Inspection on 09/11/09 for Brownlow House Residential Care Home

This inspection was carried out on 9th November 2009.

CQC 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

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Brownlow House Residential Care Home 4 Princes Avenue London N10 3LR Lead Inspector Susan Shamash Unannounced Inspection 9th – 12th November 2009 11:20 X10029.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 Brownlow House Residential Care Home DS0000073289.V378155.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 and Care Homes for Adults 18 – 65*. 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. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownlow House Residential Care Home Address 4 Princes Avenue London N10 3LR 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) 02088836264 02084444783 brownlow@ventry-care.com www.ventry-care.com Brownlow Properties Limited Alena Megova Care Home 24 Category(ies) of Dementia (8), Mental disorder, excluding registration, with number learning disability or dementia (3), Old age, not of places falling within any other category (24) Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category Code OP (24) Dementia - Code DE (8) Mental Disorder, excluding Learning Disability or Dementia - Code MD (3) The maximum number of service users who may be accommodated is 24 2. Date of last inspection Brief Description of the Service: Brownlow House formerly known as St James Residential Care Home is a care home for twenty-four older people, eight of whom may have dementia. The registered provider, Brownlow Properties Limited, is a family-run business that manages other care homes in London. The home is a large converted house on a quiet street off Muswell Hill Broadway and close to local amenities. There are seventeen bedrooms comprising seven double rooms and ten single rooms (the majority of which have en suite toilet facilities). The home is on three floors with bedrooms on each floor. A lift provides access to all parts of the building. There is a large garden at the rear and limited parking at the front of the home. The communal areas are a large dining/lounge area leading into a conservatory that is also used as a quiet room. There is a galley kitchen, and laundry room on the ground floor. The staff room is on the first floor and the manager’s office is on the ground floor in the reception area. A further office is situated in an outbuilding off the rear garden near the kitchen stores. The stated aims of the home are “to encourage and assist the residents to lead a life of their choosing within a caring and supportive environment. The home provides twenty-four hour care and support and access to a range of residential specialist services geared towards meeting individual service users’ needs.” Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 5 The fees for the home range from £482-500 as at November 2009. Copies of this report are available from the Care Quality Commission Website www.cqc.org.uk Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme, following the new registration of this home under a new provider organisation. The home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection, including notifications of incidents that the home had told us about. The inspection took place over two days, and I was assisted by Damien Heneghan on behalf of the registered provider organisation, and the registered manager, Alena Megova. I had the opportunity to speak with twelve people who live at the home, a district nurse and two relatives visiting the home, and three members of staff. I observed interactions between staff and people living at the home, walked around the building and examined a number of records relating to the care, health and safety and management of the home. What the service does well: The home provides consistently good outcomes for people. The needs of people accommodated are within the range of those specified in the statement of purpose. People are supported to maintain their cultural and religious identity. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Several residents that staff were “very kind,” and understand how to help them. Care plans make sure that people’s needs are addressed in a person centred way. Detailed nutritional, tissue viability, falls and manual handling assessments are in place, and the home is commended for a high standard of healthcare support provided in a proactive manner. People spoken to have advised that activities are provided regularly, and staff are aware of their preferences, interests and capabilities. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 7 There are appropriate policies on handling abuse and safeguarding adults, and people feel safe and well supported by the home. The home has the necessary adaptations to support people to move around safely. Bedrooms are personalised with items of furniture and pictures belonging to the people who live at the home. The rota shows that a consistent staffing level is being maintained in the home, and people spoken to felt that staff had the necessary skills to meet their needs. Staff are supported through training to meet the individual needs of people. The registered manager is appropriately trained and experienced, with a clear understanding of how to deliver good outcomes for people living at home. What has improved since the last inspection? What they could do better: People living at the home would benefit from provision of a greater range of activities within and outside of the home, and a greater variety of options available for evening meals within the home. All residents should have the option of a lockable storage facility within their bedrooms, and be encouraged