Inspection on 23/05/07 for George Brooker House

This inspection was carried out on 23rd May 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

George Brooker House 20/07/06

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 23rd May 2007 08:30 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 DS0000027918.V341265.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. DS0000027918.V341265.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 Susan Ann Setters 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 DS0000027918.V341265.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. 20th July 2006 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 26 bed unit with places for people with a more moderate dementia care need and 7 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, and there is also another enclosed garden area. Personal care is provided on a 24 hour basis, with health needs being met by visiting professionals, or by staff/relatives 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 £522.50 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. DS0000027918.V341265.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 Wednesday, 23rd May 2007 over a period of 8 hours and commenced at 08.30 hours. The inspection involved discussions with the manager, deputy manager, staff, residents, relatives and health professionals together with information taken from a preinspection questionnaire, regulation 37 notifications and regulation 26 reports. Evidence was also taken from a random inspection visit that was made to the service on the 2nd March, 2007 as a result of concerns around the number of falls being sustained by residents, and a complaint which had been made to the Commission. 6 residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, medication administration, residents’ finance records, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files. At the end of the inspection the inspector was able to provide feedback to both the registered manager, the deputy manager and a senior carer. The people living at the home were asked how they wished to be referred to in this report, and without hesitation they said ‘residents’. What the service does well: The manager and her staff were able to demonstrate a good understanding of equality and diversity issues around sexuality, religion, culture, ethnicity and disability. An example of a resident who was a Jehovah’s Witness was discussed, and the manager was very aware of the resident’s needs around the non-celebration of birthdays and other festivals such as Christmas. George Brooker House presented as very homely and there were no unpleasant odours. Both residents and staff interacted very well and several of the residents said “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 the home, and the 1st floor lounge has recently been redecorated with some new furnishings. One resident told the inspector “I really like this room it is nice and bright.” A visiting relative said “Mum seems much better since living here, although her appetite is not too good at the moment. If ever there is a problem they always let me know.” Pets are welcome and the home does have several birds and a pet cat called ‘Tigger’ who is very popular with many of the residents. DS0000027918.V341265.R01.S.doc Version 5.2 Page 6 The garden areas are well maintained and new garden furniture has been purchased to provide ample seating areas for residents to enjoy the surroundings. Also a greenhouse has been purchased because some of the residents like to ‘potter’ in the garden. The seating arrangements in the large lounge area enable residents to sit in small groups. This arrangement appears to be conducive to the calm atmosphere in the home. The interaction between the registered manager, staff and residents was observed to be extremely good and residents were being encouraged to participate in activities. At least 7 residents are going on holiday to Hemsby and they will be accompanied by 5 members of staff. One relative told the inspector “My mum is going on holiday next week, and she is really looking forward to it.” The staff are also very involved in raising money for the residents’ fund, and the manager is doing a sky-dive in the very near future, and many of the staff and residents are engaged in decorating a float for the Dagenham Town Show. Residents and staff are also involved in making things for the home’s summer fete. The care plans are now more focused on the dementia care of residents, and now contain detailed life histories. These are helping with regard to staff being more aware of the communication and behaviours of residents living with dementia. Many of the staff have undertaken training in the care of people living with dementia, and staff spoken to said “the training has really helped, and I now enjoy working with residents with dementia.” Currently residents can smoke, and there is a separate smoking lounge which complies with the requirements of the soon to be introduced smoke free regulations. The maintenance officer and the deputy manager have worked hard on producing a comprehensive manual around the COSSH (Control of substances hazardous to health) materials used in the home, and these include details of the substance, the affect if swallowed or gets onto skin, and the precautions to be taken, and what to do in an emergency. Nutritional needs of residents is given a high priority, and the food served was observed to be well presented. One of the resident’s told the inspector “the food is really lovely, I can have a cooked breakfast if I want and there is always plenty to eat.” The cook was very aware of the dietary needs of people living with dementia, and was able to demonstrate a good understanding of the need for ‘finger foods’ in some instances. 