Inspection on 24/04/07 for Brownhill Lodge

This inspection was carried out on 24th April 2007.

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

The inspector 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 Lodge 05/10/06

Brownhill Lodge 14/02/06

Brownhill Lodge 11/08/05

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 Ornella Cavuoto Unannounced Inspection 24th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 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 698 4978 tom_erman@hotmail.com DSRE Services Limited 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.V335336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. This home is registered for 21 persons of whom up to 21 can be elderly 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 Date of last inspection 5th October 2006 Brief Description of the Service: Brownhill Lodge is a large detached house in Catford, South East London. 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 that used to be shared by two service users but is now used as a single room and the remaining service users each have a single bedroom. The home consists of a ground floor and two other floors, which are now serviced by an accessible lift. There are no en-suite facilities but there are three bathrooms and seven toilets. One bathroom on the ground floor has been has converted to become a shower room that is accessible to wheelchair users. There are links with local health services for on-going advice and follow-up visits. Most referrals are drawn from Lewisham Social Services. Staff are experienced and are well trained. At the time the inspection was held the Operational Manager was acting up as manager of the home after the registered manager was dismissed. However, a new manager had since been recruited and was to commence work at the home in due course. Information about the home is not made directly available to prospective residents but they themselves or their relatives or a representative on their behalf are always invited to visit the home prior to admission and there is information available that is kept in the entrance hallway. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 5 Reports written by CSCI are also kept in the hallway of the home. Monthly fees charged currently range from £440-£520. Additional charges may be made for hairdressing services, toiletries, magazines, newspapers and an escort if required. This information was provided to CSCI April 2007. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day. The operational manager was present for the inspection. They have responsibility for both Brownhill Lodge and another home owned by the owner but they have recently been acting up in the position of manager of Brownhill Lodge after the registered manager was dismissed. However, prior to the inspection written notification was received by the Commission of Social Care Inspection (CSCI) that a new manager had been recruited and was due to commence working at the home in the next few weeks. The inspection involved speaking to two service users and three relatives. Two members of staff were also spoken to. Other inspection methods included a tour of the premises and inspection of care records and general observation. Case tracking methods were also used. What the service does well: People living at the home and relatives spoken to were happy with the home and satisfied with the care they were receiving. One service user spoken to said regarding staff, “ They are very nice girls” whilst another said, “ The staff are good. They expect you to look after yourself here, which is good. When you need it you get a bit of help”. Comments made by relatives included; “ Brilliant, staff have been absolutely fantastic with her and with me. They listen to me. They cope really well with her”. Another said in respect to the home “ Its not the most modern. I think the way she is cared for is more important. She feels safe and secure”. The home ensures full needs assessments are obtained from referrers prior to admitting people to ensure they can meet their needs. Generally individuals’ health care needs are addressed well by the home. Contact with family and friends is supported by staff at the home and visitors are welcome at any time. Where possible people are encouraged to take control of their own lives for example manage their own finances and to bring in with them their personal belongings. Overall, meals are varied, nutritious and a choice is provided. Individuals are encouraged to raise any concerns/ complaints about the home and they are also protected by the home having comprehensive adult protection procedures in place and staff that are trained in adult abuse so it can be quickly identified and they know what action to take if required. The home practices in recruitment also ensure residents are protected. The home is homely, generally well maintained and is clean and hygienic. Care staff are supported to achieve relevant qualifications and to undertake regular training to be able to meet the needs of those living at the home. The views and feedback from residents and relatives about the running of the home are regularly sought through meetings and surveys to make sure it is run in their best interests. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 8 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.V335336.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient information available for prospective residents to make a decision about the home although more efforts need to be made to ensure this information is made as accessible as possible to them and their relatives. Admissions had not been made to the home without a full needs assessment having been undertaken and people living in the home had been issued with a statement of terms and conditions outlining conditions of their stay with the home. EVIDENCE: The home had recently updated the statement of purpose and service user guide. This included all the information as specified within National Minimum Standards (NMS) and required by regulation. A copy of both documents was kept in the entrance hallway of the home so that prospective residents and their relatives had access to this information at their initial visit to the home. However, it was reported a copy of this information was not always directly Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 10 provided to them to take away and read. It is advised that this should be given to them so that they can make a fully informed decision about the suitability of the home to meet their needs. In respect to those people presently living in the home it was reported that for all new residents a copy of the service user guide is placed in their room but that this often gets discarded which is why a copy of the document is kept in the entrance hallway so this information can be accessed at all times (See Recommendations). The personal files of five residents were looked at as part of the inspection. Three of these belonged to individuals who had moved into the home since the last inspection. There was evidence for all three that a full needs assessment had been obtained prior to their admission so that the home could ensure they were able to meet their needs. At the last inspection it was identified that the statement of terms and conditions had been revised and met with regulation but this had yet to be issued to residents. At this inspection there was evidence that these had been issued to individuals and had been signed either by the resident themselves or a relative on their behalf. