Inspection on 13/11/07 for Brookside

This inspection was carried out on 13th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 04/11/08

Brookside 26/09/06

Brookside 19/01/06

Brookside 27/09/05

Brookside 02/02/05

Brookside 14/05/04

Brookside 24/03/04

Brookside 16/12/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brookside Sinderland Rd Broadheath Altrincham WA14 5JA Lead Inspector Kath Oldham Unannounced Inspection 13th November 2007 09:00 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 Brookside DS0000032585.V348484.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. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookside Address Sinderland Rd Broadheath Altrincham WA14 5JA 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) 0161 928 9320 0161 941 5586 Joan.massey@trafford.gov.uk Trafford Metropolitan Borough Council Mrs Joan Ann Massey Care Home 45 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home provides accommodation for a maximum of 45 service users, 26 of whom require care by reason of old age (OP) and 19 of whom are older people who require care by reason of dementia (DE(E)). Separate lounge and dining space must be provided to meet the needs of the service users who require care by reason of dementia (DE(E)). There are currently 6 named older service users who require care by reason of mental ill health (MD(E)) and 1 additional named service user who requires care by reason of dementia DE(E)). Should any of these service users no longer require accommodation at the home, these places will revert to the service user category (OP). The Statement of Purpose must be maintained in line with the requirements of Schedule 1, of Regulation 4(1) of the Care Homes Regulations. The Statement must be kept under review and updated. Any changes to the home’s purpose must be agreed with the Commission for Social Care Inspection prior to implementation. The staffing arrangements at the home must be maintained in line with the minimum levels set out in the guidance published by the Residential Forum `Care Staffing in Care Homes for Older People`. This must be reflected in the Statement of Purpose. The home must be managed at all times in accordance with the guidance and regulations issued in respect of older peoples` homes by the Secretary of State for Health under Sections 22 and 23(1) of the Care Standards Act 2000. The authority must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th September 2006 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Brookside is a residential care home providing accommodation and personal care. The number of bedrooms decreased from 45 to 36 on the last inspection. A new certificate has not been issued to reflect this change in registered bed numbers, as Trafford has not formally informed the Commission of this change. The home is owned and managed by Trafford Metropolitan Borough Council. In addition, Brookside has a day care centre in a separate section of the building. This is where people who live in their own homes come for the day and spend time in the centre. The day care centre was not inspected as part of this visit. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 5 In addition to providing residential care, Brookside has allocated some beds to accommodate residents for assessment. This means that they come to Brookside either from hospital or from their own home and stay at Brookside when an assessment is undertaken to see if or how they can be supported to return home and retain their independence. This could, for example, be with home care support, which is assessed while they are staying at Brookside. There are currently nine residents who are accommodated temporarily this way. It was reported that for this service there is no charge made. Brookside is located in a residential area of Broadheath, Altrincham, close to public transport routes and local green belt. There is parking space for visitors. It was reported that the statement of purpose and service user guide are available to residents. A copy of the service user guide is placed in residents’ bedrooms. The fees charged by Brookside for accommodation is £389.80 per week. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced, which means that the manager, staff and residents were not told that we would be visiting, and took place on 13th November 2007, commencing at 9:00am. The inspection included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last inspection. We also sent the home a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Brookside was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Prior to the inspection, comment cards were sent for distribution to people staying at Brookside, relatives and staff. The views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Brookside and talking with the temporary managers and staff. A tour of Brookside was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Brookside was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents was looked at in detail to help form an opinion of the quality of the care provided. A brief explanation of the inspection process was provided to the temporary managers at the beginning of the visit and time was also spent with them on conclusion of the visit to provide verbal feedback. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: To promote best practice and to aid in identification a photograph of residents needs to be in their care file and with their medication administration record. Residents need to be given opportunities to take part in activity during the day on a regular basis as a means of stimulation and occupation. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 8 Brookside needs to arrange for professionals visiting or referring residents, to receive a questionnaire to provide them with an opportunity to comment on the service, which can be then used to provide an audit to report on the quality of the service provided. In line with regulations an application must be made to the Commission to vary the number of residents that can be accommodated in the home. This requirement is outstanding form the last inspection and needs to be addressed. The manager must ensure that accurate records are maintained for all prescribed medication and that records, storage and the administration of medications comply with the medication policy and procedures. To promote the dignity and privacy of residents, the star locks on bathroom doors should be removed and be replaced with a more appropriate type of locking system. A method of maintaining the privacy and dignity of residents in relation to the use of glass panels in bedroom doors needs to be found. The care plan needs to be further developed to detail the identified individual needs, expected outcomes and the