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. DS0000027918.V341265.R01.S.doc Version 5.2 Page 7 A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present anywhere within the home. What has improved since the last inspection? What they could do better: The person assessing a prospective new resident must always ensure that comprehensive information is obtained around all aspect of the care required, DS0000027918.V341265.R01.S.doc Version 5.2 Page 8 and this must also include the necessary information around the person’s finances and who, if anybody else, is responsible for the administration of this. There are still some improvements to be made to make the environment more conducive to residents living with dementia. These would include more meaningful pictures/photographs along the corridors and some touch/feel boards along the corridors. There are plans to replace the current emergency alarm system with a more up to date system which will enable the use of techniaids. The use of such aids should also help in the reduction of falls, especially where these happen in the resident’s bedroom as it will enable the use of pressure mats and infra-red beams which will alert staff when a resident is moving about in his/her bedroom, especially at night. Daily and night recordings should also be more meaningful, detailed and relate to the desired outcomes in each part of the resident’s care plan. This will help to identify any changes required with regard to outcomes, at the monthly review or more frequently if the need is identified. 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. DS0000027918.V341265.R01.S.doc Version 5.2 Page 9 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 DS0000027918.V341265.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3 and 5 (Standard 6 is not applicable to this service. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families are given every help and assistance in making the life changing decisions required for entering residential care. Opportunities are given to visit the home prior to making a decision, and information is available in a pictorial format for those residents living with dementia. Qualified staff undertake comprehensive assessments and individuals are supported and encouraged to be involved in this process. EVIDENCE: The statement of purpose and service user guide are comprehensive and considers the different styles of accommodation, support, philosophies and services available to meet the needs of the residents. The service user guide and menus have been produced in a more user friendly pictorial format for those residents living with dementia. DS0000027918.V341265.R01.S.doc Version 5.2 Page 11 From viewing residents’ files it was apparent that all new residents receive a fully comprehensive needs assessment before admission, and qualified staff carry this out. For residents who are supported by a local authority, it was evident that they do not always provide comprehensive information on the assessment forms. This was particularly evident around the financial information, and the manager was not clear as to where the responsibility lay with the management of a resident’s personal expense allowance. The lack of this information has served to disadvantage this resident with regard to the provision of such things as clothing, toiletries and any luxury items not provided by the home. This was discussed with the manager and the deputy manager during the inspection, and this matter has now been taken up with the social worker. The assessment procedure is generally quite focused on achieving outcomes for people. This includes ensuring that the ethnicity and diversity needs of the individual can be met, in all areas such as religion, culture, social, sexual, gender and disability. Prospective residents are invited to spend time at the home and a member of staff is allocated to that person to give them special attention during the visit, and make them feel welcome and comfortable. This was confirmed in discussions with several residents and relatives. One relative told the inspector “I was told about this home by word of mouth, and decided to visit. That visit made up my mind that this is the only home for my mum.” All residents receive a contract that gives clear information about fees and extra charges, and this is reviewed and updated as necessary. Where any resident wants this explained then the manager or deputy manager are on hand to do this. This was evidenced from viewing the files of some of the residents. DS0000027918.V341265.R01.S.doc Version 5.2 Page 12 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 and 11 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of residents are set out in an individual care plan, which is regularly reviewed, and needs are generally met. Residents can be sure that they are protected by the home’s policies and procedures for dealing with medication. At all times residents are treated with respect, and their right to privacy being upheld, and they can also be sure that at the end of their life they will be treated with care and sensitivity. EVIDENCE: The inspector case tracked 6 residents and was satisfied that their current health and personal care needs are generally being met. It was evident that health care professionals such as the GP and/or district nurses are involved and there is a good working relationship with health and social care professionals. This was supported in a subsequent telephone conversation with a social worker who said “whenever I visit or ring the home the staff always seem to know about the resident, and they are always helpful.” DS0000027918.V341265.R01.S.doc Version 5.2 Page 13 From viewing the files and from observations and discussions with residents, relatives and staff it was apparent that the care is much more person centred. Care plans are now more comprehensive and work is continuing on the development of these. From observations during the visit, the inspector was satisfied that staff demonstrated an awareness and understanding of the needs of the individual residents. Personal support appeared flexible and consistent so that the changing needs of people were being met. The care plans were reviewed monthly, or more frequently if necessary, and showed evidence of an awareness of equality and diversity issues with religion, ethnicity, disability, cultural and social needs being recorded. For example there was evidence that a resident who is a Jehovah’s Witness is enabled to practice that religion, and is not involved in the celebration of birthdays, Christmas and other such celebrations. The question of how any issues around