CARE HOMES FOR OLDER PEOPLE
Brookside Sinderland Rd Broadheath Altrincham WA14 5JA Lead Inspector
Helen Dempster Unannounced Inspection 1:35pm 19 January 2006
th 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.V276137.R01.S.doc Version 5.1 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.V276137.R01.S.doc Version 5.1 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 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.V276137.R01.S.doc Version 5.1 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. 27th September 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Brookside is a Registered Care Home, which provides accommodation and personal care to 45 older people. The home is owned and managed by Trafford Metropolitan Borough Council. The home is located in a residential area of Broadheath, Altrincham, close to public transport routes. There is ample parking space for visitors to the home.
Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 5 The home is purpose built and is divided into 5 units, 3 of which accommodate 27 older people and 2 of which accommodate older people with dementia. Each of the 5 units has its own lounge/dining area and kitchen. The home is therefore able to provide a separate living area, with bedrooms located close by. Accommodation is provided in 45 single rooms. There are 6 bathrooms and 12 toilets to meet residents’ needs. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the home’s second inspection of the year and was unannounced. It was carried out on the afternoon of 19th January 2006. Some part of the inspection was spent discussing a complaint received by the CSCI. Time was also spent discussing welfare matters relating to the residents that the home supported and examining documentation in relation to the running of the home, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as “residents”. It was felt that this best reflected the function and purpose of the service. The inspection only looked at a limited number of standards, so this report should be read together with the earlier report to get a full picture of how the home is meeting the needs of the residents living there. What the service does well: What has improved since the last inspection?
All but one of the requirements made at the previous inspection had been met and the remaining requirement was in the process of being met. A number of improvements in practice at the home were noted during this inspection. Care plans were being reviewed more frequently and the manager had designed a new form for staff to fill in and record monthly reviews of care. Medication practice had improved. This included ensuring that the records
Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 7 noted the date when the dosage of residents’ medication is changed and who made the change. Risk assessments had been completed concerning one resident’s use of oxygen. Staff supervision was being provided regularly in response to a requirement made at the previous inspection and staff had received a personal review and development plan meeting. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 8 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.V276137.R01.S.doc Version 5.1 Page 9 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 4 Person centred residents’ needs assessments allowed staff to meet residents’ needs in the way each individual resident preferred. EVIDENCE: At the previous inspection, assessments of residents’ samples did not provide a detailed assessment of needs from which the care plan could be formed and the home needed to review the process of consulting residents as to how the home could meet their assessed needs. Requirements were made accordingly. The manager and staff had worked hard to address these requirements and needs assessments sampled were person centred and reflected residents’ individual needs. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. Documenting residents’ health, personal and social care needs in detailed, person centred, care plans provided staff with clear guidance to meet residents’ needs and the management of medication was safeguarding the residents. EVIDENCE: At the previous inspection, a requirement was made to the effect that care plans must be reviewed frequently and, wherever possible, be signed by the resident and their representative. This requirement had been met. Those care plans sampled were of a high standard and exceeded the minimum standard. In particular, care plans were person centred taking account of individual needs and wants, linked well with the needs assessments, consistently provided evidence of consultation with residents, made reference to respect for privacy and dignity when delivering care and had a strong focus on the impact of dementia on residents’ needs and behaviour. This is commendable. The manager had also devised a new auditing tool for recording monthly reviews of care. At the previous inspection, a requirement was made to the effect that when
Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 11 the dosage of residents’ medication is changed, the record must indicate the date of the change and who made the change. This requirement had been actioned and a clear audit trail of medication was in place. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A EVIDENCE: These standards were assessed at the previous inspection and will be assessed again at the next inspection. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 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. Residents benefited from a complaints procedure, which allowed residents and their relatives to air their views and raise concerns and receive an appropriate response. EVIDENCE: Just prior to the inspection, a complaint was received by the CSCI from the relative of a former resident of the home. The complaint concerned the care of a former resident just prior to their admission to hospital and subsequent death in hospital. The home was advised of the concerns raised and instructed to conduct a full investigation and report back their findings to both the complainant and the CSCI. It was noted that the records of the former resident had been archived at the organisation’s head office. The manager agreed to hand deliver the records to the CSCI for the inspector to view and it was strongly recommended that the home holds residents’ files for at least 3 months after their discharge from the home. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 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. The exterior of the building was in a poor state of repair, which had the potential to put residents, staff and visitors at risk. EVIDENCE: This standard was not fully assessed. However, the eaves on the exterior of the building were noted to be in a poor state of repair. A requirement was made to the effect that an assessment of the condition of the building is made by the organisation and an action plan forwarded to the CSCI as to when essential work would be completed. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 15 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 Reductions in the numbers of residents accommodated and consequent improvements in staffing levels had resulted in more regular staff supervision and better record keeping and care plans. This benefited the residents. EVIDENCE: At the previous inspection, staffing shortages and consequent use of large numbers of agency staff on shifts was having a negative impact on continuity of care, record keeping and the management team’s role. At that time, managers and staff were working hard to minimise the impact on residents’ care and were supported by the organisation. However, aspects of record keeping, the keyworker role and frequency of staff supervision were a shortfall at that time. The requirement made at that time to the effect that the home must consistently monitor staffing levels and deployment of staff to meet residents’ needs had been met. The manager was monitoring staffing levels consistently, although agency staff were still being used to meet minimum levels. The manager explained that wherever possible, the home uses the same agency workers who are familiar with the home and residents. Since the previous inspection, the number of residents accommodated had reduced in preparation for a day care service to be set up in one unit of the home. This service will be run separately from the residential home. The reduction of resident numbers had eased the staffing situation. Therefore managers had implemented regular staff supervision, record keeping had improved and care plans were of a high standard.
Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 16 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): 36 and 38 Staff were supervised which protects residents. However, fire safety standards of the building had the potential to put residents at risk. EVIDENCE: Staff supervision was being provided regularly in response to a requirement made at the previous inspection. From viewing staff files, it was also evident that staff had received a personal review and development plan meeting in 2005. A requirement was made at the previous inspection to the effect that risk assessments must be completed concerning one resident’s use of oxygen. This had been addressed. A requirement was also made at the previous inspection to the effect that the home must complete work relating to fire safety standards identified on
Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 17 previous inspections of the home. This related to detection and containment in the event of a fire, including fire detection in bedrooms and fire seals to bedroom doors. Just prior to the inspection, the inspector had met with senior managers from TMBC to discuss this issue. TMBC had costed the work to be done and were in the process of inviting tenders to complete the work. The requirement was therefore reiterated until the work commences. It is, however, acknowledged that TMBC are working towards meeting this requirement. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 18 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 2 Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 19 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 OP19 Regulation 23(2) Requirement An assessment of the condition of the building must be made by the organisation and an action plan forwarded to the CSCI as to when essential work would be completed. Timescale for action 19/03/06 8. OP38 12 19/05/06 The home must complete work relating to fire safety standards identified on previous inspections of the home. This related to detection and containment in the event of a fire, including fire detection in bedrooms and fire seals to bedroom doors and the replacement of the fire door on South corridor, upper floor that was warped. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 20 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 OP37 Good Practice Recommendations It is strongly recommended that the home hold residents’ files for at least 3 months after their discharge from the home. Brookside DS0000032585.V276137.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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