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Inspection on 03/05/05 for Brownscombe House Nursing And Residential Home

Also see our care home review for Brownscombe House Nursing And Residential Home for more information

This inspection was carried out on 3rd May 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The requirements made at the last inspection have now been met. There are also more activities organised. The home also provides a good range of training for the staff for the exception of NVQ training.

What the care home could do better:

The home could provide the manager and senior staff with essential computer equipment and internet access to help them with their professional work. Plans for NVQ training for staff was also required to be sent to the CSCI as there is not evident who was doing this training. The arrangements for meal times need to be looked at to be less rushed.

CARE HOMES FOR OLDER PEOPLE Brownscombe House Nursing and Residential Home Hindhead Road Haslemere Surrey GU27 3PL Lead Inspector Kathy Martin Unannounced 03/05/05 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brownscombe House Nursing and Residential Home Hindhead Road, Haslemere, Surrey, GU27 3PL Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr L Hasham Elizabeth McAllister CRH N 36 Category(ies) of OP - Old Age - 36 registration, with number DE(E) - Dementia - over 65 - 3 of places SI(E) - Sensory Impairment - over 65 - 1 Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Up to 25 beds may be used for the provision of nursing care for elderly people from the age of 60 years One (1) named service user within the category SI/E (Sensory Impairment over 65 years of age) may be accommodated. Date of last inspection 09/08/04 Brief Description of the Service: Brownscoombe House is a care home providing nurisng care for 36 residents with old age. The home is owned and run by Care Homes of Distinction who also run similar establishments in Surrey. Brownscoome House is a large building in impressive large grounds in Haslemere. The home provides accommodation over three floors which can be accessed by a lift. The home provides in-house catering. There is parking available in the front of the house. The home is well maintained and there are good links to the main roads by car journey. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection this year. There will be another inspection before the end of March 2006. This was an unannounced visit, which means that the residents and staff were not aware of the inspector visiting on the day. The home was being run in an organised manner when the inspector arrived in the morning. Several residents were up and about in various areas of the home and many were receiving personal care to get ready for the day. The manager also later drove one resident for an appointment, as the driver was not in that day. It was nice to be able to meet many residents either in their bedrooms or in the lounges. The inspector was able to speak with several residents and staff and also look at records. There were sufficient staff seen attending to the residents although just before lunch there was a bit of a rush to bring residents to the dining area and it was a little crowded in those areas. The inspector discussed this with the manager and a recommendation was made to closely look at a better way to organise the meal times. The interactions between the residents and staff were very polite and residents were observed to be treated with respect and dignity. The home was well maintained and clean and the garden looked attractive. The inspector wishes to thank all those who have contributed to this report as every effort was done for their views to be reflected. What the service does well: The residents are encouraged to form friendships with each other and meet in the lounges to spend time with each other or their relatives. One resident showed concern for another fellow resident being unwell and talked to the inspector about it. The food is reported as being very good. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 6 The residents were able to talk to the manager and were able to walk around the home freely. The maintenance was good and the décor was very homely. A registered nurse spoke highly of the manager and her supervisors in taking time in her induction to help her settle in the home. 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. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 The home has policies and procedures to welcome residents in an organised manner to the home. Residents receive a full assessment of their needs before they are offered a place. All their relatives or friends are also involved in the assessment process. EVIDENCE: The inspector looked at records for residents who were newly admitted. There were plenty of care notes relating to all the assessments of needs from hospital staff and community health care staff (district nurses, doctors, etc…). These notes also said how the residents moved about, any special diets, medication, discharge summary from hospital, any family involvement and what they liked and disliked. A care plan was then written following the information gathered at the assessments. There are also brochures and service users’ guides that are offered to the new residents when the manager visits them in the hospital or their homes. A photograph album of the homes is brought in for the prospective resident to Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 9 see if they are unable to visit, in which case, the family is asked to visit the home so they can feed back their experience and observations to the resident. The rooms are viewed during visits and any personal items that the resident wishes to bring in is then considered. The inspector saw several personal items in residents’ bedrooms during this visit indicating that this practice was encouraged. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 All residents have a full care plan detailing all their areas of needs. The risk assessments will need to include risks of aspiration for those identified in the care plans. Residents received care from the community professionals too. EVIDENCE: The care plans for 5 residents were inspected. There was very good detailed plans of care for each resident. The written information about each assessed need also contained realistic goals. The care plans were updated every month. Also present were all the risk assessments on pressure sores, falls, moving and handling. A requirement for maintaining risk assessments on aspiration was made. The inspector discussed the care plans with the manager and one other member of staff and it was evident that they both were very aware of their contents indicating that they were knowledgeable of the residents’ needs. Residents were also able to access community health professionals such as doctors, district nurses, chiropodist, dentist and opticians and records of each visit were maintained and seen. On the day of the inspection the manager was driving and escorting a resident to see a health care professional in the community. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 11 Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 ,13 and 15 (partly inspected) The home provides activities and opportunities for residents to communicate with each other, use their personal time in private and also go out and receive visitors. EVIDENCE: The home employs an activities organiser two days a week for planned activities. The examples given by residents were “aromatherapy”, “seniorcise” and having musicians coming to the home to play. A programme is available in the home. The feedback obtained from residents also suggest that there is open visiting hours to the home and telephones can be connected in individual bedrooms which is paid for by the residents. The hairdresser visits regularly and the vicar holds monthly religious gatherings in the home. Birthdays are celebrated. The home offers a cake and a present on these occasions. There are parties organised. The home has the use of a minibus and small groups are often taken out. Although Standard 15 was not fully inspected during this inspection, it was observed that there was a rush to get residents to the dining areas which meant several residents in the lounges not being attended to. This was Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 13 discussed with the manager. It is acknowledged that the manager had noticed that this time was not well managed and was looking at ways to make it safer and more pleasant. A recommendation was therefore made to monitor the crowded seating arrangements in the dining areas at meal times and provide a less rushed atmosphere around meal times. This Standard will be inspected in full at the next inspection. The requirements made at the last inspection regarding the storage areas for the fridge and freezers have now been met. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The procedures for complaint and protection of vulnerable adults were in place and staff received training to handle any complaint. EVIDENCE: The residents are encouraged to talk to the staff and relatives also can talk to the nurse in charge or the manager and also obtain a copy of the complaints procedure which is easy to follow with clear instructions about who will investigate the complaint right up to the owners of the home. One resident told the inspector that she was able to talk to the manager any time and thought highly of her. The home uses the local policy and procedures for managing complaints regarding abuse. Staff received training in these procedures. The manager holds a weekly “staff clinic” to make herself available for staff to speak with her at an allocated time of the week. The home is not dealing with any complaint at the moment. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home remains in a very good decorative state and was clean and hygienic. The gardens were looked after. EVIDENCE: It was observed that the home was clean and tidy during the inspection. There is a maintenance man employed for the general daily repairs. The décor is homely and pleasant. There are ample areas for communal gathering and also smaller lounges for those who wish to watch television. There were no issues observed or raised with the inspector about the home’s maintenance or cleanliness. There is dedicated staff employed to clean the home. One resident talked to the inspector about a possible problem with the specialist equipment relating to getting in and out of the bath. This was discussed with the manager and a clear assessment needs to be done for this resident to use the bath safely. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home employs adequate staff to run the rota in a manner that allows sufficient staff to be on duty on each shift. The administrator’s hours need to be replaced as the manager needs to allot her own full time hours to her management tasks. Staff are given training in many areas except for NVQ level 2 although 4 adaptation nurses are already qualified up to level 3 NVQ until they reach registered nurses qualifications. EVIDENCE: The administrator no longer works in the home and these hours need to be replaced as at the moment the manager is spending a lot of hours on administrative work instead of her management tasks. The home does offer a wide range of training, which the staff spoken with appreciated and welcomed. Examples of training covered (as evidenced in the personal training logs and when talking to staff on the day) included: manual handling, basic food hygiene, protection of the vulnerable adults, communications, equal opportunities, confidentiality infection control and other areas of basic nursing care practices. The inspector asked the home to provide the CSCI with plans for training their care staff to gain competency to level 2 NVQ. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 The manager has a good staff team and works well with meeting her responsibilities. The home has relevant health and safety procedures and staff are given training in all aspects of health and safety to protect the service users and themselves. EVIDENCE: The manager is undertaking her level 4 NVQ in management and is finding it difficult to obtain time to devote to meet this requirement. A requirement was made to provide the manager with weekly study time to enable her to complete Level 4 NVQ in management. There is no administrator at the home to replace the previous one and the manager is spending time undertaking this role too which is not ideal. A requirement was made to replace the administrator’s hours. It was noted that there was no computer equipment available and the staff were expected to handwrite letters. The staff had no internet access for study, Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 18 research and means of fast communications to undetake their professional tasks. A requirement was made to this effect. During the inspection the home was being run efficiently and communications between staff were very good and polite. Records were well organised and maintained. The inspector spoke with a new member of staff who had been there for 2 months adapting to gain registered nurse qualification. Her experience of the first couple of months were very positive and complimentary of the way in which the home run. She praised the manager and her colleagues and said she was very well looked after and felt welcome in the home. She had been given opportunity to attend training and time was set aside to meet with her mentor regularly. This is commendable. No health and safety issues were observed or reported to the inspector. All relevant procedures were available and staff received training in these areas. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 3 Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard 8, 38 27 30 31 Regulation Requirement Timescale for action 31/05/05 03/07/05 31/05/05 31/05/05 5. 37 13 (4) (c ) Provide risk assessment for those who are at risk of aspiration 18 (1) (a) Replace the administrators hours 18 (1) Provide the CSCI with plans for (a), (c) training staff to level 2 NVQ 18 (1) (c ) Provide the manager with weekly study time to enable her to complete Level 4 NVQ in management 12 (1) (a) Provide the manager with essential computer equipment to undertake her tasks 31/05/05 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. 2. Refer to Standard 15 Good Practice Recommendations Monitor the crowded seating arrangements in the dining areas at meal times and provide a less rushed atmosphere around meal times. Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 21 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brownscombe Lodge h58_s17596_Brownscombe_v224394_030505_st4.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!