sexuality would be dealt with was discussed with the manager and the deputy manager. Both demonstrated an awareness of the importance that needed to be given to residents living with dementia, who may appear to be demonstrating inappropriate sexual behaviour, and that this would be handled sensitively with every assistance being given in an appropriate manner. It was evident that residents living with dementia are enabled to maintain their independence with support and assistance from the care support staff, and the care plans for these residents were detailed around personal care, communication needs and behavioural needs. One relative said “mum is much better since she came here, and her personal hygiene has really improved.” Another visitor said “her legs don’t get so swollen because staff encourage her to put her feet up.” Many of the staff working with residents living with dementia have received adequate and appropriate training, and this was evident in their care practices. It was obvious that systems and procedures for dealing with continence problems are successful as there were no unpleasant odours anywhere in the home, and residents were being reminded and encouraged in a very discreet and sensitive manner. Risk assessments were in place for residents who were prone to falls, and changes have been made to the staffing levels in an endeavour to reduce the number of falls being sustained by some residents. All night staff are now ‘waking’ and ancillary staff no longer wash the floors in the communal areas while residents are moving about. Such improvements have been beneficial in reducing the number of falls. Plans are being progressed to change the emergency call system so that the use of pressure mats and infra-red beams can be installed in the bedrooms of those residents most at risk of getting out of bed during the night and who are at risk of falling. Although this system may not prevent falls, it will alert staff more readily that a resident is up and about in the bedroom. DS0000027918.V341265.R01.S.doc Version 5.2 Page 14 Comprehensive care plans were in place for a resident with diabetes who is not insulin dependent. Where a resident’s food and fluid intake is being monitored, charts were in place and being completed at the time, and not retrospectively. However, the current charts can be confusing and this was discussed with the manager and the deputy manager during the inspection and they have agreed to review the current charts. Nutritional screening is undertaken on admission and on a regular basis. Weights are recorded monthly or more frequently where necessary, and any cause for concern is addressed immediately with the appropriate health professionals. The manager and the deputy manager have developed close contacts with the local Primary Care Trust’s mental health team. Services such as a chiropodist and dentist visit the home on a regular basis, and a hairdresser visits the home three times a week. One resident said “I like having my hair set because it makes me feel really nice.” A medication administration round was observed during the inspection. This was done in accordance with the home’s policy and the medication administration records (MAR) were inspected and found to be in good order. There were controlled drugs in the home and the records for these were inspected and found to be in good order. Regular audits are undertaken, and all staff involved in the administration of medication have had the necessary training. However, although the medication fridge temperatures were being recorded daily, both of the rooms where the medication trolleys were stored appeared to be quite warm. The temperature in these rooms is not monitored. The room temperatures should not be above 250C because if they are this could adversely affect the medicines. This was discussed with the manager and the deputy manager during the inspection. Some of the care plans contained some information with regard to end of life wishes, but the management team is further developing these in line with the recent Department of Health guidance. However, from discussions with staff the inspector was satisfied that residents who are dying are treated with sensitivity and respect and their wishes are complied with. Such care would also be extended to family members with support being given to staff and to other residents. DS0000027918.V341265.R01.S.doc Version 5.2 Page 15 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 and 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents find the lifestyle they experience generally suits their expectations and preferences and are sure that their social, cultural, religious and recreational interests and needs are met. Contact with family, friends and the wider community is positively encouraged and all residents are helped to exercise choice and control over their lives. Food is of a good standard and most residents can be sure of being served an appealing, wholesome and balanced diet in congenial surroundings. This means that residents at the home benefit from the good care provided. EVIDENCE: From observations and discussions with residents and visiting relatives it was very evident that residents at the home are very involved in activities of daily living. This was also evidenced from records viewed, photographs and from talking to care staff. Staff have undertaken work in ensuring that all residents now have a life history, and work is still continuing in this aspect. Some residents also have an activities diary, and it was enjoyable looking through some of these and seeing photographs of residents engaged in, and obviously DS0000027918.V341265.R01.S.doc Version 5.2 Page 16 enjoying such activities. For the benefit of some of the residents there is a billiards table situated in the large lounge. The weather on the day of the inspection and on the day previous, was quite hot and some residents had enjoyed paddling in the small pool which had been put into the rear garden. It was evident from talking to many of the staff that they enjoyed working at George Brooker, and it was also apparent that all staff are involved in undertaking and encouraging residents in the participation of activities. One resident told the