Inspection on 23/12/08 for Brownhill House

This inspection was carried out on 23rd December 2008.

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

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

Other inspections for this house

Brownhill House 17/04/09

Brownhill House 11/12/07

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 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brownhill House Lower Brownhill Road Maybush Southampton Hampshire SO16 9LA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Sims     Date: 2 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Brownhill House Lower Brownhill Road Maybush Southampton Hampshire SO16 9LA 02380771808 Telephone number: Fax number: Email address: Provider web address: beverley.kenchenten@southampton.gov.uk Name of registered provider(s): Name of registered manager (if applicable) Miss Marian Wilson Type of registration: Number of places registered: Southampton City Council care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 39 The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home 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, Maybush with reasonable local transport links. The home makes provision for three separate services, Orthopaedic Rehabilitation, Social Rehabilitation and Residential/Respite Care. The first two services are classified as intermediate care, Care Homes for Older People Page 4 of 36 Over 65 39 0 0 39 Brief description of the care home whilst the later as stated is residential. All accommodation in the home is single occupancy with many rooms having en-suite facilities, especially those within the newer Orthopaedic Unit. Respite care costs are established following assessment, there is no charge for intermediate care (rehabilitation), services for up to six weeks. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a Key Inspection, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over 6.5 hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commissions database and the Annual Quality Assurance Assessment information Care Homes for Older People Page 6 of 36 provided by the service provider/manager. For the purposes of this report the feedback or results of the homes own surveys have been used to illustrate peoples experiences of living at Brownhill House. What the care home does well: What has improved since the last inspection? Three requirements were made during our last visit: 1). The registered person must ensure that care plans are written to reflect the mental health needs of the people using the service. 2). 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. 3). The registered person must make arrangements for service users 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. It was determined at this visit that generally these issues have been addressed, with new care planning documents, agreed by the provider organisation and introduced into service by the manager. The staff throughout the day were courteous, polite and helpful and the observation of their interactions with the service users and their relatives/visitors, positive and friendly. The right of the service user to lock their bedroom door, may still require a little work, as staff seem on occasions to forget that people, who have capacity, can opt to lock their door, however, most people spoken with during the visit seemed happy with the current arrangements within the home and all doors are fitted with locks. Care Homes for Older People Page 8 of 36 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their representatives have access to information about the services provided and the facilities on offer. Evidence: The Manager states via the AQAA that: The health team have a robust system for ensuring service users accessing the Rehabilitation and Orthopaedic unit can be met and supported into a 6 week programme. Leaflets are given out at the hospital to people who the hospital consultant has recommended intermediate care at Brownhill. Service users not wanting to come to Brownhill are given an opportunity to find out about the service through the leaflet but are not pressured in any way to stay. Our health colleagues carry out comprehensive assessments and identify rehab goals with service users and devise a rehabilitation programme to support service users safely back home. We have a high percentage of people going home within the 6 week period, which indicates people are achieving their goals and recovering well. In the Care Homes for Older People Page 11 of 36 Evidence: Orthopaedic and the Rehabilitation unit there is a high demand for beds and service users are accommodated at very short notice. Coordinators and Carers prepare the service user for admission and very quickly help settle people. The rehabilitation unit also receive referrals via General Practitioners (G.Ps), social workers and community rehab teams for service users in the community. This prevents admissions to the acute hospital. The respite unit receives referrals from Care Managers and the contact centre (emergencies). There is a flexible assessment plan of 24 (day or overnight) or 48 hour stay, which enables a service user to try out the service before a planned stay is confirmed. Six service users plans were reviewed during our time at Brownhill House, two folders from each unit, Orthopaedic, Rehabilitation and the Residential or Respite Unit. Each folder or plan contained details of the pre-admission assessment carried out, with those of the Rehabilitation and