to use the keys to their rooms where possible. Bed covers and some worn chairs should be replaced in people’s rooms, for their comfort. It is recommended that the local fire prevention office be consulted regarding the need for open doors between people’s bedrooms, to ensure that their right to privacy is protected as far as possible. It is also recommended that larger flat screen televisions be provided in the lounge areas. Carpets within the home must be cleaned thoroughly on a regular basis, to reduce the risk of unpleasant odours within the home. Where there are particular issues relating to incontinence the use of alternatives e.g. lino flooring, may be considered. Quality assurance processes should be further developed to ensure continuous improvements to the outcomes for people living at the home. A risk assessment must be undertaken with regard to storage of topical lotions in people’s rooms, to ensure the safety of people living at the home. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 8 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. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 (6 is not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People considering living at the home have access to relevant information about the service. Their needs are assessed prior to admission to the home to ensure they receive the care and support that they need. EVIDENCE: The home’s statement of purpose and service user’s guide provided information about how the home is run and identified the skills and staffing resources available to meet people’s needs. The home remains registered to provide care for people with dementia and mental health needs, and the needs of the people case tracked as part of this inspection, were within the range of Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 11 those specified in the statement of purpose. Training records confirmed that staff had attended relevant courses so that they had the skills to meet these needs. Staff spoken to were also able to explain in detail how they met the needs of people who have dementia or mental health needs. The statement of purpose confirms that the cultural and religious needs of people will be respected, and records show that people were supported by the home to maintain contact with church or other community groups of their choosing. Cultural and religious needs are addressed and identified through initial assessments and care planning. People living at the home continue to have varying degrees of disability. The environment has been adapted so that it is accessible. People were observed moving around the home safely with staff support where necessary. Five residents’ care files were inspected in detail, and these each contained detailed assessments of people needs. These included assessments from placing authorities, and information from health professionals, used to inform the home’s own assessment. The management confirmed that admissions are not made to the home until a full assessment has been undertaken, to ensure the best outcomes for prospective residents. One resident advised “The staff here are very kind, they look after us ever so well.” This was generally typical of responses from residents regarding their experiences of living at the home. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. They are fully protected by safe procedures for handling medication and their right to privacy is respected. EVIDENCE: The care plans of the five people case tracked, were detailed and clearly identified how the needs of people would be met. Care plans were based on Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 13 the initial assessments of each person. There are clearly defined actions highlighted in the care plans to meet particular needs. The care plan for one of the people case tracked highlighted that they had dementia and specified how this affected their memory and behaviour (e.g. wandering around). The care plan also outlined how staff should respond to these needs. Care plans were being reviewed on a monthly basis, and their format ensured that people’s needs are addressed in line with a person-centred approach. There were clear indications of people’s choices and preferences recorded in their care plans. People spoken to advised that they had been asked about how they wish to be supported by staff. Staff were observed to interact respectfully and cheerfully with residents, maintaining their privacy as far as possible, and treating them with respect. One person advised that they liked to spend time alone in their room, and that staff respected this, but were available if she needed assistance. This was also reflected in this person’s care plan. People spoken to advised that they felt staff understood their needs. A keyworker system is in place, which includes staff members allocating time to spend with particular residents, and involving them in the care planning process. Care plans referred to people’s cultural needs of people, including language needs, dietary needs and whether or not they wish to take part in religious services. There were also personal histories that provided information on people’s interests and previous occupations. However whilst people’s social, emotional, intellectual and leisure needs and preferences were recorded in care plans, this did not correlate with clear records of how these were met on a daily basis. A requirement is made accordingly under Standard 12. Each care plan included a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely and independently. Management of risk ensures that safety issues are addressed whilst promoting people’s independence of movement as far as possible. Detailed nutritional, tissue viability, falls