inspector “I lose my mind sometimes, but someone always seems to help me find it.” Some residents were observed to be engaged in a sing-a-long with staff, and others were seen looking through magazines and newspapers. Some of the residents with more advanced dementia enjoy washing their ‘smalls’ and to aid this a small clothes line has been put into the garden area. A member of staff told the inspector “some of the residents had hung their clothes on the line and it started to rain just after, and it was amazing to see one of the residents run out into the garden to take the clothes off the line.” An activities co-ordinator is employed and daily activities are undertaken with the residents on either an individual or small group basis. Whilst there is some evidence, such as photographs of London areas as they used to be, and name/pictorial indicators on bedroom doors, more could be done around the environment to make the environment more amenable to residents living with dementia. Improvements, for example, could be through the use of ‘touch and feel’ materials, pictures/photographs which are more meaningful to the residents than those currently displayed in the corridors/communal areas. It would seem that any opportunity for a celebration is taken with the involvement of the residents, and they all enjoyed festivities at Halloween, Christmas, Easter, St. Patrick’s day and St. George’s day. On the evening of the inspection some of the residents were going to a local school for a fish and chip supper which had been organised by a local Masonic lodge. Arrangements have been made for 7 residents to go to Hemsby for a holiday, and they will be accompanied by 5 members of staff. A local branch of a large international company has lent a minibus to the home at no cost, and this will be used for the holiday transport. The manager and her staff team are also very involved in fund raising activities, and also encourage the residents to participate. For example residents are currently engaged in decorating the home’s float for the local Dagenham Town Show, making things for the summer fete. The manager will shortly be doing a sky dive to raise funds for the residents at George Brooker House. Pets are encouraged and there are currently several birds and a home’s cat called ‘Tigger’ and many of the residents are very fond of him. Residents spoken to said they really enjoyed the food, one said “the meals are good, and if I don’t like something they will always get me something that I like.” The inspector observed lunch being served in two areas of the home, DS0000027918.V341265.R01.S.doc Version 5.2 Page 17 and in the main dining area the tables were attractively laid. Staff were observed giving residents choices and also giving assistance, where necessary, in a sensitive manner. However, in the unit for those residents with more advanced dementia the tables were not attractively laid. It may be that residents living with dementia will remove things from the tables, thus causing additional work for staff, but staff must recognise the importance of people living with dementia to still interact with the ‘world’ . For residents to show an interest in items on a table is positive and should not be discouraged because, from a member of staff’s perspective, it may cause additional work. The dietary needs of residents are viewed as a very important aspect of the care at this home, and menus are varied and nutritional. The cook was very aware of the varied dietary needs of some of the residents, for instance those with diabetes. Generally fresh vegetables are used, and fresh fruit is always available and is offered to all residents on a daily basis either as the fruit or made into smoothies. Residents are encouraged to be involved in the planning of menus. It was evident throughout the inspection that drinks and snacks were available for residents and visitors alike. Finger foods such as crisps, fun size chocolate bars, cheese and mini muffins were available on all units throughout the day. Four main meals each day are served and these are: Breakfast from 8a.m (this is flexible depending upon the wishes of the residents) Lunch from 12.30 p.m. Tea from 5p.m. Supper from 7.30/8p.m. (milky drinks, sandwiches and cakes) Lunch was observed being served in the main dining area, and it was apparent that any resident who needed support was given this in a discreet and sensitive way to both the individual and having regard to the feelings of other residents. Crockery and cutlery were appropriate to the needs of the individual resident. Residents are encouraged to participate in community activities, and some have taxicards. Religious services are held at the home, and if residents wish they are enabled to go to their preferred place of worship. It was evident from touring the home, and visiting some residents in their rooms, that bedrooms are very personalised. DS0000027918.V341265.R01.S.doc Version 5.2 Page 18 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 and 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are listened to, taken seriously and acted upon and all residents are protected from abuse through staff training, the ethos and practices within the home. All residents can, therefore, feel safe and protected from abuse. EVIDENCE: In discussions with some of the residents and relatives it was clear that they felt that they could express concerns or make a complaint to the manager and her staff if it was necessary. They knew of the complaints procedure and one relative told the inspector “I don’t have any complaints but if I did I would go to the manager.” All complaints and concerns are addressed promptly, taken seriously and acted upon. Outcomes are now used to influence the direction of the service in a very positive manner. Information on making a complaint is on display in the home, and staff spoken to were also aware of the need to take any complaint seriously. The complaints log was viewed, and there had been one formal complaint. This complaint had been investigated by the manager, and the complainant had been responded to in a satisfactory manner. However, the complainant was not satisfied and this matter is now being dealt with by the home’s management