Inspection on 09/06/08 for Brookvale Care Home

This inspection was carried out on 9th June 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brookvale Care Home 10/07/09

Brookvale Care Home 24/09/07

Brookvale Care Home 31/05/06

Brookvale Care Home 12/11/05

Brookvale Care Home 13/07/05

Brookvale Care Home 17/12/04

Brookvale Care Home 05/04/04

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brookvale Care Home 111 Warwick Road Olton Solihull West Midlands B92 7HP Lead Inspector Martin Brown Key Unannounced Inspection 9th June 2008 8:30 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.V365502.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.V365502.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 tracey.arms@heartofenglandcare.org.uk www.heartofenglandcare.org.uk Heart Of England Care 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) 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.V365502.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 24th September 2007 2. 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. 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 two activity organisers. The home has a Snoezelan 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 residents may participate in religious services if they desire. The registered manager advised that fees range from £345.41 - £497 per person per week, with those residents funded local authority expected to pay an additional ‘top up’ of £22 per week. 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.V365502.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report has been made using evidence that has been accumulated by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 9th June 2008, between 8.30am and 4.45pm. During the inspection, people living at the home were seen and spoken with. Staff on duty, as well as the manager, were spoken with, and their interactions with residents were observed. Visiting relatives of a number of residents were spoken with during the inspection, and a visiting professional was contacted by phone for their views during the inspection. The Annual Quality Assurance Assessment, completed and returned by the manager, also informed the inspection. This gave a summary and self assessment of the home’s achievements, how it benefited users of the service, and how it could improve in the future. Policies and procedures and care records were examined, and four service users were ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. This was done by examining their care files, talking to staff involved in their care, talking to them or their relatives, and observing interactions and care. A meal was taken with residents. Staff, management and users of the service were welcoming and helpful throughout the inspection. What the service does well: Clear recordings show that health issues such as pressure sores are dealt with satisfactorily, with relevant health professionals being used appropriately. Staff were observed helping residents in a positive, calm and respectful manner throughout. Positive comments from residents and relatives confirmed this. “This is the best home we’ve seen”, “The staff are very good”, “The food is very good,” were typical comments. Staff were seen to respond promptly to all calls for assistance. This was also commented on positively by relatives and residents. “They are always there to help straightaway” was one comment. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides information to assist people in making a choice about whether this service is a suitable one for them. Health and care needs are assessed, in order that the home can assure them that these can be met. More work needs to be done to ascertain social needs and past history, to help care and activities meet individual needs, particularly where residents find these difficult to clearly articulate. EVIDENCE: The reception area forms a positive introduction to the home, and had photographs of residents enjoying a variety of activities in and out of the home. Also prominently available was a relatives’ information booklet, as well as a copy of the most recent inspection report. This was also available in other communal areas of the home. There was information for anyone who wished to make a complaint, as well as a scrapbook filled with compliments and Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 9 commendations from people who had used the service. The ‘Statement of Purpose’ and ‘Service User Guide’ was also available. The possibility of calling these two documents something more ‘user friendly’ was discussed, and the manager was keen on such re-naming. There were also brief leaflet guides to the service available. Relatives and residents spoken with were positive about their move to the home. One relative said that their father had come to the home for a short stay and then wished to stay. Another relative said that they found the home welcoming and informative on their initial visit, and found that they have continued to be so. A sample of four residents’ care files for the home were looked at; these all contained initial assessments of their needs, in order to determine that the home can satisfactorily meet them at the outset. The emphasis in these assessments was, quite rightly, on current health and care needs. There was, however, little of their likes and dislikes, and very little background ‘life history’ to help the home be aware of what it should do to enhance each person’s quality of life, and what it should do to avoid things that may cause distress. Examination of care files showed that ‘life history’ work was uneven with information about the background of some residents who been there for some considerable time still to be completed. The manager acknowledged that more needed to be done in this area, where residents were often unable to give an accurate or clear account of what had been important to them prior to coming into the home. Discussion with staff about particular residents showed a mixed awareness about individual backgrounds. The Annual Quality Assurance Assessment returned by the manager noted that the assessment ‘tool’ used is outdated, along with the aim to have it updated and improved. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements in the recording and storage of all medications are needed to give greater confidence to residents that medication is being managed safely and effectively at all times. Medication aside, residents can be confident that their health and care needs are documented and attended to, and that they are treated with respect. EVIDENCE: A sample of four care plans was looked at. These contained, as well as initial assessments, ongoing details of all relevant health care, such as dental, optician, and chiropody visits. Nurse, doctor visits were clearly recorded, as were falls, and any incidents affecting personal well-being. Body charts showed any physical concerns such as bruises, and their management. One record of district nurse visits clearly showed concerns over tissue viability and pressure sores and its successful resolution. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 11 Staff showed awareness of such health needs as those related to diabetes, with diet and medical support being recorded. Individual risk assessments and manual handling guidelines were seen to be in place and regularly updated. Staff spoken with on specific issues of challenging behaviour and of manual handling were confident and knowledgeable. The manager advised that life histories of residents were still underway. Details in care plans were very limited, being confined in most cases to references to family contacts and some specific details, such as area of origin or address prior to admission. Some files had potentially useful documents entitled ‘a little bit about me’ with scope to give relevant details about that person that might be of use in informing their everyday care, such as previous work and life experience, important events, and likes and dislikes, but these were only partially filled in or still blank. Staff showed knowledge on some residents’ backgrounds, usually where this might have a clear and direct impact on their outlook, such as one person who used to be a matron. The great majority of notes were handwritten, and were either updated and amended by additional notes, or completely re-written if there were major changes. Dates of reviews showed that they were regularly reviewed. Although the written form of the plans posed no particular difficulty, the manager agreed that printed plans might be clearer, and that ones done by computer might be easier and simpler to update. She advised that there are no current plans to use computers to produce care plans or similar documents. A visiting professional who provides support and advice and who facilitates training in areas of mental health dementia care said that the staff were now becoming more confident, skilled, and pro-active in these areas. She noted this particularly in establishing reasons for and strategies for managing challenging behaviours. She said that staff were requesting the setting up of ‘ABC’ charts to assist them in specific instances. She also felt that staff had become more knowledgeable about residents, and more confident and more motivated, and that incidents of challenging behaviour had reduced. She acknowledged the need for more training for staff, particular regarding issues of mental health. Residents were all well-groomed, well-dressed, and neat and tidy, even when events such as mealtime impacted on this for some residents in particular. A number of visiting relatives were spoken with, and were positive in their comments about care. One noted that clothes were always well-looked after, that residents were helped to the toilet regularly, that the food was good, and that requests from residents were answered promptly. This was also observed, with a resident’s plea of ‘help me’ being picked up and responded to promptly by a staff member. One relative had been impressed on one occasion that when someone fell, several staff ‘straightaway appeared’ and she got all the necessary help. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 12 Staff were observed throughout to be supporting residents in a patient and calm manner, with positive words of encouragement, and giving them plenty of time and space. In one instance, staff were supporting one resident who was reluctant to walk or weight bear. After encouragement failed, they explained reassuringly to the person that they would let her relax a while, which they did, returning later, when the person proved far more willing and able to complete the manoeuvre. Medication dispensing and recording was looked at on two floors. Most medication is dispensed via ‘blister’ packs and was seen to be dispensed and recorded accurately. Some medication cannot be dispensed in this way, and is dispensed straight from the original packaging. In one ‘as required’ medication, there were found to be four tablets remaining, with ‘carried forward’ recording indicating that there were five remaining. Examination of the previous month recording, just finished, showed that medications had been totalled up and carried forward, but that one had been dispensed, and signed for, on the last space of that sheet, by the night staff, after totals had been ‘carried forward’. The error was corrected by the senior on duty, who agreed that they ‘system needed amending to prevent such an oversight occurring again. There was also an inaccuracy involving a medication of someone recently admitted, where some medication had been received from hospital, and some from the family. Although its receipt was recorded in both instances, the subsequent record of dispensing showed a difference of one between the total remaining and what should have been left after the recorded amounts had been given. As there was no daily stock control of this medication, it could not be pinpointed where the discrepancy had arisen. Staff and management