Inspection on 11/12/07 for Brownhill House

This inspection was carried out on 11th December 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

Brownhill House 17/04/09

Brownhill House 23/12/08

Brownhill House 21/02/07

Brownhill House 29/12/05

Brownhill House 12/04/05

Brownhill House 21/09/04

Brownhill House 28/06/04

Brownhill House 04/02/04

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

CARE HOMES FOR OLDER PEOPLE Brownhill House Lower Brownhill Road Maybush Southampton Hampshire SO16 9LA Lead Inspector Jan Everitt Unannounced Inspection 11th December 2007 09:00 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 Brownhill House DS0000039229.V353624.R02.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. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownhill House Address Lower Brownhill Road Maybush Southampton Hampshire SO16 9LA 02380 771808 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) beverley.kenchenten@southampton.gov.uk Southampton City Council Post Vacant Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (14), Physical disability (25), Physical disability of places over 65 years of age (25) Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Orthopaedic intermediate care may only be provided to a maximum of 16 service users and may only take place in the orthopaedic care unit. A maximum of 9 people may be in receipt of general rehabilitation care on Beech One unit only. When rehabilitation care is being provided on Beech One to less than 6 service users one dedicated member of staff must be available at all times. When there are between 6 and 9 service users accommodated in this unit, two dedicated staff members must be available at all times during the waking day. Service users in the PD category must be 55 years of age or over 4. Date of last inspection 21st February 2007 Brief Description of the Service: Brownhill House operates as an older persons resource centre under the management of Southampton City Council. It is located in a suburb to the west of Southampton. The home makes provision for three separate services. It can accommodate fourteen older people; one bed is allocated for long-term residential care, three for people waiting for care home placements with a further ten for respite care. The general rehabilitation unit is situated on the first floor of the house and can accommodate nine people who have been assessed as needing some assessment and rehabilitation. The service users who are admitted to this unit are both from home and hospital and have been assessed as needing a period of supervision and rehabilitation before going back into the community. The anticipated length of stay in this unit is six weeks. A new purpose built wing has been opened and can accommodate sixteen people admitted directly from the orthopaedic wards of the local hospital for a period of rehabilitation and discharge planning following orthopaedic surgery. This service is classified as intermediate care. The anticipated length of stay in this unit is six weeks, following which, most service users return to their own homes. All accommodation in the home is single occupancy with sixteen rooms having en-suite facilities. The charges for Brownhill House are £382: 13 per week for permanent residents. Respite care stays are as assessed and there is no charge for Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 5 intermediate care (rehabilitation) up to 6 weeks. Information about the home, including the last inspection report, is provided on request. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit to Brownhill House, took place on the 11th December 2007 and was attended by Jan Everitt and Chris Johnson. The acting manager Mrs. Davis assisted throughout the inspection. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The deputy manager had returned the Annual Quality Assurance Assessment (AQAA) to the CSCI and the focus of this visit to the home was to support the information stated in this document and other information received by the CSCI since the last fieldwork visit, which was an key inspection, made to the home in February 2007. Documents and records were examined and staff working practices were observed. The inspectors visited all areas of the home and spoke to a number of people using the service, staff members and the health professionals that work in the orthopaedic unit to obtain their perceptions of the services the home provides. Those spoken to were very happy and complimentary about the care and services that are provided. Surveys had been distributed to service users, relatives, care managers, GP, care managers and other visiting professionals. Two service user surveys, six staff, two care managers, one visiting health professional and two GPs surveys were returned to the CSCI and information from them is used for this report. There was no response from relatives’ surveys. The outcome of the surveys indicated that there was a high level of satisfaction with the service and that generally people using the intermediate services and the one permanent resident were very satisfied with the service. At the time of the inspection the home was accommodating 1 long stay resident, 16 orthopaedic rehabilitation residents, 9 general rehabilitation residents and 7 respite care residents. There were no residents from an ethnic minority group. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 7 What the service does well: The home provides a homely and welcoming environment and all of the service users spoken to told us the homes staff provide an excellent service and comments received included “I couldn’t wish for a better place” and “ the staff are wonderful”. The inspector observed staff interacting with service users and it was clear that there was a good relationship between service users and staff. Brownhill House provides a variety of intermediate and long-term care for people over 65 years of age. The service users gave positive feedback as to the standards of the rehabilitation and care they receive whilst in residence. Staff were observed to interact well with the service users and taking time to sit and talk to them on an individual basis. The orthopaedic rehabilitation unit is managed by a coordinator and also accommodates a multidisciplinary team managed by health. The presence of this team enables service users to undertake rehabilitation programmes and comprehensive discharge planning. The service is equipped with appropriate aids to promote independence. The activities programme provided is varied and service users reported to have enjoyed the festive activities. The local authority provides adequate training for the staff to enable them to meet the needs of the service users. The services provided in this home are unique within the area and therefore is viewed as a much-valued service for the elderly population of Southampton. The service does distribute surveys to gain the opinions and suggestions from the people who use the service. Comments on surveys from people who use the service and other stakeholders were: ‘The staff are always attentive, kind and helpful and attend to my needs’. ‘Staff are available night and day in every situation’. ‘I find it an excellent service and have been attending the home for some years’. Care managers say: ‘Brownhill take emergency placements with a calm and friendly attitude for clients’. ‘Brownhill builds good relationships with clients and families and make all visitors very welcome’. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 8 ‘Sometimes the user of agency staff does compromise relationships being formed with clients’. ‘On the whole the staff are very good’. ‘Clients are always grateful for the care they receive in Brownhill House’. ‘This care service respects individual needs and lifestyles’. Staff said that there is good communication between staff and that staff have their training needs met and that they receive regular supervision. They consider they deliver a good standard of care in all areas of the home and give support and time to the people using the service. What has improved since the last inspection? What they could do better: The care plans must be written to reflect all the needs of the people using the service, to include any pre-existing mental health needs and how this is managed. Staff must be aware of how residents’ privacy and dignity must not be compromised. The residents’ bedrooms must be made secure when they are not in use to prevent other people wandering into those rooms. It should be recorded if service users are invited to hold a key to their rooms and whether they choose to hold a key and are aware of how they can secure valuables if they wish. The staff surveys did reveal that the staff have missed having a unit manager for some time although the deputy manager has been at the home for a considerable time, the comments on surveys said: ‘’Moral at Brownhill is low and this is due to staff shortages and absence of a permanent manager for the past nine months’. ‘I have access to a line manager but not always to a unit manager’. ‘Use of agency staff and their lack of understanding of their role of carers when they enter the home’. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 9 ‘I never see the unit manager’. ‘We do not feel valued and supported the only thanks we get are from the service users’. 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. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 10 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 Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 11 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, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have the information they need to make informed choices about their rehabilitation and future and sign a contract of terms and conditions of their stay. Service users can be confident that the home will meet their needs and they will be supported to maximise their independence and return home whenever possible. EVIDENCE: The Statement of Purpose for the service was on display within the home. This had been recently updated. This will be amended, in time, to reflect the change of manager. The certificate of registration will also be replaced to reflect the post is currently vacant. Information packs were seen in all bedrooms. These were also placed in bedrooms that were waiting to be occupied and provided general information Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 12 about the home, a copy of the Service User Guide and the complaints procedure. A copy of most recent inspection report was on display within the home. Service user’s file tracked contained a copy of terms and conditions of residency. These gave information on the room to be occupied, arrangements re fees/costs, and had been signed by the service user. Evidence was seen from examination of peoples’ files that pre admission assessments are undertaken prior to admission. The home’s admission criteria vary from unit to unit. The orthopaedic rehabilitation clients are assessed by the multidisciplinary health team at the hospital to ensure they meet the criteria of achieving good outcomes and can return to the community within a six-week period. Admission to the general rehabilitation unit if via various sources i.e. GP or referral from social worker. Agreement is reached as to when the service user is admitted and a full assessment and details of the service user is shared with the home prior to the agreed date of admission. We observed a carer sitting with a service user asking her questions and going through the assessment process. The people using the respite care service are invited into the home prior to their admission to familiarise themselves with the home and assess if the home can meet their needs and give them the opportunity to make a choice whether they wish to use the service. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 13 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. Resident’s benefit from having an individual plan of care, which identifies how their health care and rehabilitation needs are to be met. However they do not address any identified mental health needs. Service users are protected by the home’s procedures for dealing with medication. Service user’s privacy is not respected by all staff. EVIDENCE: A sample of three service user’s files was viewed. Assessments and care plans are written by the health team on the orthopaedic unit and are goal focused rehabilitation programmes. The care plans are written in conjunction and agreement with the service users. The co-ordinators and carers write the care plans for the people using the general rehabilitation unit and the respite care clients. These are also done Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 14 with the service user and there was evidence that service users sign these as having participated and agreed to the care plan. The inspector observed a care worker discussing with a newly admitted lady her planned care. The care plans that were viewed were well recorded and detailed. Care plans were documented regularly to record daily the activities. The AQAA states there is uniformity about the care plans in all SCC homes. There is also a weekly review of the rehab care planning documentation in the Rehab unit However, a care plan of one service user viewed, addressed all her assessed physical health needs. Evidence was seen that physical needs were primary the reason for referral. Records showed that she had a long history of depression / anxiety. Psychiatric services were involved since her admission and she was being monitored by the service. Discussions with BW confirmed that she had mental health needs and that she had done for many years. There was no evidence of either a care plan regarding her mental health support needs or any associated risk assessments or management plans. Therefore, there was no guidance for staff re: regarding her mental health support needs, methods of intervention, signs, symptoms or triggers. The home is fortunate to have a multidisciplinary team available to give guidance and support to all clients. A staff survey commented that ‘we work well with the health team’. The consultant geriatrician visits the home weekly to review the clients in the general rehabilitation unit. A GP visits the home weekly and will attend the home if requested. The survey returned from that GP said: ‘I find the home excellent and communicates well with me’. Case conferences to review the rehabilitation programmes are held weekly and are attended by service users and the rehabilitation teams to discuss discharge planning. The community matron survey said that: ‘the home will always seek advice if they identify a health need for a client and act on any advice give’. Each unit of the home has a medication trolley to serve that area. The inspector looked at the medication trollies, which were observed to be kept in a locked environment when not in use. There have been a number of medication errors reported on Regulation 37 notices. These were discussed with the acting manager who reported that these were investigated by the service manager and action taken to address training issues. The acting manager has said she now audits medication weekly. The inspector observed a care co-ordinator administering medication. This was done as per policy and records completed. The records show that the CSCI has received notification of a number of drug errors by care co-ordinators. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 15 This was discussed with the acting manager who reported that training needs were identified and training has now taken place. The pharmacist from the hospital visits the home twice weekly to check Medication Administration Records (MAR) sheets and monitor prescribing. Service users are encouraged and supported to manage their own medication as part of their rehabilitation programme. The pharmacist undertakes the assessments to ensure service users are safe to manage their own medication. All rooms have a lockable storage area for medication. The inspector spoke to a number of service users who confirmed that they were managing their own medication. It was observed that many peoples’ doors in the general rehabilitation unit are left open throughout the day whilst they were not occupying them. The inspector observed that personal belongings were on display. The inspector observed one client being assisted with personal care needs (in rehab unit) in a state of undress. After walking past the room once, on returning the door was still open. This was discussed with the acting manager immediately highlighting that staff need to be reminded about respecting resident’s dignity and privacy. In other areas of the home it was observed that staff were interacting well with service users and were seen to knock on bedroom doors to be invited in. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 16 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 can be confidant that their preferences will be responded to and that they will be enabled to maintain contact with friends and family. Residents will be encouraged to make choices and are supported to be independent in their daily lives. Service users benefit from a varied menu with choices of wholesome and nutritious food. EVIDENCE: The home does not have a planned programme of activities owing to the nature of the rehabilitation programmes, especially in the orthopaedic unit where a programme of exercises and mobilisation is practiced every day. A care co-ordinator takes on the responsibility of activities in the daytime for the respite care clients and the one long stay service user living at the home. The inspectors observed that Christmas decorations were up and the residents were in the process of making Christmas craft pieces as decorations. The Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 17 rotary club visit monthly and undertake quizzes, bingo and general entertainment. This was advertised on the notice board. The general atmosphere in the home was friendly and carers were observed to be chatting and being interactive with the service users. The orthopaedic rehab unit clients do have rehabilitation programmes and the inspector observed this taking place in the lounge area of the unit where