CARE HOMES FOR OLDER PEOPLE
George Brooker House 100 Dagenham Avenue Dagenham Essex RM9 6LH Lead Inspector
Ms Edi O`Farrell Unannounced Inspection 09 November 2005 14:35 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.V264647.R01.S.doc Version 5.0 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.V264647.R01.S.doc Version 5.0 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 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.V264647.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th July 2005 Brief Description of the Service: George Brooker House provides accommodation, support, and personal care for 43 older people. ‘The East London Extra Care Society’, which is a member of the National Abbeyfield Society, operates the home. The home is purpose built, and is situated on the edge of parkland, a short walk from Dagenham Heathway, which has both bus and tube routes. All bedrooms are single, with 10 having ensuite facilities. There are two units; a ten-bed unit for dementia care, and a 33-bed unit with 20 places for people with dementia, and 13 for frail older people. The dementia care unit is all ground floor, with access to an attractive enclosed garden. The larger unit 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. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place on a weekday afternoon, finishing at 18.35. It was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Ten Requirements were set at the previous inspection and the registered persons have complied with all of the required action. Care plans were examined, and discussed with the keyworkers, who have recently updated them, staff they were also asked about supervision, training, and management. Three service users were asked their views, and staff were observed interacting with other service users, who could not give their views due to their level of disability. Discussions were held with the manager, head of care, manager of the dementia unit, and the chair of the management committee. Some parts of the building were toured. Health & Safety documentation was examined, and discussed with the manager. All who contributed to the inspection are thanked. What the service does well:
The home has a warm and welcoming atmosphere, and staff pay attention to detail in order to make sure that service users live as full a life as possible. This affects both the environment and the care provided. Decoration, and furniture and fittings, are as homely as possible, with pictures on the walls, flowers and ornaments, domestic furniture, and friezes in bathrooms. Tables are set with attractive table setting for all meals. Activities, both within and outside the home, are given a high priority; recent group ventures have been a fish and chip meal at Harry Ramsdons, a trip to a Hop Festival in Kent, and a visit to Buckingham Palace. Individual preferences are also catered for; for example, one carer was accompanying a service user on a family visit to the North of England during the coming weekend. The same service user is accompanied to a local pub on a weekly basis. There is a committed voluntary committee of ten, who are very involved in various aspects of the running of the home, and support the registered manager. There is a strong sense of team working, with the skills, experiences, and knowledge, of both committee members and staff being used effectively for the benefit of the people who live in the home. Many of the service users are unable to directly give their opinions, due to their level of disability, but those who did were very positive about both the home and the staff. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
As stated above the new management structure seems to be working well, and now needs to be built on, so as to improve the service further. This needs to include fuller integration of the two units, which both provide dementia care. A quality assurance system needs to be put in place, which includes seeking the views of service users, and their representatives. This, and other information, such as records of complaints, needs to be used to produce an annual service improvement report. The, excellent, work on Health & Safety needs to be built on so that all risk assessments are comprehensive, and work for the safety of both service users and staff. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 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.V264647.R01.S.doc Version 5.0 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.V264647.R01.S.doc Version 5.0 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): 2 All service users now have written contacts, which state the terms and condition of their stay at the home. Standard 6 does not apply to this home. The remaining Standards were not tested on this visit. However evidence from the last inspection was that prospective service users, and their relatives, have the information they need to make an informed choice about where to live. They have an opportunity to visit the home and assess the quality and facilities, and know that it will meet their needs. EVIDENCE: In response to a Requirement set at the previous inspection all service users have now been issued with contracts, and signed copies were seen on file. The home does not provide intermediate care. The remaining Standards were not specifically tested on this visit, as there were no outstanding Requirements. At the time of the last inspection, all of the outcomes were assessed as met. These will be re-tested at a future inspection.
