Inspection on 20/07/06 for George Brooker House

This inspection was carried out on 20th July 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

George Brooker House 23/05/07

George Brooker House 09/11/05

George Brooker House 25/07/05

George Brooker House 10/02/05

George Brooker House 16/09/04

George Brooker House 11/02/04

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

CARE HOMES FOR OLDER PEOPLE George Brooker House 100 Dagenham Avenue Dagenham Essex RM9 6LH Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 17th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address George Brooker House DS0000027918.V304817.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. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service George Brooker House Address 100 Dagenham Avenue Dagenham Essex RM9 6LH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 984 8983 0208 592 0119 georgebrookerhouse@btopenworld.com Abbeyfield East London Extra Care Society Limited Care Home 43 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (13) of places George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As and when an OP bed becomes vacant this converts to DE(E) until all beds are in the category of DE(E). Each change to be notified to the Commission via the Regulation 26 visit reports. As soon as all beds are in the new category, then another certificate to be issued. 9th November 2005 Date of last inspection Brief Description of the Service: George Brooker House provides accommodation, support, and personal care for 43 older people. The home is operated by The East London Extra Care Society, which is a member of the National Abbeyfield Society. The home is purpose built, and is situated on the edge of parkland, a short walk from Dagenham Heathway, which has connections to both tube and bus routes. All bedrooms are single, with 19 having ensuite facilities. The home is currently divided into two units; a ten bed unit for the care of older people with a more severe dementia care need, and a 33 bed unit with 20 places for people with a more moderate dementia care need and 13 for frail older people. The severe dementia care unit is on the ground floor with access to an attractive enclosed garden. The main building has a ground and first floor, which can be accessed by lift or stairs. Personal care is provided on a 24 hour basis, with health needs being met by visiting professionals, or by staff accompanying service users to hospital appointments. The intention of the organisation is for the home to gradually provide services only for those older people with varying degrees of dementia. At the time of this inspection the fees were £510. per week, and there are additional fees for other services such as hairdressing for example. The inspection report, statement of purpose and service user guide are available in the reception area of the home, and copies can be obtained on request from the home. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection took place on Thursday, 20th July, 2006 over a period of six hours and commenced at 08.30 hours. The inspection involved a tour of the premises, discussions with the acting manager, staff, residents, relatives and health professionals together with information taken from a preinspection questionnaire, regulation 37 notifications and regulation 26 reports. The care of four residents was case tracked and other records were inspected. George Brooker House presented as very homely and there were no unpleasant odours. Both residents and staff interacted very well and some residents said that the “home was nice and the staff very kind.” The home is well furnished and the décor is generally in a good condition. There is a planned programme of redecoration for some areas of the home. The garden areas are well maintained and there are seating areas for residents to enjoy the surroundings. Currently residents can smoke and there is a separate “smoking” lounge. The home will eventually cater only for older people with a diagnosis of dementia. In this respect many of the staff have undertaken appropriate training and this is still ongoing. Although there is some appropriate signage throughout the home, this does need to be extended as does appropriate décor with regard to the toilet room doors or door frames. Some of the corridor walls are quite bare and in need of pictures or photographs which would be meaningful to residents with dementia/short term memory loss. Menus should be in a more appropriate format, such as pictures, and this picture format should be extended to other information such as the complaints procedure and a simple service user guide. Since the last inspection the registered manager has resigned and since April, 2006 there has been an acting manager who was previously the head of care. The organisation must address the issue of the home being without a registered manager and this will be a requirement in this report. Care Plans are in place for all service users but there does need to be more focus on the holistic needs of people living with dementia, and more consistency in the recording of information. There is a committed voluntary committee of ten, who are very involved in various aspects of the running of the home, and support the acting manager. There is a strong sense of team working, with the skills, experiences, and knowledge, of both committee members and staff being used for the benefit of the people who live in the home. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 6 Many of the service users are unable to directly give their opinions, due to their level of dementia, but those who did were very positive about both the home and the staff. What the service does well: What has improved since the last inspection? What they could do better: The Care Standards Act 2000 and the Care Home Regulations 2001 require that a care home has a registered manager. George Brooker House has been operating since April, 2006 without a registered manager. The organisation must ensure that this matter is addressed promptly and it will be a requirement of this inspection that an application for a registered manager be submitted to the Commission by the end of August, 2006. Although the care plans currently in use are reasonably comprehensive, these must be more focused on the “dementia” care of residents especially with regard to communication, behaviour and life histories. The recording into care plans must also be more consistent to ensure that these documents are up to date with regard to all aspects of care of the individual. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 7 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. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 (Standard 6 is not applicable to this service) The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The needs of service users are assessed prior to them moving into the home and all have a contract regarding terms and conditions. However, whilst information is in formats which can be understood by relatives and friends, more work must be done to simplify the formats so that prospective service users with dementia are enabled to understand the information. EVIDENCE: A copy of the statement of purpose, service user guide and the last inspection report were available within the reception area of the home. It was evident from viewing residents’ files that all had a contract of the terms and conditions of residency at George Brooker House, and all had had an assessment undertaken to ensure that their needs could be met. