CARE HOMES FOR OLDER PEOPLE
Brookvale Care Home 111 Warwick Road Olton Solihull West Midlands B92 7HP Lead Inspector
Lesley Beadsworth Unannounced Inspection 11:30 24th September & 26 September 2007
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 Brookvale Care Home DS0000004535.V336654.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. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brookvale Care Home Address 111 Warwick Road Olton Solihull West Midlands B92 7HP 0121 706 9097 0121 706 0467 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) Heart Of England Care Mrs Tracey Belinda Arms Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (61) Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That the home can provide care and accommodation for older people, over 65 years of age who have dementia, mental disorder, excluding learning disabilities. That the home can accommodate two named people, under 65 years of age with dementia. 31st May 2006 Date of last inspection Brief Description of the Service: Brookvale Care Home was built approximately 30 years ago and accommodates up to 61 service users with mild to moderate cognitive deficits and dementia. The home does not offer nursing care. The home is over three floors, each comprising two lounges, dining room and activity areas. There are no ramps as these have been assessed as not required, the home has a passenger lift, and flat access to the garden areas, which are mature with some raised flower beds, there is also an aviary. The home has a full-time activity organiser. The home has a snoozlem installed in the smaller lounge on the ground floor. The home is situated in Olton, Solihull and is close to local amenities, and the local bus services. The home receives visits from the local church, and service users may participate in religious services if they desire. The registered manager advised that current fees are £359.64 to £359.64. Additional charges are made for hairdressing, newspapers, personal toiletries, alcohol, dry cleaning, private telephone calls, staff accompaniment for individual external visits, taxis, transport for appointments and TV in bedrooms. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included a visit to Brookvale. As part of the inspection process the registered manager of the home completed and returned a Pre-Inspection Questionnaire containing further information about the home and an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Some of the information contained within this and in notifications of incidents that have occurred since the last inspection have been used in assessing actions taken by the home to meet the care standards. A random unannounced inspection was carried out on the 14th November 2006. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11.30am and 8pm on the first day and 3pm and 7pm on the second day. What the service does well:
Efforts have been made by the manager to address the issues related to the behaviour of a small number of residents including having separate living areas for males and females and referring residents for review and reassessment. Three care files were examined as part of the case tracking process. Each of these files had a care plan. These were devised from the assessments that had identified the needs of the residents and in the main related to them. Care files included assessments related to the risk of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) and preventative measures such as pressure relieving mattresses and cushions were in use. Nutritional screening and dietary likes and dislikes were recorded and the weights of residents were measured at regular intervals to ensure that residents’ nutritional needs were met.
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 6 Care files included assessments related to the risk of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) and preventative measures such as pressure relieving mattresses and cushions were in use. Nutritional screening and dietary likes and dislikes were recorded and the weights of residents were measured at regular intervals to ensure that residents’ nutritional needs were met. All residents observed or spoken with during the visit were well groomed and appropriately dressed. The registered manager advised that the senior care requests that the GP reviews all medication every three months and that this is carried out, thereby ensuring that residents continue to receive appropriate medication. Staff were seen to be treating residents with respect and in a dignified manner. Preferred names were established and recorded in care plans and were heard to be used by staff. Those residents who were able to communicate confirmed that this was the case. All residents were dressed appropriately and in an age related fashion, further maintaining self-esteem. Residents benefited from the home employing two activity organisers and observations and discussion showed that people living at the home were occupied and stimulated. Visitors were seen to be greeted in a friendly and respectful manner and there was a comfortable rapport between them and staff. The home offers a choice in each of the three cooked meals provided for the people living at the home with a varied and nutritious menu. People requiring a special diet are catered for. The kitchen area was very clean, hygienic and in good order with the cook discussing the determination to provide a high standard of catering for the people living at the home. The home has a complaints procedure that is available to residents and visitors. A copy is also included in the Statement of Purpose. The procedure includes appropriate stages and timescales and indicates that complaints are taken seriously. The home has appropriate policies, procedures and training to safeguard residents against abuse. All areas visited were clean and free of offensive odour offering the residents a comfortable place to live. The gardens are well maintained and accessible to residents by the use of ramps. Systems were in place for preventing cross infection including appropriate hand washing facilities and cleaning equipment appropriately labelled for the area they were to be used. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 7 The greater majority of care staff have achieved National Vocational Qualification Level 2 or 3 in Care, exceeding the required 50 of care staff with this qualification. Having this qualification indicates that they have been assessed as competent in their role. Satisfactory recruitment practice protects residents from the employment of unsuitable people. A person with the appropriate qualifications and who has previous management experience manages the home. A member of staff said that the management was “excellent” and visitors spoke positively of the management of the home and the approachability of the management team. The registered manager advised that staff supervision is undertaken and is on target to take place six times a year. A random sample of Health and Safety and maintenance or service checks records were looked at and were in good order. This and staff training indicated that the home was a safe place to live and work. What has improved since the last inspection?