agreed that daily stock control would enable any discrepancies/errors to be identified and rectified promptly. All other medications looked at were accurately recorded and dispensed. Some ‘as required’ medications were recorded as ‘F’ when not given, without ‘F’ being defined on the Medication Administration Record Sheet. Although it was generally evident that this was likely to be because the person concerned did not require the medicine, staff agreed that this should be made explicit. There is currently only one medicine fridge for all three floors. Three eye drop dispensers that are required to be kept refrigerated were found in the medication trolley. The staff member concerned advised that these were kept in the fridge overnight, put in the trolley for morning, midday, and evening dispensing, then returned to the fridge. She agreed that this was unacceptable, and that in the short term, they should be returned to the fridge after every dispensing, with a medicine fridge on each floor being sought as the preferred long-term solution. The manager, when advised of this, was adamant that this would be promptly rectified and instructions made clear that it was not to reoccur. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 13 Records were noted in rooms, where topical creams are dispensed there. Where weight loss or gain was an issue reflected in medication, this was recorded. Staff advised that there were currently no controlled medication being dispensed. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that provides a variety of activities, provides appetising meals, supports continuing contacts, and helps them to exercise choice and control over their lives. There is a risk that some residents may not benefit if individual preferences and life histories are not known and taken into account when planning activities. EVIDENCE: The home benefits from two activity coordinators who work 9am to 5pm and 10am to 4pm. Activity charts show a variety of activities scheduled throughout each week. Relatives and residents commented to the effect that there are always activities. At present the activity co-ordinators are leading a programme of repainting corridors and individual doors or residents’ rooms in their preferred colour. Permanent nameboards are fixed to doors, along with a compact selection of photographs chosen by residents to illustrate their personal likes and dislikes. These, along with colourfully painted pictured hallways also containing tactile objects, are designed to aid stimulation and recognition for residents. One staff commented that, while this is a good thing, Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 15 it has distracted those staff from providing direct activities for residents while this work is being done. This appeared the case for some of the day, although activities were taking place in the afternoon, primarily in the garden. There were additional comments concerning activities not being fully inclusive, with less available for those unwilling or unable to show a direct interest. Whilst a co-ordinator was able to outline efforts to involve wide a group as possible, daily records in one file noted a comment, ‘did not want to join in activity’ recorded frequently. Staff and management agreed that, while there is an uncertain line between individual choice and being socially withdrawn, more work on individual choices and interests may pay dividends. Staff agreed that further work on life histories and interests may help inform suitable activities. A TV was on in one lounge, although no one appeared to be watching, or listening, to it. In another lounge, a radio was playing. One gentleman was noted enjoying the sun in the garden in the afternoon. Staff showed appropriate concern that he was not overexposed to the sun. A meal was taken with residents on one floor. The meal was tasty, freshly prepared, and attractively presented. Menus showed a variety of wholesome food available. Residents were offered a choice, being able to decide in advance, at the table, or by the alternatives being presented to them, according to their abilities in retaining this sort of decision. Mealtime was unhurried, with staff available to help and support residents as required. Staff showed awareness of individual preferences, not only in choice of food, but also in style of eating, and supported preferences calmly and patiently. One agency worker, unfamiliar with residents’ specific needs, showed uncertainty at what to do initially, but was eventually able to support a resident in eating successfully. Residents spoken with said that meals were good, with the only (light hearted) complaint being that the portions were too big. The kitchen was seen to be clean, tidy and hygienic. Hygiene and health checks were in place. The manager advised that the last visit from Environmental Health a year ago was very positive, and they had not had another visit since. Five visitors were spoken with during the inspection. All were positive about the home and the care provided. Visitors said they were always made welcome, and were able to sit in relative privacy in one of the smaller lounges if they wished, or to sit in one of the larger, busier lounges, as most chose to do. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse by the policies and procedures and by the positive ethos in the home, which emphasises openness and a respect for residents’ dignity and well-being. EVIDENCE: There is a clear complaints procedure that is accessible and openly displayed. The manager showed details of a previous complaint and how it had been responded to. We had received two anonymous complaints, possibly linked, concerning staffing levels. The manager was able to respond satisfactorily to these. Evidence during the inspection did not suggest a shortage of staff, other than the use of agency at short notice on occasion to cover at short notice. Residents and relatives spoken with were all positive concerning the service and the staff. Two relatives compared the home favourably with others they’d experienced, noting, in particular, its openness, and its good organisation. Residents meetings take place regularly; notes were seen of the most recent one from the previous month. This included comments about choices of drinks Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 17 available. The manager explained the context of this and how it was going to be responded to. The home regularly forwards records of incidents of challenging behaviour where this has affected the well-being of any resident. As a visiting professional noted, these have reduced as residents have become more settled and relaxed as staff have become better trained and able to meet dementia related needs. Staff were able to demonstrate awareness of abuse and safeguarding issues, and of what to do if they suspected or witnessed a vulnerable person being illtreated in any way. Observation and discussion with staff, residents and relatives, showed a calm and respectful ethos operating within the home that denies abusive practices the climate to flourish. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 18 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): 19,20,21,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although some communal areas are rather cramped, residents benefit overall from a clean, tidy and well-maintained home. The major exception to this was the fact that a bathroom hoist had remained unusable for an unacceptably long time. Corridors are being renovated in a way that should enhance the well being of residents. EVIDENCE: 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. Corridors are being redecorated ‘in house’. Those that have been done, principally on the ground and first floor, provide a brighter and more stimulating environment. The doors to each resident’s room are being personalised with personally chosen pictures, along with their names, to help Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 19 recognition. Lounge and dining areas remain rather crowded areas, particularly on the upper floors. Each does have a smaller, alternative lounge area. These tend to be used by only one or two people at a time. Although dining and lounge areas are rather cramped, corridors and other ares were refreshingly clear of ‘clutter’ and obstacles. Bedrooms vary in size and décor, with some being very personalised with individual furniture, pictures and ornaments, and others quite sparse. All those looked at were tidy, clean, and well-maintained. All bedrooms doors looked at had closure devices on. Some of these closed rather rapidly, so that individuals were potentially at risk from trapped fingers or other injuries, while nearby residents may be disturbed by doors slamming. The maintenance person spoken with, and the manager, advised that these would be checked, and adjusted as necessary. Toilets, bathrooms and shower rooms, were rather ‘clinical’ in most cases, and may benefit from more ‘friendly’ décor. They were generally well-maintained, clean and tidy. The one noted exception to this was the top floor bathroom. The top floor bathroom had a notice on dated 7/4/08 to the effect that the bath could not be used, owing to the bath hoist being broken. This meant any resident wishing for a bath had to go to a lower floor to have a bath, or either have a shower. Staff were clearly not happy at the length of time this had been out of use. The problem was a broken arm on the chair, meaning that there was only one arm to support any person using it, making it unsafe. The manager advised that the supplier had only just located a replacement, which was now due to be fitted. She agreed that the delay was unacceptable, and that a better contract with far more efficient repair/replacement service was required. There is an attractive garden area, accessible through the ground floor communal area, and this was used by residents on the day of the inspection. There is an aviary, but this was currently not in use. The laundry was operating effectively; relatives made complimentary remarks about the prompt and neat laundering of clothes. Clothes laundering is done completely separately from other laundering. Clothes are marked with names or initials. Some are marked with room numbers, the manager advised that this was something that relatives had done, rather than something the home had encouraged. The home was clean and tidy throughout this unannounced inspection, with no unpleasant odours noted at all. The cleanliness was also commented on by visitors. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the attentions of a staff team who are themselves benefiting from much-needed training in dementia, and who should continue to benefit from further training in this area. Residents also benefit from properly recruited staff, but would benefit more if the service could ensure less reliance on hastily brought in agency staff unfamiliar with the residents. EVIDENCE: Each floor has at least three staff on duty in the morning, and at least two staff on duty in the afternoon and at night. The rota confirmed this, with evidence of the use of agency both to cover anticipated gaps, and ones at short notice. This occurred on an afternoon shift on the day of the inspection, when one expected staff did not arrive. One relative commented that, while ‘the permanent staff were good, agency staff were not so good.’ It was felt by this relative that too often, agency staff were brought in who were not aware of individual needs, and therefore not confident or able to meet them without a large degree of direction or instruction. This was echoed by comments by a staff member, who while acknowledging that some agency workers could be good, and familiar with what people needed, many were not, and that sometimes staff might prefer to Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 21 work below numbers and do the extra themselves, rather than rely on people they frequently had to oversee and supervise. The manager advised that consistent agency staff were sought, although this was not always possible, and that a supply of ‘bank staff’ was being built up. One such ‘bank staff’, who showed herself to be familiar with individual needs and how to meet them, was on duty during the inspection. The manager advised that the number of staff with National Vocational Qualification level 2 was comfortably above the required 50 . All staff spoken with were enthusiastic and complimentary about training. “The training is very good here” was a typical comment. Several staff were off out for scheduled training at the start of the inspection, and schedules showed frequent training taking place in all mandatory areas. The surprising deficit noted at the last inspection, namely the absence of dementia training, is being rectified with the support of the local Primary Care Trust. The manager advised that all staff have now been on an initial ‘Understanding Dementia’ care course, with a further one, ‘Challenging Dementia’ underway. These are two hour courses, and although it was evident from comments from staff, and from a visiting professional, that their practice has benefited greatly from this, all agreed that further training on age-related mental frailties could bring further benefits ton the care of people living at Brookvale. Staff spoken with had some knowledge of issues such as diabetes and Parkinson’s, but said that they had not had specific training in these areas. Throughout, staff were observed interacting with residents in a reassuring and positive way, and respecting their dignity. This was reflected in positive remarks from both residents and relatives concerning the staff. Staff dealt with potentially challenging situations in a calm and non-confrontational manner. A sample of three staff files were looked at. These showed all required recruitment checks, including Criminal Records Bureau and reference checks taking place to help safeguard vulnerable residents. Two new staff were undertaking induction on the day of the inspection. They were both positive and enthusiastic about the service so far and the introduction it was providing. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is effectively run in their best interests and promotes their safety and well being. 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 post of registered manager. In discussion she demonstrated her commitment to improving the service and consequently the well-being of all those using it. She is proud of the achievements of the home, such as its continuing retention of its ‘Investors in People ‘ award. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 23 Visitors and others spoke positively of the running of the home. The phrase ‘well organised’ and ‘well run’ featured in several discussions. Surveys of relatives and residents carried out by the home were seen. These were broadly very positive, expressing satisfaction with all aspects of the service. Comments seen were all positive. Records of staff meetings were seen, as well as residents meetings. The manager advised how issues raised at the most recent residents’ meeting had been responded to. A sample of residents’ finances, where the home looks after personal monies of individuals, were looked at. These were accurately recorded, with clear accounting of expenditure and the keeping of receipts. T.he person responsible for these advised that they are audited regularly by an outside representative of the organisation. There is a health and safety committee, made up of staff, whereby staff look at areas of the home that are not their direct responsibility. Comments from staff and management, records in the home, and responses on the Annual Quality Assurance Assessment showed that Health and Safety in the home continued to be managed appropriately. Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 3 2 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement All medicines required to be stored in fridges must be so stored at all times when not in use, so as not to compromise residents’ treatment. Timescale for action 20/07/08 2. OP9 13(2) The medication recording system 20/07/08 must be robust enough to ensure that any errors are immediately noticed and rectified, to minimise the risk of any potential harm to those for whom medication is being administered. The bath hoist on Aspen floor must be able to be safely used, so that residents are able to use the bath there safely. 20/07/08 3. OP21 23(2) Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 26 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 OP3 Good Practice Recommendations The service should ensure that they have a clear idea of each person’s background, likes and dislikes, as part of the admission process, to help them meet individual needs better. Daily stock control of medication not dispensed in blister packs will enable any errors in the dispensing or recording of such medicines to be promptly spotted and rectified, to minimise the risk of any ill-effects to the persons using those medicines. Reasons for medications not being administered should always be clearly recorded on Medication Administration Record Sheets. A more comprehensive completion of ‘life histories’ may help staff, and ultimately residents, with regard to understanding individual activities and wishes. To minimise risks to individuals, and noise nuisance to those in nearby rooms, door closures should be adjusted to minimise doors ‘slamming’ shut. The service should look at ways of making lounges and dining areas less cramped. Residents would get more consistent care if there was less need to provide emergency staff cover with agency staff who are unfamiliar with their needs and how to meet them. Further training for staff in dementia and age-related mental and physical frailties will help residents’ needs to be better met. 2. OP9 3. OP9 4. OP12 5. OP19 6. 7. OP19 OP27 8. OP30 Brookvale Care Home DS0000004535.V365502.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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