Inspection on 30/11/05 for Little Brocklesby House

This inspection was carried out on 30th November 2005.

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

Little Brocklesby House 26/07/06

Little Brocklesby House 16/02/06

Little Brocklesby House 03/02/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Little Brocklesby House High Street Great Limber Lincolnshire DN37 8JL Lead Inspector Dawn Podmore Unannounced Inspection 30th November 2005 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 Little Brocklesby House DS0000054666.V265117.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. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Little Brocklesby House Address High Street Great Limber Lincolnshire DN37 8JL 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) 01469 561353 01469 561353 Little Brocklesby House Ltd. Mrs Sheila Casey-Evans Care Home 36 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (31) of places Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide are for service users of both sexes whose primary needs fall within the following categories Old Age not falling into any other category - OP (31) Dementia - Over 65 years of age - DE(E) (5) The maximum number of service users to be accommodated is 36. 2. Date of last inspection 03/02/05 Brief Description of the Service: Little Brocklesby House is a two storey care home located in the village of Great Limber, which has a pub and a post office/general store. It is situated ten miles from Grimsby . The home is located down a private driveway, away from the main road and is set in nine acres of parkland on the edge of the Lincolnshire Wolds. It was built during the mid Victorian period and has retained many original period features internally which help make it homely. Bedrooms are located on both floors; the upper floor is accessed by a sweeping staircase or passenger lift. The home provides care for residents over the age of 65 years and can accommodate up to 5 residents who have dementia. . Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours and was conducted by two inspectors. A tour of the premises was undertaken with the assistance of the deputy manager and discussion and feedback was given to the registered manager at the end of the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. The manager had completed a pre inspection questionnaire. Other documentation was also inspected. Three members of staff were interviewed and the opinions of five residents were sought. What the service does well: The home provides a comfortable and very homely environment for residents. One resident stated that ‘this is more than my home, it is one big happy family’. Residents with help from their families were able to personalise their bedrooms. All residents spoken with had very positive comments about the staff, ‘they are wonderful and really care’, ‘nothing is too much bother, and staff are all kind’. There was a choice of meal daily and residents said ‘the food is fantastic, something different everyday’. The kitchen is clean and well organised. There is a choice of lounges all of which are homely and comfortable with views overlooking the beautiful gardens. Residents commented that they enjoyed watching the wildlife in the gardens, which included rabbits, squirrels and peacocks. The manager has been proactive in purchasing pressure relieving equipment to support a particular resident who would otherwise would have had to wait to receive this equipment from the Primary Care Trust. By purchasing this equipment this has assisted to make the resident more comfortable and helped prevent skin damage occurring to pressure areas. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected at this inspection. EVIDENCE: This standard was not inspected. The home did not provide intermediate care and there had not been any new residents admitted since the last inspection. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 9 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 and 9. Care plans were available but resident’s needs were not identified and recorded in sufficient detail to make a judgement as to whether their individual needs were being met. The lack of individual risk assessments means that residents are placed at potential risk of injury. Safe medication systems were in place, which reduced the risk of residents receiving the wrong medication. EVIDENCE: Although care documentation was in place it did not identify all individual needs of each resident and therefore the plan of care did not contain detail as to how staff should care for that resident. This means that residents may not be receiving the care they need and staff may not take into account the preferences and choices of the individual. Review dates for plans of care were infrequent such as March 2006 instead of more frequent or monthly dates. When speaking to staff they were able to give more detail on individual care given but this was informal and not recorded, there is danger that these informal systems of communication can break down through Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 10 miscommunication, lack of understanding and interpretation, which will affect the quality of care that a resident receives. One service user who had severe dementia only had two needs identified in her plan of care, one of which described basic care needs, which were not personalised or detailed, and the other need identified was social activities but the description only covered receiving in house hairdressing and chiropody. Another resident who required intense care had specific pressure relieving equipment in place but this was not detailed in the care programme nor was there clear instruction as to the day-to-day care of this resident. None of the plans looked at identified health checks such as the arrangements and screening for optical and dental treatment. Input from other health professionals such as community psychiatric nurse and general practitioner had not been identified when clearly their contribution in terms of support and advice would be of value to several residents care. There was no evidence to show that care plans and reviews were discussed with residents to offer choice and for preferences to be recorded; residents spoken to did not recall any discussions with staff about their plans of care. Individual risk assessments where not detailed enough to show how a decision had been made and how often the risk was reviewed and the outcome of that review. For example, a service user with dementia had a table put up to her chair to prevent her from attempting to get up and subsequently falling. However, the manager and staff need to ensure that there is a very detailed risk assessment in place, which shows which other health professionals have been consulted and that alternatives have been considered, such as a seating assessment; this is vital to ensure that staff are not seen to be using the table as a form of restraint. Manual handling assessments were not seen in individual care programmes, which is placing both resident, and staff to the risk of injury. Accident records showed that a resident had fallen three times within a month but it was not identified as to how this could be prevented or managed, no risk assessment was in place. Medicines were stored safely. The home did not have a medical fridge but items were stored appropriately in the kitchen fridge. The manager should give consideration to providing a double locked metal cupboard, which, is bolted to the wall to store controlled medication, although there were no such medicines kept in the home at present, there had recently been some prescribed. Little Brocklesby House DS0000054666.V265117.