Inspection on 27/09/06 for Little Brook House

This inspection was carried out on 27th September 2006.

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

Little Brook House 23/09/08

Little Brook House 21/11/05

Little Brook House 30/06/05

Little Brook House 16/11/04

Little Brook House 07/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Little Brook House 101 Brook Lane Warsash Hampshire SO31 6FE Lead Inspector Mrs Pat Trim Unannounced Inspection 27th September 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Little Brook House DS0000057924.V312752.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. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Brook House Address 101 Brook Lane Warsash Hampshire SO31 6FE 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) Little Brook House Limited Mrs Janet Cooper Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 Brief Description of the Service: Little Brook House is a registered care home that provides personal care and accommodation to 20 older people. The home is located in the rural area of Warsash, Hampshire, with Southampton as the nearest large city. The name of the house derives from the brook, which runs through the garden area of the property. The 300 year old home was formerly a farmhouse, the original building having been modernised and extended to include further accommodation. The building is well maintained, tastefully decorated and furnished and has extensive well-kept grounds. Two conservatories to the rear of the property overlook the gardens. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection carried out by one inspector in 6.30 hours. The key standards were assessed by case tracking three residents and talking with six people currently living in the home. Time was also spent observing staff practice and talking with two care staff, the cook and the registered manager. Some time was spent reviewing a random selection of documentation and a partial tour of the premises was carried out. The people living in the home had previously expressed their wish to be called residents. This term is therefore used throughout this report. What the service does well: What has improved since the last inspection? What they could do better: Residents said they were regularly asked if they received the help they needed, but care plans did not reflect their involvement. Care plans could be developed so they show the resident’s involvement in identifying their personal abilities, needs, wishes and aspirations. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 6 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 Brook House DS0000057924.V312752.R01.S.doc Version 5.2 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 Brook House DS0000057924.V312752.R01.S.doc Version 5.2 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): 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have sufficient information to enable them to make an informed choice about whether to move into the home, and detailed pre admission assessments ensure residents may be confident they will only be offered a place if their needs can be met. EVIDENCE: Information about the admission process and the care that could be provided was included in the statement of purpose. The terms and conditions gave information about the room the resident would be offered, the weekly fee and what was not provided. The statement of purpose did not make it clear that due to the layout of the building, service users must be reasonably mobile and that people who needed to use a wheelchair to move round inside could not be accommodated. The registered manager said the statement of purpose was due to be reviewed and more information could be added. The registered manager said she visited prospective residents to carry out an assessment of need and to see whether she felt the home could provide the Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 9 care the resident required. Copies of these assessments were seen on three residents’ files and residents confirmed they had been visited prior to going to the home. Residents said they had been invited to visit the home prior to admission and some had come for a weekend or respite break before deciding to move in on a permanent basis. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to receive personal care in the way they like it and can be confident their health care needs will be met. Robust systems and staff training ensure medication is managed safely. EVIDENCE: The majority of residents are well able to verbally express their needs and said that staff enabled them to manage their own personal care. They only offered assistance when it was required. Residents said staff respected their privacy and dignity, always knocking on bedroom doors before entering and being sensitive when assisting with personal care. Staff were observed giving assistance to residents at their own pace and in a calm and unobtrusive way. A brief care plan is completed on admission to ensure basic needs and areas of risk are identified quickly. A more detailed care plan is completed for areas where support needs are higher. Three of these were seen. There was evidence that they were reviewed on a monthly basis, using an assessment tool to identify changes in dependency levels. The deputy manager said each Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 11 month she sat with every resident to discuss his or her needs, identifying where these had changed. Residents confirmed they were asked regularly whether they needed any more help. However, the care plans did not reflect that residents actively participated in the care planning and review process, as there was no record of their requests for change or comments on the care they received. This was discussed with the registered manager who said she thought this was something the service could review and improve on. Risk assessments were completed when a possible risk had been identified. For example, where there was a risk of falls. The risk assessment included an action plan for staff to follow to minimise the potential risk. Residents said they were able to see their doctor when they wished and staff supported them if necessary. For example, when someone wanted a medication review the registered manager assisted them by phoning the doctor for a consultation. Daily records showed that residents had regular visits from health care professionals such as doctors, district nurses and chiropodists. Outcomes from these visits are documented. Residents said they were able to see opticians and dentists when they needed to and thought they were well supported by staff to access health care. The home monitors residents’ nutritional