and manual handling assessments are in place. People were being weighed regularly and action taken if their weight changed. The continence needs of people had also been assessed and recorded as part of their care plans. I had the opportunity to speak with a district nurse visiting the service, and she spoke highly of the home’s management of health issues amongst residents, being proactive regarding potential problems, and providing clear information regarding residents’ case histories. Diary notes alongside recording in people’s daily records, showed that appropriate medical attention and advice is sought including regular contact with the GP, district nurses, opticians, dentists and chiropodists, and this was confirmed by people living at the home. The opticians were visiting Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 14 the home at the time of the first day of this inspection. I was also very impressed with the standard of recording regarding resident’s health needs and the proactive approach of the management in addressing issues swiftly prior to their becoming a more serious concern. The home is commended for the high quality of performance in this area. The records of medicines received, administered and returned to the pharmacist were complete and appeared to be accurate and up to date. Where the General Practitioner had made changes to peoples medication this was signed to confirm the change had been made. The home has the latest guidance on the safe handling of medications as appropriate. I observed staff administering medication to residents as prescribed, and recording these at the time of administration as appropriate. Medicines were stored safely and at the appropriate temperature, with separate records maintained for controlled drugs, although no controlled drugs were in stock at the time of this inspection. Weekly management checks are carried out to make sure that medication is administered safely to people, and these appear to be effective in ensuring safe practices regarding medication administration within the home. Training has been provided on the safe administration of medicines. Discussion with staff indicated that they were clear about their responsibilities and how to handle medicines safely. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with a variety of activities to meet their needs. They are supported to maintain contact with relatives and other representatives of their choice. The home’s menu reflects their preferences and generally offers a balanced and varied diet. EVIDENCE: Residents spoken to during the inspection advised that they were provided with a range of regular activities. The majority were happy with activities Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 16 provided, however some advised that they would like to have the opportunity to go out to local shops/cafes with staff support. I observed that activities relating to Remembrance Day were being organised by staff during the inspection, with several residents colouring posters relating to the occasion. In addition it was one resident’s birthday on the first day of the inspection, and the room was decorated with balloons and banners accordingly, and all residents enjoyed a slice of birthday cake after their evening meal. An activities schedule was posted in the home’s conservatory including quizzes, exercises, puzzles, movies, reminiscence, discussions and bingo, in addition to a church service within the home. The annual quality assurance assessment for the home also described a successful pilot project of drama therapy within the home, which staff and management confirmed had been very successful. Peoples’ interests were recorded as part of their care plans, however people’s daily records did not reflect activities that they had been involved in. A requirement is made accordingly. The registered provider and manger advised that they were in the process of recruiting an activities coordinator, who would also work across other homes owned by the provider organisation. It is expected that this will make sure that a wider variety of activities can be provided for people. I observed staff spending time talking with people within the communal areas of the home, and staff spoken to were aware of the importance of one-to-one contact for people. Residents spoken to were very positive about staff support provided, with their friendliness and cheerful manner particularly appreciated. Relatives spoken to advised that there were no restrictions on visiting the home, and that they could visit freely. They confirmed that they could see their relatives in private, although one relative would have preferred to have a quiet area available, other than their relative’s bedroom. Daily notes, and the visitors book also showed that people had regular contacts with family, friends and the wider community. Risk assessments had been undertaken for people who wished to go out in the local area, on their own. I spoke to one person who confirmed that they went out as often as they wished to, and enjoyed this aspect of their independence, meeting friends within the local community. However there was less evidence available that residents who require support to go out within the local community, were being provided with this opportunity on a regular basis. A relative who visited commented that whilst they took their relative out regularly themselves, other residents did not appear to have this opportunity. Staff spoken to also advised that they did not generally have time to take people out to the local shops. A requirement is made accordingly. Staff and the management advised that residents were consulted regarding the home’s menu. The menu showed that options are offered