Orthopaedic Units having been completed by a professional member of the health care team attached to Brownhill House, Occupational Therapist, Physiotherapist or Rehabilitation Nurse. The pre-admission process for the Residential or Respite Unit is slightly different, with the people referred to the Unit, via their care manager/social worker, invited to visit the Unit for an afternoon and an assessment of need carried out by the Care Coordinators. The assessments seen, during our visit, were generally informative documents, although the health care staff should be aware that the use of abbreviations, when making records, should be avoided, especially when the document is likely to be used by people from varying professional backgrounds, as abbreviation can cause problems in communicating information. Copies of the services statement of purpose and service users guide were accessible to people throughout the building, as they were pinned to notice boards in each unit. Within the Orthopaedic Unit the Care Coordinators have created an information of welcome pack, which is left in the persons room and provides access to various leaflets and brochures, including the service users guide, which might be of use to the person being admitted to the unit. People admitted to the Orthopaedic and Rehabilitation Units are, as mentioned, supported by health care staff attached to the Unit, Occupational and Physiotherapist and the Rehabilitation Nurse. An individualise programme of exercise and skills development is planned for each Care Homes for Older People Page 12 of 36 Evidence: person and the facilities within the Units used to support them, i.e. kitchenette and adapted areas within the Orthopaedic unit and exercise equipment. The documentation referred to above also makes clear, via the contract, to anyone entering Brownhill House that their stay is not permanent and that there is a timescale of up to six weeks in operation within the Orthopaedic and Rehabilitation Units and twelve weeks within the Residential/Respite Unit Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The Manager states via the AQAA that: Service users are involved in the planning of their care and goals. The care plans are written in plain English and are person centred. Service users are given a choice of menus and comment regularly that the food is lovely. Staff receive intensive skills for care training covering the basic principles and care of older people. Additional training on safeguarding, parkinsons, needlestick, dementia, rehabilitation is offered to enable staff to understand the needs of older people. In the Rehabilitation Unit there is a elderly care consultant geriatrician who attends weekly and gives each service user a thorough medical assessment. Any health needs are picked up and investigated. In the Rehabilitation and Orthopaedic Units service users are encouraged to be as independent as possible and this is reflected in people Care Homes for Older People Page 14 of 36 Evidence: being sufficiently able to safely go home within the 6 week period. As stated previously six care planning documents were reviewed during the fieldwork visit, two from each Unit. Of the six reviewed four were using a new care document, which reflected peoples needs and how these could should met, whilst two were based on a slightly different format, which whilst identifying the persons needs did not encourage the staff to record how these needs were to be met. However, in conversation with the Care Coordinators and latterly the Manager it was explained that the new version of the care planning documentation had only recently been introduced and therefore anyone admitted prior to this would be on the older format. The running records are updated three times a day and provide a good oversight of the persons care and social activities across that period, the records are Multi Disciplinary Team (MDT) records with Community based Nurses, Occupational Therapist, Physiotherapists, General Practitioners, Geriatricians and Care Staff all using the single document to record the persons progress and achievements. The services approach to risk assessment is a little restrictive and, as discussed with the Manager, should be reviewed and based on an individualised assessment of the person and not the generic approach presently in use. The present risk assessment documentation is also poorly designed, with small boxes allocated for the documenting of the risk and more importantly the planning on how to manage the risk, this issue has also been brought to the Managers attention, with an assurance given that this will be looked at. The views of people using the service are very encouraging with people spoken with during our visit and comments made via the services survey evidencing peoples satisfaction and appreciation for the care and attention they receive: I was very happy and satisfied with everything I received and the care and the food were excellent. The nurses deserve great praise for their fun and laughter that made everyone happy and content. I have nothing but praise for every member of the staff. They could not have done more to make me welcome and cared for. A service user and their relative, spoken with during our visit, discussed their experience of the home, explaining that the service user had come to the home from Care Homes for Older People Page 15 of 36 Evidence: home after a brief illness and inflammation of their joints. It was now five weeks into the stay and they were approaching