Inspection on 12/04/05 for Brownhill House

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brownhill House 17/04/09

Brownhill House 23/12/08

Brownhill House 11/12/07

Brownhill House 21/02/07

Brownhill House 29/12/05

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 SO16 9LA Lead Inspector Jan Everitt Unannounced 12 April 2005 9:30 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Brownhill House Address Lower Brownhill Road, Maybush, Southampton, Hampshire, SO16 9LA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 8077 1808 Southampton City Council Mrs Pat Dixon Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability (22), Physical disability of places over 65 years of age (22) Brownhill House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1.Service users admitted in the categories PD and PD(E) may only be accommodated in the designated rehabilitation areas. 2.Service users in the category PD may only be accommodated between 55 and 65 years of age. 3. Only seventeen service users in the category of OP may be accommodated at any one time. Date of last inspection 29/9/04 Brief Description of the Service: Brownhill House, built originally as a private residence in the late 1900s, now operates as an older persons resource centre under the management of Southampton City Council.It is located in a suburb in the west of Southampton. The home makes provision for three separate services. Currently the home can accommodate eleven service users in the old age category of over 65 years. Three beds are allocated for long-term residential care with a further eight for respite care. A new purpose built wing to the home has been opened and accommodates sixteen service users admitted directly from the orthopaedic wards at the General Hopsital for a period of rehabilitation and discharge planning following orthopaedic surgery. This service is clasified as intermediate care. The anticipated length of stay in this unit is six weeks, following which, most service users return to their own homes. The rehabiliation unit is situated on the first floor of the house and can accommodate twelve service users 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. At the time of the inspection only six of these beds were operational. All accommodation in the home is single occupancy with sixteen rooms having en-suite facilities. Brownhill House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day on the 12 April 2005. Two senior officers for the home assisted the inspector with the inspection process. The inspection focused on the requirements made from the last inspection and fifteen of the 20 key standards to be inspected over the forthcoming inspection year. The inspector spent a considerable part of the day touring the building and talking with service users and staff. A sample of records and documentation were also inspected. What the service does well: Brownhill House provides a variety of intermediate and long-term care for the people over 65 years of age. The service users gave positive feedback as to the standards of the services and care they receive whilst in residence. Staff moral was good and staffing levels are adequate. The orthopaedic 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 rehabilitation unit is managed by a coordinator and is overseen by a geriatrician who visits the unit once a week. The two intermediate services aim is to offer a rehabilitation programme of approximately six weeks to enable service users to reach their full potential of independence. The outcomes from the rehabilitation and orthopaedic rehabilitation programmes for those in intermediate care have been proved to be good and lead to service users being able to return to independence and in most cases to their own homes. The staff team are well trained and are able 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 environment is pleasant and well decorated. Service users reported that the quality and variety of food served was good. Service users also commented on enjoying the activities and social interaction with other service users and staff. Brownhill House Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brownhill House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Brownhill House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 & 6 Service users in the Rehabilitation unit do not have a written contract/statement of terms and conditions with the home. Service users move into the home following a full assessment of needs. Service users assessed and referred solely for intermediate care are helped to maximize their independence and return home. EVIDENCE: Contracts of agreement to the terms and conditions of residency are in place for the residential service users. A separate contract for those admitted for intermediate care and rehabilitation were not evidenced. This is reported as currently being developed. Service users spoken with reported that they felt lucky to be able to receive the period of rehabilitation and their desire was to return home as soon as possible and they fully understood the reasons for being at the home for a short period of time. Pre-admission assessments are in place for the residential service users and those receiving intermediate care and contain appropriate information to assess care and rehabilitation needs. Care managers share information with the home at the time of referral. All admissions to the orthopaedic unit are Brownhill House Version 1.10 Page 9 directly from the orthopaedic wards at the hospital and service users are preassessed by one of the multidisciplinary team that are based at the home. The rehabilitation unit has separate facilities and a separate staff group that are suitably qualified. A consultant geriatrician attends the home weekly to review service users receiving rehabilitation and members of a multidisciplinary team are available for consultation. The orthopaedic unit has separate facilities and staff group and is supported by qualified members of a multidisciplinary team. The stated average length of stay for both the intermediate care units is six weeks. Brownhill House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 & 10 The service user’s health, personal and social care needs are set out in an individual plan of care. The home has no agreed medication policy. Service users, where appropriate, are responsible for their own medication, Service users feel they are treated with respect and their right to privacy is upheld EVIDENCE: Individual plans are available for all service users in residence at Brownhill House. The care plans are detailed and ensure that all aspects of the person’s