George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 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 Service users’ health, personal, and social care needs are set out in individual care plans, which are now being regularly reviewed. The recording system has improved since the last inspection. EVIDENCE: Care plans were examined and discussed with care workers. Since the last inspection the dementia unit manager has provided in-house, care planning, training for care staff from both units. Staff have used the knowledge they gained from this training to review all care plans, as required in the last report. The care plans seen were comprehensive, and clearly identified individual need. The staff spoken to were knowledgeable about these needs, and the care observed to be being provided during this visit matched the care plans. Daily reporting is now more robust, and gives a good picture of the service provided, and the lifestyle of the service users. At on previous visits staff were observed to be very respectful of service users, and to give a high priority to privacy and dignity. The three service users spoken to confirmed that they found this always to be the case. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 11 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): These Standards were not tested on this visit. However evidence from the last inspection was that the home is to be commended for the high priority that is given to maintaining each service user’s previous lifestyle, and to encouraging new interests. Contact with family, friends, and the local community is encouraged, 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: The above Standards were not specifically tested on this visit, as there were no outstanding requirements, and no apparent changes in the service. At the time of the last inspection a score of 4, commendable, was awarded in recognition of the range of activities that the home offers. The level of activities remains high. These Standards will be re-tested at a future inspection. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 12 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 Service users are protected by the home’s approach to complaints and potential abuse. Management and care staff understand their responsibilities, and seek appropriate advice where necessary. EVIDENCE: Two Requirements were set at the last inspection relating to complaints and adult protection, and both of these have been actioned. Following the last visit, the Commission met with the chair of the management committee, the newly appointed manager, and head of care. This was a fruitful meeting, and the Commission is now confident that all concerns would be appropriately responded to. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 13 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): These standards were not tested on this visit. However evidence from the last inspection was that service users live in a homely, safe, and comfortable environment, where both communal areas, and individual bedrooms meet their needs. Management have funded plans to make further improvements to the home, and it is clean, pleasant, and hygienic. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding Requirements in relation to the eight Standards. At the time of the last inspection all the outcomes were assessed as met. These Standards will be re-tested at a future inspection. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 14 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): These standards were not tested on this visit. However evidence from the last inspection was that the numbers and skill mix of staff meet service users’ needs. They are supported and protected by the home’s recruitment policy and practice. Staff are trained and competent to do their jobs. In the last report Standard 29 was incorrectly scored as not assessed, whereas it was checked, and was met. It has therefore been scored as three in this report, though not reassessed. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding Requirements in relation to the four Standards. At the last inspection all of the outcomes were assessed as met. These Standards will be re-tested at a future inspection. In order to rectify a mistake in the last report Standard 29 has been scored, rather than marked as not assessed. This is because staff recruitment files were checked at the last inspection, but were scored as not assessed in the report. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 15 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, 32, 33, 36 & 38 Service users benefit from living in a well managed home, which is run in their best interests. The recent change in the management structure has improved the management of the home, and provides clarity of roles and responsibilities. This needs to be built on so as to continue to improve the service to both service user groups, i.e. older people with dementia, and frail older people. The health, safety, and welfare, of service users and staff are promoted and protected by regular checks, and this needs to be built on in order to continue the recent improvements. EVIDENCE: The management of the home was a major focus of this inspection, as at the last visit several changes were being implemented. The, then, manager was due to leave, and a new management structure had been agreed. This involved the former Bursar, who, although having worked at the home for
George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 16 many years, did not have a care background, being appointed manager. In addition one of the unit managers was promoted to Head of Care. Since that inspection the manager has been interviewed by the Commission and been approved as the Registered Manager, though the new registration certificate has not yet been issued. All the evidence seen during this inspection demonstrated that the new structure is working. Examples are, delegation of key responsibilities, such as Health & Safety, inclusion of senior carers in key tasks, such as pre-admission assessment and medication, and closed links with the relative’s group. During the registration process the Commission discussed with the manager the importance of managing the home as a whole as both units provide a service to people with dementia. Following this discussion the door between the two units was left open, but this proved too great a risk for some service users, so has now been stopped. Other methods of greater integration were discussed during this inspection; this included more interchange of staff between the two units. This would mean that staff on both units would get to know the needs of all service users, and be able to cover shifts more easily in emergencies. The role of the Registered Manager, and the Head of Care across both units was also discussed, as this is the management structure that the Commission agreed to in registering the manager. This is Requirement 1. In between inspection visits the Commission partly relies on two types of reporting by homes to monitor how the service is doing. These are Regulation 26 visit reports by the Responsible Individual, and Regulation 37 notifications from the Registered Manager, about significant events. At the last inspection these two Regulations had not been being fully complied with, and two Requirements were set. Both the Requirements have been met, and further refinements to the Regulation 26 reports were discussed with the chair of the management committee during this visit. The lead inspector will continue to work with that person on this issue, so no further Requirement has been set. The notification of significant event has also greatly improved, and the Commission are now confident that both the Registered Manager, and the Head of Care, contacts the lead inspector for advice and guidance when necessary. The home now needs to build on these, and other improvements, to set up a comprehensive, formal, quality assurance system, that includes seeking the views of service users, and their representative, on a regular basis. This should include the production of an annual development plan, based on the outcome of the information obtained by this, and other means. This is Requirement 2. Responsibility for Health & Safety has recently been delegated to the dementia care unit manager. She is to be commended for the systems that she has already put in place, and the prompt action she has taken, where breaches of legislation have been identified. This includes using regular events, such as George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 17 fire drills as staff training, and taking immediate action where cleaning materials were inappropriately stored. One aspect of Health & Safety that needs further work is COSHH assessments, where the potential problem section of the risk assessments simply states ‘hazardous to health’. They need to be more detailed, for example, where oven-cleaning foam is used, inhalation, and eye irritation needs to be identified as a potential problem. This is Requirement 3. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 18 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X X 3 X 2 George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 19 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 OP32 Regulation 12 Requirement Timescale for action 28/02/06 2 OP33 24 3 OP38 13 (4) The Registered Manager must be able to demonstrate that the home is run in the best interests of all service users. The allocation of staff within the home must take account of the number of places for service users with dementia provided in each unit. Staff working in both units must be equipped to work with all service users living in the home. The home must have a quality 30/06/05 assurance system in place, which includes seeking the views of service users, and their representatives. This must measure the success of the home in meeting the aims and objectives as set out in the statement of Purpose. A development plan based on the results must be forwarded to the Commission. All COSHH assessments must 28/02/05 include details of health hazards, and what action to take if an accident happens. George Brooker House DS0000027918.V264647.R01.S.doc Version 5.0 Page 20 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.V264647.R01.S.doc Version 5.0 Page 21 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
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