discharge, which had been delayed as the care package could not be commenced until after Christmas. They feel the care received has been excellent and that good progress has been made during the staff, the staff are good and the foods praised. At the last inspection issues were raised with regards to the lack of privacy shown to people during the delivery of personal care, a client seen in a state of undress in their room, as the door was left open. During a look around the home and visits to each unit, the practise or habit of people leaving their bedroom doors open appears to be common place, although when asked the staff state this is the persons choice and not a requirement of the service. In conversation with service users they stated they were happy leaving their doors open and saw nothing wrong with this practise, as they felt safe and happy in the home. Doors are fitted with locks and each room is supplied with a lockable draw or cupboard, which can be used to secure personal items of value, etc. All accommodation within Brownhill House is single occupancy, which provides people with privacy during the delivery of personal care, when meeting with health and social care staff or entertaining visitors. The residents preferred terms of address were document on their care plans and the interaction between the staff and the residents and the staff and the visitors noted to be appropriate and respectful. Over the last twelve months we have received a large number of reports, under Regulation 37 of the Care Homes Regulations, following medication errors at Brownhill House. The identification of these incidents has come from the home itself and the diligence of the staff, who are prepared to question potential medication errors, without fear or repercussion. The Manager discussed the problems the home had experienced and the measures taken to reduce the incident of error, including the involvement of the Primary Care Trust (PCT)Pharmacist who has audited, advised and prepared training for staff on the safe handling of peoples medications. Care Homes for Older People Page 16 of 36 Evidence: The Manager and the PCT Pharmacist have also produced new policy documents for the staff, aimed at improving the way medicines are handled, these new documents are presently being considered by the Council before being implemented into practise. The manager was also able to produce documented evidence of the work undertaken with staff involved in any medication errors, including initial investigations, ongoing support and development and regular supervision sessions. Recently the number of errors and/or reports being sent to us, regarding medication errors, has decreased, which indicates that the measures being taken by the Manager are having the desired effect. The practise of the staff, as observed during our visit, was very good, with staff doning a red tabard, which indicates to other staff that they are not to be disturbed, as they dispensing and administering medications. Medications were observed being administered directly to the service user and records updated only after the person was seen taking their medicine, no medications were left with the service user to be taken at a later date/time. People admitted to the Rehabilitation and Orthopaedic Units, especially, are encouraged to maintain control of their own medication regimes or to work towards the management of this process. An assessment tool is available to the staff to ensure anyone self-medicating is fit and safe to do so. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use service are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities could be improved to better meet individuals expectations. Evidence: The manager states via the AQAA that: We have 2 hairdressers and a chiropodist who regularly visit the home and provide a welcome service. The Orthopaedic and Rehabilitation Units provide daily exercises to develop daily living skills. The health team undertake regular assessments to monitor skills, progress and abilities. The Rehabilitation Unit also promotes activities of daily living and service users undertake tasks such as laying tables and washing up. The rehab and Ortho Units set up care packages for safe discharges home and ensure G.P visits and District Nurse visits are set up and in place. We have a very flexible visiting time programme from 7am to 10pm and actively encourage family and friends to come and visit. We are supported by the rotary club who offer activities to people, such as Bingo. In the Respite unit daily activities are organised to help stimulate and entertain people. A book is held by staff to see what Care Homes for Older People Page 18 of 36 Evidence: has been offered to ensure service users have a variety of activities offered during their stay. The kitchen staff feel they have a good understanding of the needs of service users and have a robust system for being informed of the dietary needs of service users. In the kitchen there is a white board that details abbreviations of service users dietary, cultural and or religious dietary needs taken from the nutritional screening assessment. The kitchen staff feel confident they are able to meet the dietary needs of service users. Details of the visiting arrangements, to the three Units, at Brownhill House are on display within the home, a copy of the visiting times seen on display in the main entrance area of the home, just beyond reception area. The reception desk is staffed throughout the