an additional goal in the care plan had been promptly documented, with instructions for care. Two relatives confirmed that the care needs of a resident have been discussed with them. This is good practice. There is a lack of detail about how staff are to meet needs in relation to mouth care in particular. One care plan said that this was to be done four hourly but carried no additional instruction regarding the action needed by staff. This was discussed with the visiting manager and nurse in charge and agreed there was a need to specify what was expected and the equipment or techniques to be used. The record of personal care delivered does not support that this assessed need is being met. There has been a substantiated complaint about Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 10 poor oral hygiene in the past, meaning that the home should have improved recording and practice in this area, if they were learning from mistakes. Staff say that they do not always have time to assist people to have baths as they would wish. (See staffing standards.) This is borne out by records of personal care delivered, which consistently show washes rather than baths. As at the last inspection, there remain gaps in records of personal care, where it is impossible for the home to demonstrate that needs have been attended to properly with the staff support that is required. One person said that they would like to try more walking to help recover mobility, but that staff are needed to assist and so this did not happen often. One person informed the inspector that often there were no staff in the main lounge immediately following lunch and that staff are very busy. This meant, they said, waiting for up to an hour and a half for assistance to use the toilet, sitting with “your legs crossed” and “all clenched up”. A report compiled by the regional manager for the providers and the outgoing manager highlights another expression of concern about toileting routines and staff response times and the need for this to be investigated. The inspector verified that when lunch had finished, there were no staff in the main lounge as they were busy attending to needs of residents elsewhere in the home. The call bell was accessible to one resident. One other needed to shout out for assistance from staff. One staff member responded to a request for use of the toilet by advising it was alright for the person to do it where they were as they had a pad on (within the hearing of other residents). This was discussed with the visiting manager who agreed this did not represent best practice. The resident concerned was very distressed and the visiting manager highlighted a number of possible reasons in an emerging pattern which staff could explore and which now needs addressing. Brooklyn House Nursing Home DS0000015621.V260628.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, 15 Residents feel there are some shortcomings in meeting their expectations and preferences, and satisfying the full range of needs, although activities “in house” are clearly valued. Residents are able to maintain contact with friends and family. Residents are helped to exercise control over their lives as set out in the standard (separate from the issue of preferences as set out in standard 12). Residents do not always receive food which matches their preferences and which they consider appealing. EVIDENCE: Staffing rosters have been revised to provide opportunities for people to get up before lunchtime, by introducing an earlier start. However, staff report that this now on occasions results in people being physically woken in order to be assisted to get up, when they would otherwise have slept for longer. Three residents spoken to say that there are not enough staff and that they cannot always get help when they need it. Care plans for two people seen say that they like to attend church. One spoken to said that there were not enough staff to provide an escort to church at weekends and so they were not able to worship as often as they would like. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 12 Residents all singled out the activities coordinator for praise, saying that the activities were very good. One said that they participated in everything that was going and that the person was “wonderful”. There are notices displayed showing activities planned, and a photograph album showing some of these has been placed in reception. Relatives were noted as present at various times during the inspection. Two spoken to confirm that they come regularly. Residents spoken to confirm that they receive regular visits from friends and family. There is information about visiting in written information given to residents. A copy of this was seen in one person’s room. One person spoken to confirmed that they managed their financial affairs, and that they had brought in some personal possessions when they came to the home. Other residents had done likewise based on bedrooms seen. At the last inspection it was commented that one resident could not always manage the meat options and sausages were mentioned specifically. At this inspection, the main menu included sausages. Two residents spoken to say that had left these, one finds sausages difficult to eat, and one said “I hate sausages.” Asked whether they could choose something else, the residents said that they just left the things they did not like. One said that they were not asked about main meal choices, but were asked about tea and “that is just soup and sandwiches”. The rolling menu is in small print and displayed at some distance over a table. Dates are not distinguished so residents would have to ask which week of the menu is applicable. The cook says that residents do not often choose an alternative to the main meal but that choices are taken into account and the main menu is not always followed if people say they would like to try something else. The chalkboard in the main dining room did not show the options available to residents, the partially erased message showing only that it had been someone’s birthday. Fresh fruit and vegetables were available, as was home made cake for tea. Tables in the main dining room were appropriately laid out for the meal. Some residents eat in their own rooms, this was confirmed as preference by one spoken to, and as necessity for those who are too unwell to attend the main dining room. The cook has records to show the meals taken out to each person so that she knows people have not been “missed.” She said that residents had suggested they would like smoked haddock and that this had been included in the menu for tea on the day of the inspection, this is good practice. