Inspection on 11/04/05 for Brookside

This inspection was carried out on 11th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Brookside 30/05/06

Brookside 08/12/05

Brookside 14/09/04

Brookside 13/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

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

CARE HOMES FOR OLDER PEOPLE Brookside Ruskin Avenue Melksham Wiltshire SN12 7NG Lead Inspector Roy Gregory Unannounced 11 April 2005 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. Brookside Version 1.10 Page 3 SERVICE INFORMATION Name of service Brookside Address Ruskin Avenue Melksham Wiltshire SN12 7NG 01225 706695 01225 703181 manager.brookside@osjctwilts.co.uk The Orders of St John Care Trust 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) Miss Eleanor Joan Walton Care Home Only 50 Category(ies) of DE(E) Dementia - Over 65 (13) registration, with number MD(E) Mental Disorder - Over 65 (13) of places OP Old Age (37) Brookside Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 13 service users with Mental Disorder or Dementia at any one time Date of last inspection 14 September 2004 Brief Description of the Service: Brookside is a purpose-built residential home for 50 elderly people, 13 of whom may have needs associated with dementia or other mental health issues. The home was formerly owned and run by the local authority, but has for some years been provided by the Orders of St John Care Trust, one of a number of homes provided by them in Wiltshire, Oxfordshire and Lincolnshire. Miss Ellie Walton was registered as manager of the home in June 2004. Accommodation is all in well-proportioned single rooms, located on two floors, with a passenger lift to the first floor. All bedrooms have wash hand basins. The home has seating areas rather than identifiable lounges. In addition there is an attractive enclosed garden that has benefited from recent attention to make it accessible to all service users. Three rooms are used exclusively for short stay residents.The home is situated in a residential area, a short walk from Melksham town centre, where shopping and social facilities are available. There are good bus links to neighbouring towns, whilst the home has its own adjacent car park. Brookside Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9:00 a.m. and 5:45 p.m. on Monday 11th April 2005. The inspector spoke at length with five residents, including sharing lunch in the dining room with two of them. The manager being on holiday, the inspector received helpful guidance, including access to documentation as required, from the administrator (Karen Johnson) and the care leaders on duty. Additionally there were conversations with care and housekeeping staff, and with the activities co-ordinator. The inspector had the benefit of meeting with a visiting relative, and a social worker and occupational therapist who visited a resident during the morning. Since the inspection, the inspector has been able to share findings with the registered manager, Miss Walton, by telephone. The inspector selected a number of care plans to compare observations of care with written records. Other records consulted included those relevant to recruitment, staffing and health and safety. Most of the building was visited and a number of individual rooms were seen with the consent of their occupants. The inspector sat in on two care staff shift handovers. What the service does well: What has improved since the last inspection? Care plans were now showing signs of regular review, as required at previous inspection; all included recognition of social needs as well as physical care, resulting in a greater “whole person” emphasis in the nature of care provided. Sit-on scales have been provided, meeting another requirement and allowing for regular weight recording for all residents. There have been improvements to the lighting and décor of the dining room, much appreciated by residents. Brookside Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookside Version 1.10 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 Brookside Version 1.10 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) 3 (Standard 6 is not relevant to this service) There is a clear admissions policy in place. Assessments include visits by the manager or a care leader to a person’s existing care environment. The standard of assessment is effective, and prospective residents are involved in the process. EVIDENCE: Records of recently admitted residents showed they were involved in preadmission assessments and this was confirmed by two such residents. Their care plans had been commenced prior to admission, demonstrating continuity from assessment to care planning. One of those residents had moved from another care home because the assessment suggested Brookside would be better able to match their care needs. They were satisfied this assessment had proved accurate, a view supported by care records. Brookside Version 1.10 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 standard(s) 7, 8, 10 & 11 The care provided to residents is guided by care plans, which receive regular review. Residents feel confident in responses to health needs, and with regard to provision for terminal care, which is very good. Manual handling and pressure area risk assessments are under-developed, leaving an area of potential risk to service users. Residents value provisions made for their privacy. EVIDENCE: Care plans were in place for all residents and showed evidence of regular review. Plans were focussed and covered “whole person” needs, including details such as preferred terms of address. All service users spoken to felt staff had a good understanding of their respective health needs. Records showed that professional attention was quickly procured in response to health concerns, including dental, optical and chiropody services. Weight records were now being maintained. However, both manual handling and pressure area risk assessments were under-developed. Residents, whilst being aware of the care planning process, generally saw it as a staff issue rather than their own. Similarly, a visiting relative said they had always left care planning to staff as “the experts”, whilst having felt listened to and informed of all developments. Brookside Version 1.10 Page 10 Patient and sensitive