committee. DS0000027918.V341265.R01.S.doc Version 5.2 Page 19 It was as a result of a complaint that the times/duties for the ancillary staff have been reviewed, and that there are plans now to replace the emergency call system. Discussions took place with the manager around the production of a complaints procedure in a user friendly format more suited to the needs of people living with dementia. She has agreed to look at providing the residents with a complaints procedure more suited to their needs. There is an open culture within the home and residents spoken to said that they felt safe at all times. They said that they could speak to the manager and the staff about anything. All staff have very recently undertaken training in safeguarding adults and the necessary procedures. Staff spoken to demonstrated a good understanding of safeguarding adults and the whistle blowing policy. The manager was clear when an incident needed to be referred to the local authority as part of the local safeguarding procedures. Staff spoken to had a clear understanding of what restraint is, and alternatives to its use in any form are always looked for. The use of bed rails is not promoted within this service, and alternatives are used wherever possible. DS0000027918.V341265.R01.S.doc Version 5.2 Page 20 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, 20, 23, 25 and 26 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well-maintained environment, which is clean and hygienic and they are able to have their own possessions around them. People who use the services are encouraged to see the home as their own. There is a selection of communal areas inside the home that means that people have a choice of place to sit quietly, meet with family or be actively engaged with other residents. The rear gardens offer a secure and pleasant place to sit, EVIDENCE: During a tour of the home, and when visiting individual residents in their rooms, it was evident that residents are encouraged to personalise their bedrooms. 19 of the bedrooms have en suite facilities, but the remainder of the rooms do have a wash handbasin and are all within easy distance of a toilet and bathroom. DS0000027918.V341265.R01.S.doc Version 5.2 Page 21 Throughout the home decorations and furnishings are to a good standard, and there is an ongoing programme of redecoration. The home was very clean and well maintained, and there were no offensive odours. One relative told the inspector “although many of the people need help with going to the toilet, there are never any horrible smells when you come into this home.” There is a proactive infection control policy and staff work to ensure that any infections are minimised. The maintenance officer has put into place a system for the repair and maintenance of wheelchairs and this has been successful. This was as a result of a complaint from a local taxi company that often wheelchairs were in a poor condition of maintenance. Within the home there are two small units and one larger unit. However, the seating arrangements in the lounge area of the larger unit are such that residents can sit in small groups and are not sat around the edges of the room. The environment is fully able to meet changing needs of the residents, along with their cultural and specialist care needs. Appropriate signage and décor is in place so that residents are, where possible, able to identify a toilet. Discussions took place with the manager and the deputy manager around the introduction of more appropriate and meaningful pictures/photographs along the corridors and also in the lounges. The kitchen was inspected and food was being stored appropriately and was labelled. Fridge/freezer temperatures were recorded on a daily basis. The kitchen was clean and well maintained. The laundry area was clean, and a clothes labelling system is in place to ensure that the clothes of new residents are clearly labelled with their name. Adequate equipment was in place and the machines and dryers were in good working order. There is a staff room, and it is essential that staff are encouraged to use this for their breaks unless, of course, they take their breaks with the residents. Residents spoken to confirmed that there is always plenty of hot water and the temperature in the home can be adjusted on request. Some of the residents do smoke and there is a designated smoking room which does comply with the requirements of the smoking legislation which will come into force on the 1st July, 2007. DS0000027918.V341265.R01.S.doc Version 5.2 Page 22 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 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff, and residents can feel that they are in safe hands at all times. Staff are trained and competent and residents are supported and protected by the home’s recruitment policy and practices. EVIDENCE: From viewing staff files, training records, talking to residents, relatives and staff, it was apparent that the majority of staff were skilled and competent to carry out their jobs. Induction training is undertaken for new staff, and many of the current staff have recently completed refresher training in safeguarding adults, health and safety, moving and handling, food hygiene, first aid, dementia awareness, challenging behaviour, infection control and fire safety. Approximately 95 of the care staff are trained to either NVQ level 2 or 3 and both internal and external trainers are used for the various courses identified as being required by staff. Some of the catering staff have also recently achieved the NVQ level 2 in catering. The cook demonstrated a good knowledge of the nutritional and dietary needs of residents living with dementia. DS0000027918.V341265.R01.S.doc Version 5.2 Page 23 There is good team working in the home and this was confirmed in discussions with staff. Residents and relatives spoken to also confirmed that staff always seem to be working co-operatively with each other. One resident told the inspector “the staff are always kind to me, and they even sit and talk to me.” The files of new staff were inspected and all were found to be in good order with the necessary references being received and verified, application forms and any gaps in employment