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 13 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 and 18 Residents are confident that staff do their best to address their concerns but are not always able to act to address these. Residents are not consistently protected from abuse. EVIDENCE: Residents know who to speak to if they have concerns, but say some of the difficulties they experience are to do with staffing (for example their preferred times for rising and retiring), which they consider to be beyond the capacity of staff at the home to deal with. Staff receive training in abuse awareness, and those interviewed had a good understanding of various aspects of this, together with the importance of reporting. A recent adult protection investigation concluded that people were being neglected (this constituting a form of abuse) in that they were not able to rise from their beds until very late if they required assistance from staff. Since then, shift patterns have been revised to attempt to address this. The preferences for times of rising and retiring have been verified by the recently departed manager, but staff recognise these may change from day to day according to how each person feels. Staff report that on occasions this has meant waking residents in order to help them to rise because the working day now starts one hour earlier and recognise this also as potentially abusive. See staffing standards. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 14 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, 22 and 26 Although generally well maintained and with some good refurbishment, there are shortcomings which affect the safety of residents. Where other requirements relating to premises were previously made, compliance was checked and so some may be repeated where standards were not fully inspected. Residents do not have access to the full range of equipment. The home is clean but there are problems maintaining hygiene. EVIDENCE: There have been extensive works to refurbish corridors. This is complete on the first floor and almost finished on the ground floor. As a result, suitable locks have been provided to all bedroom doors. There is further work planned to the reception area, and for the replacement of carpets. Some of these are stained, being of light colour. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 15 There has been slippage from the schedule for refurbishment of other areas. As noted at the last and previous inspections, there are numbers of rooms with wallpaper damaged by the removal of brackets leaving bare patches, or where screws have been removed. There are redundant brass name holders by some beds. Painted wooden covers to pipe work in one bathroom are noted to be flaking. Staff report that not all hoists are functioning properly. One was seen as left in a resident’s room with a laminated sign on the seat saying it needed attention and was not to be used. The label from the maintenance company indicated it needed attention. Staff also say that there are sometimes problems with the supply of slings, given the need to launder these and keep separate slings available for those with particular infections. The visiting manager was unable to find confirmation that remedial action had been taken to ensure the hoist was safe and could be used. The providers schedule for the provision of lockable facilities to all bedrooms has not been met. However, one person informed the inspector that they did have a lockable facility and used this. There remain concerns regarding the safety of electrical heaters. Records do not show that requirement made at the last inspection for risk assessment was met in July, with work not completed to document this until October. The providers’ own schedule was for covers to be fitted by the end of October to prevent risk of accidental burns and this has not been met. An audit of the heaters carried out in August shows that some still present a risk of overheating. The winter weather will mean that all heaters must be capable of functioning effectively and safely. The second machine necessary to keep up with laundry has been fitted but is reported as unusable as the floor is not suitable for securing the machine properly. Two ancillary staff confirm difficulties keeping up with the amount of laundry using the one machine that is available, even with current levels of occupancy (24 residents). Continence is reported as an increasing difficulty meaning that there is a considerable amount of laundry to complete each day. Areas of the home seen were clean. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 16 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 The numbers and skill mix of staff does not meet residents’ needs. EVIDENCE: The duty roster left by the outgoing manager has been altered to reduce staffing levels to those specified as the minimum in the staffing notice issued at the point of registration. This does not take into account the heavy dependency of residents. The outgoing manager has carried out detailed assessments of the dependency of residents upon care staff. At the time these were carried out there were 25 people in residence with only four identified as of average dependency, 3 as highly dependent, and 18 as extra high. Using residential forum figures and taking into account dependency for personal care (NOT nursing needs), the outgoing manager identified a shortfall of 5.75 full time equivalent carers. Residents say that staffing levels continue to impact on the care they receive (assistance for using the toilet, assistance with getting up). Staff report that staffing levels mean that they cannot always deliver personal care such as baths with the frequency needed, to change continence pads as often as required and agree that this does