health, personal and social care needs are identified and planned for. Staff spoken with reported they are guided in their practices when caring for the service users by following the plans. The rehabilitation and orthopaedic rehabilitation service users have detailed plans to which the multidisciplinary team contribute, appropriate to their area of care and rehabilitation. Plans in the long-stay residential area of the home are reviewed appropriately. Service users sign an agreement of their rehabilitation programme, which is compiled with their participation and agreement. Programmes of rehabilitation are agreed with service users in the orthopaedic unit. Service users spoken with were aware of their programmes of rehabilitation, plans for any further Brownhill House Version 1.10 Page 11 treatment they may need and felt they had been fully consulted on all aspects of their care and discharge planning. Staff spoken with reported that regular review meetings with the team members, which include physiotherapist, occupational therapist and nurse, enable them to discuss individual care and progress with rehabilitation programmes and the expected date of discharge home. Staff expressed confidence and knowledge of their own roles within the team. Self-medication forms part of the rehabilitation programme and a number of service users do manage their own medicines. Assessments of their capabilities and understanding of their medication takes place before they are able to be completely be independent of direction. There was no evidence of a medication policy in place. The officer in charge reported that this is in draft format and has not been issued as yet. There are various methods of administration of medication. The medication is stored appropriately and records maintained. The home has the support of the visiting pharmacists who was visiting the home at the time of the inspection and described his role within the home. Staff have received training on all aspects of medication handling. Service users spoken with reported their satisfaction and respect for the care they receive from the care staff. Service users receiving rehabilitation programmes from the intermediate units felt involved and respected by the staff and that their privacy was respected. Staff were observed to knock on individual bedroom doors before entering. Staff spoken with were able to identify the core values of care which form part of the induction programme based on the TOPSS standards. Brownhill House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Service users find the home life matches their expectations and preferences, and satisfy their social, religious and recreational interests and needs. Service users in the intermediate care services find that the services meet their expectations of their rehabilitation needs. Service users are able to maintain contact with family/friends daily. There is no visiting policy for each of the units to identify that in the rehabilitation and orthopaedic units there are restricted visiting times. Service users receive a wholesome varied diet in pleasant surroundings. EVIDENCE: The home has a variety of activities planned by the care staff. On the day of the inspection a quiz was taking place, which the service users appeared to be enjoying. Outings do take place but the officer in charge reported that there is difficulty in obtaining transport. The service users in the rehabilitation unit and those in the orthopaedic rehabilitation unit individually participate in activities that appertain to their rehab programme and exercises are practiced twice every day. Service users interests are documented on the assessment documentation. The clergy attend the home once a month to take a service. It was observed that daily newspapers are delivered for each of the units. One service user was in receipt of taped talking books from the blind society and also the visiting library will supply these to her. Brownhill House Version 1.10 Page 13 The visitors’ book evidenced that many visitors visited the home throughout each day. Restricted visiting times, which are displayed on the notice boards, are in place in the two intermediate care units to allow for rehabilitation programmes to be undertaken. The residential unit displayed a notice that visiting was from 7am - 10pm. These visiting times are not detailed in the service user guide. All bedrooms are single occupancy and therefore service users may receive their visitors in the privacy of their own room. The home does not manage service users’ financial affairs and those in long stay care have individual bank accounts. Service users who are resident in long-stay care are encouraged to bring their personal belongings and those rooms were observed to be individual and homely. A significant number of service users were spoken with and they all reported to be very satisfied with the food served. They reported that there was choice every day at all three meals and the meals were well presented. Homemade cakes are served every day. The menu was seen to be displayed daily on a chalkboard with a choice of the main course. For the service users in rehabilitation they have the availability of a kitchen in which they practice tasks around preparing food and beverages. The cook was spoken with and she reported that menus are rotated three weekly and that most of the service users enjoyed the ‘old fashioned meals’ which she accommodated within the menu planning. Snacks are available throughout the day and night but fresh fruit is available only as part of the daily menu. Brownhill House Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their relatives/representatives are given information that would enable them to be confident that their complaints would be taken seriously and acted upon. EVIDENCE: The home has a complaints policy in place that is presented in a booklet type leaflet, which is given to all service users. These are on display in the main reception area for access and information. The manager maintains a complaints logbook and this was viewed for inspection. Two complaints were logged and had been investigated by the home. Service users spoken with were aware of who they would go to if they felt they wanted to complain. Staff are also aware of who they report any complaints to if a service user complains to them. Brownhill House Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home has well maintained but does not provide the service users in the home with safe surrounding environment. The newly built orthopaedic unit does not provide service users with a safe environment. The home is clean and free from offensive