Inspection on 07/08/07 for Cary Brook

This inspection was carried out on 7th August 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 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

Cary Brook 09/08/06

Cary Brook 07/03/06

Cary Brook 16/11/05

Cary Brook 10/01/05

Cary Brook 12/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Cary Brook Millbrook Gardens Castle Cary Somerset BA7 7EE Lead Inspector Barbara Ludlow Unannounced Inspection 7th August 2007 09:30 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 Cary Brook DS0000016106.V346851.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. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cary Brook Address Millbrook Gardens Castle Cary Somerset BA7 7EE 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) 01963 350641 01963 351364 Somerset Care Limited Mrs Judith Mary Pullen Care Home 35 Category(ies) of Dementia - over 65 years of age (35), Old age, registration, with number not falling within any other category (35) of places Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 35 persons in categories OP and DE (E) Date of last inspection 9/08/06 Brief Description of the Service: Cary Brook is situated close to the town of Castle Cary, at the top of a small hill overlooking a residential housing estate. The home was purpose built in the 1960s and offers specialist care to older people with physical and mental frailty. Most of the rooms have views overlooking parts of the town. The layout is simple and over two floors. This allows those individuals, who need space, the opportunity to move around the home, with lounges available on both floors and a secure garden. The home offers a generally relaxed, homely atmosphere with planned activities. The manager of the home has been in post for three years; prior to this appointment she had been the deputy manager at Cary Brook and has worked for Somerset Care for many years. The fee range is: £373.00 to £500.00 per week. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. B.Ludlow carried out this inspection visit for CSCI over one full day. The manager and her deputy were present all day to contribute and assist with the inspection process. The residents and daily life at Carybrook was observed. Residents and staff were spoken with and their views of the service were sought. A tour of the premises was made and records were sampled. Feedback was given to the manager at the conclusion of the visit. The inspection period was extended by two weeks to allow written feedback forms to be returned to CSCI. This was a positive inspection. What the service does well: What has improved since the last inspection? The recommendation made at the last inspection to improve the care practices around continence management has been addressed. Good practice and good continence management was seen. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 6 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. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. There is a good level of information available about Carybrook and visits are welcomed to allow people to make an informed choice of their care home place. Pre admission assessment would be made by the manager or the deputy to determine whether or not persons care needs could be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The choice of home is often made by families; the prospective residents are often very frail. The manager Mrs Pullen said that families are welcome to view the home as often as they wish to help them with their decision making. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 9 Information about the home is available to people looking for a place and their families, and can be produced in large print or audible format (Compact Disc). The manager stated that where people cannot visit the home a copy of the service user guide would be sent out to them. There is a good level of information available about Carybrook and visits are welcomed to allow people to make an informed choice of their care home place. The Annual Quality Assurance Assessment sent to CSCI stated that the home would like to do more pre admission to allow people considering a place to spend more time on the unit, unfortunately respite care cannot usually be offered because the home tends to be full. Pre admission assessment would be made by the manager or the deputy to determine whether or not persons care needs could be best met at the home. Five care plans were sampled. The single assessment process paperwork (SAP) is always requested pre admission to assist the manager with her knowledge about the person and her subsequent assessment. The first four weeks are considered a trial period. The six monthly SAP reviews were seen on file for each person. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good The home offers a good standard of person centred care to residents. There are good links and input where needed from the community health care services. Residents were seen and heard to be treated with respect and kindness by staff; this was supported by positive comments from residents and their relatives. Medicines are fairly well managed; a requirement is made to correct one example poor practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had care plans. Most were up to date and full of person centred information. There has been relative’s involvement with the care planning and reviews. Families commented that they are informed promptly of any changes in health of their relative. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 11 Residents were seen and spoken with during the day; all were well kempt and nicely attired. Drinks were served and staff interactions were kindly and appropriate. Residents were able to move freely around the home and were able to go out onto the patio garden where there was seating. One resident was seen outside sweeping around the patio area. A quick response was made to assist the safety of one resident who was outside in the garden. The area had been examined for security and attention was paid to reducing the risk in future. Health care needs were met, one resident said they had received their flu jab last winter and that if they are ever unwell the home would ask their GP to visit. Care plans demonstrated a nutritional assessment and a moving and handling assessment. There was an ABC chart where behaviour was recorded and ways to reduce deterioration of a situation such as shouting and hallucinations could be care planned. Body maps were seen in use to show any marks or bruising so they can be monitored. Chronic health conditions such as diabetes was monitored and regular urinalysis checks were recorded. Night care plans were in place. These had an indication of preferred time of retiring and sleep pattern. One care plan had an incomplete social care and personal history. Risk assessments were in place for use of the call bell and pressure mats. Falls analysis and risk had been assessed and identified. Input to individuals by visiting professionals was recorded, such as the district nurse providing skin care. Charts were maintained for the application of all individually prescribed skin creams. One person at risk of developing a pressure sore had a pressure-relieving mattress from the district nurse and they also had their position changed in bed overnight and a record of this was kept. Positive responses were made by GP completing the questionnaire for CSCI. One lady said of the care staff that they are ‘all very nice people’; she said she has ‘help to wash each day’ and ‘has a bath once per week’. The care plans for personal care were written in a person centred way. Staff interactions were kind and friendly. Service users were confident with their carers and a number pointed out staff that they liked. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 12 Medications management was examined. The Medication Administration Records were satisfactory; a small number of hand written entries need a second signature. This is a good practice recommendation. The staff are currently using lactulose generically by opening only one bottle at a time. This has not been bulk prescribed, therefore the home need to confirm this practice with the General Practitioner (GP) and have a bulk prescription arrangement or change their practice. A letter was sent to the home after the inspection to bring this to the manager’s attention and request a response to confirm the action taken. The home has a medications fridge and this is temperature monitored. The temperatures of the fridge must be checked properly and recorded. All drug storage and the Controlled Medication was well managed. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 13 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 good Residents have a pleasant home with good communal space. There are things to do during the day and events are held to entertain the residents including trips out. Residents said they were happy living at the home, had plenty to do and enough to eat and drink. Mealtimes are unhurried social occasions but lunch was poorly organised and could have been less stressful with clearer management. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Trips out are made using the council minibus, which is hired with an approved driver. Up to 10 persons can go at one time and this year residents have visited Chew Valley Lake and Portland Bill; three or four staff would accompany them. One resident said they do no Bible study here. The home does have church visitors and services on the television or radio are switched on by staff. Staff Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 14 said that at teatime ‘Songs of Praise’ is switched on for those wishing to watch it. Lunchtime was disorganised and a number of service users who had sat in the dining room too early lost interest as they faced a long delay. Some got up to leave and were brought back; others questioned what was going on. One person got up to collect their meal from the serving hatch. The three other service users on the same table watched with increasing interest as the meal was consumed, one person picked up a fork and began sharing the person’s meal. Drinks were offered after the serving had begun and this detracted from the serving. Overall the meal at lunchtime was very poorly managed. Staff were kind and helpful, meals were taken around to offer a choice to each person, some of whom appeared to be confused by this as the meal appeared to be offered to them and was then removed. Seconds were offered and there was plenty to eat. Another delay was evident as trays and the servery were cleared before the dessert trolley was brought out. Cleaning schedules and kitchen records were up to date, temperatures were monitored and recorded for food deliveries and hot meals as served. Corporate menus were being used and beef burger in orange sauce was a new menu being tried on the day of inspection and seemed to be a popular choice. The kitchen staff bake daily and they cater for individuals with special diets. These included a coeliac diet (gluten free) and a number of diabetics. A real effort is made to offer a choice of menu and residents had been sent a questionnaire to ask if they were aware of the menu choices. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good Complaints procedures are in place and can be monitored, the company system is called ‘Seeking your views’. One complaint made since the last inspection had been thoroughly investigated and was not upheld. Residents are protected by recruitment policy and practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint was made to CSCI and was passed to the home to investigate. This complaint has been answered by the home but had not been closed off, as the complainant had not responded to the home. No other complaints had been raised. The company corporate complaints policy ‘have your say’ is available and advertised for residents, families and staff to use. The home has a recruitment policy and some good practice was recorded, there was one deficit in the recruitment practice. See staffing. Resident’s rights to vote if they wish will be supported. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good The premises are suitable for the client group, being safe and secure. The home is clean, bright and well maintained with comfortable private and communal accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Tour of premises, service users asked about their accommodation, all spoke positively about their rooms, saying they are ‘comfortable’. The premises will benefit from the upgrading planned but subject to planning permission. The home continues to be well maintained, clean and comfortable. Communal areas and garden are very nice, attractive and easily accessed. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good Staff recruitment was of a good standard. Staff at night are stretched to provide care for individuals at bedtime and supervise the service users that remain in the communal areas. A review of the evening duties and workload is required at this inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were seven new starters since the last inspection. Staff files were examined for a sample of four new starters, all files demonstrated good recruitment practice, staff had two references and Criminal Record Bureau checks (CRB) / POVA first before commencing work at the home. Staff had received induction training and staff supervision records were up to date. Service users and relatives spoke highly of the staff. Thank you cards and letters demonstrated thanks for making visitors feel welcome and supported. Staffing numbers were sufficient by day but at night there is a period of 30mins where there is only one staff available for all service users currently thirty but maximum of thirty-five. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 18 A review of the period between 9.30pm and 12 midnight is recommended to check if the cover offered is sufficient and risk assessed as safe. A recent accident at 11pm highlighted the fact that night staff assist a number of residents to bed at this time leaving the lounge unattended. No concerns about staffing levels have been raised by staff, relatives or residents. The manager confirmed that extra staff are brought in when there is a concern for a resident or a very ill resident. This extra person may be sleeping in and ‘on call’ from 12 to 7 am. Night staff do have designated cleaning tasks, the manager confirmed that these tasks are not given priority above the care of the residents. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 19 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 A well managed home with an approachable management team. Good maintenance for equipment and a safe clean environment for residents to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a capable manager and deputy manager. Their management style is open, friendly and helpful. Residents and relatives say they find the management approachable. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 20 Cleaning schedules seen were up to date. Kitchen records were completed and were up to date. Temperatures are monitored for food deliveries and the hot meals as served. Corporate menus being used, beef burgers in orange sauce being tried and was popular and well received. The catering staff bake daily. The special diets offered at the home included a celiac diet and eight diabetic diets. Residents asked said they were aware of the menu choices available to them. Records inspected included: Legionella testing, 27.1.07, this was a pass. Water temperatures are checked, the last ones were, 1.8.07 a range of 39 degrees to 41 degrees had been recorded. Utilities were up to 27 degrees Celsius. The kitchen identified those below 60 degrees for attention. This work to increase the temperature had been carried out. Quality Assurance is monitored; corporate audit and action plan were seen. The Fire test records were sampled; the last was 1.8.07 for the emergency lights and fire alarm. Extinguishers were checked on 14.8.06 and servicing had been on 7.7.07. Resident monies are held safely. Books are used to record this and have two signatures for all transactions. Designated staff have access to the petty cash for which a record is made and is signed for. Checks are made on all monies held. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 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 3 3 X 3 3 X 3 Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement The use of prescribed lactulose with only one opened bottle at a time for more than one recipient (as if bulk prescribed) must stop unless done legitimately by a bulk prescription agreement with G.P surgeries. Timescale for action 08/10/07 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 OP27 Good Practice Recommendations The evening and night staffing levels should be reviewed and should be kept under review with regard to meeting the needs at such times of residents in the home. Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Cary Brook DS0000016106.V346851.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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