not allow them sufficient time to deliver a proper service and proper care. There is no time to spend with residents “to talk”. Although resident numbers have declined to 24 (the home being registered for 31), staff report that dependency has not declined. There are still high Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 17 numbers requiring hoisting (reported as 18 or 19 people needing assistance from two staff) and full assistance with continence, personal care and mobility. Staff say they sometimes have to wash people rather than bathe and specifically that they sometimes have to wash the lower part of residents, and then just hands and face as they often did not have time to carry out a proper strip wash. Staff confirm that on the day of the inspection, one of their number had needed to escort a resident to hospital, and that as a result some residents had been washed in bed, or washed rather than bathed in order to ensure this happened before the staff member needed to leave. Effectively, during her absence, staffing numbers were below the minimum specified level. Staffing levels have been the subject of repeated requirement. Staff had good understanding of their roles and of needs and show great commitment to the work they do. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 18 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): Persistent changes mean that residents do not live in a home run by a person who is able to discharge his/her responsibilities fully. This presents concerns for consistency of management systems, staff support, and for making sustained progress to meet national minimum standards. The health safety and welfare of residents is compromised. EVIDENCE: The registered manager for the home left recently. The owners have made arrangements for a temporary manager to oversee the home who is currently on leave. A manager from one of the other homes in the group has been offering support to the staff team. The temporary manager is the 9th person to assume a managerial role in the home since April 2002. There are concerns for the safety of residents from hot surfaces with previous requirements unmet, and continued risk identified. The provider’s risk assessment for fire prevention is compromised where equipment is identified Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 19 as presenting signs or risk of overheating, particularly given the time of year and the forecast of a very cold winter. It was not possible to locate full records of testing of fire equipment during the inspection. No comment could therefore be made regarding these. There is a lack of evidence that hoists identified as presenting concerns, have been attended to. It is noted that requests for work have been submitted and that the outgoing manager had also requested quotes for replacing faulty equipment. The risk assessment for the use of bed rails on some files, is not fully completed so does not show that the risk of injury from trapping parts of the body between the rails or between the lowest rail and the mattress has been fully addressed. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 20 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 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x 1 x x x 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x x x 1 Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 21 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(1) 15(1) Requirement The registered persons must ensure that care needs are set out in sufficient detail, so that staff can consistently follow them. Outstanding requirement The registered persons must ensure that records of personal care delivery are completed and accurate, to demonstrate care delivered in this area is consistent with assessed need. The registered persons must review systems for managing and promoting continence. The registered persons must submit a revised schedule showing when previously proposed maintenance is to take place and how outstanding issues are to be addressed. The registered persons must ensure and confirm that all hoists are repaired as required and available for use. Outstanding requirement The registered persons must ensure that lockable facilities are DS0000015621.V260628.R01.S.doc Timescale for action 04/12/05 2 OP7 12 04/12/05 3 4 OP8andOP7 12, 13(6) OP19 23(2) 31/12/05 31/12/05 5 OP22 13(5) 04/12/05 6 OP24 12(4) 31/01/06 Brooklyn House Nursing Home Version 5.0 Page 22 7 OP25 and OP38 OP26 10, 12(1), 13(4) 16(2), 13(3) 8 9 OP27 10, 12(1), 18(1) 10 OP31 8, 10 11 OP38 13(4) provided to all rooms. Previous timescales, including those submitted in the provider’s action plan, are not met. Outstanding requirement The registered persons must ensure that all hot surfaces are guarded. The registered persons must ensure that washing machines are capable of use and capable of dealing with the amount of soiled linen generated by dependent residents. The registered persons must employ staff in numbers that are adequate to care for residents, taking into account their dependency. The registered persons must employ a suitably qualified manager to run the home, who must be registered with the Commission. The registered persons must ensure that the risks associated with use of bed rails is fully and thoroughly assessed and documented, with actions taken as necessary. 04/12/05 31/01/06 31/01/06 31/01/06 04/12/05 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 persons should explore emerging patterns of behaviour at particular times of day to see whether there are underlying causes which, if addressed would reduce behaviour which is hard to manage or which impacts upon the welfare of other residents. The registered persons should consider how they will DS0000015621.V260628.R01.S.doc Version 5.0 Page 23 2 OP15 Brooklyn House Nursing Home promote choice for residents with regard to the main meal of the day, and how they can improve the awareness of residents about the choices they can make. Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 24 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 Brooklyn House Nursing Home DS0000015621.V260628.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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