odours. EVIDENCE: The home was observed to be clean and hygienic. Cleaning materials were observed not to be maintained in a locked environment this places certain vulnerable people at risk. The home is pleasantly decorated and individual rooms have been personalised. The new orthopaedic wing had experienced some building faults and the coordinator reported that there remain faults in the building to be rectified. It was noted from the accident records that heavy fire doors in the orthopaedic wing had been the cause of a service user falling. This is under discussion with the local authority and Hampshire fire and rescue people as to having fire release doors fitted. The residential unit of the home has only one small cramped patio area for service users to enjoy the outside in the pleasant weather. A service user Brownhill House Version 1.10 Page 16 spoke freely that she felt aggrieved that the garden had been taken from them to house the orthopaedic unit and that although there was garden down a long ramp the garden was uneven and not safe to walk on with no seating areas. She reported that she had written to the appropriate people to put her views forward. The rehabilitation unit reported a similar situation where a ramp has been fitted that leads to the garden but comes to an abrupt end on an uneven grassed area. These garden areas should be made accessible to service users. These issues were identified at the previous inspection. The fire officer inspected the home in August 04 with no recommendations made. Staff are trained and are aware of the procedures for infection control. The laundry room is fit for purpose but awaits a more proficient ventilation system to enable the door to be closed when the laundry person is working. Brownhill House Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The number of staff on duty is sufficient to meet the needs of the service users in residence at the time of the inspection. Training for staff is provided to enable them to do their job with confidence and meet the needs of the service users. EVIDENCE: Staffing levels on duty at the time of the inspection were adequate to meet the needs of the number in residence in the home. It was observed that there were adequate numbers of ancillary staff available to maintain the kitchen and the cleanliness of the building. The officer in charge reported that the home does have to employ agency staff if their own staff cannot cover staff absence, but that extra staff had been employed and were undergoing training. Each unit in the home has their own designated staff group to ensure continuity of care and rehabilitation. The home has a comprehensive training programme and an individual training matrix is maintained in staff training files. The homes’ induction and foundation programme is based on the TOPSS standards. One new member of staff spoke to the inspector and reported to be shadowing other staff and was undergoing her induction and reported to feel very supported during this time. Members of staff spoken with were very positive about the training available to them and one reported to be undertaking her NVQ level 3 and was motivated to make a career in the caring profession. Service users spoken with reported that staff were very kind and worked hard. The interaction between staff and service users was observed to be good and good communication skills were Brownhill House Version 1.10 Page 18 displayed by the carer when talking to a service user who had a broken hearing aid and had difficulty in hearing. The atmosphere in the orthopaedic area was happy with lots of banter between the staff member and service users. Brownhill House Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The practices within the home ensure that the health, safety and welfare of the service users and staff are protected. EVIDENCE: The building has been risk assessed and documented. The home has policies on all health and safety issues and staff receive annual training on these in line with the corporate calendar for all local authority homes in the area. A sample of servicing of systems and equipment was viewed and found to be in order. The fire logbook was viewed and the fire alarm system had not been recorded as being tested every week. The officer in charge assured the inspector that it was undertaken every Saturday. The testing of emergency lighting and other fire equipment is undertaken by the works department for the city council and maintain their own records. The copies of the service sheets for various equipment were carbonated and it was not possible to identify the date and what work had been undertaken. Brownhill House Version 1.10 Page 20 The kitchen was toured and found to be clean and well organised. It was observed that a large quantity of dry goods was being stored, the cook reported that she does rotate the stock every delivery. The environmental health officer has visited the home recently with one recommendation made. Brownhill House Version 1.10 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 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 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 2 Brownhill House Version 1.10 Page 22 yes Are there any outstanding requirements from the last inspection? 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. 2. Standard 9 19 Regulation Reg 13(2) Reg 23(2)O Requirement A medication policy must be put in place and made available to staff. Garden areas provided for the rehabilitation and the long stay service users must be landscaped and made safe and accessible for their use. An action plan must be submitted to the CSCI within the stated timescales. This remains outstanding from the last inspection. Cleaning materials must be maintained in a locked environment when not in use and must not be left unattended. The fire log book must be recorded at the time of every fire alarm test. Carbonated copies of the records of maintenance work undertaken must be able to be read to identify the date and type of maintenance undertaken. Timescale for action 31.5.05 30.6.05 3. 38 Reg 12(1)a 31.5.05 Brownhill House Version 1.10 Page 23 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 2.2 Good Practice Recommendations It is recommended that a separte terms and condition of residency contract be compiled to include points stated in standard 2.2 for the long/short stay unit, the orthopaedic unit and the rehabilitation unit. Brownhill House Version 1.10 Page 24 Commission for Social Care Inspection Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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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