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): 15 The home provided a daily choice of menu, which was appealing, nutritious and well balanced. EVIDENCE: Residents were very positive about the choice and quality of meals provided. ‘The food here is wonderfully good’, ‘There is a good choice and always plenty of empty plates after our meal’. The menu was displayed in the home, residents were asked on a weekly basis their choice of menu for the week, but it was not a problem if they changed their meal choice on the day. The lunchtime meal seen looked and smelt very appetising. Home baking was evident. The home had been awarded the ‘Good Food’ award by Environmental Health last year. Little Brocklesby House DS0000054666.V265117.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): 18 There are some good systems in place to help protect residents to ensure that their safety and welfare is promoted. Since the last inspection there have not been any investigations of abuse undertaken. EVIDENCE: Staff spoken to had a good understanding of how to protect residents from abuse and there was evidence that adult protection training was provided in August and November this year. Residents said that staff are very understanding, ‘I can talk to staff if there is a problem’. Little Brocklesby House DS0000054666.V265117.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): 19,20,25 and 26 Residents live in a comfortable, homely, clean environment with a choice of communal areas and personalised bedrooms but environmental risks are inadequate to keep residents safe. EVIDENCE: The kitchen was noted to be well organised, clean and had clear documentation in place. The manager said that an environmental health visit had taken place recently with no requirements, but the report was not yet available. The manager said that there were water regulators on the baths but not on sinks. There was no record of audits of water temperatures from hot water outlets accessible to residents. There is a risk of injury to residents particularly those with dementia, from exposure to excessively hot water. Surface temperatures of exposed piping accessible to residents was too hot to touch which would cause injury if a resident came into accidental contact with it such as due to a fall. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 14 The home is clean. Odour control is good within the home, there are no odorous smells, which, is of credit to the cleaning staff. Where required, bedroom carpets had been replaced, however, the mat left in an upper floor bedroom is a potential trip hazard and should be removed. Attention should be given to the frayed carpet in bedroom 4 so that the resident and staff do not trip up. In order to prevent cross infection, soaps should not be for communal use as seen in bathrooms. The dining chairs did not have any arm supports in place. A seating assessment should be undertaken for residents to ensure that the type of dining chairs in use were suitable to meet individual needs, particularly for those with mobility problems. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 15 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): 29 Staff are recruited in a manner, which will aid protection and support to residents. EVIDENCE: Employment files demonstrated that staff had been safely recruited. One of the newly recruited staff was on duty at the time of inspection and was able to confirm their individual recruitment process. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 16 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): 35,37 and 38 The home’s policies and procedures ensure that residents’ finances are safeguarded. Individual and environmental risk assessments need to improve as a matter of urgency to ensure that residents are not placed at unnecessary risk. EVIDENCE: The manager confirmed the home’s policy for safeguarding service users finances. Three service users personal allowance records were recorded well. The Registered Responsible Individual for the home needs to undertake a monthly visit to the home and this needs to be recorded and the documentation left in the home. This is to ensure that an audit of the homes environment and record management is undertaken and that there is an opportunity for the views of staff and residents to be obtained regarding the running of the home and choice offered. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 17 A fire risk assessment is going to be undertaken by a company. However, the manager needs to liaise with the fire officer regarding the use of door wedges, which were noted in all communal areas, the majority of bedrooms and the kitchen. The Commission needs to be informed in writing about the outcome of discussions with the Fire Officer. There was no evidence of detailed moving and handling risk assessments within individual care programmes, these are required to protect residents and staff from injury. Staff had received manual handling training. There was no risk assessment regarding window restrictors. Downstairs bedrooms with wide outward openings should be risk assessed to keep residents safe. A number and variety of toiletries were displayed in bathrooms. These areas should be assessed so that storage facilities are provided. This will minimise the risk of accidents occurring to residents, particularly those with dementia.. The footplates had been removed and stored for wheelchairs that were kept in the hallway. This practice should be reviewed as it may mean that staff transport residents in a wheel chair without putting on footplates which is likely to cause injury to lower limbs of residents. Little Brocklesby House DS0000054666.V265117.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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 2 x x x x x 2 2 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 x x x x 3 x 3 1 Little Brocklesby House DS0000054666.V265117.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 OP7 Regulation 15 (1) and 13 (4) Requirement Ensure that all residents have an up to date detailed care programme which includes an initial assessment, identification of all needs, detailed plan of how care will be delivered, regular evaluation review, risk assessments and residents agreement. Review risk fall management and accident recording processes to ensure that an audit trail is in place and that a risk assessment is triggered. Assess suitability of dining chairs to meet individual residents needs Ensure that residents have access to identified health care professionals or services according to need. Risk assess the unprotected hot pipe work that is accessible to residents in order to prevent injury. Demonstrate by risk assessment to show how residents are protected from harm from hot water outlets temperatures DS0000054666.V265117.R01.S.doc Timescale for action 01/04/05 2 OP8 13 (4) (c) 01/03/05 3 4 OP20 OP8 23 (2) n 13 (1) (b) 01/06/05 01/03/05 5 OP38OP25 13 (1) (c) 15/02/05 Little Brocklesby House Version 5.0 Page 20 6 OP26 13 (3) 6 OP31 26 (4) (5) 7 OP38 23 (4) 8 OP38 13 (c) 9 OP38 23 (2) j which are accessible to service users do not discharge water that is in excess of 43 degrees Celsius. Review cross infection practices to ensure that residents have access to their own toiletries and that the practice of using communal soaps is discontinued. Ensure compliance by the registered responsible individual by, at least monthly, visiting and preparing a report on the conduct of the home. A copy of the report to be left in the home and available for inspection. Liaise with the Fire Authority regarding the use of door wedges. Record any outcomes within the fire risk assessment. Risk assess windows that do not have a window restrictor in place giving consideration to security and vulnerability and safety of residents particularly those who have a memory impairment. Assess the need for suitable storage facilities in bathrooms for toiletries. 15/02/05 15/01/05 01/01/05 01/02/05 01/01/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Consider purchasing a double locked metal wall mounted metal medication cupboard for the storage of controlled medication. Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Brocklesby House DS0000054666.V265117.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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