Creams and ointments were dated on the day they were opened safeguarding the welfare of the residents. The grills of radiator covers were in the process of being replaced for more substantial ones as the original ones were getting damaged. There had been progress in the provision of signage to assist those people with dementia and purpose made signs had been purchased to further improve this. New armchairs had been delivered on the day of the inspection visit. The registered manager advised that new stools and garden furniture had also been provided recently. The ground floor lounge had been modernised and decorated in the past year and also has a light and sound therapy room, known as the snoozelum, which had recently been refurbished and moved to an area away from the lounge. Residents had assisted with this and photographs of them were displayed in the reception hall. The manager, because of several behaviour incidents and following consultation with the appropriate agencies and relatives, had in recent months made the ground and second floor for female residents and the first floor for male residents. She and other staff and visitors spoken with felt that this had created a “much more settled” and relaxed atmosphere. All residents come together for activities. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 8 After identifying the need for appropriate training, negotiation and liaison with the Community Mental Health Team the registered manager had succeeded in reaching an agreement with them to carry this out with the staff group. What they could do better:
The home is experiencing difficulties in managing the behaviour of several of the people living at the home, which is having an impact on other residents, and indicates that the staff do not currently have the specialist skills and knowledge to meet the needs of people living at the home. Although the registered manager advised that all staff had undertaken dementia awareness training this was ‘basic’ training that took place over only a few hours with the organisation’s training department. There are plans for the Community Mental Health team to carry our more specialised training over a series of sessions and covering different associated subjects but in the meantime the staff may not have the all the knowledge that would be required to meet the needs of the majority of the residents who have severe dementia or the home be able to justify the description of being able to offer “specialist dementia care” that is promoted in the Statement of Purpose. The registered manager needs to monitor that the content of this training meets the needs of the home. The Statement of Purpose advises that responsibility cannot be taken for the accidental damage of personal clothing but there is a duty for the home to ensure that this does not occur or to compensate the owner if it does. The complaints procedure included in the Statement of Purpose does not show our current title of Commission for Social Care Inspection. Training records showed that only limited training had been undertaken by staff related to the specialist needs of residents. The registered manager needs to look at such training for other conditions predominately affecting older people including sensory impairment. Not all care plans seen were in sufficient detail or did not include the information required creating the risk of needs not being met in a person centred manner. Generic-type risk assessments were in place for use of the staircase, the hot trolley, use of electrical equipment in the kitchen and hot weather trips out but apart from the risk of falls there was none related to the individual, including for a resident with aggressive behaviour. Eye drops had not been dated on opening. This is necessary as they can become unstable after being open for 28 days and need to be discarded. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 9 There were a few gaps where medication had not been signed for or an appropriate code added to show a reason why not, thereby not recording if medication had been taken or not. The home does not have a home remedy policy, which means that short-term treatment cannot be safely given for minor ailments like headache or indigestion without the need to contact a GP. A policy needs to be devised that has the agreement of the GP and the pharmacist. An audit was carried out on a random number of medicines. The majority checked were satisfactory but there were a few errors and two people were receiving medication at a different time than was indicated on the Medication Administration Record Sheets. Advice regarding these medicines being given at different times than the instructions state should be sought from the GP and/or the pharmacist. The home needs to retain copies of the prescriptions to use to ensure that the medication received is as ordered by the GP. As far as practicable all mail should be given unopened to the resident, or their representative if appropriate, or opened with them in order to maintain privacy and self-esteem. Clothing was labelled with the room number in most cases rather than the name of the owner. This is impersonal and considered institutional practice. Risk assessments need to be in place for residents using the home’s vehicle and for any trips and activities that take place. The corridors and some of the communal living areas were in need of redecoration. The registered manager had identified this and funding had been acquired to address this. Three of the bedrooms looked at were quite sparse and showed little sign of being personalised or made to look attractive. Ways of making these bedrooms look homely, despite the disorder that may be caused by residents with dementia, need to be considered by the registered persons. There are occasions when there are insufficient staff available to meet the needs of some of the residents. It was noted that in the evening when one care assistant on a floor left to have their break there was not enough staff available to supervise or in particular to manage any difficult or challenging behaviour. The registered persons need to monitor this and to audit the times and circumstances of the incidents that have occurred between residents with dementia with challenging behaviour and to be able to demonstrate that there are adequate staff to meet the needs of these people and those with whom they interact. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 10 The shifts of care staff no longer overlap for handover purposes. Senior care staff who then handover to care staff now carries this out. The registered manager needs to monitor this arrangement to ensure that information sharing is not put at risk. Whilst service users surveys are used in order to acquire feedback about the service the home does not yet have a Quality Assurance Programme implemented. 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. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 11 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 Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 12 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): 1,3,4 Quality in this outcome area is adequate. There are shortfalls in the correctness of the Statement of Purpose. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Some effort is made to meet specialist needs, although there are shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose that advises that the home offers “specialist dementia care” and caters for those with associated mental health problems. However the home is experiencing difficulties in managing the behaviour of several of the people living at the home, which is having an impact on other residents, and indicates that the staff do not currently have the specialist skills and knowledge to offer the specialist care that is promoted in the Statement of Purpose. Efforts have been made by the manager to address these issues including having separate living areas for males and females and referring
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 13 residents for review and reassessment. The registered manager advised that all staff had undertaken dementia awareness training to meet the specialist needs of the people living at the home. Half of the care staff had undertaken in house training related to dementia in 2007, although there were plans for other staff to undertake dementia training later in the year. The training sessions are ‘basic’ and only of five hours duration and therefore may not cover all the knowledge that would be required to meet the needs of the majority of the residents who have severe dementia or the home be able to justify the description of being able to offer “specialist dementia care”. The training planned for later in the year is to be carried out by Community Psychiatric Nurses and will consist of a series of sessions and covering a range of relevant mental health needs. The registered manager needs to monitor and assess that the content is sufficient for the needs of the home. The Statement of Purpose also advises that responsibility cannot be taken for the accidental damage of personal clothing but there is a duty for the home to ensure that this does not occur or to compensate the owner if it does. The complaints procedure included in the Statement of Purpose does not show our current title of Commission for Social Care Inspection. The Statement of Purpose and the Service User Guide are made available to residents to give them and/or their representative information about the home. Training records made available showed that five members of staff had undertaken training related to continence but there was no evidence of any other training to meet any specialist needs of the people living at the home, for example in conditions predominately affecting older people including sensory impairment. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 14 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. There are shortfalls in care plans and risk assessments that carry the risk of residents’ needs not being met. Residents have access to health care professionals and are cared for in a respectful manner. There are some concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were examined as part of the case tracking process. Each of these files had a care plan. These were devised from the assessments that had identified the needs of the residents and in the main related to them. Generic-type risk assessments were in place for use of the staircase, the hot trolley, use of electrical equipment in the kitchen and hot weather trips out but apart from the risk of falls there was none related to the individual. A resident with challenging and aggressive behaviour did not have risk assessments related to this behaviour and care plans did not give staff the guidance they needed to manage this, with only brief information about the mental health needs. Other areas of care plans were also not always in sufficient detail, for
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 15 instance a plan related to personal hygiene stated, “assist with all parts not able to do.” but with no information as to what these were or what amount or type of assistance was required. A further comment, “bath or shower her on a weekly basis” was insufficient to inform staff of what care to provide and the phrasing was impersonal. Reference was made in both the assessment and in the life history of one resident about the interest of music and dancing but in the activity section of the care plan no mention of this was made or any record in the care file as to whether these were continued interests. The only comment in this section was “does not join in”. These omissions create the potential for needs not to be met in a person centred manner. Care plans must set out the care required in sufficient and up to date detail to ensure that all aspects of the health and personal health needs of residents are met. Daily records are maintained and related to the care plan and the care provided. Care files included assessments related to the risk of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) and preventative measures such as pressure relieving mattresses and cushions were in use. Nutritional screening and dietary likes and dislikes were recorded and the weights of residents were measured at regular intervals to ensure that residents’ nutritional needs were met. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. Approximately half of the residents are patients of a GP who receives a retainer from the home although residents are able to keep their own GP if they wish and the GP is willing. All residents observed or spoken with during the visit were well groomed and appropriately dressed. The home uses a monitored dose system although some medication is unable to be dispensed in this way and was therefore in original containers. The procedure for medication administration was observed and apart from the trolley being left unsupervised for a very brief time the procedure was safe. Medication Administration Record Sheets were looked at and a photograph of the resident was included in those looked at in order to assist in identifying the right person for the medication being administered. There were a few gaps where medication had not been signed for or an appropriate code added to show a reason why not, thereby not recording if medication had been taken or not. The home does not have a home remedy policy, which means that short-term treatment cannot be safely given for minor ailments like headache or
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 16 indigestion without the need to contact a GP. A policy needs to be devised that has the agreement of the GP and the pharmacist. Although creams and ointments were dated on the day they were opened, safeguarding the welfare of the residents, eye drops had not been dated on opening. This is necessary as they can become unstable after being open for 28 days and need to be discarded. An audit was carried out on a random number of medicines. Whilst the majority checked were satisfactory the Loperamide of one resident had five tablets more remaining than records showed. This indicated that five tablets might have been signed for but not given. It was noted that Sodium Valporate, a drug used for treating epilepsy, was being given at 2.55pm instead of 12midday as instructed on the Medication Administration Record Sheets. The member of staff giving out medication at that time said that this was as a result of a series of urgent events at lunchtime and that the tea time dose would be given later to address this. However it was also noted that the times of this medication was not evenly spaced over the waking day. Another resident’s daily medication prescribed for 9am was recorded as being given at noon as that person tended to be up late. Advice regarding these medicines being given at different times than the instructions state should be sought from the GP and/or the pharmacist. The home did not have any residents currently requiring controlled drugs. A member of staff said that the key for the controlled drug cupboard was not available and therefore this storage was not checked. The registered manager advised that the senior care requests that the GP reviews all medication every three months and that this is carried out, thereby ensuring that residents continue to receive appropriate medication. All staff responsible for medication had undertaken accredited medication training thereby safeguarding the health and well being of the people living at the home. The prescriptions from the GP are collected from the surgery by the pharmacist. The home therefore has no record of what the GP has ordered against which to check the medication that is received into the home. Copies of the prescriptions need to be retained by the home in order for them to be able to do this. The registered manager advised that the staff open residents’ official looking mail. Mail that is obviously personal is taken to them or given to their family to open with them. As far as practicable all mail should be given unopened to the resident, or their representative if appropriate, or opened with them in order to maintain privacy and self-esteem. There are facilities for residents to take or
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 17 make phone calls in private if they wish, the cost of which is said in the Statement of Purpose to be additional to the fees for accommodation. Clothing was labelled with the room number in most cases rather than the name of the owner. This is impersonal and considered institutional practice. More effort needs to be made to ensure that clothes are labelled with the person’s name as discussed in the home’s Statement of Purpose, and a system be put in place for if the resident’s representative have not done so. Staff were seen to be treating residents with respect and in a dignified manner. Preferred names were established and recorded in care plans and were heard to be used by staff. Those residents who were able to communicate confirmed that this was the case. All residents were dressed appropriately and in an age related fashion, further maintaining self-esteem. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 18 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 good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home benefits from two activity coordinators who work 9am to 5pm and 10am to 4pm. There was an activity programme and at the time of the visit the coordinators were enabling residents to carry out colouring, painting and picture making. Later in the day residents were enjoying a manicure session with one of the coordinators. Other activities included in the varied weekly activity programme were reminiscence/reality orientation sessions, quizzes and games, bingo, sing song, baking and gardening, with sessions arranged for morning and afternoons on each weekday. There were church visits arranged each Wednesday in order to give residents the opportunity to pursue their faith. Care staff were interacting with other residents and the atmosphere in all communal areas was lively but relaxed. Despite male and female living areas Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 19 now being separate they do come together for activities as was seen at the time of the visit. The home has access to a suitable vehicle for trips out but discussion with the manager showed that whilst spontaneous risk assessments are made for these trips and for the use of the vehicle these were not documented. Visitors were seen to be greeted in a friendly and respectful manner and there was a comfortable rapport between them and staff. A visitor spoken with made very positive comments about the care received by their relative. The Statement of Purpose states that there are no formal restrictions to visiting times but goes on to say that for the comfort and security of residents visiting would normally be between the hours of 10am and 9pm, unless prior arrangements had been made with the home manager. These times would be likely to be reasonable for most residents and their visitors. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. Whilst some residents had personal possessions in their rooms others had little of their own things around them. The people living at the home are offered a cooked breakfast of poached egg, sausage and tomatoes or scrambled egg each day. Two choices of main meal taken at lunchtime are also offered and include a roast dinner on at least one day on a weekday and most weekends. The teatime meal consists of hot soup and a cold meal each day such as sandwiches, chicken nuggets, pizza or sausage rolls. Cake, scones, mousse or jelly are provided as a dessert. Consideration should be given to extending the hours of catering staff so that the alternatives can be offered hot at this time of day. Special diet meals are adapted from the main menu so that those residents that need these diets do not feel different. Pureed food was also attractively presented in order to aid appetite and a member of staff spoken with was able to articulately describe why certain residents had pureed meals. There was a menu available on each floor for residents to read or for staff to read to them so that they were informed of the choices of food each day. The home has three dining rooms in the home, one on each floor, and these are comfortable and adequately furnished. Food is taken from the kitchen to each floor in heated trolleys. There is also a kitchenette attached to each dining room where drinks can be made for the residents on each unit. The kitchen was visited and found to be very clean and hygienic. Cleaning schedules were in place for tasks to be carried out either daily, weekly or in a few cases monthly. Records wee seen showing that an annual ‘deep clean’ of
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 20 the kitchen is carried out. Fly screens were fitted to the kitchen windows to prevent contamination by insects but not to the external kitchen door. The cook said that the home has a daily delivery of meat, fruit and vegetables, dairy products and bread ensuring that food is fresh, and demonstrated a determination to provide a high standard of catering for the people living at the home. The home also provides the lunchtime meal for the people attending the adjacent Local Authority Day Centre. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 21 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 good. The home has appropriate policies, procedures and training to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is available to residents and visitors. A copy is also included in the Statement of Purpose. The procedure includes appropriate stages and timescales and indicates that complaints are taken seriously. An anonymous complaint was by to us about communication between care staff and senior staff. Discussion with care staff and senior staff showed no evidence of this and therefore no requirements regarding the complaint were necessary. The registered manager said, and further advised in the AQAA, that “all staff are encouraged to adopt an honest open approach” and to “deal with issues sympathetically” and this was witnessed in interaction between visitors and staff. There is an appropriate Adult Protection policy and staff have either attended relevant training and the registered manager advised that there is refresher training each year. This training should give them the knowledge and skills to Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 22 be able to identify and to protect residents from abuse. Staff spoken with showed an awareness of the subject. The home has forwarded a large number of incident notifications to us regarding dementia related behaviour episodes from a small number of the people living at the home and that have also resulted in concerns about safeguarding other residents. The home has taken measures to address this and to reduce the risk to other residents and one safeguarding referral had been made to the relevant local authority concerning the behaviour of one resident towards another. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 23 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): 19,20,26 Quality in this outcome area is adequate. The home offers the people living there comfortable indoor and outdoor surroundings, which are clean, free of offensive odour and safe and generally well maintained but with some shortfalls. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas visited were clean and free of offensive odour offering the residents a comfortable place to live. The home has three floors, each of which is a separate living unit within the home and has a separate team of care staff. Each unit has communal sitting and dining areas, a kitchen or kitchenette and residents’ bedrooms. The manager, because of several behaviour incidents and following consultation with the appropriate agencies and relatives, had in recent months
