Inspection on 11/05/06 for Rivendale Lodge EMI Care Home

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rivendale Lodge EMI Care Home 10/05/07

Rivendale Lodge EMI Care Home 30/01/07

Rivendale Lodge EMI Care Home 12/10/05

Rivendale Lodge EMI Care Home 17/05/05

Rivendale Lodge EMI Care Home 19/01/05

Rivendale Lodge EMI Care Home 03/06/04

Similar services:

Springfield House

The Old Downs Care Home

Ridgemount

Lawrence House

Anchorstone Services Limited

Lulworth Residential Home

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

CARE HOMES FOR OLDER PEOPLE Brook Hill Rest Home Brook Hill Rest Home 14 Prideaux Road Eastbourne East Sussex BN21 2NB Lead Inspector Judy Gossedge Key Unannounced Inspection 11th May 2006 1:00 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 Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 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. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brook Hill Rest Home Address Brook Hill Rest Home 14 Prideaux Road Eastbourne East Sussex BN21 2NB 01323 731575 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) Mr Sunjay Kumar Rai Mr Ashish Sharma Vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (26) registration, with number of places Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is twenty-six (26). Service users must be older people aged sixty-five (65) years and over on admission. Service users with a dementia type illness only to be accommodated. The second floor accommodation is restricted to use by service users who are ambulant and can access their private accommodation independently. 12th October 2005 Date of last inspection Brief Description of the Service: Brook Hill is a residential care home for older people with dementia. It is situated in a residential area of Eastbourne. The home is a detached older-style building, on three floors standing in its own grounds. There are sixteen single and five double bedrooms sited on all floors, with a lounge and dining room on the ground floor. It is not purpose built and there is no passenger lift, but equipment is provided in the home to help service users up and down the stairs if required. All the bedrooms have a wash-hand-basin. The majority of bedrooms do not have en-suite facilities, but three bedrooms have a toilet and wash-hand-basin and of these three, one also has a shower facility. Assisted bathing facilities are available in the home. There is a garden laid to lawn at the rear of the home. The Statement of Purpose, Service Users Guide and a copy of the last inspection report are available to reference in the entrance to the home. At the time of the inspection fees were documented to be between £380.00 and £500.00. Additional charges are made for hairdressing, chiropody, newspapers and dry cleaning. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a quarter hours on 11 May 2006. There were two Inspectors present during the inspection. Prior to the inspection a pre-inspection questionnaire was sent to the home to be completed with information required as part of the inspection process. This was returned and information detailed within is quoted in this report. A tour of the premises took place to look at communal areas and a selection of service user’s bedrooms, rotas and care records were inspected. Seventeen service users were resident, but due to communication difficulties it was not possible to speak to all service users individually, though a number were spoken to as part of the inspection process. The care that four of the service users received was reviewed. The opportunity was also taken to observe the interaction between staff and service users in the communal area. Ten service user surveys were sent out and all came back completed. The Acting Manager stated that service users were assisted to complete these by relatives or members of staff. Four care staff, the cook, a laundry assistant, a general assistant, the activities co-ordinator, the maintenance person, the admin and recruitment officer, the deputy manager and the Acting Manager were all spoken with. One of the proprietors was also present during the inspection. Seven staff questionnaires were sent out prior to the inspection and no completed questionnaires were returned. One relative, a service users friend were spoken with on the day and a relative was spoken with on the telephone. Two relatives were also spoken with on the telephone after the inspection. Five General Practitioners comment cards were sent out and two completed comment cards were returned. A District Nurse who has visited patients in the home also provided some feedback. There has been a significant period of change in the home with the Registered Manager leaving in October 2004 and replaced by an Acting Manager who left the home in July 2005. Currently there is still not a Registered Manager for the home and interim management arrangements are in place, with the Administration and Policies Manager in the position of Acting Manager. A new deputy manager has just commenced working in the home and additional support from a former Registered Manager working with the Residential Recovery Service, a consultancy service is also provided. What the service does well: The home presents a relaxed and happy atmosphere. One relative commented ‘that staff are extremely welcoming, seem to know the service users, are caring and take the time to talk with service users’. The Inspectors observed good interaction between staff and service users. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 6 Staff were observed during the inspection to ensure that the privacy and dignity of service users is respected at all times. The feedback from service users surveys and visitors was that they were happy with the overall care provided in the home. Comments included ’I feel that it is a very good home with a good atmosphere’, ‘Staff are very welcoming and easy to talk to and get things done’, ‘I am happy here’ and ‘I enjoy the company that I get.’ Visitor’s felt that they are enabled them to raise any issues of concern if they wished and these would be listened to. A detailed Statement of Purpose and Service User Guide is in place and one visitor confirmed they had had the opportunity to look around the home prior to their relative’s admission to the home. There are also opportunities for potential new service users to visit the home. Regular activities are being organised for service users during the week with opportunities for service users to socialise with their relatives/representatives at events arranged in the home. A periodic newsletter is sent out to inform every one of the forthcoming events in the home. One relative commented ‘The newsletter is really lovely. It gives all the dates of the forthcoming activities’. What has improved since the last inspection? The Statement of Purpose has been updated to include the required information. The detailed pre-admission assessment was seen to be fully completed to enable staff to make a judgement on if the service users care needs can be met in the home and plan in advance for any specific care needs identified. The content contained within the individual plans of care have continued to be developed to detail all the service users care needs and provide guidance to staff as to how these will be met. Supporting risk assessments were also seen to be in place. The recording of meals provided to individual service users has been maintained to enable staff to ascertain that service users are receiving a varied and adequate diet. Evidence has been supplied to confirm that the Water Regulations 1999 have been met. The Acting Manager confirmed in the pre-inspection questionnaire the staff working in the home who have received basic first aid training. Providers seek feedback on the quality of the service provided. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 7 The routine fire checks carried out in the home had been recorded and were adequate. A risk assessment to minimise the risk of Legionella is in place. What they could do better: Service users clothing has been named to ensure that service users have their own clothes returned after being washed. But it should also be ensured that socks and stockings are also identifiable. A maintenance plan for the home has been developed and work is ongoing to make the home more attractive and homely. Proprietors have also previously stated that work will be undertaken to improve the external décor of the home, the standard of the windows, to improve toilet and bathing facilities and provide a passenger lift in the home. An action plan with timescales has been requested to identify work to be completed in the home. Hot water is not always delivered at outlets accessed by service users near to the recommended safe temperature of 43 ° C to protect service users. The recruitment process is poor. The recruitment process followed was viewed for four new members of staff working in the home. One new member of staff did not have a record of a POVA First check and the member of staff was working in the home. Where staff are awaiting a CRB check, it was not evident during the inspection that staff were being closely supervised as required whilst this check was being completed. One member of staff only had one written reference in place and for another there was no evidence that the two references provided had been requested as part of the homes recruitment process, or had been verified. The adequacy of recruitment procedures has been a recurring issue identified at the inspections carried out on 25 October 2005, 17 May 2005 and 19 January 2005. Monitoring visits were carried out on 20 January 2006 where this issue was not found to have been addressed, and on 22 March 2006, at which time it was not possible to evidence the recruitment checks had been completed prior to staff commencing work in the home, or in all cases the manner in which references had been obtained. As a result the CSCI is issuing a Statutory Requirement Notice, which requires that nobody is deployed in the home without a POVA First check and that where a CRB check is awaited staff are closely supervised as required. An action plan has been requested with timescales to identify the progress made to have a Registered Manager for the home. Regular recorded visits by the providers to meet the requirements of Regulation 26 need to be maintained. The staff training records should detail the date when staff complete training to identify when any updates are required. It was not possible to confirm if all staff have received the required health and safety training. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 8 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. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 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 Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions process is good with staff being provided with adequate information in advance of admission to ensure each service users care needs can be met in the home. EVIDENCE: The Statement of Purpose, Service Users Guide and a copy of the last inspection report are available to read in the entrance to the home. One of the visitors involved with the placement of their relative confirmed they had received this information. A further two visitors were aware that this information was available to read. There is a detailed contract/terms and conditions in place to be used between the home and the service user. All ten of the service users completed surveys confirmed that a contract was in place. Three completed contracts for new service users were also viewed on the day. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 11 New service users are visited prior to any admission. This is to ensure individual service users care needs can be met in the home and to provide staff with information on the care to be provided. One relative commented they had had a detailed discussion with staff about the care needs of their relative. There were two new service users resident and their pre-admission information had been fully completed and was detailed. Staff also spoke of two new potential service users due to visit the home, to have lunch and to spend some time in the home. Service users religion was not always recorded and where possible this information should be sought to ensure where a death occurs appropriate actions are taken in line with service users or relative’s wishes. Not all staff have received guidance/training for providing care to service users with dementia. The Acting Manager stated that training has been arranged for these staff to attend during May 2006. One of the visitors who had been involved in the placement of their relative confirmed that they had had the opportunity to look around the home prior to their relative moving in. They stated that they had liked the fact that service users could go out in the garden and commented, ‘Staff are extremely welcoming, seem to know each of the service users, are caring and take the time to talk with service users’. Intermediate care is not provided in the home. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 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 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. Service users are protected by an individual detailed plan of care being in place, where all their personal, social and health care needs are identified at the start of their stay and which informs staff of the care which needs to be provided. EVIDENCE: A selection of the service users individual care plans was viewed. The information detailed on the care plans continues to demonstrate more detail being recorded. This gives clear guidance to staff of the care to be provided, service users health care requirements, dietary needs, social and leisure interests, how any identified risks are to be managed and these had been reviewed. Staff were observed during the inspection to ensure that the privacy and dignity of service users is respected at all times. The feedback from all the service users surveys and visitors was that they were happy with the overall care provided in the home. Comments included ’I feel that it is a very good Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 13 home with a good atmosphere’, ‘Staff are very welcoming and easy to talk to and get things done’, ‘I am happy here’ and ‘I enjoy the company that I get’. Medication policies and procedures are in place and the administration of medication was observed at lunchtime and at teatime. The storage and a sample of the recording of the administration of medication were also viewed and were adequate. Staff and records confirmed that a pharmacist regularly visits. All the service user surveys completed indicated that service users felt that their medical care needs were met in the home. Feedback from visiting medical professionals stated that they were happy with the overall care provided and that staff work in partnership with them. One did comment that there was not always a senior person available during their visit to confer with. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where possible service users are enabled to exercise choice in their lives whist resident in the home, with good opportunities to participate in social and recreational activities provided, with a varied diet provided, which offers a choice at every meal. EVIDENCE: Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 15 An activities’ co-ordinator works in the home twenty hours a week over five days. A regular programme of activities has been arranged. The activities are organised by the activities’ co-ordinator and additionally care staff were observed to facilitate an activity during the inspection, after the co-ordinator had finished for the day. External entertainment/activities groups are also arranged to provide entertainment in to the home. The service user surveys completed indicated a mixed response with service users stating activities were always or usually organised in the home. Records viewed, observations during the inspection and feedback from three visitors who have visited their relative/friend and observed activities taking place, confirmed that a range of activities are organised. On the day of the inspection a number of service users were playing a ball game and there was a pleasant atmosphere and good interaction between staff and service users was observed. Some service users were having a manicure when the Inspectors arrived and the activities coordinator stated that several of the service users had spent the morning in the garden doing some gardening. The lounge is decorated and personalised with some of the artwork service users have completed. A periodic newsletter is sent out to inform every one of the forthcoming events in the home. One relative commented ‘The newsletter is really lovely. It gives all the dates of the forthcoming activities’. Service users social interests are now starting to be recorded on their individual care plans. Feedback from the visitors identified that there is flexible visiting, that staff are always very welcoming and it is possible to go to a service user’s bedroom if a private meeting is required. A new rotating menu is in place, which has been seasonally varied and identifies the choices available at all meals. The cook confirmed there is flexibility where service users do not like the choice of meal on the day and special diets are catered for. There were homemade jam tarts served with afternoon tea and a visitor also confirmed they had observed afternoon drinks and cakes being provided. Tea on the day was various sandwiches, mousse or crème brule. It was a very warm day and service users were all eating sandwiches. The Inspectors asked if there had been a choice of meal provided and staff on duty stated that this was the service users choice and that a hot meal option had also been available. Some service users were assisted with their meal in the dining room and lounge area. It was possible to evidence a varied and adequate diet for all service users from the records kept of food consumed individually by each service user. One visitor who had had the opportunity to observe the meals provided in the home on many occasions and had also eaten a number of meals in the home spoke very well of the food provided. The service user surveys completed indicated a varied response of always, usually or sometimes enjoying the meals provided. One service user commented ‘I enjoy the food and drink.’ Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable service users or their representatives to raise any concerns about the care being provided and to ensure that service users are protected from abuse. EVIDENCE: There is a detailed complaints policy and procedure in place. No complaints had been received at the home since the last inspection. The visitors felt it was an environment where they would feel comfortable to raise any issues and that they would be listened to. None had made a formal complaint. One service user commented on the service user survey when asked if they knew how to make a complaint, ‘I can talk to the Manager’. The CSCI received a complaint relating to the lack of notice period detailed in the contract/terms and conditions and for the short notice given to one service user to find alternative accommodation. After investigation the complaint was not upheld, but did highlight the need for service users care plans to have more detailed guidance for staff as to how individual service users care needs are to be met. As recorded under Standard 7, care plans viewed demonstrated an improvement in the detail provided to staff. There are detailed policies and procedures in place in relation to the protection of vulnerable adults and further training was in the process of being provided Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 17 at the time of the inspection. Several staff spoken with confirmed they had attended this training. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 18 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): 19,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment continues to be improved to ensure that service users are provided with an attractive, clean and homely place to live. However, the management of the safe delivery of hot water remains inadequate. EVIDENCE: The maintenance person confirmed there is an ongoing maintenance plan for the home and spoke of planned work, for example a ramp is being built to improve access in to the garden. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 19 The external décor of the home is poor and the proprietors have previously stated that work is to be carried out on the windows. There is not a passenger lift in the home, but the Acting Manager stated that the proprietors are still considering options for a passenger lift to be provided in the home. A stair lift is available to service users unable to use the stairs. It is required that when in use a risk assessment is undertaken and recorded to ensure individual service user’s safety. An action plan with timescales to identify work to be completed in the home has been requested. There are sixteen single bedrooms of which five do not meet the minimum space requirements, and five double bedrooms on all floors in the home. Access to the second floor is by way of a steep stairway with no alternative means of escape in case of a fire. The present registration states that service users accommodated on this floor should be fully ambulant. The care needs of the service user at present living on that floor should continue to be reviewed on a regular basis to ensure their safety and care needs continue to be met whilst resident on the second floor. The décor and furnishing of the bedrooms continues to be improved. A number of bedrooms displayed service users individual styles and interests. Some service users at the time of redecoration have also been able to choose the colour of their bedroom. One visitor confirmed this and said that their relative’s bedroom had been decorated, the furnishings improved and that their relative had commented how happy they now were with their bedroom. Bedroom doors are not fitted with a lock. If a lock and furnishings are not provided due to health and safety issues specific to individual service users then the Acting Manager has stated a risk assessment has be undertaken, recorded and available to view. Night-lights have been purchased instead of a bedside light. Though some bedside lights have been provided if this is identified to meet individual service users care needs. Again not all bedrooms had a rubbish bin and it was not apparent where staff threw away their disposable aprons and gloves. The Acting Manager stated that more rubbish bins were due to be provided. An emergency call system was fitted in the home last year so all bedrooms now have an emergency call bell system. A number also have an alarmed floor mat to alert staff particularly at night where a service user may need assistance. Service users are unable to control the temperature in their own bedrooms. The homes recording of hot water temperatures was viewed and a sample of thirteen hot water outlets used by service users were tested. Four were satisfactory, but for the remaining the temperature was recorded to be between 25 º C and 32 º C. The lack of hot water has been an ongoing issue in the home and was reported to the Acting Manager on the day of the inspection. An Immediate Requirement Form for action was issued to ensure adequate supply of hot water is maintained. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 20 Bathroom facilities are provided throughout the home. However most service users use the assisted bathroom on the ground floor. The home does not provide sufficient toilets throughout the building. The ground floor where most of the service users were observed to spend a significant part of their day has limited toilet facilities. This had been an ongoing requirement following previous inspections and the proprietors have previously stated that both these issues will be addressed within further developments of the home being considered. An action plan with timescales to identify work to be completed has been requested. Evidence has been provided to confirm that the home meets the Water Supply Regulations 1999. There is one lounge and adjoining dining area on the ground floor. The majority of the service users congregate here during the day in this area. The floor finish in the laundry is readily cleanable. Staff identified a system to sort clothes in the laundry area and ensure all items of clothing are named. The Inspectors raised some concerns as to how individual service users tights and socks are identified as these were in a big pile and were not named. The Acting Manager agreed on the day to look into this and ensure service users only wear their own socks or tights. The home was clean and odour free and feedback from the visitors was that they were very satisfied with the cleanliness in the home. The service user surveys stated service users felt the home was always or usually fresh and clean. Recording of routine fire checks carried out in the home were viewed and were adequate. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 21 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 poor. This judgement has been made using available evidence including a visit to this service. Staffing was adequate on the day to meet the care needs of the service users resident, but a robust recruitment procedure needs to be in place to ensure service users are in safe hands at all times. Staff supervision arrangements remain inadequate. EVIDENCE: A copy of the staff rota was provided with the pre-inspection questionnaire. Staffing on the day was adequate to meet the number and care needs of the service users resident. There is still a reliance on agency staff to work in the home. Staffing levels will need to be increased when additional service users are accommodated up to the maximum registered number of twenty-six. Ancillary staff working in the home, cover catering, domestic and laundry tasks. Visitors stated that they felt there were adequate numbers of staff on duty during their visits. Service users surveys completed indicated that majority of service users felt that they received the care and support that they needed, that staff listened and acted upon what was said to them and that staff were always available when they were needed. Standard 28 has not been met as fifty percent of the staff have not achieved NVQ level 2 or equivalent in care by April 2005. The pre-inspection questionnaire detailed that five care staff hold NVQ level 2 in care or above. That equates to 38 of the homes care staff. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 22 The recruitment process followed was viewed for four new members of staff working in the home. One new member of staff did not have a record of a POVA First check and the member of staff was working in the home. An Immediate Requirement Form for action was left to address this issue. Where staff are awaiting a CRB check, it was not evident during the inspection that staff were being closely supervised as required whilst this check was being completed. One member of staff only had one written reference in place and for another there was no evidence that the two references provided had been requested as part of the homes recruitment process, or had been verified. The adequacy of recruitment procedures has been a recurring issue identified at the inspections carried out on 25 October 2005, 17 May 2005 and 19 January 2005. Monitoring visits were carried out on 20 January 2006 where this issue was not evidenced to have been addressed, and on 22 March 2006, at which time it was not possible to evidence the recruitment checks had been completed prior to staff commencing work in the home, or in all cases the manner in which references had been obtained. As a result the CSCI is issuing a Statutory Requirement Notice, which requires that nobody is deployed in the home without a POVA First check and that where a CRB check is awaited staff are closely supervised as required. The Acting Manager has stated that induction training to meet the requirements has now introduced for new staff to complete. One new member of care staff spoken with also confirmed they were working on the induction. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 23 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): 31,33,36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a quality assurance plan in place to give proprietors and staff feedback on the service provided. Regular supervision of care staff needs to be maintained to ensure staff are supported to be able to perform their roles effectively. The recruitment practices are poor with staff being deployed in the home without adequate recruitment checks in place. In general the management of the home remains poor with regard to staff supervision and recruitment practices, albeit there have been improvements in some areas, for example pre-admission assessments and care planning. EVIDENCE: Interim management arrangements are in place, with the Administration and Policies Manager working as the Acting Manager for the home. He is currently undertaking the Registered Managers Award. A new deputy manager has Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 24 started to work in the home and support is also being provided from a former Registered Manager working with the Residential Recovery Service, a consultancy service. The CSCI is awaiting an application to register a