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans drawn up for individuals had not all been fully completed and reviews carried out were variable. Health care needs generally had been met but weight monitoring had not taken place on a regular basis for all those living in the home. There had been some improvements in the administration of medication but residents were still not fully protected by the home’s policies and procedures. Individuals’ privacy was maintained and staff treated them respectfully. EVIDENCE: The home uses the Standex format for care plans. A previous inspection had identified that care staff had found it difficult to use the Standex and care plans had not been completed and contained little detail. However, at the last inspection there had been a marked improvement in care planning and although some care plans for individual residents had not been completed and monthly reviews of the care plans had not regularly been carried out, overall they were more comprehensive with individuals’ personal, health care and social care needs being addressed in detail. At this inspection, it was found Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 12 that the previous improvements in care plans had not been sustained. The personal files of five residents were looked at and although all included a care plan, three had not been fully completed. For one individual it was noted that information contained in the full needs assessment in relation to their social care needs had not been addressed in the care plan. In addition, although there were monitoring sheets in place to record any incidents in respect to confused or aggressive behaviour for the resident, their needs in respect to confusion or memory impairment had not been addressed in their care plan or risk assessment as to how this should be managed or addressed by care staff. Monthly reviews of care plans had not been carried out regularly and only two of the care plans had been signed one by a resident themselves and the other by a relative on the residents’ behalf. Case tracking methods used did confirm that these people had been involved in the care planning process. One of the files did not contain a completed risk assessment that paid particular attention to falls and none of the risk assessments that were in place had been regularly reviewed. Finally not all the files included a photograph of the resident and it is advised this is put in place as soon after admission as possible (See Requirements & Recommendations). It was evident from individuals’ care plans and from notes contained within the files of visits from a range of health care professionals including GPs, district nurses, opticians and mental health professionals that residents’ health care needs had been generally well addressed. However, it was noted that for two individuals their weight had not been monitored monthly and in respect to one of them there was information contained in their care plan that due to a medical condition they had experienced considerable weight loss over a period of time. On discussing this with the operational manager it was reported that the home does not have sit down weighing scales to be able to monitor the weight of those more frail individuals living at the home. This needs to be addressed in that the provider needs to ensure the home has the necessary equipment to be able to address all the needs of those people living in the home. Furthermore, it was identified that some forms contained within residents’ care plans such as pressure sore risk assessments and nutritional risk assessments had not been completed or reviewed. The operational manager reported that these were not always relevant to the needs of residents. It is advised that where this is identified the forms should be removed rather than be left blank (See Requirements & Recommendations). At the last inspection it was found that although the home had a robust medication policy and procedures in place and staff had been trained there were inconsistencies in the handling and administration of medication by staff. At this inspection a small sample of medication records specifically those that belonged to individuals who were being case tracked was inspected. Apart from one minor error all records looked at were accurate. Also, at the previous inspection it was identified that medication was being administered that had not been written up on the medication record. However, at this inspection all Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 13 medication that had been prescribed and was being administered was written up. Yet, in respect to a previous requirement that staff should ensure that quantities of medication including any balance brought forward from the previous month’s medication cycle should be written on the medication records so that medication stocks can be accurately checked this was partially met. Not all medication records checked included the balance of medication (See Requirements). It was noted that as part of a residents’ meeting that individuals had complained that staff did not always knock before entering their rooms. At the inspection service users spoken to stated staff did knock and they felt staff treated them respectfully. Relatives spoken to also confirmed this. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities provided by the home need to be improved to give residents more opportunities for stimulation particularly those for those individuals with dementia. Also, staff need to ensure that individuals’ personal routines of daily living are upheld rather than being led by staff requirements. Contact with family and friends for those people living at the home are supported by the home. Generally, meals provided at the home are nutritious although some repetition was identified. EVIDENCE: At the last inspection an improvement in the activities provided to residents was identified. Individuals had been given opportunities for social interaction inside and outside the home, with outings arranged for some people to attend the local theatre and also to go to the Pump House museum. In the home it was observed that bingo was played with service users and prizes given to those that won. Also, a sing a long took place. At this inspection, the weekly activity logs that had been maintained indicated that the activities provided to people were not as varied. Some of the activities that had been recorded in which residents had been involved included; board games, playing skittles, card making, soft ball and a quiz. However, the records mainly indicated that Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 15 individuals had spent time watching television and listening to music or the radio, which does not require input from staff. Furthermore, serviette folding was recorded as an activity, which is not appropriate. Also, apart from a care staff member being observed playing some soft ball with a few of the residents overall there was little social interaction between care staff and those living at the home. In discussing activities with the operational manager they reported that cake baking had been introduced as an activity but this had been stopped due to a lack of interest. Also, they had tried to secure some places at a local social club but none were available at the present time. Although, the minutes of a resident meeting in which activities were discussed indicated that people living there were happy with what the home does in the way of activities, it was evident that more needs to be done to provide individuals with opportunities for social interaction and staff need to engage more with service users. A previous recommendation that the home’s key worker system is used more effectively to spend individual time with residents had not been addressed nor had a recommendation that there should be more activities involving reminiscence to stimulate and engage those individuals living at the home experiencing memory impairment or dementia (See Requirements and Recommendations). In respect to how residents are supported to exercise choice around routines of daily living although personal preferences had been specified within care plans during the inspection it was observed that some people had been placed in their bedclothes ready for bed despite it still only being afternoon. This was discussed with care staff who stated it was necessary to do this to support the night staff due to the numbers of residents that require support with washing and to be able to have time to complete other duties. However, staffing levels provided by the home were deemed adequate (For details see Standard 27). The operational manager confirmed that staff numbers had not been reduced and the home was not at full occupancy and that they themselves considered it had not been necessary for staff to commence preparing individuals for bed so early. They explained that they would usually have left for the day by that time and had not been aware that this was occurring. It is important that the home’s routines are kept flexible to ensure individual choices and wishes are respected. Furthermore, for those individuals experiencing dementia or confusion keeping to personal routines is particularly important as part of person centred care and to help them to remain as orientated as possible. This needs to be addressed with care staff (See Requirements). It was evident in speaking to relatives who visited the home during the inspection that residents are supported to maintain contact with family and friends. One relative said they were able to visit at any time and were always made to feel welcome by staff. A priest from the local church visits the home, which was confirmed by residents spoken to and the operational manager reported that a Baptist Minister was also to visit the home. One service user visits a day centre locally that meets their specific cultural needs. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 16 Apart from the issue discussed in respect to Standard 12 in relation to residents being given more support to exercise choice around routines of daily living, it was identified that individuals were supported to exercise choice and control in other areas of their lives where appropriate, for example two people living at the home manage their own finances. Furthermore, residents are encouraged to bring in their personal belongings when they move into the home. This was evident from rooms that were inspected as well as being confirmed by a relative who said that they had been informed by staff that their mother could “ carry as many personal belongings as possible” when they moved in. The home had a four-week rolling menu that offered a choice of foods. It was evident from the menu and records kept about meals prepared that a previous recommendation regarding suppers that they could be more varied had been addressed. However, it was identified that there was some repetition of foods, for example in one week, it was identified that the same dessert had been provided four times in one week. It is advised that the menu be kept as varied as possible. Residents spoken to were happy with the food, one individual said, “Its good food”. Furthermore, lunchtime was observed that was relaxed and unhurried with service users appearing to enjoy the food. At the last inspection, a care worker was observed standing over one of the residents whilst assisting them to eat but on this occasion, care staff were observed helping individuals in an appropriate and respectful manner (See Recommendations). Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 22&23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints policy and service users are encouraged to raise any concerns they may have about living in the home. Service users are protected from abuse. EVIDENCE: The home’s complaint policy is comprehensive. Relatives of service users spoken to had no complaints about the home. They were aware of the home’s complaints policy and stated they would feel comfortable bringing their concerns to staff. There was also evidence within the minutes of resident meetings that residents had been encouraged to raise their concerns and individuals had voiced issues they were not happy with. The home’s complaint log was checked and there had been no complaints made since the last inspection. The home’s adult protection policy and procedure is robust. All staff had completed training in adult abuse apart from one care staff member who had only recently been employed by the home. It was reported they would be required to complete this although the care worker was spoken to and was found to have a good working knowledge of the different types of abuse and procedures to follow if abuse was identified or suspected. There has not been any adult protection investigations carried out since the last inspection. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical environment of the home meets the specific needs of the people who live there with safe and comfortable communal facilities, sufficient toilet and washing facilities although some minor repairs and renewals are required. Residents’ bedrooms are suitably personalised and the home was clean and hygienic. EVIDENCE: The home is suitable for its stated purpose and it is generally well maintained, safe and homely. All parts of the home are accessible to service users with a passenger lift being in situ and the home can accommodate wheelchair users. The home has adequate communal facilities. There is a separate dining area, a lounge and a conservatory area that leads out to a small, well - maintained garden. At the last inspection an immediate requirement was issued after it was identified that water was leaking into the conservatory when it rained. This Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 19 was promptly addressed by the home with evidence sent to CSCI that the necessary repairs had been carried out. The home has sufficient bathrooms and toilets. There is a shower on the ground floor specifically for those individuals who may be wheel chair users and also for those with mobility problems. Subject to a previous requirement the toilet seat of one of the toilets on the ground floor had been replaced. However, at this inspection it was noted that one of the toilets on the first floor was leaking water by the handle and this would need to be repaired. Also, one of the baths on the ground floor was worn and clearly in need of being replaced. The operational manager reported that the home had submitted a grant application and if obtained this would partly be used to replace the bath. This will be checked at the next inspection (See Requirements). All residents’ bedrooms were inspected and they were suitably personalised. Subject to a previous requirement the carpets in two of the residents rooms that were identified as being badly stained and there was a notable smell of urine in both rooms had been replaced with more suitable flooring. The home was clean and hygienic on the day of the inspection and there were no offensive odours. The home has laundry facilities sited away from the preparation of food. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient levels of staffing are provided although it is advised these are regularly reviewed to ensure the individual needs of residents can be met flexibly at all times. The home supports staff to undertake relevant qualifications and other regular training courses required under National Minimum Standards (NMS). The home’s recruitment practice protects those people who live at the home. EVIDENCE: Through observation it was identified that there were sufficient levels of staffing. However, concerns were raised when as mentioned in relation to Standard 12 it was observed that some individuals were already in their bedclothes when it was still only afternoon. When this was discussed with staff on duty it was reported that this was necessary to support the night staff indicating that staffing levels may not be adequate to be able to meet residents’ support needs. On discussing this with the operational manager they disagreed as the home had not reduced staffing levels and the home was not at full occupancy. They considered it was more an issue of staff not managing their time effectively. The home provides three care staff in the morning, three in the afternoon and two waking night staff. If an escort is needed an extra staff member is also provided to ensure the number of staff on duty are not compromised. There are two vacancies at present but the home uses regular agency staff for consistency. However, care staff are required to prepare Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 21 supper as a cook is not employed to work at this time and it is advised this is reviewed to assess whether or not this impacts negatively on staff time. Furthermore, in recognition that the level of support needs of people living in the home may vary it is recommended that staffing of the home is regularly reviewed and changes made accordingly. This is to be monitored at future inspections (See Recommendations). The operational manager reported that out of the present eleven care staff employed by the home seven have achieved a National Vocational Qualification (NVQ) Level 2 and one has achieved a NVQ Level 3. Two of the care staff have qualifications at a higher level than the NVQ with one being a qualified nurse although they obtained their qualification abroad. This meets the required target within the NMS that 50 of the care staff working within the home should have obtained a relevant qualification. Previous inspections have demonstrated the home has robust recruitment procedures that ensure individuals living at the home are protected. At this inspection it was reported that only one new care staff member had been recruited since the last inspection. The staff member’s file was looked at and found to include all the required documentation as required by regulation and NMS. There was also evidence of the interview process undertaken and that an induction was being carried out. The staff member who was spoken to confirmed this. The home supports staff including the cook and domestic to undertake the relevant mandatory training courses for example, in manual handling, food hygiene, first aid, infection control and fire safety amongst others and ensures these are updated as required. Specific training courses are also completed in areas to support staff to be able to meet the needs of people living in the home effectively. These include dementia training, diabetes, communication, foot care and diversity. Subject to a previous requirement, there was evidence that appraisals had been carried out with staff and individual training plans were being drawn up outlining training needs for the forthcoming year. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new manager has been recruited to be responsible for the running of the home. The home is generally run in the best interests of people who live at the home but the home needs to draw up a development plan that reflects identified aims and outcomes for residents. Individuals’ finances were not fully checked at this inspection but it has been found at previous inspections that the home has robust procedures for managing residents’ finances and these have been safe guarded. The health, safety and welfare of residents has been protected and promoted. EVIDENCE: As mentioned in the summary of the report the registered manager of the home was dismissed after only a few months in post. This was due to unsatisfactory performance. The operational manager who has previously Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 23 worked at the home as registered manager has been acting up in the post until the new manager that has been recruited can commence work. It was reported that the new manager has also worked previously at the home as a senior carer. Notification of the appointment had been sent to CSCI and it was reported that an application for them to be registered has already been submitted. The operational manager is very familiar with the running of the home and the residents and has ensured that generally the home has been well run and managed. In respect to quality assurance there was evidence that customer satisfaction surveys, which were very comprehensive had been provided to residents and also sent to relatives and professionals involved in the service. At the time the inspection was held completed questionnaires had just been received back by the home that were seen although a report detailing the results had yet to be completed. However, this was sent to CSCI shortly following the inspection and overall feedback was positive from all parties. Also, there was evidence that a meeting had been held at the home to feedback results to people who live there and to which relatives were invited. The purpose of the meeting was also to carry out a review of the running of the home involving residents and relatives to get their suggestions on areas such as activities, refurbishments, and key worker role amongst others. This is very positive but as a result of the surveys and the review meeting a development plan for the home needs to be completed detailing aims and outcomes for residents and action to be taken to address these. Subject to a previous requirement monthly provider reports have been sent to CSCI (See Requirements). Standard 35 was not fully inspected at this inspection. However, previous inspections have consistently identified that the home has robust systems and procedures in place for managing service users personal allowances. The operational manager reported how one of the senior carers has been delegated responsibility for this area but that they carry out fortnightly audits. Records of these audits were seen which were accurate. Also, receipts had been obtained for all transactions. Therefore this standard is deemed met. There was evidence that the health, safety and welfare of people living in the home had been protected. Up to date maintenance certificates were seen for gas safety, portable appliances, fire equipment and the nurses call system. Following an inspection and a recommendation by the LFEPA the home has installed magnetic door holders in parts of the home. There was an up to date fire risk assessment in place, regular fire drills had been carried out and subject to a previous requirement fire alarm call points had been tested weekly. Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 24 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)&(2) (c)&(d) Requirement Timescale for action 31/10/07 2. OP8 12(1) (a) 3. OP9 13 (2) The registered provider must ensure that all residents have a completed care plan in place that outlines their individual needs. Also, that the care plan is signed by the resident, their relative or a representative where appropriate to indicate their involvement in the care planning process and that care plans are reviewed monthly to reflect any changing needs. (Previous timescale of 31/05/06 & 31/03/07 partially met) The registered provider must 31/10/07 ensure that monthly weight monitoring of residents takes place so that health risks or signs of deterioration are detected early and appropriate action can be taken. Also, that the appropriate equipment to carry this out is available in the home. The registered provider must 31/10/07 ensure that the quantity/stock of tablets including any balance brought forward is written on the Medication Administration Record DS0000025613.V335336.R01.S.doc Version 5.2 Brownhill Lodge Page 26 4. OP12 16(2)(m) &(n) 5. OP12 12(1), (2)&(3). 6. OP21 23(2)(b) 7. OP33 24 (MAR) sheets at the beginning of each monthly cycle. (Previous timescale of 31/03/07 partially met) The registered provider must ensure that residents are given opportunities for social interaction and stimulation with a range of activities provided both inside and outside the home around which they are consulted. Also those for those individuals who may be experiencing memory impairment or dementia reminiscence or other needs appropriate activities are provided. The registered provider must ensure that residents’ individual choice of daily routine is upheld by staff as specified and agreed within their care plans to ensure their expectations and personal preferences are met as opposed to being led by staff requirements. The registered person must ensure that the toilet leaking on the first floor is fixed as part of maintaining the physical environment of the home in a good state of repair. The registered provider must ensure as a way of ensuring the home is run in the best interests of residents that as a result of customer satisfaction surveys completed and suggestions made that a development plan for the home is drawn up that outlines identified aims and outcomes for people living in the home. 31/10/07 31/10/07 31/10/07 31/10/07 Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 27 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 OP1 Good Practice Recommendations The registered provider should consider providing information to prospective residents and /or their relatives when they visit the home so they can make a fully informed decision about the home and that it is suitable to meet their needs. The registered provider should try to ensure that there is an up to date photograph in place on all residents personal files for staffs information and in case any incidents occur particularly if a resident goes missing from the home. The registered provider should consider using the home’s key worker system to ensure that individual time is spent with service users particularly those that may find it more difficult to engage in group activities and a record of this is maintained. The registered provider should try to ensure that the menu is kept as varied as possible and repetition of dishes are kept to a minimum. The registered provider should try to carry out a review of the present arrangements for the preparation of supper times to make sure this is not impinging on time staff need to spend with residents. Also, that the level of the support needs of individuals living at the home are periodically reviewed to ensure staffing levels are adequate to meet their needs flexibly and effectively. 2. OP7 3. OP12 4. 5. OP15 OP27 Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brownhill Lodge DS0000025613.V335336.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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