caring interactions were observed throughout the day, with the exception of a housekeeper entering a room without first knocking; the resident concerned was upset by this, but said it was exceptional. A number of residents expressed satisfaction with the degree of privacy they experienced in their personal rooms. A care plan indicated precisely how a gentleman wished to receive assistance with bathing. One resident was in receipt of terminal care. The district nurse was visiting daily to oversee operation of a syringe driver and had facilitated links with the local hospice. A relative of the resident was provided with overnight accommodation within the home. This person expressed total satisfaction with the home’s care of their relative both at this time and before the resident became so ill. One resident told the inspector they hoped to die at Brookside, where they were confident of the quality of care they would receive. A social worker and occupational therapist visited a resident for whom there was a possibility of a return home after a short stay. They were pleased with the level of liaison extended to them by the home. They had seen that the home staff were encouraging mobilising, and they saw staff as gently supportive of the resident’s position of having to arrive at an important decision, without making the person subject to any pressure. Brookside Version 1.10 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, 14 & 15 Residents have access to varied activities, by personal choice and related to needs and expressed preferences. Contacts with the wider community are supported. High quality meals are served. EVIDENCE: The activities co-ordinator plans a varied programme of daily activities to help meet physical and social stimulation needs, and also shopping trips and entertainments. This is backed up by her recorded individual and small group consultations with residents to identify wishes and preferences. Residents told the inspector they valued the activities programme, regardless of to what extent they might choose to participate. A pre-lunch ball game was creating a great deal of hilarity, whilst at the same time a resident enjoyed a card game one to one with a carer. Notice boards and newsletters showed good dissemination of information, including details of church services available within the home. Care plans, conversations and observations showed contacts with family and others in the community to be an everyday feature. Residents were overwhelmingly complimentary of meals in the home. The midday meal offered two hot choices (one non-meat) and a cold option, with a choice of three sweets. All choices are made at table. Residents also said they looked forward to breakfasts and teas. Service was friendly and efficient. Meals Brookside Version 1.10 Page 12 may be taken in the pleasant dining room or elsewhere. One resident appreciated that the menu is displayed during the morning and at table. Brookside Version 1.10 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 standard(s) 16 & 17 There are good formal and informal means for receipt of complaints, which receive appropriate investigation and action. Civic rights are recognised and protected. EVIDENCE: Records showed that complaints receive investigation, rectification where substantiated, and feedback to the complainant about actions taken. There is good guidance to residents and staff by way of the provider Trust’s complaints procedures. Residents said variously that they would raise any concern with any member of staff, or with the most senior person on duty at any time, and were confident that they would receive attention. One had felt aggrieved that a relative had complained on their behalf, but then had appreciated the outcome achieved by the complaint. Resident meetings, care reviews and quality questionnaires were seen as channels for making comments without the formality of “complaining.” Compliment letters are filed along with the complaints record, and outnumbered complaints for the previous six months. The administrator confirmed that residents were registered for postal votes for the forthcoming general election. She intended checking arrangements for those admitted since annual electoral roll registration. Brookside Version 1.10 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 standard(s) 19, 20, 21, 23, 24, 26 The environment is welcoming and safe, although with the development of activities provision, more communal space would be of value to the home. Residents have made themselves very much at home in their own rooms. Housekeeping staff and the handyman maintain a clean, attractive home. The deteriorated state of many window frames, however, detracts from the overall presentation and poses risks to infection control and health and safety. EVIDENCE: There was plentiful evidence of the home being kept clean. Residents were very satisfied with this aspect of the home, and the environment as a whole. Two long-term residents spoke of the continual improvement they had seen in the fabric of the home, and were very pleased with recent improvements to the lighting and décor of the dining room. Another expressed appreciation of the garden. The handyman spoke of recent work to bring the summerhouse fully into use, and there are plans for further development of the garden. For activities, the absence of discrete lounge space is unhelpful, as the dining room Brookside Version 1.10 Page 15 and the adjacent sitting area have to be relied upon. The activities co-ordinator said this could mean conflict of interest between activities and, for example, watching television, whilst there is also no room where craft activities can be done without having to clear away. Toilets and bathrooms presented well, although some tiled floors had difficult to clean edges and residents complained those floors were cold, and slippery when wet. Some wash hand basins, in bedrooms and toilets, presented minor problems of rusting and scaling around taps and waste outlets, which compromise the cleaning task. A relief housekeeper stated she had not received training in infection control. Residents considered there to be sufficient toilets, albeit there is reliance by a majority on use of commodes at night. Related infection control practices were satisfactory. A