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 10 However, because the home is now providing a specialist service for older people more work must be done to provide information in a simpler format so that as many residents with dementia can be enabled to understand the service being provided. It is acknowledged that this can be very difficult but often in the early stages of dementia, and provided the simpler formats are used, people can understand and comprehend. Information can be obtained from the Alzheimer’s Society with regard to the appropriate formats to be used, and it is essential that the person with dementia is kept at the centre of their care. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All service users are provided with a care plan around health and social care needs and these are generally reviewed on a monthly basis, but these need to be more focused on the aspects of “dementia” care. Service users can be assured that they are protected by the home’s policies and procedures for dealing with medicines. The privacy and dignity of service users is respected by all members of staff at all times. EVIDENCE: The care plans of four residents were examined and discussed with the acting manager. Generally the care plans were comprehensive around the physical health care needs. However, more work must be undertaken to identify the needs around the actual impact and consequences of dementia for each individual. For instance there was little evidence that communication, continence and challenging behaviour had been addressed within the care plans. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 12 Although there was evidence that reviews were being done, again this was not consistent. For instance there was a recording that a resident was due to attend hospital for laser eye treatment but there was no recording on the care plan that this had been done, or of any follow up treatment. Some information was being recorded in the daily logs but this was not being transferred to the care plans. The weight of a resident was being taken on a monthly basis but again evidence of this was being recorded in a separate book but also on occasions in the care plans. Again there was no consistency. A copy of the checklist around nutrition contained within the Commission’s report, “Highlight of the day” was given to the manager and the manager’s attention is drawn to the clinical triggers for nutrition which is published on the Commission’s website. Care plans should identify the problems which need to be addressed with each resident. For instance if there is a problem with continence then the care plan should clearly indicate the programme to be implemented and the size of pads to be used during the day and the night. If there is a problem with mobility and staff are being asked to encourage mobility, then the care plan should quite clearly state the frequency of encouragement, for example 5 minutes in every hour or, in some instances, appropriate exercises. The daily recordings should indicate the fact that identified needs within the care plan are being implemented and the progress being made. One recording indicated that a resident was in danger of falling out of bed or from a chair and needed to be observed “at all times.” Obviously this was not possible especially during the night and, therefore, the statement should not have been made, but there was no evidence of the strategy in place to safeguard this resident. The possible use of cot sides at night was discussed with the acting manager, and these could be used following consultant with the resident, GP and relatives and within a risk management framework. In this way care plans should then be updated following the monthly reviews. In some areas there may not be any progress because the resident has reached the optimum and this should be recorded on the care plan. There was evidence that residents are enabled to visit the GP, hospital, dentist, optician or chiropodist when necessary. The district nurses visit daily as there is a resident who is diabetic and requires insulin injections. Also the home has close contacts with the local Primary Care Trust’s mental health team. The accident records were inspected and these were in order. The administration of medication was in line with the home’s policies and procedures. However, there are some residents who have allergies and this information must be more prominently displayed on both the residents’ files and on the medication administration records. If a district nurse is responsible for the administration of any medication within the home then that nurse must sign the MAR sheet, and this must not be signed or ticked by the manager or other member of staff. There was a record that before administering digoxin the resident’s pulse must be taken, but again there was no record that this was George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 13 being done. The manager must address this issue as a matter of urgency and ensure that if the pulse must be taken, then staff must be trained to do this under the direction of the district nurse. Any changes on the MAR sheets must indicate the source of the instruction the date as well as the signature. The inspector observed that all staff treated residents with care and respect and that they knew the residents well and were responsive to their needs. On the day of the inspection the weather was very hot, but the staff were ensuring that windows and doors were open, fans were on and residents were being encouraged to take plenty of fluids. Of the files viewed none had a night care plan and there was little evidence that discussions had taken place with residents or relatives regarding end of life wishes. Both of these issues were discussed with the manager and she has undertaken to involve night staff in the development of night care plans so that a more holistic record is being maintained for each resident. It is important that good records are kept around a resident’s night pattern as this can impact on the care required during the day, and vice versa. It is acknowledged that end of life wishes is a delicate area to be addressed but the manager and staff must begin to address this area, especially in line with the Government’s End of Life programme, and a copy of this was left with the manager during the inspection. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users’ social, cultural and religious lifestyles are encouraged and promoted. Contact with family, friends, and the local community is maintained and social events are organised on a regular basis. Staff help service users to exercise choice and control over their lives. Service users receive a wholesome, appealing, and balanced diet, and both care and catering staff make every effort to ensure that all nutritional needs are met on a daily basis. EVIDENCE: It was evident from discussions with staff, some residents and from looking at many photographs that residents are very engaged in activities. Staff had organised a holiday for several residents and accompanied them on what was an enjoyable break away. The photographs showed that the residents obviously had a good time. The relatives of these residents had been involved in the discussions regarding the holiday. There is an activities co-ordinator who visits the home on a regular basis and some paintings which have been done by residents are displayed on the walls George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 15 of some of the corridors. During the inspection some residents were observed to be engaged in a sing-a-long with staff, while others were sitting and talking to care staff. It was really nice to see that staff are given the time to engage with residents, and in discussions with some of the care staff they said that this was an important part of their work. Staff had been, and were, very busy organising the home’s summer fete which is taking place on the 29th July, 2006, and it was very apparent that many of the residents would be involved in this event. Excursions are organised to local pubs and shops and also further afield. On the ten bedded unit staff have begun developing “life history” books with each of the residents. These include family photographs and details of events which have been important in the life of the individual, and then the life history is used during reminiscence activities. This can prove to be very stimulating to the person with dementia, and the manager will be extending this to residents within the main home. Obviously this will entail a lot of work for staff who will need to encourage input from relatives and friends of residents. People with dementia are often prone to “walking” and there could be boxes of items situated around the home so that residents could handle and look at these. One box could contain different fabrics such a silks, fur, wool and linen which people with dementia could touch and feel. Another box could contain some memorabilia of bygone days which again would stimulate the memory and the senses, and so on. Old photographs of the general area could be displayed around the home which would give people something to look at while walking along the various corridors. From observation during breakfast and lunch residents were obviously enjoying their meals and staff were sensitive when assisting and encouraging residents to eat. The dining areas were congenial and new furniture had been purchased. Residents are served four meals a day which are breakfast, lunch, tea and supper. In between times drinks and snacks are freely available. Mealtimes at George Brooker House appeared to be very pleasant and the cook and care staff were very aware of the dietary needs of residents. However, so that residents can be even more involved in making choices around meals, menus should be provided in picture formats, and a sample of each meal could be provided on a small plate so that residents can smell or touch the food which, again, would assist them in making a more informed choice. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 16 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 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users and their relatives can be confident that their complaints will be listened to, taken seriously and acted upon and that all service users will be protected from abuse. EVIDENCE: From viewing the complaints record it was evident that complaints are dealt with promptly and effectively. The acting manager said that “complaints are dealt with in a positive manner since this is a way of monitoring quality within the home.” During discussions with staff it was also apparent that they were aware of the importance of dealing effectively with complaints from either residents or relatives. One service user said “if I wasn’t happy I would certainly say and if I saw another person not being treated very well I would speak up on her behalf.” There would seem to be an “open and positive” culture at George Brooker House when dealing with complaints. Staff spoken to said that they had undertaken training in recognising abuse and dealing with adult protection, and were aware of the home’s policy and procedure in this area. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 25 and 26. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users live in a homely, safe and comfortable environment where the communal areas and individual bedrooms generally meet their needs. However, more can be done around décor so that the needs of people with dementia can be better met. Service users also benefit from the home being clean, pleasant and hygienic. EVIDENCE: Since the last inspection, areas of the home have been redecorated and new furniture has been purchased for the lounges and dining areas. The acting manager said that the first floor corridors were next on the list for redecoration. The lounge furniture had been arranged so that residents could sit in small groups which was very calming for those people with dementia. There was a piano in the lounge which the manager said one of the residents liked to play. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 18 The dining areas were nicely decorated and the tables laid at mealtimes. The dining chairs had arms which made them more secure for frail residents so that the danger of falling sideways is minimised. Although the doors of the communal toilets had a sign of a toilet fixed on to assist residents with dementia, such residents would benefit even more if either the doors or the frames were painted in a colour through the spectrum of reds to oranges. Research has shown that these colours are more recognisable to people living with dementia. All of the garden areas were well maintained and residents could move freely between the small ten bedded unit and the main building and the garden areas. The kitchen area was inspected and all food was appropriately stored and labelled. The kitchen was clean and well maintained. The laundry area was tidy and all equipment was in working order. All COSHH materials were safely stored in a locked cupboard. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 19 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 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The current numbers and skill mix of staff ensure that service users are in safe hands at all times, and that staff are trained and competent to do their jobs. Service users are supported and protected by the home’s recruitment policy and practices. EVIDENCE: From viewing the staff rota, from talking to staff, the manager and residents and from observation, it was evident that there were sufficient staff on duty to ensure that the needs of residents could be met. Staff obviously had sufficient time to positively interact with residents and had time to sit and talk to individuals without feeling that “they were doing something wrong.” In discussions with two new members of staff they were very clear that the organisation provides adequate and appropriate training. They had undertaken induction training but also had NVQ level 3. One was an NVQ assessor and both had worked at other care homes. Other staff that the inspector spoke with also said that training was always available. The training schedules supported this. Training has taken place around dementia care, moving and handling, infection control, medication, diabetes, epilepsy and chronic chest infections. Because people living with dementia can sometimes George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 20 present as “challenging” it would be appropriate for staff to undertake training in dealing with challenging behaviour. The recruitment procedures are generally robust but during interviews it is necessary to ensure that interview notes are kept. From viewing a selection of personnel files it was evident that references are being received and verified, and that enhanced criminal records bureau disclosures are being obtained. However, under the Criminal Records Bureau code of conduct and the Data Protection Act, disclosures should not be retained on file once a decision has been made by the employer to either employ a person or not, and the disclosures have been seen by an inspector at the next inspection following the employment of an individual. From viewing records staff are receiving adequate and appropriate supervision, and in discussions with several members of staff they felt that the supervision and training had enabled them to improve their care practices. Over 50 of the care staff have achieved NVQ level 2 and many have also achieved NVQ level 3. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 21 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, 36, 37 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users benefit from living in a home which is run in their best interests, and can be sure that their financial interests are safeguarded. The health, safety and welfare of service users are promoted and protected. The acting manager has not been registered with the Commission, and it is therefore not possible to make a judgement as to her fitness. However, during the inspection it was evident that service user benefited from her management approach to the home. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the last inspection the registered manager has resigned and the acting manager has been in post since April, 2006. The Care Standards Act 2000 and the Care Home Regulations 2001 require that a registered premises has a registered manager. The organisation will be required to appoint a manager and submit an application for registration by the end of August, 2006. In discussions with the acting manager, who had been the previous Head of Care, it was evident that the interests and needs of the service users were paramount. She has made changes at the home and staff and residents spoke highly of her. The past eighteen months has been an unsettling time for the home with two managers and now a third to be appointed. However, all of the staff at George Brooker House are to be commended in that the general care of the residents has remained a priority. The acting manager has ensured that there is always sufficient staffing, that activities are organised and have improved and that training and supervision is still arranged and available to care staff. There is a programme of redecoration and refurbishment some of which has already been implemented. Residents’ and staff files are kept secure and in accordance with the Data Protection Act 1998. Staff supervision is being undertaken on a regular basis and this includes regular staff meetings. During discussions with staff they said that “the meetings were open and that they felt able to express their points of view.” However, more work needs to be done to ensure that care plans are more effective, that recordings are more consistent and that signage and décor throughout the home is appropriate to enabling residents living with dementia to remain as independent as is possible for as long as is possible. The organisation does not act as appointees for any resident, but the Bursar does manage some pocket monies. All records are maintained to a high standard with receipts, where necessary being retained. Maintenance records such as lift, fire safety, gas, electric and water are being kept to a good standard, and fire drills are being undertaken on a regular basis as is the testing of fire alarms. Quality assurance systems are in place and the views of both residents and relatives are being obtained and these are influencing the practices within the home. Regulation 37 and Regulation 26 notifications and reports are being George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 23 sent to the Commission and the information contained within these notifications and reports is used to inform the inspection process. The acting head of care is responsible for the health and safety aspects of the home which were found to be in good order during the inspection. George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 3 X 3 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 2 X 3 X 3 3 3 3 George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 5 Requirement Timescale for action 30/11/06 2 OP7 15 3 OP9 2 4 OP11 15 The registered person must ensure that prospective residents living with dementia are given information in a format suited to their needs. The registered person must 30/09/06 ensure that care plans are comprehensive and appropriate to all care needs of people living with dementia, and that these are reviewed and accurate and up to date. Also to include night care plans. The registered person must 31/07/06 ensure that medication administration records are signed by the person/s actually administering the medication, and that any changes to the MAR records indicate the source and date of the change. Also if pulses are to be taken prior to the administration of medication that this is done by staff trained to do so. The registered person must 27/02/07 ensure that end of life wishes and needs are addressed with each resident and their families, DS0000027918.V304817.R01.S.doc Version 5.2 George Brooker House Page 26 5 OP14 12 (2) 6 OP22 23 (n) 7 OP30 18 (1)(c)(i) 8(1)(a)(b) (i) 8 OP31 and information retained in the resident’s file. The registered person must ensure that through the use of information in appropriate formats, people with dementia are helped to exercise choice and control over their lives. This includes the provision of menus in a format such as pictorial. The registered person must ensure that signage and décor throughout the home is suited to the needs of people living with dementia to enable them to remain as independent as is possible. The registered person must ensure that staff undertake training in dealing with challenging behaviour. The registered person must appoint a manager and submit an application to the Commission for the registration of that person 30/11/06 30/09/06 31/10/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations George Brooker House DS0000027918.V304817.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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