manager for the home and the proprietors have been asked for an action plan to address this issue. A quality assurance system has been developed. The Acting Manager stated and evidenced that feedback about the service provided is being sought from service users, relatives/representatives and other professionals who attend the home, all of which is due to be collated. A regular recorded visit by a proprietor of the home to meet Regulation 26 has not been maintained. None of the service users at the time of the inspection handled their own financial affairs and a number had a relative or advocates supporting them. A procedure is in place for quarterly billing of any additional services or purchases, which alleviates the need to hold service users monies in the home. Supervision for all care staff has not been maintained to meet the requirements of Standard 36, which details supervision standards to be in place. Supervision should also be provided by a senior member of staff who has experience of managing staff or has received training/guidance on supervising staff and of care work. Staff spoken with confirmed good access to training and of attendance on health and safety training. Training records do not include the date the training was undertaken. So it was not possible to evidence if all staff had received training within the required timescales. The Acting Manager stated that fire training was held in November 2005 and further training is booked for May 2006. Again the new recording of the training provided did not evidence what training staff had attended, when staff completed this training and if the required frequency for training had been met, or if staff had participated in a fire drill. The pre-inspection questionnaire detailed staff who have received basic first aid training. The new deputy manager could not evidence but stated she had attended of a full first aid course. An external provider was commissioned last year by the proprietors to undertake an environmental risk assessment of the building. It was not evidenced that this had been regularly reviewed and updated where issues are identified. The Acting Manager stated that it is the intention that staff in the home will now be completing any environmental risk assessments in the home. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 25 A recorded risk management assessment in relation to Legionella is now in place. The maintenance person stated ongoing monitoring systems were in place in relation to the prevention of Legionella. There is no evidence of a current electrical wiring certificate for the home. The Acting Manager confirmed that he was in the process of trying to get a copy of the certificate, or would be engaging an external contractor to provide a new certificate for the home. Portable appliances were checked in July 2005. Recording was viewed of incidents and accidents, which had occurred in the home. The collation of this information has improved to facilitate easy access and to identify any patterns in incidents and accidents, which have occurred in the home. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 26 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 3 X 3 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 2 X X X X 3 1 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 x 2 Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 18 (1) (c) (i) Requirement That confirmation is received that staff have received training/guidance in providing care to service users with dementia. This issue is outstanding since 30.11.05 and 31.03.06. That an action plan with timescales is provided to identify work to be completed on the home. That hot water is delivered to outlets accessed by service users near to the recommended safe temperature of 43 C. The CSCI receives confirmation as to how this has been addressed. This is outstanding since 17.05.05 and 12.10.05. That confirmation is sent that POVA First checks are in place for staff working in the home. That a thorough recruitment procedure is evidenced. This issue is outstanding since 30.04.06. Staff do not work in the home until a satisfactory recorded Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 28 Timescale for action 30/06/06 2. OP19 23 (2) (ab) 13 (4) (ac) 30/06/06 3. OP25 11/05/06 4. 5. OP29 OP29 19 (1) (b) (i) 19 (1) (b) (i) 11/05/06 23/06/06 POVA First check has been received Staff working in the home whilst awaiting a CRB check are adequately supervised during this period. That an action plan is provided with timescales as to identify the progress made to have a Registered Manager for the home. That the Registered Provider will undertake a monthly visit to the home, which will be recorded, and a copy is sent to the CSCI. That moving and handling risk assessments will be completed where required. This issue is outstanding since 31.12.05 and 31.03.06. Confirmation of how these assessments are to be completed will be provided. That evidence is provided that all staff have received up-todate training in first aid, infection control, moving and handling and basic food hygiene and the date this was undertaken. That it is evidenced that risk assessments completed of the homes environment are regularly reviewed. That evidence that supplied to confirm an electrical wiring certificate is in place. 6. OP31 8 (1) (ab) 30/06/06 7. OP33 26 (3) (4) (a-c) (5) (a) 13 (5) 30/06/06 8. OP38 30/06/06 9. OP38 12 (1) (a) 30/06/06 10. OP38 13 30/06/06 11. OP38 13 (4) (a) (c) 30/06/06 Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 29 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 OP7 Good Practice Recommendations That service users religion is recorded. Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Brook Hill Rest Home DS0000046374.V289339.R01.S.doc Version 5.1 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. 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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