recently refurbished bathroom was let down by the original aluminium window frame, which was badly pitted. A housekeeper said that despite evident efforts, it was not possible to clean these frames to a satisfactory standard. Furthermore, there are records of accidents to residents being incurred through opening and closing windows, and staff confirmed that the sash design means that they jamb easily. One, in the care office, had a broken mechanism, and so others will be at risk of breakdown. Neither are the home’s windows double-glazed. Individual rooms were highly personalised. Residents considered their rooms to be well proportioned and liked their outlooks to the exterior. Brookside Version 1.10 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 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) 27 & 29 Staffing is sufficient to meet both the care needs of residents, including activities provision, and the domestic needs of the home. Care leaders take responsibility for liaison with outside professionals, which results in delivery of care in accordance with identified priorities and professional guidance. The process of staff recruitment ensures that all the checks and references necessary to protect service users are in place. EVIDENCE: Rotas showed the home to be staffed in the mornings by 5 or 6 care staff, and 4 in the evenings. These shifts included care leaders, whose tasks were largely office-based in the mornings. The activities co-ordinator’s hours are provided in addition to the care rota. On the previous Sunday the morning cover had been sustained by use of an agency worker. Staff said weekends posed some difficulties in maintaining cover, but the home has the advantage of a bank of relief staff and so agency use is minimal. Three waking staff are provided by night. Residents commonly described the care staff as continuously very busy, but had no complaints about quality of staff. One said they had waited half an hour for a response to a call bell, whereas others said response times were very quick. Records in respect of recent appointments were thorough, in accord with required regulations. A newly appointed night carer was spending time “shadowing” day staff during her first week of employment, and was to undertake the Trust induction course, prior to working on nights. Brookside Version 1.10 Page 17 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, 33 & 38 Staff project an attitude of shared endeavour whilst residents express confidence in the staff and management. The provider Trust has put a quality assurance system in place, within which the home has achieved to a high standard. Health & safety of residents and staff is well provided for, but recording of fire precautions requires attention. EVIDENCE: Residents considered themselves well informed about matters of importance to them in the home, by way of residents’ meetings, newsletters and individual care reviews. They were aware of quality assurance questionnaires, whilst the complaints and compliments record showed both that complaints were used constructively, and that appreciation of the home’s service to residents was consistently expressed. In staff shift handovers, observations and opinions of all staff were valued and demonstrated a shared emphasis on providing quality Brookside Version 1.10 Page 18 care. The home had a certificate for having recently achieved a recognised quality assurance standard. A care leader described and showed evidence of her designated responsibilities for health & safety matters. These included risk assessments for individual rooms, which were re-assessed in the event of accidents and falls. There was an up to date fire risk assessment, but there were some shortfalls in fire precautions recording, and it was not possible to ascertain who had current responsibility as “designated fire precautions officer”. There were, however, good records of fire drills. The Fire Officer had visited earlier, making some requirements for compliance before the end of July 2005. Brookside Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 x 3 3 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 4 3 x x 4 3 x x x x 2 Brookside Version 1.10 Page 20 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. 2. Standard 7, 8, 38 7, 8 Regulation 13 (5) 12 (1)(a) 15 (2)(b) Requirement Manual handling assessments must be completed in full. Pressure area risk assessments must indicate care decisions based upon them; be reviewed at an individually decided and recorded frequency; and identified risks must be included in short-term care plans. (Original timescale 31st October 2004) There must be a programme of regular inspection (six monthly suggested) under and around all wash hand basins to identify and rectify problems caused by rusting and limescaling. All housekeeping staff, including relief staff, must receive infection control training. The tiled bathroom and toilet floors must be assessed for comfort, safety and potential for adequate cleaning, with a view to replacement by modern alternative floor coverings. There must be a detailed survey of all external windows both for safety and potential for adequate cleaning of frames, leading to a programme for replacement of Version 1.10 Timescale for action 31st May 2005 31st May 2005 3. 26 13 (3) 31st May 2005 4. 5. 26 26, 38 13 (3) 18(1)(c) 13 (3), (4)(a,c) 31st July 2005 31st July 2005 6. 26, 38 13 (3), (4)(a,c) 31st July 2005 Brookside Page 21 those where risks are identified. 7. 38 23 (4) The Fire Officers requirements from his inspection of 01.03.2005 must be addressed, and identified shortfalls in fire precautions recording, including instructions to staff, be made good. 31st July 2005 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 7, 12 20 Good Practice Recommendations The activities co-ordinator should be allocated discrete time to evaluate social needs components of short-term care plans in detail every six months. Consideration should be given to whether additional space can be created to aid unimpeded provision of activities, particularly crafts. Brookside Version 1.10 Page 22 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Brookside Version 1.10 Page 23 - 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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