Inspection on 28/08/07 for Brookvale House

This inspection was carried out on 28th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 House 08/06/06

Brookvale House 02/02/06

Brookvale House 20/01/05

Brookvale House 03/09/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Brookvale House 4 Brookvale Road Portswood Southampton Hampshire SO17 1QL Lead Inspector Liz Palmer Unannounced Inspection 28th August 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brookvale House DS0000011775.V342788.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 House DS0000011775.V342788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookvale House Address 4 Brookvale Road Portswood Southampton Hampshire SO17 1QL 023 8032 2541 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) Brookvale Homes Limited Mrs H Ward Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (35), Physical disability over 65 years of age (8) Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 8 service users to be accommodated in PD(E) category. Date of last inspection 8th June 2006 Brief Description of the Service: Brookvale House is a home providing care and accommodation for up to 35 older people with age related mental health problems and illness associated with dementia. It is one of a number of homes in the Brookvale Homes Ltd group. Accommodation is arranged over two floors with a passenger lift affording access to rooms on the first floor. Most rooms are for single occupancy and several have en suite facilities. Staffing is provided 24 hours a day, including the provision of two waking night staff. The home is situated in a residential area of Southampton, close to the shops and local amenities of Portswood. There is an enclosed garden and patio area to the rear with seating for residents’ use. There is an off-road car park to the front, from which there is ramped access into the home via the front door. Weekly fees range from £425 to £450. Brookvale House DS0000011775.V342788.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 site visit to the home over a period of four hours. During this time staff and people who live in the home were spoken to and observed. Care plans, medication records, policies and staff records were sampled. Other information used to make judgements about the standard of care in the home included three relatives surveys and six surveys from people who live in the home. The last inspection report was also taken into account and information received from the home including their Annual Quality Assurance Assessment (AQAA). This was received within the timescale requested by the commission. These have been referred to throughout the report. What the service does well: People who live in the home say staff are kind and helpful, they are happy and well cared for. The home is clean, welcoming and well maintained. The home encourages people to pursue their hobbies and interests and welcomes visitors. People who use the service say they have enough to do. Staff are well trained and know the service users really well, they say it is a nice place to work and there is a low staff turn over. The home is well run and staff and people who live in the home say they have confidence in the manager and feel they can talk to her about things that worry them. Some of the comments about the home from relatives’ surveys were ‘….is very happy and contented within his environment’, ‘take good care of relativegood not to have to worry about their care’, ‘the staff are always happy and obliging’ and ‘food is excellent, home is exceptionally clean and fragrant’. Brookvale House DS0000011775.V342788.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 House DS0000011775.V342788.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 House DS0000011775.V342788.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): 3, standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for assessing prospective service users enable the home to be sure that only those whose needs can be met are admitted to the home. No service users are admitted for intermediate care. EVIDENCE: Files were looked at for the three most recently admitted service users. All contained a full assessment, a contract, a care plan and risk assessments. Pre-admission assessments covered areas such as health, mental health, likes and dislikes regarding food, hobbies and interests. Significant details of the persons history, for example, employment history and any impact this may have on their care needs. Personal details such as the name of eah persons Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 9 general practitioner, their next of kin, any relevant religious or culture needs. Assessments clearly link to care plans. Brookvale House DS0000011775.V342788.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning ensure that people who use the service have their health and personal care needs met in a way that respects their views and upholds their right to privacy. EVIDENCE: Three care plans were looked at. These were drawn up from the initial assessments also seen by the inspector. People who live in the home are involved in drawing up their care plans and sign where possible. Relatives and next of kin are involved where appropriate. Relatives’ surveys said that they feel care needs are met in the home and that they are involved and kept informed of any changes. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 11 The plans included details of people’s individual care needs and how these should be met. For example one care plan stated ‘can shave himself but carer needs to make sure he has everything he needs to hand’, another stated ‘‘staff to always ensure she has her handbag with her’, another said ‘sleeps well, likes window open’. Social interests and hobbies and preferences were also noted with details of how these needs and wishes could be met. People who use the service are all registered with a local GP. Daily records were sampled and seen to be very detailed around the time of admission. Recordings showed evidence of medical needs being met in a timely and suitable way. Details of follow up and outcomes were recorded. Service users spoken to said they could rely on staff to seek medical help when they needed it. The care plans looked at had details of healthcare needs recorded, including any mental health issues. Care plans are reviewed monthly and changes noted. Staff receive training in administering medication. The deputy assisted the inspector in sampling the storage and recording of medication. She was competent and confident. The medication cupboard was seen to be suitably secure, clean and organised. A separate safe for storing ‘controlled drugs’ (CD) has been fitted and is secured to the inside of the medication cupboard. A CD register is in use and was seen to meet the required standard. Records for recording were sampled, no omission or errors were found. The surveys received from people who live in the home all said they were satisfied with the care provided and people spoken to on the day all said they felt well cared for and that staff treat them with respect and respected their privacy. During the inspection staff were observed interacting with people in a positive and respectful way at all times. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for social and leisure activities in the home ensure that people have enough to do and are engaged in activities of their choice. EVIDENCE: There was evidence of regular activities taking place, including arts and crafts, outings and outside entertainment in the home. Religious and cultural preferences are recorded and people are supported to worship if they wish. Peoples recreation and leisure interests are noted in their care plans. An activities notice board was seen in the dining room, which included a list of activities and when they were happening as well as photographs of people enjoying these activities. People talked about going on outings, sitting in the garden. Families and friends are included in social events as much as possible. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 13 People were observed enjoying a board game with staff in the afternoon. People asked said they had enough to do and there was evidence of people’s hobbies being encouraged and supported, for example, one service user was making a card for one of the staff. They had a variety of art materials in their room and some of their work displayed on their wall. They also had a parakeet in their room. People who use services said in their surveys that there are ‘always’ activities arranged that they can take part in. Visitors are welcome at all times and no rules or restrictions apply regarding this. Evidence of people being supported to maintain contact with families and friends was seen. Relatives commented in their surveys that the home ‘always’ supports their relative to keep in touch. People who live in the home said they could see visitors in private if they wished. People who live in the home said the food is good and there is always enough. Special dietary requirements and personal preferences of individuals are catered for. For example, one person prefers vegetarian food and this is provided for them. A kitchen assistant was spoken to she knew all the special diets and peoples preferences. No cultural or religious diets are currently required but these could be catered for as and when needed. Meal times are relaxed, people are encouraged to see it as a social occasion but can eat in their room if they prefer. One person who needed prompting to eat their lunch was observed being supported by a member of staff. This was done with patience and respect and at the pace of the person living in the home. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for complaining and dealing with abuse protect the people who use the service. EVIDENCE: People who use the service are all provided with a complaints procedure. Those asked said they knew how to complain and expected their concerns and complaints to be listened to and addressed. All the surveys from relatives and people who live in the home stated they knew how to make a complaint. Relatives said concerns were ‘always’ responded to appropriately by the home. There have been no formal complaints to the home since the last inspection. Staff are trained in Adult Protection. Those spoken to are generally aware of the home’s policy and their responsibilities within it. No allegations have been made. People who use services said they felt safe and well protected in the home. No monies are held on behalf of service users. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 15 Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service benefit from a clean, pleasant and homely environment. EVIDENCE: A partial tour of the premises was made during the visit. Generally, all areas seen were exceptionally clean, homely and furnished and maintained to a high standard. One of the bathrooms is in need of updating. As a result of a requirement made at the last inspection a new bath chair has been installed. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 17 There are still scratches on the bath from where the old chair had caused damage. The flooring was also worn and peeling back in places. The manager explained that the bathroom is ‘on the list’ for updating and the bath will be replaced at this time. The home’s AQAA states that service users and families are involved in the future planning of redecoration of the home. Residents rooms were seen to be are personalised and people asked said they had everything they needed. All communal areas are accessible to those with physical disabilities. An infection control policy is in place and staff were seen wearing gloves and aprons. A National Vocational Qualification (NVQ) assessor who was present during the inspection said the standard of hygiene was exceptionally high in this home. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The arrangements for recruiting staff protect the people who use the service. The training and support for staff enables them to carry out their roles confidently and competently. EVIDENCE: The three staff spoken to during the inspection were seen to be confident and competent at their jobs. They said they liked their jobs and were able to describe in detail the care given to individual service users. They spoke highly of the on going training provided including mandatory courses such as, first aid, food hygiene, infection control, health and safety, adult protection and fire training which are provided to all staff. Other courses undertaken include; dementia, death and bereavement, care of aging skin, medication and adult protection. Staff are supported to undertake NVQs. Over 50 of staff have achieved NVQ level 2, or above. During the inspection an NVQ assessor was in the home assessing one of the care staff. She said she was very impressed with the staff member she was assessing and said she had observed very high standards of hygiene in the home. The manager keeps a record of when Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 19 refresher courses are due therefore ensuring that staff knowledge is up to date. The home has a stable and well-trained staff team which ensures consistent care at a high standard. During the inspection there were suitable numbers of staff on duty to attend to the needs of service users and spend time with them socially. Staff said there are usually adequate numbers of staff on duty so they don’t feel rushed. People living in the home said there were always enough staff on duty. Staff also said that the manager ensured there was always a staff member designated to organise activities for service users in the afternoon. Staff were observed interacting in a positive and respectful manner at all times. They responded promptly to requests from service users and were caring and polite. All service users met were well dressed, clean and looked well cared for. They spoke highly of the staff making comments such as, ‘they are all lovely’. There was a calm and relaxed atmosphere in the home, staff were seen to work at the pace of service users and interact with them in a patient and friendly manner. The recruitment files of the three most recently recruited staff were looked at. These were seen to contain the records required to meet the standards. For example, an application form, two suitable references, a criminal record check and a protection of vulnerable adults check. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and has the views and best interests of people who use the service at the forefront of its planning. EVIDENCE: The registered manager is registered with the commission and has suitable experience. She has achieved the Registered Managers’ Award and NVQ level 4. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 21 Staff and people living in the home said they thought the home was well run and had confidence in the manager. Staff spoke highly of the management of the home and said they could talk to the manager or deputy if they have a problem. People living in the home were observed speaking to the manager in a relaxed and friendly way. People who use the service are supported to remain independent with regard to their finances. No cash is held on behalf of service users. Staff spoken to said they receive regular supervision. They said this was useful and made them feel supported. The home’s AQAA states that they seek the views of people who live in the home via twice yearly questionnaires. These are responded to individually and any issues are addressed. A further quiet sitting area has been provided as a result of comments from service users. Further plans include a rockery in the garden. Information received from the home states that policies and procedures relating to health and safety are regularly updated and training is provided to ensure the safety and welfare of people who live in the home. Regular maintenance checks are undertaken and the manager reports all incidents to the commission as required. Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 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 3 18 x 3 X X X X X X X STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brookvale House DS0000011775.V342788.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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