needs and regularly checks their weight. The home has an agreement with a local pharmacy to supply medication in a monitored dosage system. The pharmacy also carries out regular checks on the storage of medication and provides some training to staff. The policy of the home stated that staff were not permitted to give out medication until they had completed a training course, which included an assessment of their ability. A record of this training was kept. The home had a procedure for staff to follow to ensure medication was managed safely. A record was kept of medication received into the home and any returned to the pharmacy. Medication administration records were signed whenever the member of staff who administered it gave medication to a resident. The procedure included guidance for staff on what to do with medication belonging to a resident who had died. This did not seem to be correct so the registered manager was advised to seek guidance to ensure the correct procedure was followed. The home had a policy that included supporting residents to self medicate if they wished. Several residents did look after their own medication and risk assessments were completed to ensure they were supported to do this safely. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about all aspects of their daily living. The activities they are offered provide mental stimulation whilst enabling them to participate in doing things they enjoy. The food provided offer a balanced diet with choices that residents like. EVIDENCE: Residents said they felt the daily routines of the home were organised around their needs and that they were able to make choices about all aspects of their daily lives. They were able to get up and go to bed when they wished. Some residents liked to have breakfast in their rooms and then get dressed. Others liked to go to the dining room or conservatory for breakfast after they had got dressed. Everyone said their individual preferences were respected. Throughout the morning residents came into the communal areas to chat or read the morning papers. Some said they loved to spend time in the gardens and walked there every day. Residents were supported to continue with the hobbies they had enjoyed before moving to the home. These included gardening and painting. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 13 The home provided some activities such as exercise and craft classes and a singer. Some residents said they enjoyed these activities, whilst others preferred to make their own entertainment. All felt they had enough to do and liked the peaceful environment provided by staff. Some residents went out independently. Others said that if they wished to go out staff would go with them. Staff were observed asking residents if they wished to go for a walk during the morning. During the inspection several residents had visitors. None of these wished to speak to the inspector as they all said they were very satisfied with the service and had no complaints. Residents said their relatives were made very welcome when they visited and felt the layout of the home gave them a number of choices as to where they received their visitors. Information about visiting was included in the statement of purpose, terms and conditions and in a notice displayed in the entrance hall. Some residents said they continued to manage their own finances. Others said they had appointed a relative to manage on their behalf. Residents said they had been able to bring personal possessions with them when they moved to the home. Information about what could be brought was given to them prior to admission. Brochures about an advocacy scheme were easily accessible to residents as they were kept on the hall table. Residents said the food they were given was very good. Staff were observed asking people which of two choices they would like for their main meal. On the day of the inspection there was a choice of roast beef or lamb. Residents said they had a roast dinner several times a week. The menu plan showed a well balanced diet was provided and residents said the choices offered were very good. Staff serve the meal at the dinner table, so that residents may choose the portion sizes and vegetables they have. They said there was always a good supply of fruit and home made, ‘old fashioned’ puddings such as steamed sponge and bread and butter pudding. Residents said drinks and snacks were routinely offered and this was observed throughout the day. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to enable them to make complaints and be confident they will be informed of the outcome of any investigation. A robust procedure and staff training ensure residents are protected against abuse. EVIDENCE: Residents said they had not had to make any formal complaints, but felt they knew how to do so and were confident any issues raised would be addressed. They said issues were often discussed at resident meetings, which took place every month. The registered manager always gave them written feedback about any action taken following these meetings. Information about the complaints procedure was included in the statement of purpose and a complaint log was kept to record any complaints, action taken and outcomes. The registered manager said no complaints had been received since the last inspection neither had any been received by the commission. The home had a policy and procedure for the protection of vulnerable adults. Some staff had attended a training course, or had covered aspects of adult protection as part of their National Vocational Qualification (NVQ). Two staff were asked what they would do if they witnessed something they thought was abusive practice. Both knew what action they would be expected to take and were clear which agency took the lead role in adult protection issues. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to live in a comfortable, clean and safe environment that meets their needs and that they like. EVIDENCE: The home provides a clean, comfortable environment for residents, who said how much they liked the communal areas. The home is a listed building that has a lot of steps throughout. Residents can access all parts by using stair lifts, but the home cannot accommodate anyone who needs to use a wheelchair, as there is no shaft lift. The home employs domestic staff to clean the home and residents said it was kept to a high standard. The registered manager said money is allocated for maintenance on a monthly basis and there were plans to replace a number of carpets and to refurbish chairs in the communal areas. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 16 Residents said how much they liked the landscaped gardens and spent a lot of time in them. The registered manager said there were plans to reinforce the fence that encloses the stream running through the grounds to further reduce the risk of residents or visitors getting through it and slipping into the water. Training records showed that staff had recently completed infection control training and the home had policies and procedures to provide further guidance. Staff had access to disposable gloves and aprons when they needed them. The home had a contract for the disposal of clinical waste. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by well-trained staff in sufficient numbers to meet their needs. A robust employment procedure ensures residents are protected. EVIDENCE: The home rota showed that the normal staffing levels were two care staff on duty throughout the day and evening. The registered manager’s hours are in addition to this. Residents are supported at night by one waking, one sleeping night staff. Care staff do not cook the main meal or clean the home, but do get breakfast and tea. Residents said they felt there were sufficient staff to meet their needs and that calls for assistance were answered quickly. The majority of residents require minimal assistance with personal care, moving and handling or help with eating. Staff also felt the staffing levels were sufficient to enable them to provide a good level of care and support to residents. The providers and registered manager promote a culture where staff are encouraged to obtain qualifications. The registered manager said that ten staff have achieved their National Vocational Qualification (NVQ) 2 and four have nearly completed it. Two other staff have completed social care courses. The home employs eighteen care staff in total and exceeds the minimum standard for staff trained in NVQ. The staff on duty confirmed they were supported to obtain qualifications. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 18 Three care staff were case tracked to assess the recruitment, induction and training procedures. All three had completed an application form, provided two references, one of which was from their last employer, and attended an interview. The registered manager had obtained a Protection of Vulnerable Adults (POVA) first check on these staff whilst waiting for the Criminal Records Bureau (CRB) check to be returned. She had informed the commission that the POVA first was clear and all other recruitment checks had been completed before permitting these staff to start working in the home. The completed CRB check was also on file. The requirements made in respect of staff recruitment following the last two inspections had been met. The registered manager had a copy of the induction pack new staff were expected to complete. Training records showed how staff were expected to work through this, attending training courses where these were identified as a need. The registered manager said the induction programme was taking several months to complete satisfactorily. When completed, staff were then required to go on to complete their NVQ. Two staff were interviewed as part of the inspection. They said they felt supported by the registered manager and providers to develop their skills and knowledge. They said they had completed basic training such as moving and handling, food hygiene and first aid, as well as training that enabled them to support individual residents, such as dementia care. Their training records confirmed this. They said supervision was used to identify their individual training needs. The registered manager kept a record of all staff training, which she used to monitor when further training and refresher courses were needed. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and there are systems in place that enable residents to give feedback about the service they receive. There are systems in place that make sure health and safety issues are addressed and residents are protected. EVIDENCE: Residents and staff said they felt the home was well managed and that the management team were open, accessible and supportive. The registered manager has completed an NVQ 4 in care and is currently working towards a management qualification. She has previous experience of managing care services. Residents said they felt able to give feedback about the service they receive. This is done informally by talking with the registered manager and formally Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 20 through the resident meetings. Minutes are usually kept of these meetings, although the most recent ones were not available. Residents are given written feedback of actions taken to address issues raised during these meetings. Residents and their relatives are also given the opportunity to provide feedback on an annual basis through questionnaires. This information is collated into a report by the registered manager, which identifies any issues and actions to be taken. A copy of the latest report was seen. Residents and their families are able to see this report. Residents are informed in their terms and conditions that the home may look after small amounts on money on their behalf. An individual record is kept of the amount held and any expenditure, together with receipts. Following a requirement made at the last inspection, staff were asked if they now received regular supervision. They said they did and records on individual staff files confirmed regular supervision was now taking place. Staff training records showed that staff received mandatory training such as first aid, food hygiene and moving and handling. A random selection of service contracts seen during the inspection evidenced that all equipment is regularly serviced to ensure the health and safety of residents. These included recent ones for the stair lifts, bath hoist, fire detection and fire fighting equipment. The fire logbook showed that all tests are carried out in accordance with the requirements of fire safety legislation. The accident book showed that all injuries are recorded appropriately and the commission notified if any resident has a serious injury so that these can be monitored. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard OP7 OP9 Good Practice Recommendations That care plans are developed to demonstrate residents’ involvement with the process and their review. That you review the medication policy in respect of the disposal of medication belonging to a resident who has died, to ensure it complies with the Royal Pharmaceutical guidelines. Little Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Brook House DS0000057924.V312752.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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