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 24 made the ground and second floor for female residents and the first floor for male residents. She and other staff and visitors spoken with felt that this had created a “much more settled” and relaxed atmosphere. The ground floor lounge had been modernised and decorated in the past year but the corridors and some of the communal living areas were in need of redecoration. The registered manager had identified this in the AQAA, and said that some Government funding had been acquired to achieve some of the redecoration. The home had received new armchairs on the day of the visit. These were comfortable and colour coordinated to the sitting areas. Non-slip and attractive floor covering had appropriately replaced carpet in several areas of the home. The registered manager advised that new stools and garden furniture had also been provided recently. On the ground floor the home has a light and sound therapy room, known as the snoozelum, which had recently been refurbished and moved to an area away from the lounge. Residents had assisted with this and photographs of them were displayed in the reception hall. Three of the bedrooms looked at were quite sparse and showed little sign of being personalised or made to look attractive. Photographs belonging to one resident had been put in a drawer although staff said that they had previously stood on top of the chest of drawers. Another room had bare walls apart from several empty picture hooks. Curtains were thin, looked of poor quality and would not keep out the early morning light and create the risk of disturbed sleep. The registered manager and AQAA advised that the provision of new curtains was planned for the coming year and lined curtains should be considered at this time. Other ways of making these bedrooms look homely, despite the disorder that may be caused by residents with dementia, end to be considered by the registered persons. Two other bedrooms looked at had been decorated and personalised by the families of the residents occupying them and they looked attractive and comfortable. The home was making good progress in providing signage to assist the people with dementia and had recently purchased a supply of purpose made ones. They were also collecting tactile items to place around the home for the benefit of these residents. The gardens are well maintained and accessible to residents by the use of ramps. A gazebo was in place offering shade/shelter for residents who wanted it. There was also an aviary, hanging baskets and good quality garden furniture adding to the pleasant outdoors environment. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 25 The home employs two maintenance people and a gardener enabling decorating and maintenance tasks to be addressed promptly. They were in the process of replacing the grills in the radiator covers for more robust ones as the original grills had been damaged. The home has two laundry areas and this aids the maintenance of infection control. Both areas were clean and well organised with good separation of clean and dirty laundry. The designated staff spoken with in this area continue to have a pride in the way they carry out their job and in ensuring that residents’ clothing is looked after. Protective clothing was available for them to use when handling items that may be soiled. Systems were in place for preventing cross infection including appropriate hand washing facilities and cleaning equipment appropriately labelled for the area they were to be used. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 26 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. There are occasions when there are sufficient staff available to meet the needs of some of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff spoken with showed a commitment to the home and to maintaining a good standard of care for the people living at the home. Residents and visitors spoke highly of the staff, using such terms as “kind” and “caring”. The rotas, discussion with staff, management and observations made showed that there were three care staff on each floor/unit each morning/afternoon and two each evening. There is also a senior member of staff on duty on each floor during the working day. There is a care assistant on each floor, and a senior member of staff in charge, throughout the night. Whilst this is mainly adequate it was noted that in the evening when one care assistant on a floor left to have their break there was not enough staff available to supervise or in particular to manage any difficult or challenging behaviour. The registered persons need to monitor this and to audit the times and circumstances of the incidents that have occurred between residents with dementia with challenging behaviour and to be able to demonstrate that there are adequate staff at all times to
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 27 meet the needs of these people and those with whom they interact. The incident notifications show that there has been a tendency for incidents to occur when staff are occupied at mealtimes or when writing reports or in the afternoon/evening. Care staff no longer overlap their shifts for handover purposes. The senior care staff overlap for a quarter of an hour and then cascade this information to care staff on their shift. The registered manager should monitor this to ensure that information sharing is not put at risk. The greater majority of care staff have achieved National Vocational Qualification Level 2 or 3 in Care, exceeding the required 50 of care staff with this qualification. Having this qualification indicates that they have been assessed as competent in their role. Other training undertaken by staff at the home includes mandatory training related to health and safety and Protection of Vulnerable Adult training by most of the staff, dementia in-house training, continence management, infection control, palliative care, and tissue viability by some of the staff. The registered manager advised that the organisation puts no restrictions on training and staff spoken with felt that they had ample opportunity to undertake training. Most of the training undertaken by them is carried out by the organisation’s training section but the home has recently had the offer of training from the Community Psychiatric Nurses of the Mental Health Community team and which will cover a variety of subjects, including dementia, depression, Parkinson’s Disease and strokes. Although some staff have attended a course related to violence and aggression there has not been any training related to challenging behaviour, which given the people living at the home is an urgent need. The registered manager advised that senior staff have attended an inhouse course related to mental health and an ‘Advanced Dementia’ one day training session given by an external trainer. Three staff files were looked at, contained all the information that is required and demonstrated good recruitment practice to safeguard residents from the appointment of unsuitable people. Protection of Vulnerable Adults and/or Criminal Records Bureau checks were carried out prior to the appointment of new employees. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 28 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 good. A person with the appropriate qualifications and who has previous management experience manages the home. There are shortfalls in the monitoring and auditing of the service and practices to ensure that all services operate in the best interests of residents. The health, safety and welfare of people living and working at the home is protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has the Registered Managers Award, Registered Mental Nurse and Diploma in Management qualifications and several years experience both in the management of care homes and with caring for people with dementia, showing that she is suitably qualified and experienced for the
Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 29 post of registered manager. Records and discussion with her showed that she has also undertaken training during the year to update her knowledge and skills, enabling her to more effectively fulfil her role. The registered manager said that she maintained an open door policy and staff spoken with said that they felt supported by the manager, deputy manager and senior care staff, with a member of staff saying that the management was “excellent”. Visitors spoke positively of the management of the home and the approachability of the management team. Quarterly staff meetings take place giving staff the opportunity to contribute to the manner in which the service is provided. The AQAA and discussion with the registered manager demonstrated that she had an awareness of the strengths of the home and of some of the areas that needed to improve. Efforts are being made to address these weaknesses; in particular after identifying the need for appropriate training, negotiation and liaison with the Community Mental Health Team had succeeded in their agreement to carry this out with the staff group. Whilst service users surveys are used in order to acquire feedback about the service the home does not yet have a Quality Assurance Programme implemented. Small amounts of personal allowance money are kept safely by the home for the majority of residents, for incidental purchases such as hairdressing or newspapers. Records are kept of all transactions made. The registered manager advised that staff supervision is undertaken and is on target to take place six times a year. The registered manager supervises the deputy manager, other senior staff and the garden and maintenance staff and the deputy manager supervises the other staff. A random sample of Health and Safety and maintenance or service checks records were looked at and were in good order. Staff had undertaken moving and handling, food hygiene, health and safety and fire awareness training in order that the home was a safe place for the people living and working at the home. The home is conscientious at sending incident notifications to us and also at informing relevant social services departments of these incidents. The process of telephoning social workers to pass on this information was seen to be time consuming and the registered manager should consider liaising with them to try to identify an alternative and effective form of communication. Accident books for staff and residents are kept on each floor and had been completed as necessary. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 30 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 2 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 3 3 x x x 2 3 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 4 Requirement The Statement of Purpose must accurately reflect the facilities and services available at the home. This will ensure that prospective and current residents will have accurate information about the service. Staff must have the knowledge and skills to meet the specialist care of the residents. This will ensure the health and welfare of the people with these specialist needs. Timescale for action 30/11/07 2. OP4 18 31/12/07 3. OP7 15 Care plans and risk assessments 31/12/07 must be in sufficient detail and revised as an individual’s circumstances change. This will enable their needs to be met in a person centred manner and minimise risk to their health and welfare. • Eye drops must be dated on opening and disposed of after 28 days. This will protect the health and welfare of the residents receiving the eye
DS0000004535.V336654.R01.S.doc 4. OP9 13 30/11/07 Brookvale Care Home Version 5.2 Page 32 drops. • Medication Administration Record Sheets must be completed accurately and medication given as instructed by the GP. This will ensure that residents’ health is safeguarded. • A homely remedy policy must be established in conjunction with the GP and/or pharmacist. This will ensure that the residents’ health and well-being is protected. 5. OP19 13(4)(a) The manager must ensure that all broken radiator covers are replaced. (The previous timescale of 30/04/07 was not met) 31/12/07 6. OP27 18 There must be a sufficient staff 30/11/07 number of staff available at all times to meet the needs of the residents. This will ensure that the health, safety and welfare of the people living at the home are safeguarded. The home must establish and maintain a Quality Assurance system. This will ensure that the home is monitoring and making changes for growth and improvements. 30/01/08 7. OP33 24 Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 33 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. 3. Refer to Standard OP10 OP19 OP23 Good Practice Recommendations Where practicable mail should be opened by or with the resident or their representative. All residents’ living areas should be decorated to a good standard. It is recommended that the home’s management team consider the decommissioning of the rooms that fall below 9 square meters. Not completed and is carried forward. 4. OP24 Residents’ private accommodation should be able to offer comfort and a homely environment. Brookvale Care Home DS0000004535.V336654.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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
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