all clients were participating. Throughout the day staff were observed to have time to spend with people on a one to one and group basis. Some of these activities were focused on rehabilitation needs and input from health staff such as physiotherapists was taking place regularly. In all parts of the home care staff were seen to engage with people in a friendly manner and spend time talking with them and interacting with them. The AQAA states that staff do find out service users interests and preferences and this is documented on the care plans. The inspector observed that the assessment does include a social history and states the service user’s preferred routines. The home displays a notice stating visiting times. The manger said this does need not be adhered to too strictly but is a guideline to allow residents time for their meals. The visitor’s book evidenced regular visitors to the home. One upstairs lounge was being used to store old and broken furniture and white goods. The communal areas in the rehab unit and orthopaedic rehab unit does not allow much privacy for visitors and therefore inhibits resident’s choice as to where they see their visitors. It was suggested to the manager that this lounge area would provide people with an alternative place to meet with their visitors as opposed to their bedrooms, as is current practice. It was noted that people living at the home are currently asked to meet with their visitors in their bedrooms. This was displayed on notices within the home and the inspector also observed a resident being told that they had a visitor and that the visitor was in their bedroom waiting for them. This practice needs to be reviewed as it leaves people without a choice whether they wish to a. Receive visitors b. Does not give them an option as to where they would like to meet with visitors. c. Could put people at risk. The local vicar visits the home monthly and the AQAA states that the home encourages the service users to follow their cultural beliefs. People’s preferences and choices of how they wish to practice their activities of daily living are documented on the assessment records. Residents can choose when they go to bed and rise in the morning. The rehabilitation programmes are agreed with the service user on assessment and this may have an impact on how they live their lives normally. The residents using the respite care Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 18 service, although encouraged to be independent, are able to choose how they spend each day. Comments on the surveys returned by a car manager and service users were; ‘The care staff respect individual needs and lifestyles’. ‘Good relationships exist between the home and regular respite care residents’ ‘The staff are kind and attentive to my every need’. The inspector observed that posters advertising Advocacy services were posted around the units should a service user request this service. In discussion with people living at the home they told the inspectors that they were happy with the quantity and quality of the food. The inspectors saw that people have a choice of main meal and the day’s menu is displayed throughout the home. Each unit has a separate dining area in pleasant surroundings. Service users were observed at lunchtime to be sitting to the table enjoying a social time with other residents. The kitchen was visited. The AQAA identified that the kitchen has been refurbished with large new extractor fans being fitted. The kitchen was clean and well organised. New heated trollies have been purchased as a result of feedback from the service users to say that food was not reaching them in a hot state. This has now been resolved and the inspector observed the lunchtime meal being served from the trollies, which service users said was ‘ Very good they look after us so well’. ‘The meals are always excellent with a good choice of menu the cooks should be congratulated every thing is very appetising’. Routine weights and nutritional assessments are not undertaken. The acting manager said that this would be done if a problem were identified. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents/their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place, which do not fully create an atmosphere for protecting residents from abuse. EVIDENCE: The home has a complaints policy and procedure. Information regarding complaints procedure on display in the home and in all information packs provided in bedrooms. These were observed to be in place. The AQAA states that two complaints have been received by the home, one of which was also directed to the CSCI. Both of these complaints have been investigated by the service manager and upheld. Service users spoken to said they would speak to the staff if they were not happy about anything. Staff surveys returned also indicated that they are aware of whom to go to if there are any concerns raised by the residents. A survey returned by a care manager said that residents would report to her any concerns that are highlighted during their respite stay. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 20 Safeguarding policy and procedures are in place. Training records evidenced that staff have received training on safeguarding with annual updates of this. Staff spoken to at the time of this visit confirmed they have undertaken the training on abuse and have an understanding of the processes for reporting. We observed that although all bedroom doors were lockable from the inside, the majority were open throughout the day when unoccupied. It was unclear how many people held keys to their rooms. This needs to be reviewed, as we know from notifications sent to us from the home that there have been thefts within the home, which have been reported under the Safeguarding policy. All other aspects of the home appeared to be secure with a secure entry system, and exits doors alarmed. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well-maintained and clean environment. EVIDENCE: During the visit to the home the inspectors saw all communal areas, the kitchen, laundry and offices as well as a selection of bedrooms in each of the three areas. The home was clean throughout and there were not any adverse odours present apart from one upstairs area and it was thought that this was possibly due to a toilet door being left open. The acting manager began to investigate the source of the odour as soon as this was pointed out to her. All bedrooms seen were very clean with appropriate furnishings. All of those seen contained lockable storage facilities to enable people to lock their valuable items and or medication in. Vacant bedrooms are prepared well in advance of people moving in. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 22 One upstairs lounge was being used to store old and broken furniture and white goods. The acting manager said that there were plans to dispose of the old furniture and that they hoped to purchase some new armchairs. It had been identified on a previous visit that the bathroom in the rehabilitation unit, the toilet facility only being used, was not appropriate or safe for people to use with a walking aid. This has now been refurbished and now provides a safe environment for service users to use. Infection control procedures were observed to be in place and followed. Liquid soap and paper towels were in place in all bathrooms and toilet areas. Alcohol gels also in place around the home. Staff observed to regularly wash their hands and use the gel after dealing with a resident or going outside. Supplies of gloves and aprons were available and staff were observed to use them. The service users who are in for only a limited period do not bring personal possessions with them but those spoken to said their rooms were comfortable and they considered the environment to be pleasant. The home employs a separate housekeeping staff group and the housekeeper spoken to at the time of this visit said she took pride in the standard of her work. Communal grounds with patio areas surround the home. These are used in the better weather and staff support residents to maintain containers and baskets in the summer. The AQAA states that the Southampton City Council property services department co-ordinates the repairs and maintenance of the home ensuring health and safety issues are responded to promptly. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 23 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’ needs are met by sufficient staff that are competent and trained to meet their needs. Residents are supported and protected by the home’s recruitment practices and procedures. EVIDENCE: The staff surveys returned to the CSCI were discussed with the acting manager. The surveys comments indicated that the staff were identifying that the home was reliant on agency staff, which were not always satisfactory. Comments were: ‘We have been short of staff. The home is reliant on agency staff that need a lot of support and guidance, which takes time, and I am unable to do my job properly and meet all resident’s needs’. ‘Enough staff most of the time’. ‘Sometimes there is enough staff’. ‘Never enough staff’. ‘Depends on the dependency of the client group’. The acting manager said that the home is in the process of recruitment and the process is protracted and whilst this is happening the home is served by relief/agency staff to make up the shortfall. The home has introduced a Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 24 performance monitoring procedure for allocated agency staff to ensure there is a consistent approach. Rotas are maintained which show who is on duty when and where, and in what capacity. The manager was confident that sufficient staff are on duty at all times and there was no evidence to suggest that residents needs were not being met. In discussion with one staff member they confirmed that staffing levels are maintained and that they considered staffing levels to be sufficient. The inspectors observed staff to spend time talking with people on an individual basis and within group settings and to engage with people in activities. Rehabilitation programmes were also in progress and staff were supporting these. The home employs a separate housekeeping staff for cleaning, cooking, kitchen assistant and laundry. The AQAA records that the home has 63 staff trained to NVQ level 2 or above with a number of co-ordinators having achieved NVQ level 4 in care. The recruitment records of three members of staff who had been employed by the home since the last inspection were examined. These demonstrated that the home follows correct procedures and carries out all relevant checks on staff prior to recruitment. This was consistent with findings at the last inspection. Records and discussion with staff showed that new staff receive induction training that covers relevant health and safety issues and addresses core areas such as moving and handling and fire. New staff are supernumerary for the first few days at the home and have the opportunity to shadow experienced staff. During the visit the inspectors were able to speak with recently appointed members of care staff. One person was in the process of shadowing and had done so for three days. In addition to the homes’ induction process newly appointed staff are enrolled on the Skills for Care eight-week induction training programme. In discussion with staff they reported that they felt sufficiently supported to carry out their role. It was evident that the staff spoken with enjoyed their job. One person commented that they had sufficient time to spend with individuals and were not just carrying out tasks all day long. A selection of staff training files was looked at during the visit to the home. These demonstrated that staff have the opportunity to undertake a range of training pertinent to their role. A training matrix was in place for all staff with planned updates and a training programme in place for the forthcoming months. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 25 Surveys from staff suggest that they consider they receive training relevant to the client group they care for and that they are fully supported to undertake the training. Comment on the survey from member of staff said: ‘ The Diversity training is a great tool to enhance carers skills and give them a greater understanding of individual needs and their right to choice’. The AQAA stated that the home has planned further rehabilitation training for staff to advance their knowledge and experience Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 26 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has not had the benefit of a permanent manager for some months. Residents’ financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. EVIDENCE: Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 27 The home is currently being managed by Mrs. Davies, who has been a senior member of staff for some years in the local authority homes, and who will continue to manage the home until a new manager is appointed. The acting manager has achieved her NVQ level 4 in management and care but said she has no desire to take on the management role permanently. The acting manager has a length of experience in care of the elderly and management and the staff on duty were observed to respect her and she integrated well with staff. She says she has an open door policy and staff are welcome to approach her at any time. She has instigated formal staff meetings with the team to allow issues to be discussed and to support staff during the transition to a new manager. The staff surveys returned indicate that the staff are feeling the lack of a permanent manager and comments on surveys said: ‘We have access to a line manager but not to a unit manager’. ‘I have not met the unit manager’. ‘My line manager does meet with the care staff, but never see the unit manager’. ‘Which manager?’ The AQAA acknowledges that the recruitment of a business support person is proving to be supportive to management and alleviating pressures in that area. The AQAA states that the acting manager works closely with the service manager to ensure clear understanding of the objectives of the service both corporately and strategically and to ensure that the service provides value for money. The home has a quality assurance system by which the home measures the quality of the service against that of the standards. The AQAA states that the plans for improvement over the next twelve months will be to improve the quality assurance system of the home to evaluate the service and identify how the service can be improved. The Service manager visits the home monthly and Regulation 26 reports are maintained in the home. The inspector viewed a sample and these are comprehensively completed identifying areas for improvement. Service user’s surveys have been distributed as well as family and friends and other stakeholders have been approached to give feedback on how well the home is meeting its goals. Comments or issues highlighted in these surveys are actioned for improvement. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 28 The staff at Brownhill Home do not get involved with any residents’ money and there are appropriate policies and procedures regarding gifts to staff and safekeeping of valuables. Evidence was seen in staff files that staff had received regular supervision. This was confirmed in discussion with a staff member. Newly appointed staff are supervised through regular review meetings carried out throughout their six month probationary period. One such meeting was carried out on the day of the visit. Staff surveys also indicate that the staff have supervision from their line managers. There was also evidence in records that disciplinary and support systems are in place. E.g. staff member involved in medication error, stopped from doing medication. Monthly one to one supervision sessions with notes maintained. Management monitoring of the staff member’s progress and performance. Retrained in medication procedures before being allowed to administer medication. Examination of the fire logbook demonstrated that regular and thorough testing of the home’s fire detection and fire-fighting equipment was being carried out. Some certificates were seen to demonstrate that equipment used within the home had been regularly checked and serviced. There were not any concerns with regard to safety within the home environment and staff undertake regular fire training. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 29 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 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 3 X X X X X X 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 2 X 3 X 3 3 X 3 Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 30 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 OP7 Regulation Reg 15 Requirement The registered person must ensure that care plans are written to reflect the mental health needs of the people using the service. The registered person must ensure that all staff working in the home have an understanding of how the privacy and dignity of service users must be respected at all times. Following a spout of thefts in the home, the registered person must make arrangements for service user’s rooms be made secure when they are not occupying them and ensure that records are documented to inform if that person has had choices as to whether they lock their bedroom doors when they are not in them. Timescale for action 31/01/08 2. OP10 Reg 12(4) 31/01/08 3. OP18 Reg 13 (6) 31/01/08 Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 31 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 OP14 Good Practice Recommendations Procedure needs to be looked at as to why visitors cannot be asked to wait at reception, until it is confirmed that the person they are visiting wishes to see them and not show them directly into the service user’s room until the person is there and the person be given the choice as to where they wish to meet with their visitor. Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 32 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 Brownhill House DS0000039229.V353624.R02.S.doc Version 5.2 Page 33 - 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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