day and on entering the main building the Care Coordinators and Managers offices are the first areas of the home reached by visitors. Additional information, relating to visits, can be found in the services statement of purpose and service users guide literature, which again is accessible to people around the home, as mentioned earlier. During our visit a number of visitors were observed arriving at the home and being welcomed by the staff and management prior to meeting up with their next-of-kin. In conversation with one relative it was established that she visits the home daily and that the arrangements within the home, to accommodate visitors, meets both her and her relatives needs. Activities and entertainment seem to be a little bit of a mixed bag at Brownhill House, with the structured exercise and life skills programmes well organised and delivered. However, the leisure activities programme seems a little less well structured and organised, with the main entertainment provided for service users being a monthly bingo session, according to three services users and two staff members. During our visit to the home a bingo session, with a Christmas theme, had been arranged by the staff and this appeared to be popular with the service users, who appreciated the staffs efforts in dressing up and arranging gifts and prizes. Care Homes for Older People Page 19 of 36 Evidence: However, despite the additional theme, this was basically another bingo session and not something different for the clients i.e. a carol service or quiz, etc. The hairdressing salon, mentioned in the AQAA statement, was in use during our visit and several people spoken to later in the day confirmed their attendance at the hairdressers and their appreciation at being able to have their hair done in the run up to Christmas. The premises was also very well decorated throughout, with festive decoration on display in every Unit and around the home, the tree within the Residential/Respite Unit dining area, exceptionally eye catching. In conversation the staff did say that they try to engage people in activities in the afternoons when things are quieter, although they also stated that people were less willing to participate in afternoon events, as they encounter the post diner malaise and visitors beginning to arrive. The service users also discussed the fact that their are no televisions in the bedrooms, which they find difficult, as often they would prefer to retire to their rooms of an evening and settle down to watch a programme of their own choosing. In discussions with the manager she stated that she is aware of the shortage of personal entertainment systems, televisions and radios, etc and that plans are in place to provide the latter in each room next year. The manager has also taken on board peoples observations and comments in relation to entertainments and will undertake a review of the services current approach. The mix of lounges and dining areas, available to residents and their relatives, ensures that meetings can be conducted in private, although their single occupancy rooms can be used if they prefer. The evidence indicates that the home is good at promoting peoples rights to selfdetermination and independences, as this is the basic core principle of a rehabilitation unit/service. The care planning records discussed earlier in the report reflecting peoples choice and involvement in the care planning process and the surveys indicate that people who use the service are asked or encouraged to share their views and therefore influence the future direction of the service. Care Homes for Older People Page 20 of 36 Evidence: A visit to the kitchen was undertaken in the company of the manager. The kitchen is a large well equipped facility, that is extremely well looked after and spotlessly clean throughout. The manager indicated that the home operates a rotational menu, which offers people variety and choice and that meals are normally taken in each Unit separately, heat trolleys available to take the food to the Rehabilitation and Orthopaedic Units during the day. In conversation the service users all praised the meals provided and the response to the services surveys, also contain positive remarks about the food provided: The food was outstanding. The care and food were excellent. However, the manager did indicate that presently the service does not offer a hot meal choice at teatimes and that she was in the process of reviewing this historic practise with a view to introducing a hot and cold meal option. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. Evidence: The Manager states via the AQAA that: We listen to people and ensure complaints no matter how minor are resolved as quickly as possible. We display information on advocacy services and health care information. We have a team of care managers and social workers who provide information and offer assistance and in some cases investigate safeguarding issues promptly and effectively. We have a robust safeguarding system in place and have provided training to all staff on recognising abuse and raising concerns. All staff are aware of the alert 1 forms and where they are and receive annual training to ensure their awareness is at the fore front of their practice. We have learnt from the recent alleged thefts in the rehabilitation unit and have devised tighter safeguards to safeguard people staying at Brownhill. Our culture is very open and all complaints whether formal or minor are dealt the Care Homes for