had been discussed with the individual and recorded, the individual’s identification had been verified and the appropriate criminal records bureau (CRB) disclosures had been obtained. The manager ensures that there is always sufficient staff on duty to meet the needs of the residents, and this was evidenced from the staff rota and also from talking to residents and relatives. It was also evidenced from the many varied activities which take place at the home where often additional staff members are required. It was apparent that some of the residents knew the names of the different members of staff and were able to communicate with them freely and easily. Staff were observed to demonstrate a thorough understanding of the needs of the individual residents, and were seen to deliver effective care which was more person centred than had been observed at previous inspections. DS0000027918.V341265.R01.S.doc Version 5.2 Page 24 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, 36 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A person who is qualified and able to discharge her responsibilities fully manages the home. Residents can be sure that the home is run in their best interests, that their financial interests are safeguarded, that staff are appropriately supervised and that their health, safety and welfare will be promoted and protected. EVIDENCE: The manager has now been registered by the Commission, and is competent to run the home and meet its’ stated aims and objectives. The manager was able to describe a clear vision for the home based on the organisation’s values. A clear sense of direction is communicated to her staff, and she was able to DS0000027918.V341265.R01.S.doc Version 5.2 Page 25 demonstrate continuous improvement with regard to the service. Support is given by the management committee. A member of staff told the inspector “the manager is brilliant, very understanding and supportive.” Other staff said “we are more involved with the home now that Sue is here.” Customer satisfaction surveys are undertaken and there are meetings at the home with residents and relatives, and the outcome of such meetings is used to influence the service. In discussions with the manager it was apparent that she gives priority to equality and diversity issues, and she demonstrated an awareness of the varying strands that this involves. The manager ensures that staff deliver in this important area through training and supervision. The policies and procedures are effective, and there are efficient systems to ensure effective safeguarding and management of residents’ money. Small sums of money are kept for each resident for personal expenses, and any expenditure is always supported by a receipt. The administrator maintains records in this connection and these were viewed by the inspector and were in good order. The manager and the deputy manager are towards the end of an in depth training course on the care of people living with dementia, and have completed the NVQ level 4 in care. The manager will soon begin the registered manager’s award. In discussions with the manager and the deputy manager it was evident that at various times they undertake unannounced inspections at different times, including nights, and also undertake observations of staff practices. 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. During the inspection there was an unexpected fire drill to which the staff responded well and in good time. The working practices in the home are all within a risk management framework. Accidents have been reduced and accurate records are maintained and the necessary Regulation 37 notifications are sent to the Commission. Where necessary advice is sought from health and safety professionals. Regulation 26 visits are undertaken a copies of the reports are kept at the home. The manager was aware of the recently introduced Mental Capacity Act 2005 and she is discussing training needs with the organisation. The further development of preferred place of care and end of life plans were discussed with the manager she will be progressing this in line with the guidance from the Department of Health. DS0000027918.V341265.R01.S.doc Version 5.2 Page 26 The manager was also aware of the new smokefree legislation which comes into effect on the 1st July, 2007, and in this connection she is guided to ensure that staff are aware of the dangers from exposure to second-hand smoke. The Royal College of Nursing has produced a best practice guide for staff and managers, and this can be obtained from www.rcn.org.uk. DS0000027918.V341265.R01.S.doc Version 5.2 Page 27 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 3 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 3 X X 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 3 X 3 X 3 3 X 3 DS0000027918.V341265.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14(1)(A)( B) Requirement Timescale for action 10/06/07 2 OP30 18 3 OP30 18(1)(c)(i ) The registered persons must ensure that a comprehensive assessment is received from the commissioning authority, prior to a prospective resident moving into the home. This must also include information as to a person who may be responsible for the finances of the resident (if necessary). This will ensure that residents moving into the home will have their needs met and not be put at a disadvantage. The registered persons must 30/09/07 ensure that all staff undertake training in the implementation of the Mental Capacity Act 2005 to ensure that all residents are deemed to have capacity to make decisions unless it can be proven otherwise. 30/06/07 The registered persons must ensure that all care support staff receive the necessary information and risk assessments applicable under the Health Act 2006, and the Smoke-free (Exemptions and Vehicles) Regulations 2007 DS0000027918.V341265.R01.S.doc Version 5.2 Page 29 which come into effect on the 1st July, 2007. This is to maintain the health position of care support staff. 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 DS0000027918.V341265.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000027918.V341265.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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