at each meal, and that a varied selection of meals is offered. All but one person spoken to were Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 17 happy with the quality of the food provided. One person advised “the food’s lovely here” and others confirmed that staff would bring an alternative if you were not happy with the menu choices. Discussion with the chef indicated that she is very aware of people’s preferences and makes an effort to accommodate each person’s preferred cooking styles. However I was concerned to note that the evening meal within the home predominantly consists of soup and sandwiches. Whilst no residents complained about this provision, a greater choice of evening meals should be offered to ensure that they have a more varied diet offered to them. The registered provider advised that this was an area that had already been prioritised for improvement. Although supplies of fresh fruit and vegetables had run out on the first day of the inspection, discussion with staff, and examination of food records indicated that there are usually fresh fruit and vegetables available, and a balanced and nutritious diet is provided. Observation of meals served within the home indicated that these are well presented and are provided in a relaxed manner, with people requiring assistance, supported in an unhurried manner. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: A clearly recorded complaints policy is in place for the home with agreed timescales for managing complaints. People living at the home seemed to be aware of the procedure, and indicated that they would feel able to speak up about issues of concern to them should the need arise. No complaints had been referred by the Commission to the home since last key inspection. Inspection of the home’s complaints book indicated that concerns raised were being taken seriously, with actions taken to address issues recorded alongside the timescales. One person advised “I know I can speak to the manager, or a staff member if I am unhappy about anything.” Relative confirmed that their experience was that the home has an open culture that allows people to express their views, and takes action to bring about improvements when these are needed. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 19 Clear policies were also available on handling abuse and safeguarding adults. People living at the home and their relatives felt confident that any concerns they raised would be handled sensitively and appropriately. Discussion with the management indicated that they were aware of the local authority’s procedures in the event of an allegation or disclosure of abuse. The registered provider had completed the relevant train the trainer course on safeguarding adults, and staff confirmed that they had received training on adult protection. Staff spoken had an understanding of the signs of potential abuse, and how they should respond. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that generally provides a safe, clean and homely environment. EVIDENCE: Inspection of the building indicated that it was comfortably furnished, and that the home has the necessary adaptations to allow people to access all areas in Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 21 the home safely including a passenger lift to all floors. There are large open plan dining and sitting areas which were well used on the days of the inspection. At the rear of the house is a conservatory, which provides a relatively quiet area for activities, or for people to meet friends or relatives. A number of televisions screens set to different channels were available in these areas, however it is recommended that consideration be given to providing larger flat screen televisions in theses areas, for the comfort of people living at the home. There is a large rear garden which is accessible and well presented. The management advised that some residents had been involved in a gardening group, and there were two raised flowerbeds for this purpose. People spoken to advised that they enjoyed using the garden in good weather. Most bedrooms were personalised with items of furniture, photographs and pictures, and all were decorated to an adequate standard. Privacy screens were available in shared rooms, although staff advised that most residents chose not to use them. Staff advised that they thought carefully about who would be most compatible for sharing rooms, and those sharing generally got on very well together. This was confirmed by residents spoken to at the time of the inspection. However the presence of open fire doors connecting a number of residents’ rooms, may compromise people’s privacy. It is recommended that the local fire prevention office be consulted regarding the need for open doors between people’s bedrooms, to ensure that people’s right to privacy is protected as far as possible. On the first day of the inspection I noted that some prescribed topical lotions, and cosmetics were being stored in people’s rooms, none of which were kept locked at the time of the inspection. A requirement is made accordingly under Standard 38. However all residents should be given the option of having a lockable storage facility within their bedrooms, and be encouraged to use the keys to their rooms where this is possible. A large number of bed covers in use within the home appeared to be marked with bleach, and these should be replaced as a matter of priority. There were also a number of well worn chairs in people’s rooms, which were in need of replacement. Maintenance records show that there is ongoing maintenance of the homes environment undertaken by a dedicated maintenance team. Staff and residents confirmed that any repairs are dealt with quickly to ensure people’s comfort and safety. There is a rolling maintenance programme in place for the building and grounds. Staff and residents confirmed that hot water is available at all times, and records showed that the water temperature is checked to ensure that it remains within safe limits. Inspection of the kitchen indicated that it is maintained hygienically, however the handle on one of the oven doors had come off, and needed to be replaced. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 22 The home was generally clean and tidy with appropriate measures in place to prevent cross infection, and detailed policies on the prevention of cross infection, and action to be taken in the event of a swine flu pandemic. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. However although staff advised that a number of carpets are washed each day, there was an odour of urine in a small minority of bedrooms on the first day of the inspection. A requirement is made accordingly. In cases where there are particular issues relating to incontinence that make it very difficult to keep carpets clean, the use of alternatives e.g. lino flooring, may also be considered, in consultation with residents, and their representatives. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home are protected by rigorous recruitment practices. Staff have appropriate skills, training and supervision to meet their assessed needs effectively. EVIDENCE: The rota showed that a consistent staffing level continues to be maintained in the home. Staff and residents spoken to confirmed that there are generally sufficient staff available to meet people’s needs. Observation of staff interactions indicated that staff were available at busy times of the day (e.g. mealtimes) to assist people, and staff were observed spending time with people both individually and in small groups. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 24 Residents and relatives spoken to felt that staff had the necessary skills to meet their needs. One person said “ the staff have a really nice way about them.” Training records showed that staff had been on a range of courses relating to the needs of people who live at the home. These included training on dementia, depression and other mental health issues, and person centred care as well as mandatory training in first aid, food hygiene, safeguarding adults, health and safety, infection control and fire safety. As recommended at the last inspection some staff had undertaken training in equality and diversity issues, and further training was planned for remaining staff. The management advised that further training was planned for staff members in the Mental Capacity Act 2005, and Deprivation of Liberty Standards. Inspection of staff files and information provided in the annual quality assurance assessment showed that over 50 of staff have achieved the National Vocational Qualification level 2 in care, or equivalent. Staff spoken to confirmed that they had all the areas of required training. A training matrix was available for the staff team in order to prioritise training for individual staff members. Seven staff files were inspected, and these were found to contain all the required information relating to staff recruitment including application forms, two written references, enhanced CRB disclosures, induction and training records, and supervision notes. No unexplained gaps were found in the employment history of recently recruited staff, and identity documents had been checked and health checks had been carried out to ensure that staff could safely meet the needs of residents. Supervision records indicated that staff are seen at least six times annually for one to one meetings with the manager, and that these address relevant issues relating to their performance and development. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home and their representatives are consulted about the quality of the service, and encouraged to make Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 26 suggestions for improvement. People living at the home have their financial interests protected by the home’s procedures, and are protected by the home’s health and safety procedures. EVIDENCE: The registered manager is appropriately qualified and experienced to manage a service for older people. She was due to go on maternity leave shortly after the inspection, and had been training a staff member to cover her position with support from the registered provider. The registered provider remains in regular contact with the home, working alongside staff, to ensure a high standard of care practices. Staff advised that the registered manager is supportive, and also has a ‘hands on’ management approach. Residents were seen coming in and out of the home’s office, indicating that they were comfortable chatting to the management team. The home uses surveys to obtain views of the quality of the service it provides. Surveys of the views of people who live at the home, relatives and professionals were seen. However there is a need for a full analysis of feedback received, and further development of quality assurance systems to audits of all areas of the home’s performance. The provider carries out regular monthly regulation 26 visits, and keeps reports of these, to ensure that the management consistently addresses any issues where improvements have been identified. People who live at the home have meetings on a regular basis to discuss how they wish the home to be run, and staff meetings take place to ensure staff are consulted and made aware of plans to develop the service. However the minutes of residents meetings tended to be quite repetitive, and those of staff members did not indicated much staff participation. It is recommended that these meetings be further developed to encourage staff/residents to be more proactive in raising issues, and considering solutions, and that a clear list of actions be drawn up as a result of each meeting. A progress report should be delivered at the next meeting, to confirm that these have been taken seriously. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. A detailed fire risk assessment was in place including potential fire risks within the home, and staff were knowledgeable about the fire safety procedures. Fire drills were taking place periodically, however these tended to be held at approximately the same time on each occasion. It is recommended that fire drills should be undertaken at varied times within the home. The fire alarm call points were tested weekly, as appropriate, in a set order to ensure that Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 27 each call point was tested regularly. It is recommended that a key be provided for the order of testing fire call points, to ensure that when this task is undertaken by other staff members, they remain aware of the order. All health and safety policies were available, with current certificates for gas, Legionella and portable appliances testing, and maintenance of the lift, hoists, and aid call system. However only the first page of the last electrical installation certificate for the home was available, so that it was not possible to verify the timescale recommended for the next inspection. COSHH guidance was in place, however I identified a risk to some residents who may be confused, and wander into other people’s rooms, due to non secure storage of topical prescribed medicines, and other cosmetics. A risk assessment should therefore be undertaken with regard to this issue, with appropriate action taken to ensure that these items are stored safely. The home has an effective system for monitoring accidents to ensure the safety of people who live and work at the home. The temperatures of the refrigerators and freezers were recorded and within safe limits, as were the cooking temperatures for high risk foods. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 28 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 3 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2mn) Requirement The registered persons must ensure that records evidence that people living at the home are provided with a greater range of activities within the home , including regular opportunities to go out of the home and use local facilities, according to their preferences. The registered persons must ensure that a greater variety of options are available for residents’ evening meals within the home. The home’s stocks of fresh fruit and vegetables should not be allowed to run out, to ensure that people’s nutritional needs and preferences are met. The registered persons must ensure that all people living at the home have the option of a lockable storage facility within their bedrooms, and are encouraged to use the keys to their rooms where this is possible. Bed covers marked with bleach and some worn chairs, should be replaced in people’s rooms. The Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 30 Timescale for action 08/01/10 2. OP15 16(2i) 18/12/09 3. OP19 23(2cm) 29/01/10 4. OP26 23(2d) 5. OP33 24 6. OP38 13(4) 23(4c) handle on one of the oven doors must also be replaced, for the comfort of people living and working within the home. The registered persons must 11/12/09 ensure that carpets within the home are cleaned thoroughly on a regular basis, to reduce the risk of unpleasant odours within the home. Where there are particular issues relating to incontinence the use of alternatives e.g. lino flooring, should be considered, for the comfort of people living in the home. The registered persons must 29/01/10 ensure that an analysis is undertaken of feedback received in quality assurance surveys, and that quality assurance systems are further developed to include all areas of the home’s performance, to ensure continuous improvements to the services provided by the home. The registered persons must 18/12/09 ensure that a risk assessment is undertaken with regard to potentially harmful topical lotions stored in people’s rooms, and that appropriate action is taken to ensure that these are stored safely. A copy of the full current electrical installation certificate should also be provided for the home, to ensure the safety of people living and working within the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 31 No. 1. Refer to Standard OP19 Good Practice Recommendations It is recommended that the local fire prevention office be consulted regarding the need for open doors between people’s bedrooms, to ensure that people’s right to privacy is protected as far as possible. It is recommended that larger flat screen televisions be provided in the lounge areas, for the comfort of people living at the home. It is recommended that staff and resident meetings be further developed to encourage greater participation, and that a list of actions be drawn up as a result of each meeting, with an update on progress at the next meeting, to confirm that these have been taken seriously. It is recommended that fire drills should be undertaken at varied times within the home, and that a key be provided for the order of testing fire call points, to ensure the safety of people living and working at the home. 2. 3. OP19 OP33 4. OP38 Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA 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. Brownlow House Residential Care Home DS0000073289.V378155.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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