Older People Page 22 of 36 Evidence: same efficient way. Service users give us positive and sometimes constructive feedback on what we could improve upon. Service users appear relaxed, safe and comfortable. Details of the homes complaints process is contained within the service users guide and statement of purpose literature and these documents are made accessible to service users and their representatives around the home, as mentioned earlier in the report. The dataset, which forms part of the AQAA documentation, confirms the existence of the homes complaints and concerns procedure, which was last reviewed and updated in the November of 2007. The dataset also contains information about the homes complaints activity over the last twelve months: No of complaints: 3. No of complaints upheld 2. Percentage of complaints responded to within 28 days: 100 . No of complaints pending an outcome: 0. Information taken from the services internal surveys indicate that people moving into the home were provided with sufficient pre-admission information, the packs seen on the Orthopaedic Unit containing details of the Local Councils complaints process and the service users guide and statement of purpose. The dataset indicates that policies on the protection of service users are in place, Safeguarding adults and the prevention of abuse and Disclosure of abuse and bad practise, the policies updated in the November and March of 2007, respectively. The dataset also establishes that over the last twelve months three safeguarding referrals have been made to the Local Authority, a statement support by a review of our database, which confirms the receipt of Local Authority alert forms and Regulation 37 reports. The evidence indicates that the incidents were appropriately handled by the service and have now been satisfactorily resolved. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The Manager states via the AQAA that: We have a full compliment team of housekeepers who keep the unit free from offencive smells and ensure the units are kept clean and tidy. They are very dedicated and committed and do their job to a high standard. We have a robust system for reporting faults and repairs and these are normally dealt with by the department within 24 hours. The Orthopaedic unit is tastefully decorated and all the bedrooms have en suite facilities. The rooms are spacious, clean and have nurse call systems, pleasant furniture including lockable unit. Bedrooms, bathrooms and communal areas are fully equipped with aids to support with individual mobility needs. The rehabilitation unit is fully equipped to rehabilitate service users home, perch stools, rails, chair risers and walking aids are individually assessed. Care Homes for Older People Page 24 of 36 Evidence: We have attractive gardens and several patio areas for service users to sit and relax in. The kitchen is kept clean. The reception area is light and welcoming and has information available to visitors on customer charter, department aims, visitor times etc. There is a settee for visitors who have appointments to sit comfortably until the person they came to see arrives. The Manager also states via the AQAA that: We have advised the council of the decoration that is required and have obtained quotes for a new carpet. We are making improvements to the laundry room and relocating the hairdresser room. A look around the home was undertaken in the company of the administrator who discussed the plans to relocate the hairdressing salon and the managers office, which it is planned will make-way for the new hairdressers. The property was found, generally, to be well decorated throughout, although the Residential/Respite and the Rehabilitation Units do appear a little tired in comparison to Orthopaedic Unit, which is newer and therefore more recently decorated and furnished. As the client group of Brownhill House are not permanent and often only in the home for six to twelve weeks, the rooms they occupy are not personalised to the same extent as those you would expect to see in a traditional residential home. However, the people occupying the rooms do appear to do their best, in the time they have, to create some sense of belonging and ownership, using pictures, cards and cuddly toys to personalise their space. Maintenance of the home is the responsibility of the Local Authority, who via the estates department ensure remedial work and redecorative programmes are carried out. The Manager, in conversation, discussed how she has to submit plans to the Local Authority, for their approval and/or agreement, in order for any renewal or redevelopment work to be commenced, although this appears to differ little from other Local Authority run establishments. As mentioned within the AQAA the home employs a dedicated domestic staff team, who are reasonable for the cleaning of all areas of the home, although some service users, as part of their life-skill programme may undertake bed making and general tidying of their rooms. During the look around the home and then later, as we visited each Unit separately Care Homes for Older People Page 25 of 36 Evidence: members of the domestic staff team were observed undertaking their duties and supporting the Laundry Person, who was absent from work on health grounds. The Units were noted to be free from odours and very clean and tidy throughout, as were the separate communal areas and those areas of the home used by the daycentre and reception. Communal toilets and bathrooms were noted to contain liquid soaps; paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the Control Of Substances Hazardous to Health (COSHH) regulations. The laundry, which is located within the main building, is the responsible of the laundry person, who as stated was absent during our visit, the laundering of the service users clothing and the returning them to the persons room falling on the domestic staff team. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person, each Unit using a different colour to mark its clothing, thus ensuring it is returned to the right place. Care Homes for Older People Page 26 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. Evidence: The Manager states via the AQAA that: We have a robust recruitment procedure for employing competent, reliable and suitable staff. We have a skills for care induction programme for all staff and an excellent on-going training programme for staff, designed to meet the changing needs of people accessing our service. We have a dedicated diverse team of carers and co-ordinators who manage the intermediate care of people accessing the units. The numbers of staff are kept consistent to provide quality of care to service users. We have regular co-ordinator, unit and staff meetings. All staff receive supervisions and observations and appraisals, as part of their development. Staff are encouraged to undertake National Vocational Qualifications (NVQ) training and on going developmental training. Each Unit is individually staffed and it is the responsibilities, via delegated tasks, to Care Homes for Older People Page 27 of 36 Evidence: ensure the Units are appropriately staffed and covered at all times. The duty roster for the Rehabilitation Unit was seen during the visit to this Unit, as the Care Coordinator was planning or agreeing relief cover over the Christmas and New Year Period. In discussion with two Care Coordinators it was established that when a vacancy occur attempts are made to cover the shifts internally, however, if this fails then carer vacancies are past onto an Agency to cover, whilst Care Coordinators are covered by relief staff employed by the Local Authority. Observations made throughout the day support the fact that sufficient staff were employed at the home and that the needs of the service users were being meet, with Care Staff, Health Care Professionals, Care Coordinators, Domestic, Catering, Administration and the Manager all seen around the home during the fieldwork visit. Details of the homes staffing arrangements/structure, their skills and experience are also set out within the homes statement of purpose and service users guide documentation, which as mentioned is accessible to people around the home. Information taken from the services surveys also provide evidence of the service users experience of the staff: I was very happy and satisfied with everything I received and the care and the food were excellent. The nurses deserve great praise for their fun and laughter that made everyone happy and content. I have nothing but praise for every member of the staff. They could not have done more to make me welcome and cared for. The carers and all staff are lovely and the food was outstanding, I have enjoyed my stay here. During conversations the staff stated that training opportunities were good and that training was discussed during supervision. Training we were informed addresses mandatory issues on a yearly basis, whilst additional training could be applied for via your line manager, often the courses are repeated, which enable people to get to them. NVQ training is also provided with Care Staff completing NVQ level 2 courses and the Care Coordinators stating they complete NVQ level 3 courses in care and management. In discussion with the Manager, she confirmed that the Care Coordinators, as the line managers for the Care Staff are required to submit applications for courses on their behalf, this is an electronic exercise and confirmation is electronically and postally Care Homes for Older People Page 28 of 36 Evidence: confirmed with the applicant. She (the Manager), as the line manager for the Care Coordinators, undertakes their supervision and makes electronic applications for courses on their behalf, the Manager feels the Local Authority, as the employer, provides staff with access to good levels of training and development. Presently the Manager can evidence the courses attended by staff, as she retains a copy of the certificates awarded for the completion of a course. Staff are also required to complete reviews of the courses attended, including assessing the pre-course information provided, which can lead to questions being asked about the Coordinators, if the staff seem ill prepared. During the visit the Manager provided us with sight of the new staff portfolios being introduced by the Local Authority. These new employment tools have yet to be rolled out for general use, however, the file seen during our visit, provides the staff with a system for documenting the outcomes of training sessions completed, supervisions and appraisal sessions, etc. Information taken from the dataset indicates that currently the home employs thirty seven care related staff. Twenty of the thirty seven have completed a National Vocational Qualification (NVQ) at level 2 or above and this provides the home with a rate of 54 of its care staff possessing an NVQ at level 2 or above. The Manager also makes clear via the dataset that all newly recruited and employed staff