support required to meet residents’ needs. This will go some way of ensuring that all staff provide residents with the care and support they need. Regular reviews of residents’ care need to be undertaken to ensure their care needs are altered as they change and that these are clearly recorded so staff are able to provide residents with the right level of care. Risk assessments for residents who are self-administering medication need to be put in place, which are accurate and up to date, so residents are safe. As a safeguard to residents and staff, a second signature must be in place to verify that handwritten medication has been copied correctly in the medication administration records. To promote best practice, staff who are trained and are competent to administer medication should detail their usual signature and initials, which should accompany the medication records. This will enable a check to be made on which member of staff has administered medication. To ensure an accurate record is maintained of residents’ medication, the number administered should be clearly recorded in the medication administration records. Consultation with residents and their relatives is needed on their preferences and interests in order to develop daily occupation, stimulation and activities. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 9 The Annual Quality Assurance Assessment (AQAA) completed by the manager indicated that they need to record any minor complaints, which are dealt with but are not recorded. This needs to be done so there is a clear indication that the home takes comments seriously and can demonstrate what they have done to put things right. The home needs to be maintained to a good standard and the identified misted double glazed windows need repair or replacement so that residents who are accommodated in these bedrooms can see out of their windows. Cleaning routines must be put into place that appropriately manages those areas of Brookside that were noted to have unpleasant odours. To comply with regulations, all events that affect the health, safety and wellbeing of residents need to be routinely notified to the Commission for Social Care Inspection in writing. 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. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 10 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 Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 11 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): 1, 3 & 6 (standard 6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents and their relatives are given information about Brookside to help them in making a decision about their care arrangements. Residents’ needs are assessed prior to admission so they are confident their needs will be met, and Brookside can meet their needs. EVIDENCE: The home had a statement of purpose and service user guide containing information to help prospective residents to make an informed choice about their care arrangements. A copy of these documents and the latest inspection report is available for residents and their relatives. The service user guide is placed within bedrooms so residents can refer to this at their leisure. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 12 Brookside is a residential care home providing accommodation and personal care. The number of bedrooms decreased from 45 to 36 on the last inspection. A new certificate has not been issued to reflect this change in registered bed numbers, as Trafford has not formally informed the Commission of this change. A requirement issued on the last inspection regarding this has not been complied with and has been repeated. We were told prospective residents are encouraged to visit Brookside before making a decision to move in. A resident said they had visited a few homes prior to making a decision. They said it had been an important part of the process and staff really helped to allay any anxieties and provide support. A member of the senior management team would visit any prospective residents in their own home prior to admission to carry out a pre-admission assessment. This assessment is used to develop the care plan. Brookside does not provide an intermediate care service. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 13 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 were not sufficiently detailed to identify individual residents’ needs and how these are met. Medication practice was not completely safe. EVIDENCE: Examination of the care files identified a statement of need, a plan for care and any risk identified as a consequence. The detail was, on occasions, not individualised to the resident, so it wasn’t clear what, how or when the care was provided. If the care plans are person centred, they could focus on identified individual needs, expected outcomes and list the support required to meet needs. The care plans do not currently include information on the resident’s perception of their own needs, or a positive focus on what the individual can do. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 14 The care plans included a profile, which contained basic information about life events. Developing this record further would ensure staff are aware of times when residents may need additional support, and could provide information about the lifestyle that was preferable to the resident. Residents were not sure how, for example, staff knew what time they liked to get up or go to bed. Residents said, “staff just come and get you ready in the morning and let you know when you need to go to bed”. One resident added that they were “usually tired when the staff tell me it is time for bed”. There was little evidence that there was a good system for carrying out regular reviews of the care plans. An evaluation sheet may provide the opportunity for staff to monitor individual care needs and record any significant changes in health care and social/emotional care needs, and amend the care plan appropriately. A comment card indicated, “I feel that communication between staff could greatly be improved. I once asked how my (cared for relative) walking was doing (after a fall). The worker on her wing did not know she had fallen. She told me she must have not read the file thoroughly enough!” A further relative indicated, “On occasions I feel that I have to drive the situation, i.e., getting GP to visit. Asking the district nurse to visit earlier than planned”. In response to the question, ‘What do you feel the care home does well’, one relative responded, “Attempts to keep clients safe, fed, cared for, etc., but like any establishment, the staff are the deciding factor”. A relative said in response to the question ‘what do you feel the home does well’, “inform me if there are any problems”. A relative said, “I am very rarely contacted about anything. My (cared for relative) rarely writes and its never informative. I would appreciate knowing if there are things she needs or if there are any health worries. I would like a monthly or quarterly report on her health and needs would be nice”. Comments also included, “Communication needs improvement, is poor verbally and written … care plans not up to date always”. Examination of the medication administration records could not confirm, on occasions, that prescribed medication had been given to residents. There were photographs on the medication records for residential residents, however for residents who were staying at Brookside for assessment, which could be for any period up to about six weeks; there were no photographs available. Photographs are used to identify residents, as is best practice. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 15 There were handwritten medication records these need to be signed and also signed and verified by a second member of staff to confirm that the detail has been accurately copied from the prescription. A recommendation was made on the last inspection to undertake this, which has not been addressed. Specimen signature and initials of staff who have been trained in medication administration could not be located. Senior staff said that these were usually with the medication records but could not locate where they had been placed. The medication administration records contained signatures for medication administration to residents, which had then been crossed out. This does not confirm that staff are signing for medication administration at the same time they give out medication to residents. This practice must stop. Medication must be signed for as administered to ensure an accurate record is maintained. It was good that staff recognised that some residents were able to look after some of their own medicines but there was no record of what steps they made to make sure people who did this were safe from harm. Some residents are prescribed a variation to their medication, for example, one or two tablets. The actual number administered was not indicated. To ensure an accurate record is maintained, this should be clearly recorded in the medication administration records. Medication, which has a limited shelf life, should be marked on the bottle and box with the date it was opened to ensure that the medication is safe to use. Eye drops prescribed to a resident were not indicated in this way so it wouldn’t be known when or if they needed to be discarded. On the visit, a tablet was observed on a dining room table. We were told that a resident had been given the tablet and had gone to their room to do something else. Leaving tablets unattended can potentially put other residents at risk, as they could take the tablet undetected. The administration of medication needs to be looked at to make sure that residents take their medication when staff administer it and staff support residents to take it at this time. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 16 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. Social activities need to be developed, so all residents benefit from stimulation. Visitors are welcome in the home; the meals provided need to offer more choice. EVIDENCE: Information provided by Brookside before the visit identified that they feel they need to “offer more in-house activities” and, in the next 12 months, they plan to “look at activity programme to offer more in-house activities”. There was no activity programme for residents to choose from. From discussion with residents, it was evident that Brookside consistently offered limited or no daily activities. We were told the local college has withdrawn the activities they provided. The home needs to consult with residents and their relatives on their preferences and interest in order to develop an activities programme. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 17 One resident said, “the days seem so long, the next thing you know you have been asleep, there is nothing to do except go to sleep”. The lunchtime meal was a relaxed and social occasion. pleasantly presented and set in small groups. Table settings were Residents said they were usually offered a choice of menu, however there were mixed comments about the meals and the way, on occasions, they were cooked. One resident said they didn’t know whether it was the cut of meat or the cooks’ abilities to cook the food, which sometimes made the meal not enjoyable. Other residents were complementary about the quality of the meals served at Brookside. Another resident said sometimes there is nothing they like on the menu and they have to just have something made quickly. A relative in response to the question ‘what do you feel the home does well’ responded, “meals”. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 18 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. Procedures for dealing with complaints were in place, however there were no recordings to evidence the procedure. Staff had undertaken training in adult protection to protect residents from neglect and abuse. EVIDENCE: The complaints book did not detail any recent complaints or comments, which did not validate the procedures in place. The Commission for Social Care Inspection has not received any complaints. A relative commented that they felt there was, “room for a lot of improvement, staff make light of some serious matters”. Some staff don’t spend enough time out of the office (lack of incentive)”. In response to the question, ‘Do you know how to make a complaint about the care provided by the home if you need to’, one relative responded, “I would make it my business to gain this information if needed. I recall notices on the communal areas regarding this topic”. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 19 Brookside has in the past arranged focus group meetings, which residents and their friends and relatives have attended to discuss the development of the home. These have not been arranged for about four months and we were told that there was a plan to start these up again if that is what residents and their families wanted or introduce a newsletter to stimulate feedback. The statement of purpose indicated that these focus groups take place monthly. In discussion with staff it was evident that they had a good understanding of issues surrounding abuse. Staff were aware of policies and procedures designed to protect residents from abuse and knew the procedures to follow in the event of any allegation. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence, including a visit to this service. The lack of attention to detail does not promote the comfort and respect of residents. EVIDENCE: There are 36 single bedrooms so everyone is afforded the privacy that a single room provides. The bedroom doors have glass fitted in them so it is possible to see shadows through the window, which does not afford residents privacy and dignity. Some bedrooms have curtains fitted to the door as a means of promoting residents’ dignity and privacy whilst using their room. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 21 All the bedrooms have been redecorated since the last visit and looked bright and clean. The bedrooms have all been decorated the same. We were told that residents said that they wanted a neutral colour so they could put their own personal items in the room, which would match. Residents spoken to said they thought the bedroom walls were yellow which they felt wasn’t a neutral colour. A number of residents couldn’t recollect being asked their views on the colour scheme. Whilst looking at the bedrooms it was identified that some of the curtains were without hooks or the hooks weren’t fitted to the curtains or the rail. Incontinence pads were in bedrooms as opposed to them being put away. Bedroom doors were left open wide so anyone could walk into residents’ bedrooms, which doesn’t promote the privacy of residents and their personal belongings. One bedroom had a hoist stored within the room, which we were told was not used by the resident. Prescribed creams, shampoo, talcum powder and cleaning fluid were within bathrooms. This practice does not promote the respect and dignity of residents and if people use creams other than the person they are prescribed to, this could lead to cross-infection. The house hasn’t had external windows or doors painted, some of which are in need of repainting. A number of the windows within residents’ bedrooms were misted so residents would not be able to see out. There was an odour of incontinence within some bedrooms and corridors. We were told that these odours were not as bad as had been previously experienced, due to the improved routines in the home, the products used and the toileting programmes in place. It was unclear whether the odours could be totally eliminated as the carpets in some areas were quite old and no end of cleaning would get rid of the ingrained smell. The odours need to be eliminated. A call bell system is in place, which residents can use to summon staff for support or assistance. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 22 At a previous visit there was a requirement to remove the star locks from bathroom doors and replace with a more appropriate type of locking system. The star locks are still in place and an additional key lock has been fitted. The purpose of the requirement was to have locks on the bathroom doors so residents can lock the rooms when using the bathroom. We were told that Brookside had misinterpreted the requirement and now understood that privacy locks should be fitted to all bathroom doors. There is a smoke lounge where residents are able to smoke. We were told this meets the requirements of the new legislation in relation to smoking. A comment card indicated, “The smoke room door is left open when occupied. A bit pointless don’t you think”. On the visit there were occasions when the smoke lounge door was left open when in use. There are four combined lounges and dining rooms and residents were seen in the lounges resting or having meals. Each “unit” has nine residents who accommodate the bedrooms in that area. The lounges and dining kitchenette were clean and a variety of seating was in the lounges. Patio doors lead out from the lounges on the ground floor. One resident said it was lovely looking out onto the garden and seeing the birds and squirrels. We were told that the kitchenettes had been upgraded since the last inspection visit. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence, including a visit to this service. Residents are protected by the training provided by Brookside. The use of agency staff compromises the quality and continuity of care to residents. EVIDENCE: There have been no new staff appointed at Brookside since the last inspection. When vacancies have arisen, staff have transferred from care homes which were owned and managed by Trafford Council into vacant posts at Brookside. We were told that staff have, on occasions, found it difficult to transfer into these posts, as they have not always chosen to work at Brookside. Brookside engages a lot of agency staff. Comments received on the visit and from comment cards have been critical of this. In response to the question, ‘how do you think the home can improve’, one relative said, “Have no agency staff or only use when the need is of absolute necessity”. Another comment was, “When agency staff are on duty I sometimes am at a loss to understand their accents. My (cared for relative) does not try as its too difficult for her. I have observed this with other clients living there”. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 24 In response to the question, ‘How do you think the home can improve’, a relative said, “more staff to undergo all the jobs they have to do”. In response to the question ‘what could the service do better’, a comment card said, “Employ more cleaners and permanent care staff”. Another commented, “Employ more permanent staff instead of using agency staff. Stop putting job freezes on”. Examination of the staff duty roster identified that, on occasions, there are three agency staff on duty each day. Staff have to spend time with agency staff to let them know about the care and support residents’ needs. Relatives said that the care is not the same when agency staff are supporting residents, as they don’t know their cared for relatives well enough to provide their care and support to a standard they are used to. We were informed that interviews were taking place to recruit to the vacant posts in forthcoming weeks, when it is hoped these vacancies will be filled. There are four care staff on duty during the day plus a senior member of staff. The manager is in addition to these numbers. Training needs were identified through the staff supervision programme. All staff spoken with said they had plenty of opportunities to access ongoing training and development opportunities. A comment card indicated, “More training is required”. One member of staff said they had recently received updated training on a range of care related topics. Staff do not routinely have staff meetings where they would have an opportunity to discuss the development of Brookside and be involved in the running of the home. We were told that a staff meeting was scheduled for later in the week of the inspection. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 25 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, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The management team are approachable and there is a focus on meeting the needs of residents. EVIDENCE: The registered manager is currently absent from work and, in the interim; a manager from another home owned and managed by Trafford Council is providing management support. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 26 The senior management team supports staff, and there was evidence of an ongoing supervision programme for staff. This ensures that senior staff monitor the performance of staff and any training needs are identified. One member of staff confirmed that they received regular supervision, and that there was a rolling programme for training and development. A representative from the Trafford Council, in line with Regulations, visits the home unannounced once a month and undertakes specific tasks to check that Brookside is being managed appropriately. The reports of these visits have been completed with a copy supplied to the manager, which is kept at Brookside available for examination by the Commission. The accident book details accidents, incidents and occurrences experienced by residents. The details of events that affect the residents should be sent routinely to the Commission for Social Care Inspection, in line with regulations. This hasn’t been happening routinely and needs to be addressed. The home maintained records in respect of fire safety at Brookside. The checks to fire safety equipment were recorded as having been completed as required by the fire authority. This practice safeguards residents and staff. A quality assurance system is in place that seeks the opinions of residents and relatives in terms of their day-to-day experiences. The outcome of the survey needs to be produced and given to people who have contributed to the survey in a format that is understandable. The quality assurance survey needs to be extended to seek the views and opinions of professionals who come to Brookside. Information provided in the Annual Quality Assurance Assessment (AQAA) forwarded to the Commission indicated that appropriate policies and procedures were in place for the effective running of Brookside. However, some policies were not recorded as having been reviewed. Health and safety procedures presented as being effectively implemented. A selection of records relating to the maintenance of equipment was looked at. These were appropriately maintained. Staff confirmed they were provided with protective equipment, including disposable gloves and aprons, to minimise the risk of cross-infection. During the inspection no obvious risks to the health and safety of people living at the home were observed. Maintenance checks are undertaken and contractors contacted to ensure equipment is working correctly. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 27 The home does not handle the finances for any of the people living at Brookside, as their families or their representative assist them. There were small amounts of money held on behalf of some residents for such things as hairdressing or toiletries. For the sample looked at, receipts were in place for purchases made. Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 28 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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 29 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 OP9 Regulation 13 Requirement Timescale for action 11/01/08 2 OP19 13(4)(a) 3 OP19 23 The manager must ensure that accurate records are maintained for all prescribed medication and that records, storage and the administration of medications comply with the medication policy and procedures. ‘Star’ locks must be removed 11/01/08 from bathroom doors and be replaced with a more appropriate type of locking system. (Previous timescale of 23/11/06 not met). A method of maintaining 11/01/08 residents’ privacy and dignity in relation to the use of glass panels in bedroom doors must be found. (Previous timescale of 23/11/06 not met). Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 30 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 OP2 OP7 Good Practice Recommendations An application must be made to the Commission to vary the number of residents that can be accommodated in the home. Care plans should be developed to include all identified individual needs, expected outcomes, and detail the support required to meet residents needs and should be regularly reviewed. Ensure that risk assessments for residents who are selfadministering medication are in place, and are accurate and up to date, so residents are safe. A second signature must be in place to verify that handwritten medication has been copied correctly in the medication administration records, to ensure residents get the correct medication. To promote best practice and to aid in identification, photographs of residents need to be with the medication administration records. To promote best practice, staff who are trained and are competent to administer medication should detail their usual signature and initials which should accompany the medication records. To ensure an accurate record is maintained of medication, the number administered should be clearly recorded in the medication administration records. Consult with residents and their relatives on their preferences and interest in order to develop occupation, stimulation and activities. Further develop the menus providing meals that are cooked to residents’ preferences and are residents’ choices. Record all comments and complaints made to Brookside and the investigation and outcome for the complainant. Ensure the home is maintained to a good standard; replace the misted double glazed windows. 3 4 OP9 OP9 5 6 OP9 OP9 7 8 9 10 11 OP9 OP12 OP15 OP16 OP19 Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 12 13 14 Refer to Standard OP26 OP27 OP31 Good Practice Recommendations Cleaning routines must be put into place that appropriately manage those areas of Brookside that were noted to have unpleasant odours. Appoint staff to the vacant posts to ensure that the care and support of residents is provided consistently by staff who know them well. All events that affect the health, safety and wellbeing of residents need to be routinely notified to the Commission for Social Care Inspection, in writing, in line with regulations. It is recommended that the home develop a report of the findings of any quality audit questionnaires and insert it into the home’s statement of purpose as part of its quality monitoring process. It is recommended that all policies and procedures are regularly reviewed to ensure information is up to date. 15 OP33 16 OP38 Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Brookside DS0000032585.V348484.R01.S.doc Version 5.2 Page 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!