Inspection on 11/08/05 for Brownhill Lodge

This inspection was carried out on 11th August 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 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 Lodge 24/04/07

Brownhill Lodge 05/10/06

Brownhill Lodge 14/02/06

Brownhill Lodge 21/09/04

Brownhill Lodge 10/12/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Brownhill Lodge 334 Brownhill Road Catford London SE6 1AY Lead Inspector Sean Healy Unannounced Inspection 11th August 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brownhill Lodge Address 334 Brownhill Road Catford London SE6 1AY 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) 0208 6984978 tom_erman@hotmail.com DSRE Services Limited Margaret Cronin Care Home 21 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (21), Physical disability (1) of places Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 1 person, aged 55 years or above, suffering from a mental health disorder up to 10 elderly persons can have dementia up to 4 elderly persons can have a physical disability 1 person, aged 55 years or above, with a physical disability This home is registered for 21 persons of whom up to 21 can be elderly 28th February 2005 Date of last inspection Brief Description of the Service: Brownhill Lodge is a large detached house in Catford, South East London. Work is being done to make all parts of the home accessible. There are good local public transport links. The home is situated on the South Circular Road. It is approximately 10 minutes walk from a parade of local shops and a short drive from Catford town centre, which has some larger shops. It is registered to provide 24-hour care for 21 older people 10 of whom can have dementia. The aim of the home is “to provide high quality residential care and support services in a homely and caring environment in which residents can be persuaded and will be encouraged to determine the pattern of their lives.” The home has one double bedroom shared by two service users and the remaining service users each have a single bedroom. It consists of a ground floor and two other floors, which are now serviced by an accessible lift. There are no ensuite facilities but there are three bathrooms and seven toilets. (One bathroom currently being converted to become a shower room) There are links with local health services for on-going advice and follow-up visits. Most referrals are drawn from social services department through the home finding scheme. The home employs a registered manager, sixteen care staff, one senior care staff, one full time cook and cleaner. Staff are experienced and are well trained. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out on the 11th August 2005. The registered manager was present and took part in the inspection process. The registered manager provided complete co-operation during the inspection. Two staff were individually interviewed, one who has been employed for a number of years, and one who had started work within the previous four weeks. A number of service users informally provided comments, including an interview with one service user. Two service user’s relatives who were visiting the home also were interviewed and expressed their views. All spoke well of the service and the management of the home. Comments from all are included in this report. The inspection included a tour of the home and examination of records on care plans, staff records and building maintenance records. During the inspection staff interaction with service users was observed to be conducted in a respectful and friendly manner. What the service does well: What has improved since the last inspection? Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 6 The home has recruited three new staff and have put them on training and made sure that they know what to do and how to help service users. Several staff have started NVQ 2 training, which is the qualification to help staff to better understand their job. There has been good progress made in putting into action recommendations made by an Occupational Therapist and a height adjustable sink has been installed in the bathrooms. Work has started on converting one bathroom to an accessible shower room on the ground floor, for service users who do not like having baths. One service user said, “I am glad this is happening, I’d rather a shower than a bath”. The homes manager has conducted an activities survey asking service users what activities they prefer and made changes to activities on offer. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 the following standard(s): 3,5 and 6 All service users are admitted on the basis of a full needs assessment but all are not assured that these needs are and will be met. All service users have the opportunity to visit the home to assess its suitability before moving in. EVIDENCE: All service users are referred and funded by Lewisham Council, with the exception of one service user who is privately funded. There have been three new admissions in the previous twelve-month period. Examination of six service users files showed that all admissions were made with a full assessment of need. However, one service user who was admitted in January 2005 had not had a three month or six month review following admission. The manager has now prompted social services in writing to carry out this review. Two other service users have not had care management involvement in reviews since June 2004. One other service user who moved in to the home over a year ago has not had her place confirmed by care management and states that she has not made her mind up yet about whether she wants to stay at the home. (Refer to Requirements) Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 9 There is a sensitive and well thought out approach to assessing service users needs and to helping new service users to get to know the home before moving in. Two relatives said that they were fully involved in getting to know the home with their mother and in providing information before their mother moved in. The policy on resettlement includes the option to stay over where suitable support facilities are available. Intermediate care is not provided. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 the following standard(s): 7,8,10 and 11 Service users health, personal and social needs are included in care plans but some risk assessments need to be more detailed in order to minimise risk of injury. Service users health needs are fully met, and they are treated with respect and their right to privacy is maintained. Assessments have been done to ensure that service users wishes regarding ageing, illness, and death, are respected by the staff and management. EVIDENCE: There is a care and support plan in place for all service users which are reviewed regularly. These plans include all aspects of health care and involve appropriate professionals in providing support, such as the GP who visits weekly and the District Nurse who visits the home a few times a month. Dental care is provided for by a visiting dentist and a chiropodist attends to foot care needs. There is very good attention paid to implementing health care plans and there is minimal occurrence of bedsores. There are good details regarding individual service users support needs for personal care and eating. Staff are aware of the details of the care plans. Two service users commented that staff are, “very good at helping me in the bathroom”, but one service user Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 11 said that, “different staff do things differently when helping me in the bathroom”. Risk assessments are in place to address all areas of perceived risk in relation to personal care support, and the general safety of service users. However, there are a number of instances in care plans where the risk assessment identifies a high or medium risk of falls during personal care, but guidance for staff is not very detailed. For example, where one service user’s assessment shows a weakness on one side, the guidance for staff does not direct staff in how to support this person when transferring from chair to bed. The home needs to ensure that in areas where risk is assessed as medium or high there is detailed guidance for staff corresponding to this risk, maintained in the place where the support activity is to happen. (Refer to Requirements) The home has a good programme of activities to support recreational interests and to provide exercise for service users, such as bingo, skittles, exercise to music and outings to the shops and park. The home has conducted a survey to ensure that activities reflect service users views. The home has also audited service users abilities and wishes regarding self-medication and all service users asked that the home continues to provide support in this area. The home has capacity for twenty one service users, of which nineteen have single rooms. The remaining double room is currently vacant but when in use curtains are used to maintain privacy. Service users have the facility of a portable phone for use in their bedrooms for private calls and all service users spoken to said staff respect their privacy and service users open their own mail. The home has sensitively assessed service users wishes regarding illness, ageing and death, and have appropriate information and plans in place for those who ask for the homes support. Many service users have arrangements in place for people external to the home such as family or solicitors to facilitate arrangements and the home is fully aware of relevant contacts. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14 and 15 Service users find that their lifestyle in the home matches their expectations and preferences. They are enabled to maintain contact with family friends, their representatives and the local community. Service users are empowered to exercise choice and control over their lives, and receive a wholesome and balanced diet in suitable surroundings. EVIDENCE: Service users are provided with a range of activities. Their views have been canvassed in a recent survey. The results of this survey have been made available to service users and action taken to amend activities on offer. Activities are recorded on an individual basis for each service user and are monitored by key-workers and the manager. Activities include: music, knitting, crochet, board-games, walking, shopping, painting, drawing, reading, quiz evenings and reminiscence. Two service users confirmed that these activities happen and that they were happy with what was on offer. Care is taken to ensure that service users have contact with the local community and the home has access to a local social club called the Diamond, which only a few service users want to attend. The home’s visitors policy was discussed with relatives and service users at a recent meeting. Service users and two relatives confirmed that the home welcomes service users friends and families Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 13 to the home and said, “the staff and manager are very approachable and the manager is very helpful”. Service users abilities and wishes regarding managing their finances are assessed when they are admitted to the home. Only one service user continues to want to manage her own finances. The home has robust procedures in place for looking after service user’s money and receipts are kept for all expenditure. Wholesome meals are available to service users, who are offered choices in what they want to eat daily by the home’s cook. Menus are changed monthly and service users views have been sought on the quality and choice of food in a recent survey. Comments were generally very positive. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 the following standard(s): 16 The complaints policy does not ensure that service users or their representatives will be confident that their complaints will be listened to, and acted upon. EVIDENCE: There have been no complaints recorded since the last inspection of 28 February 2005. The written complaints policy needs to be reviewed and updated to include the following. Timescales for investigation of complaints, examples for staff and service users of types of complaints, reference to advocacy support, and commitment to providing written outcomes showing findings and action to be taken. (Refer to Requirements) A logbook for keeping track of complaints also needs to be introduced. (Refer to requirements) Although service users and their families have been given information on how to complain and the complaints policy is advertised, discussion with the manager and two visitors suggested that it may be the case that complaints are sometimes made and action quickly taken by the home to address the issue but that these are not then recorded as complaints. It is recommended that the manager raises awareness among staff regarding this issue and ensure that complaints are always recorded even in cases when the complaint has been quickly resolved. (Refer to Recommendations) Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 the following standard(s): 19,20,21 and 22 Service users do not yet have the specialised equipment required to maximise independence although work is being done to address this problem. EVIDENCE: The home is situated on a busy road in South London, the South Circular Road. Noise levels from traffic are reduced greatly by double-glazing throughout the home. Work is currently taking place to improve accessibility and when this work is completed the home should then be fully accessible for wheelchair users. The home is accessible to all its current service users. It is bright, airy and well decorated. Cleanliness is good and two service users said they can get around to all parts of the home and are very happy with their rooms. Shared facilities are adequate and include