have satisfactory pre-employment checks completed before commencing work within the home and that policies and procedures on the Recruitment and Employment, including redundancy are available to staff, this policy was last updated in the November of 2007. The Manager, has introduced electronic personnel files, where scanned copies of all the relevant documentation, in support of a persons application, can be stored. This is presently not a system, which has been authorised by the Local Authority, however, it appears to function well and the Manager was able access staff employment information, which supported the fact that a robust recruitment and selection process is in operation at Brownhill House. Care Homes for Older People Page 29 of 36 Care Homes for Older People Page 30 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The Manager states via the AQAA that: The manager has the required skills and a vast amount of experience working in local authority and with older person. The manager has financial and managerial experience leading teams and working under the national minimum standards (NMS). The manager provides appropriate support and supervision to staff and monitors standards. All incidents and accidents are monitored and kept to a minimum. Working practises appear safe and any potential hazards are identified and actioned. This was the Managers first full inspection since becoming the Registered Manager for Brownhill House, although previously she has worked within and managed other Care Homes for Older People Page 31 of 36 Evidence: social care services. The evidence contained within this report indicates that the Manager is generally running a good home, although one or two issues, as mentioned in the report, were brought to the Managers attention and these issues should receive some attention on her or the providers part. Our visit to the service suggested that the Manager was being well supported in her role by the Care Coordinators, however, the Managers statement, made via the AQAA, tends to raise questions about this assumption: The coordinators have not had a permanent manager for sometime and past leadership has not given coordinators a role model for working together. The new manager has put in a structure of management meetings, supervision and unit meetings to open up communication channels for all staff to improve service delivery and quality. The management team are working in a period of change and have identified a number of communication issues, which are being addressed in the management meetings. There has also been a high level of sickness in the management team, which has not helped the cohesiveness and development of the team. However, we are satisfied that the present management arrangements at Brownhill House are working well and that the welfare, safety and wellbeing of the people using the service is being appropriately addressed. The Managers approach to quality assurance is also good, with surveys used to gather information from people about their time and experiences within the home. The comments of several people, who competed surveys, used by us within this report to support our findings and to evidence how people view their time at Brownhill House. Staff meetings, at both a Unit level and generic service level are also being conducted, with the minutes of one such meeting seen on display within the Rehabilitation Unit, whilst copies of visits undertaken by the Provider or Council were also available within the home for review. Care plans and risk assessment were being reviewed and updated accordingly and other records, like those relating to the handling or receipting of medication, training and development and the recruitment and selection of staff appropriately and accurately maintained. In discussion with the manager it was established that the home or service does not Care Homes for Older People Page 32 of 36 Evidence: become involved in the handling or managing of peoples monies. Lockable facilities are provided in each bedroom and people are welcome to bring in small amounts of money should they wish. The Manager states via the dataset that health and safety policies and procedures are made available to the staff with the Health and safety (Health and Safety at Work Act 1974), Fire safety and First aid policies last reviewed and updated in the November or 2007. The dataset also verifies that domestic appliances are regularly maintained and that personal protective equipment is made available to staff, carers observed wearing gloves, aprons and tabards throughout the day. Health and safety training is being made available, with the training record providing evidence of the courses attended and staff statements confirming regular attendance of mandatory courses, including: health and safety, infection control and moving and handling, etc. The look around the home identified no immediate health and safety issues, whilst the risk assessments consider both environmental and personal risks, although these are on a generic level and not an individualised level, as would normally be recommended. Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety during our visit and ensuing conversations. Care Homes for Older People Page 33 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 The manager should review the activities programme for people, once their structured activities are completed. Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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