CARE HOMES FOR OLDER PEOPLE
Brookside Sinderland Rd Broadheath Altrincham WA14 5JA Lead Inspector
Helen Dempster Unannounced Inspection 27th September 2005 10:00 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.V253997.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 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.V253997.R01.S.doc Version 5.0 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. 2nd February 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.V253997.R01.S.doc Version 5.0 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.V253997.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on 27th September 2005 by 2 inspectors. The inspection took approximately 4.25 hours to undertake. Time was spent talking with the manager, residents and staff. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the operational part of the home, the management arrangements, 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 this best reflected the function and purpose of the service. What the service does well:
The management team had attended a course about person centred care planning. This approach to care plans was in the easily stages of being implemented into the home. Once implemented it would enable the home to consistently produce care plans, which reflect the views and wishes of residents. Daily records for those residents sampled demonstrated that a range of health care professionals met residents’ health needs. Overall, good practice was evident in the storage and administration of medication. When talking to residents, they confirmed that they were treated with respect and that their privacy was maintained. The home welcomed visitors to the home and endeavoured to consult residents about the running of the home and activities provided. Residents were in receipt of a nutritious and appealing diet with choices offered. The home had a clear complaints procedure and a record of complaints. Good practice was evident in that the record was balanced with the inclusion of compliment letters and complaints had been followed up in writing. The “Protection of Adults from Abuse Policy” was readily available at the home and staff had received training in protecting adults from abuse. At the time of inspection, 12 of the 25 staff had achieved NVQ level 2. This almost meets the target of 50 of staff holding the award by the end of 2005. All staff had a training record and copies of training certificates inclusive of the personnel file. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 7 The manager was experienced. She had good communication between herself and the staff team. Residents spoken with said the manager was very approachable and caring. What has improved since the last inspection? 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.V253997.R01.S.doc Version 5.0 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.V253997.R01.S.doc Version 5.0 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, 4 and 6 Residents’ needs were not consistently assessed and documented in sufficient detail to enable staff to form a care plan. However, management training in person centred care planning and proactive attempts to resolve staffing difficulties should address this problem. EVIDENCE: The initial assessments of residents sampled at the time of inspection did not provide a detailed assessment of needs from which the care plan could be formed. The manager explained that staffing shortages had resulted in using agency staff fairly extensively and that this had resulted in managers spending more time assisting and supporting these staff in the delivery of care to residents. (See staffing for further details). The manager stated that this had resulted in some aspects of record keeping being behind. Advice was given on the assessment process and transfer of information into the care plan and a requirement was made accordingly. At the previous inspection, a requirement was made to the effect that the home must review the process of consulting service users as to how the home can meet their assessed needs. This requirement had not been actioned and
Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 10 has been repeated. However, it was acknowledged that the management team’s attendance on a course about care planning, which was based on the views and expressed wishes of residents about how they wished to be cared for (person centred planning), would have a significant positive impact on assessment and care planning when staffing issues had been resolved and the managers were able to devote time to implementing these care plans. The home does not provide intermediate care. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Residents’ health, personal and social care needs were documented in a care plan. However, staffing difficulties were impacting on the review of care plans. Overall, the management of medication was safeguarding the residents and residents were treated with respect and their privacy was maintained. EVIDENCE: A number of care plans were sampled. Overall, they detailed the way in which each resident should be cared for. However, there were gaps in information recorded. The manager said that recent staffing difficulties meant that the key worker system was not fully operational due to the high usage of agency staff. Care plan profiles were, however, used in conjunction with the main plan and these provided a summary of the care plan which staff used as a daily guide to meet residents’ needs. A weakness found from examining the records was that not all records were dated and the care planning system was not being reviewed on a monthly basis. A requirement was made accordingly. The manager explained that the management team had attended a course about person centred care planning. The manager said that she had found this
Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 12 course to be excellent. The learning achieved and skills developed were apparent when viewing examples of care plans prepared after this course attendance, which were of a high standard and clearly reflected the views and wishes of residents. The manager had not been able to extend this good practice to all care plans due to staffing difficulties (See choice of home for details). However, it was apparent that these learned skills would have a positive impact on care planning when fully implemented, which is commendable. Brookside has five separate units and the manager stated that this can result in logistical difficulties in care staff accessing information. She had dealt with this proactively by obtaining funding to purchase lockable cupboards on each unit to store confidential information about residents living there. Daily records for those residents sampled demonstrated that a range of health care professionals met residents’ health needs. The home administered medication from a monitored dosage system. Overall, good practice was evident in the storage and administration of medication. Particular examples of good practice included writing to residents’ GPs to obtain updated information and clarification about residents’ medical conditions and prescribed medication and the use of a helpful card system which included a photograph of each resident alongside details of medical history. At the time of inspection, the dosage of one resident’s medication had been changed, but the record did not indicate the date of the change and who made the change. A requirement was made accordingly. When talking to residents, they confirmed that they were treated with respect and that their privacy was maintained. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home welcomed visitors to the home and endeavoured to consult residents about the running of the home and activities provided. Residents’ were in receipt of a nutritious and appealing diet with choices offered. EVIDENCE: The home has an open visiting policy, although visitors were asked to avoid mealtimes. Residents said that their visitors were made welcome. At the previous inspection, a requirement was made to the effect that the home must evidence that it has consulted residents about their preferences at meal times and on social care issues. This requirement had been addressed by introducing menu choices and documenting residents’ choices each day. The home also held focus meetings to obtain the views of residents. The most recent focus group meeting was held in April 2005 and it would benefit residents to hold these more frequently. The manager said that a meeting was planned to consult residents about the introduction of film evenings and other activities. She added that she had recently been allocated £1,000 to purchase equipment for activities. She said that residents would be consulted on what to use this money for. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 14 The home has a rotating menu, which offers a nutritious and varied diet to residents. Residents said that the food was good and confirmed that they were offered choices. At the time of inspection, a hairdresser was at the home and the ladies who used this weekly service said that it was good. The home offers a weekly art class and health and beauty class provided by a local college. At the time of inspection, some residents were enjoying the art class, which they said was good. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints procedure was available to allow residents to air their views and raise concerns. The availability of, and staff familiarity with, the ‘Protection of Adults from Abuse Policy’ protected residents. EVIDENCE: The home had a clear complaints procedure and a record of complaints. Good practice was evident in that the record was balanced with the inclusion of compliment letters and complaints had been followed up in writing. A letter from a resident about a current affairs programme concerning residential care homes and a response from the department of health was also stored in the record as the resident had made direct and positive reference to the staff at the home and care received. The ‘Protection of Adults from Abuse Policy’ was readily available at the home and staff had received training in protecting adults from abuse. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 16 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 and 26 Overall, the home was clean, tidy and comfortable but needed redecoration. The planned completion of fire safety work on the premises would increase the level of health and safety for residents and staff. EVIDENCE: A partial tour of the premises was undertaken. The home was clean and comfortable, but needed redecoration as wallpaper was torn. The manager stated that redecoration was planned following completion of essential fire safety work. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 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. 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. EVIDENCE: At the time of inspection, the home was experiencing some staffing difficulties. This was impacting on aspects of the provision, including record keeping and continuity of care. The home aimed to deploy one carer to each lounge area, with additional senior staff providing support. Both the manager, and another member of the management team, expressed concerns about the degree to which staffing vacancies and the subsequent use of agency staff was creating difficulties at the home. One example given was a recent occasion when 5 agency staff were booked to care for residents and only 3 turned up. Other examples included the use of 5 agency staff on one shift, deployed to the 5 units at the home, with one member of the management team working hard to support these staff in an attempt to meet residents’ needs. The staffing problems were reflected in a report of a recent statutory visit to the home by a senior manager from the organisation. The manager said that she had felt supported by this manager and had been given approval to advertise vacancies more widely in an attempt to recruit staff. Residents said that the staff were good and caring but some had expressed concerns to this senior manager about language difficulties experienced with some agency staff. The manager
Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 18 was aware of this and was monitoring the situation. The manager stated that her request to her line manager for additional management support to allow managers to update care plans and other records had been agreed. At the time of inspection, 12 of the 25 staff had achieved NVQ level 2. This almost meets the target of 50 of staff holding the award. All staff have a training record and copies of training certificates are held. Staff have at least 3 days training each year. Staffing shortages had impacted on the frequency of staff supervision and a requirement from the last inspection about this was repeated. The home has a recruitment procedure, which includes obtaining appropriate references and checks, including CRB checks. There were no new applications since the previous inspection to review. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38. The residents benefited from an experienced manager that had good communication skills and understood the lines of accountable with the management of the home. This approach resulted in the home running in the best interests of the residents. EVIDENCE: Throughout the inspection, the manager was seen to talk openly about staffing difficulties and their impact on the running of the home. In this context, she clearly demonstrated her commitment to resolving the problems in the interests of residents. She had good communication skills, in particular with residents and their families. The residents spoken with all said positive things about the manager. The manager stated that she had applied to study towards a Diploma in Dementia Studies. She explained that as many of the residents had dementia, this training would enable her to increase her knowledge and understanding of the condition. This would have a positive
Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 20 impact on the service and is commendable. Overall, the manager was felt to exceed this minimum standard. All fire safety checks were up to date. A requirement made at the previous inspection concerning fire safety in the building had not been actioned and was therefore repeated. However, the organisation was in the process of planning this work. The manager stated that oxygen was in use for one resident. A requirement was made to the effect that risk assessments were completed which addressed the environmental risks and the risks to the individual resident, which needed to be documented in the care plan. Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
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 2 2 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X X X 3 2 X 2 Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NO 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 OP3 Regulation 14(1) Requirement Information from the needs assessments must consistently form the care plan and must be subject to review to take account of any changes in need. The home must review the process of consulting service users as to how the home can meet their assessed needs. Care plans must be reviewed frequently and, wherever possible, be signed by the resident and their representative. When the dosage of residents’ medication is changed, the record must indicate the date of the change and who made the change. Timescale for action 15/11/05 2 OP4 3 OP7 15 15 15/11/05 15/11/05 4 15/11/05 OP9 13 5 OP27 18 The home must consistently monitor staffing levels and deployment of staff to meet residents’ needs. 15/11/05 Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 23 6 OP36 7 OP38 12 18 The home should ensure that programmes of supervision and staff meetings are sustained in the home. Risk assessments must be completed concerning one resident’s use of oxygen. These must address the environmental risks and the risks to the individual resident, which must be documented in the care plan. 15/11/05 15/11/05 8 OP38 12 15/11/05 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 which was warped. . RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brookside DS0000032585.V253997.R01.S.doc Version 5.0 Page 24 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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