a living room, dining room and conservatory area. The home was asked to engage an Occupational Therapist to carry out a full assessment of the homes facilities and equipment, and to act on the requirements and recommendations of the report produced. Good progress is being made to carry out works on the home and to install new equipment to Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 16 make the home more accessible to all service users and to improve washroom facilities. An adjustable height sink has now been installed in bathrooms. The step to the front of the building has now been fitted with non-slip tiles. A lift has been installed to access the second floor and work has started to convert a bathroom to an accessible shower room. The home is commended for efficiently undertaking these works and must continue the work to completion. (Refer to Requirements) All other aspects of the environment are suitable to meet service users needs. Two service users commented that the home is comfortable and one said, ” I can go wherever I like in this house, and am glad to hear of the new shower room”. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30 The level of NVQ trained staff falls below the required level and does not currently ensure that service users will be always in safe hands. However, all other aspects of staff training ensure that staff are competent to do their jobs. EVIDENCE: There are sixteen support staff currently employed at the home, four of which have attained NVQ level 2/3. This falls short of the requirement for 50 of staff to attain this qualification by 2005. However, some staff turnover has affected the ability to reach this level and the manager has ensured that three more staff started the course with a view to completion within eight months. (Refer to Requirements) Otherwise there is a good level of training in place for staff. Discussion with a new member of staff confirmed that a good induction process is in place. Training needs for all staff are assessed through the home’s appraisal system and each member of staff has a training plan in place. Six senior staff are scheduled for supervision training, and an interview with one of these staff showed a good level of experience and training. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 36 The manager is competent and fit to be in charge with the exception of being qualified to NVQ level 4 in management and care. The home operates an effective quality assurance monitoring system, which ensures that the home is run in the best interest of service users. Staff are appropriately supervised. EVIDENCE: The registered care manager has excellent experience of working in and managing community care homes for this service user group. It is now an occupational requirement for the registered manager to attain NVQ level 4 in management and care, in order to continue to remain in charge of the home. However, the manager has stated that she does not wish to do this, and has decided to take early retirement. The manager wanted to retire earlier this year but only agreed to stay on to enable the provider to recruit a new manager. She has said she will be leaving by the end of December 2005. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 19 The provider has tried unsuccessfully to appoint a new manager of the home. This was supposed to have happened by the 31/03/05 but should now happen by 31/12/05 (Refer to Requirements) The home has in place good systems for carrying out service user surveys and publishing results, and taking account of service users views to make changes to the running of the home. Surveys conducted include: social contact opportunities, leisure activities, awareness and choice, and arrangements for providing food and quality of food. A report has been produced showing findings and has been distributed to service users and their families and to CSCI. Two service users and two relatives confirmed having had taken part in these surveys and said that the homes manager acted on the results of these surveys. The home does not employ volunteers and provides structured supervision for all staff at least every two months. Details of these were available in four staff files and confirmed also by two staff. The home has started to engage senior support staff in providing supervision for less experienced staff and has scheduled supervision training for them Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 3 3 2 2 x x x x STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x 3 x x Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 21 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 Standard OP3 Regulation 14.2 Requirement The registered manager must ensure that all service users have an annual care review involving their social worker, and show that social services have been prompted regarding this in writing. The registered manager must ensure that the service user admitted in January 2005 has a formal placement review to ensure that there is agreement that the home is meeting her assessed and perceived needs. The registered manager must ensure that service users risk assessments showing high or medium levels of risk are supported by clear support guidance for staff and that these are kept in a place most accessible to where the task is being undertaken by staff. The registered manager must review the complaints policy to include all of the requirements of National Minimum Standard OP 16 including a written outcome for complainants. DS0000025613.V250013.R01.S.doc Timescale for action 30/11/05 2 OP3 14.1 (c,d) and 14.2 31/10/05 3 OP7 13.4 (b,c) 30/11/05 4 OP16 22 30/11/05 Brownhill Lodge Version 5.0 Page 22 5 OP16 22 6 OP22OP21 23.2 (a,c & n) The registered manager must 31/10/05 put in place a complaints register for monitoring complaints trends to include the date received, who investigated the complaint, the date resolved and whether or not the complaint was upheld. 20/09/05 The registered manager must ensure that the recommendations from the occupational therapist report are carried out. Ongoing requirement Still within timescale 20/09/05 7 OP28 18.1 (a,c) 8 OP31 8 The registered manager must 31/12/05 ensure that a timetabled plan is put in place to ensure a minimum of 50 of support staff attain NVQ level 2 in care. 31/12/05 The responsible person must ensure that a registered manager is recruited who is able to undertake the required training for the post. Previous timescale of 31/03/05 not met. 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 OP16 Good Practice Recommendations The registered manager should raise awareness among staff regarding the recording of complaints received, whether or not these complaints have been quickly resolved. Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI Brownhill Lodge DS0000025613.V250013.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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