Inspection on 07/03/06 for Cary Brook

This inspection was carried out on 7th March 2006.

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

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

Other inspections for this house

Cary Brook 07/08/07

Cary Brook 09/08/06

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 Lesley Jones Unannounced Inspection 7th March 2006 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.V281135.R01.S.doc Version 5.1 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.V281135.R01.S.doc Version 5.1 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 (0), Old age, registration, with number not falling within any other category (0) of places Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered For 35 Persons In Categories OP and DE (E) Date of last inspection 16th November 2005 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. Most of the rooms have views overlooking parts of the town. The home was purpose built in the 1960s and offers specialist care to older people with physical and mental frailty. 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. A quiet dining area is also available on the first floor with a small kitchenette offering additional facilities for service users and their visitors. The home offers a generally relaxed, homely atmosphere with planned activities. The manager of the home has been in post for just over one year; prior to this appointment she had been the deputy manager at Cary Brook and has worked for Somerset Care for many years. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced inspection took place on March 7th from 9.30 am to 2.00pm. Thirty-three service users were residing at the home. The last inspection was also unannounced and took place on the 16th November 2005. At that inspection one requirement and two recommendations were made. At the time of this inspection the requirement had been complied with and the recommendations actioned. Not all of the standards were inspected on this occasion, but it was evident at this inspection that the National Minimum Standards inspected had been met or partially met and that the care delivered to service users is good. Service users spoken to during the inspection expressed their satisfaction at the care delivered, and they appeared happy and well cared for. A visiting relative said that his mother always looked clean and well cared for and that her room was always tidy. He confirmed that if he had any concerns, he would have no hesitation in approaching the manager of senior staff, and that he was happy with the care provided. The inspector would like to thank the Manager Mrs Judith Pullen, and the staff for their time and help during the inspection. What the service does well: What has improved since the last inspection? Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 6 Since the last inspection, the room used for the storage of medication has been upgraded, and is now a more practical facility. The programme of redecoration has commenced. To assist with orientation, plans are in hand to colour code certain areas as well as introducing signs, which have personal links to individuals. Which will be fitted to bedroom doors and other communal areas. As part of the last inspection CSCI pharmacist Mr Brian Brown made a visit. He wrote a separate report, which offered some advice to the home on improving the management and administration of medication. The home has been able to implement his recommendations. What they could do better: The location and layout of the home was found to be suitable for service users. At the last inspection, the general décor, carpeting in communal areas, some of the soft furnishing, and some toilets and bathrooms were observed to be in need of upgrading. Flooring in communal area needed to be replaced as soon as possible with consideration given to using materials that will be practical, safe and promote a homely atmosphere. Work has started to re-decorate some communal areas, and upgrade the premises generally; this is to include consideration of the needs of people with dementia. For example, the use of colour coded corridors, to assist service users find their way around the home. Of concern is the continued use of inco sheets/ padded seat covers on all soft furnishing to prevent staining and odour. Consideration should be given to more discreet ways of managing this aspect of care. During this inspection. I was aware of the noise created by call bells. I understand from the manager that Somerset Care have guidance on answering calls according to priory; this does not address the level of noise created by the current system, which can be quite overpowering at times. Consideration should be given to looking at ways to move away from this very institutional practice. Please contact the provider for advice of actions taken in response to this Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 These standards are met. There was good evidence that appropriate procedures are followed to assess individual’s suitability to the home, and that there needs are regularly reviewed. EVIDENCE: A selection of care plans were sampled to track care and support. All files contained evidence of professional/care manager assessment prior to moving in to Cary Brook. The deputy manager confirmed that one of the senior staff also carry out a pre-admission assessment using a standard format. The service user and family are as involved as possible. The deputy manager also said that a pack is sent to all potential enquiries that contains a brochure and information about the home. She also said that service users and their families are encouraged to visit the home prior to admission. The home takes emergency admissions occasionally and it was reported that a one-week review of the suitability of the placement is undertaken following an emergency admission. Intermediate care is not a service offered by this home. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. The inspector feels satisfied that overall great care is given to treating service users with respect by staff in the home and that visiting professionals similarly are supported to treat residents in a dignified manner. With this in mind, a small private area/quite room is planned on the ground floor to replace the managers/staff office in this area. This will allow for checks, and treatment by visiting professional, a private space for visitors other than bedrooms, and for meetings with families and other professionals. The recommendations of the CSCI pharmacist made as part of the last inspection have been implemented and the administration and management and storage arrangements of medication in the home have been improved. EVIDENCE: The home uses the comprehensive corporate assessment documentation. Care plans contained appropriate risk assessment and showed written evidence of continuous review. Some care plans demonstrated service user/family involvement and six monthly customer in-house reviews of a formal multidisciplinary and family involvement are common. Social histories are included in care plans, enabling mental health planning and activity scheduling linking activities with past likes and interests. Where aids are used that invade Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 11 personal privacy, such as wander mat alarms, these had been risk assessed and written permission obtained from service user or next-of-kin, where applicable. An individual record sheet of activities carried out by each service user has been introduced. All service users are registered with a GP. The home uses three surgeries and has community-nursing support from all practices. There is an established link with the local mental health team and a CPN visits the home for reviews and to provide advice. All other health services are accessed through the GPs. Where the nurse is providing care this is indicated in the home’s plan for the service user. As part of the last a visit was made with the CSCI pharmacist Mr Brian Brown. The home has carried out the recommendations made following this visit. Staff were observed to knock on doors before entering and treat all service users sensitively when assisting them. Personal care was given in private. Rooms are locked downstairs during the day to protect belongings, service users are able to have a key to their own room. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 These standards are met. EVIDENCE: During the inspection service users were observed getting up at different times maintaining the home’s intention to make routines flexible. Staff confirmed that service users could get up and go to bed at the time they wish. The home maintains a routine for those who need more structure and activities always take place in the same room to help orientation. There are approximately 30 hours per week allocated specifically to activities by an activities organiser and care staff will also lead or assist with activities when they have the time. A programme is displayed detailing what activities are available morning and afternoon. Staff hour available for activities has improved since the last inspection. Individual activity records were sampled and gave a clear picture of the opportunities available and accessed by service users. The records inspected showed a least one entry per week for service users, most had more than this. Visiting at the home is open, with meal times being avoided. Activity schedules displayed in the home and photographs of recent community activity events give testament to continuing service user community access Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 13 Lunch was observed during the inspection. The menu was displayed in the dining room. Service users are able to choose where they eat. The majority used the dining room, which was pleasantly laid out, and the meal was unhurried. Lunch was a choice of two home cooked main courses, four puddings or fresh fruit. Special diets are available as required. The chef confirmed that all kitchen staff hold current food hygiene certificates and that the most recent Environmental health inspection was satisfactory. Cooks either have or are working towards an NVQ in Catering. Residents are encouraged to go the dinning room for their meals, so that they can socialise, be supported both emotionally and practically to eat, and their intake monitored. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 These standards are met. EVIDENCE: The home has a complaints procedure ‘Seeking Your Views’, which is readily available, and a complaints and compliments file is kept and was seen during the inspection. There have been no complaints since the last inspection. CRB checks are made on all new staff, who also sign a criminal declaration as part of the application procedure. The home does not employ any volunteers. The home has a whistle blowing policy, a copy of which is available in the staff room. The Department of Health Protection of Vulnerable Adults list is operational, and staff files sampled demonstrated that POVA checks had been carried out. No services users are able to manage their finances or personal allowances. During this inspection, I looked at a selection of records relating to the management of personal allowances, and found that they were balanced correctly and it good order. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home requires upgrading particularly in communal areas to meet this standard. It was good to see that work had commenced to upgrade these areas. Of concern is the continued use of inco sheets/ padded seat covers on all soft furnishing to prevent staining and odour. Consideration should be given to more discreet ways of managing this aspect of care. During this inspection. I was aware of the noise created by call bells. I understand from the manager that Somerset Care have guidance on answering calls according to priory; this does not address the level of noise created by the current system, which can be quite overpowering at times. Consideration should be given to looking at ways to move away from this very institutional practice. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 16 EVIDENCE: During this inspection, the premises were inspected. Staff work very hard to keep the home clean and odour free. Certainly the home was clean, but despite the best efforts of staff, there was a slight malodour. This is a result of hard wear and tear, and constant cleaning. Plans are in hand to replace flooring in communal areas using materials that will be practical, safe and promote a homely atmosphere. Work to redecorate some communal areas has commenced. This is to be carried out with consideration to the needs of people with dementia. For example, the use of colour coded bedroom doors to assist service users find their way around the home. Work has been completed to add a sunroom and raised terrace/patio; although not in use at the moment because of the winter weather this has made a considerable improvement on communal space and outdoor garden facilities. A sample of bedrooms were seen. These clean and tidy, appropriately furnished and personalised. The home was clean and tidy. The home has a control of infection policy and hand-washing facilities are available in all communal areas. It was noted that hand washing facilities, soap and paper towels and foot operated flip top bins were available in all areas where personal care is carried out. This is good infection control practice. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Overall, good practice was evident in the recruitment and training of staff. It was noted however on one staff file that there was no proof of identity. The manager must ensure that all the requirement of Schedule 2 are followed. EVIDENCE: Staffing levels were seen to be consistent with the previous inspections, indicating that current staffing levels are adequate to manage service user dependency levels. At the time of this inspection, the home was fully staffed. The Company has a clear commitment to continuous staff training. At the time of this visit , the company has recently introduced a dementia care package as part of ongoing training. All staff are required to undergo the company induction programme that meets NTO targets. A copy of current staff training was provided to the inspector, indicating relevant training to post, induction training and ongoing professional staff development. All care staff are required by the company to register for NVQ training following their induction. This is facilitated by the company’s own training organisation. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 With the exception of some fire training , overdue for some staff, these standards are met. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 19 EVIDENCE: Mrs Pullen is the manager at Cary Brook. She has been in this role since May 2004, following the retirement of the previous manager. The previous manager had inducted Mrs. Pullen into the role over the last year. Mrs. Pullen was the deputy manager for 18 months at Cary Brook prior to this appointment. She holds an NVQ level 3 in Management, D32 NVQ assessors award, NEBS supervisors certificate and company health & safety trainers certificate. She is currently working towards the NVQ level 4 in Care and the Registered Managers’ award. The company by a regional manager who conducts at least monthly supervisory visits supports Mrs. Pullen. The home hold the quality rating status awarded by Somerset County Council and is an ‘Investor in People’ as part of the Somerset Care Group. (Awarded October 2003). Somerset Care conduct formal quality assurance feedback tools on an annual basis. Training records examined demonstrated an organised approach to ensuring staff training is current with regard to health and safety matters. The home’s accident records were inspected and the recording and auditing of accidents in the home is done particularly well. Bath and mobile hoists were inspected and seen to be in working order with appropriate servicing records maintained. Hoist slings are likewise audited at least six monthly by a competent person in accordance with LOLER regulations. The home has appropriate health and safety policy documents. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x 2 x x STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP38 OP29 Regulation 18 17 Schedule 2 Requirement Timescale for action 01/04/06 The manager must ensure that fire training for all staff is up to date. Overall, good practice was 01/04/06 evident in the recruitment and training of staff. It was noted however on one staff file that there was no proof of identity. The manager must ensure that all the requirement of Schedule 2 are followed. 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 OP24 Good Practice Recommendations During this inspection. I was aware of the noise created by call bells. I understand from the manager that Somerset Care have guidance on answering calls according to priory; this does not address the level of noise created by the current system, which can be quite overpowering at times. Consideration should be given to looking at ways to move away from this very institutional practice. DS0000016106.V281135.R01.S.doc Version 5.1 Page 22 Cary Brook 2 OP24 Of concern is the continued use of inco sheets/ padded seat covers on all soft furnishing to prevent staining and odour. Consideration should be given to more discreet ways of managing this aspect of care. Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Cary Brook DS0000016106.V281135.R01.S.doc Version 5.1 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. 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!