Inspection on 04/10/06 for The Brake Manor

This inspection was carried out on 4th October 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 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

The Brake Manor 08/11/05

The Brake Manor 17/06/05

The Brake Manor 02/02/05

The Brake Manor 08/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Brake Manor Bodmin Road St Austell Cornwall PL25 5AG Lead Inspector Elaine Bruce Key Unannounced Inspection 4th October 2006 08:15 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 The Brake Manor DS0000050568.V307942.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. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brake Manor Address Bodmin Road St Austell Cornwall PL25 5AG 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) 01726 75748 01726 69003 Morleigh Ltd Care Home 26 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11), Old age, not falling within any other category (26) The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Service users to include up to 26 adults of old age (OP) Service users to include up to 11 adults aged over 65 with dementia (DE{E}) Service users to include up to 11 adults aged over 65 years with a mental illness (MD{E}) Service users to include 1 named resident under 65 years Total number of service users not to exceed a maximum of 26 Date of last inspection 8th November 2005 Brief Description of the Service: The Brake Manor Care Home provides care for up to 26 older people; of which 11 may fall into the category of mental disorder or dementia. Day care is also provided by the registered provider. The home stands in substantial wooded grounds of some 13 acres and is situated not far from the town centre of St Austell. It is accessible via a long driveway, with car parking for visitors by the main entrance. There are various seating areas, including a patio area near to the house. The home is owned by Mr and Mrs Juleff (Morleigh Limited). The registered manager has recently left the home and is now registered at another home owned by Morleigh Limited. The assistant manager Ms Angela Miners is responsible for the day to day management at this time. The majority of the bedrooms offer en-suite facilities; many have pleasant views over the wooded valley. The communal areas are spacious, homely, well decorated and furnished. There is access to the patio and grounds from the main lounge. Stair lifts and a passenger lift are available to provide access to the upper floors. Morleigh Limited has acquired planning consent for a new care home to be built within the grounds, which will provide an additional 32 beds. Development plans however are currently on hold. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at The Brake Manor took place over 8 hours and was a key unannounced inspection. The acting manager was present during the course of the inspection as was one of the directors of the Company who own the home. The inspector spoke with a considerable number of service users, two visitors, staff on duty as well as touring the premises and inspecting documentation. Written information about the services, facilities and staffing arrangements was received from the acting manager before the inspection. Written documentation was also received (directly at the CSCI) which indicated satisfaction with the service at The Brake Manor from relatives/visitors. All the service users spoken to during the course of the inspection expressed very positive comments on the standard of care that they are receiving at the home. Particular positive comments were made on the standard of the meals available and the good choice of meals provided. The range of fees at the home are from £293.25 to £393.75 per week. The home provides day care three times a week. A number of service users are admitted to the home after first getting to know the service through day care. What the service does well: Service users spoken to during the course of the inspection expressed very positive comments on the standard of care that they are receiving. Particular reference was made to the staff member who has responsibility for social activities at the home. One particular service user stated that she had missed her when she was on holiday. Time was spent reading the records of the social activities at the home and observing a morning activity which took the The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 6 form of a quiz. Positive comments were also made on the standard of the meals at the home. 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. The Brake Manor DS0000050568.V307942.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 The Brake Manor DS0000050568.V307942.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): 1,3 and 4 The quality outcome in this area is adequate. The home’s statement of purpose and service user guide are satisfactory providing service users and prospective service user with details of the services the home provides enabling an informed decision about admission to the home. The acting manager (or team leader) assesses all service users prior to admission to the home to ensure that the home will be able to meet the care needs of the service user before offering a placement. EVIDENCE: The home has in place a statement of purpose document which sets out the aims and objectives of the home, and includes a service user guide and a brochure which provide information about the service. All this information is available in the entrance of the home in a presentation pack. It is noted that the service user guide states that priority is given to admissions to people that are resident in the local area, with an aim of retaining their links (when in care) to the community, family and friends. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 9 An assessment of care needs of a prospective service user takes place prior to admission to the home. This assessment is carried out by the acting manager (or in her absence a team leader) and appropriate documentation is completed. The home has in place copies of assessments carried out through care management arrangements for most of the service users where applicable. Staff have the necessary skills and ability to care for service users who are admitted to the home although at this time there is a reduction in the number of senior staff on duty. This is to be addressed soon with two new team leaders who are due to commence at the home in two weeks time. The Brake Manor DS0000050568.V307942.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 The quality outcome in this area is poor. Care plan reviews are out of date and therefore staff are not provided with adequate information to satisfactorily meet service users needs. Systems for medicine administration potentially place service users at risk. It was noted during the course of the inspection that staff and service users interaction was good with respect to privacy and dignity. EVIDENCE: Each service user has in place a care plan which is supported by daily records that are completed well. The care plans have not been reviewed for two months and there is no guidance in care planning for the staff on the dementia/mental health needs of the service users. There are considerable gaps in the medication records and there were no records in place to evidence when the medication was received into the home. The medication of one service user had recently run out. In addition a comment care from a relative/visitor also indicated that this had happened. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 11 Any amendments to the medication are not dated and signed. Care staff lack training and do not meet the requirements of accreditation. There is evidence in place that the service users can access the services of health care professionals as required. It is recommended that the weights of the service users are recorded and undertaken monthly. Each service user is registered with a general practitioner of their choice. It was noted during the course of the inspection that staff treated the service users with privacy and dignity. The Brake Manor DS0000050568.V307942.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 The quality outcome in this area is good. Social activities are organised and meet the needs of the service users. A staff member is employed specifically for these duties. The meals in the home are good offering both choice and variety and catering for special dietary needs. Arrangements are in place for service users to receive their visitors. EVIDENCE: The routines of the home are planned around the service users’ needs and wishes. Systems enable the service users to be flexible and changed to meet individual wishes. On the morning of the inspection the day started late at the home to suit the wishes of the service users. Sufficient staff resources are provided to allow time for activities and stimulation. The home operates a key worker system, which enables good service user/staff relationships. On the morning of the inspection a quiz took place with a number of service users and a staff member employed specifically for these duties. It was noted that this was a very enjoyable occasion but that some of the questions were not of a suitable time period for the service users. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 13 Good records of the activities are in place. Regular activities that are taking place at the home include bingo, video afternoons, music sing along and quizzes for example. The staff member employed for social activities has raised a large amount of money for the benefit of the service users. The home has developed a good system for displaying information and bringing attention to community events and activities. This information is well displayed in the entrance hall of the home. A regular newsletter is also put together with the involvement of the service users. The diverse religious needs of the service users are met by services coming into the home. Family and friends appear to feel welcomed when they visit the home. Two visitors to the home were spoken to during the course of the inspection. They confirmed their satisfaction with The Brake Manor. All visitors to the home are asked to sign the visitors’ book in the entrance of the home. The service users are encouraged to take responsibility for their own financial affairs and to use their money as they wish. The service users spoken to indicated that food and mealtimes are an occasion to look forward to. The service users are given a good choice of meal at every occasion. Care staff ask them what they would like and records are then given to the cook. They are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. On the day of the inspection the main meal of the day was roast chicken with a good selection of fresh vegetables. This was followed by rice pudding and jam. The choice for tea was either bubble and squeak or sandwiches. Birthdays and celebration are made special for individual service users. The Brake Manor DS0000050568.V307942.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 The quality outcome in this area is adequate. The home has a satisfactory complaints system with information provided to service users in the service user guide pack. Policies and procedures on adult protection should be updated as well as staff training to ensure the safe protection of the service users at all times. EVIDENCE: The Brake Manor has a complaints procedure that meets The National Minimum Standards and Regulations. The complaints procedure is available in the home. The service users and their relatives are provided with this information in the service user guide. The policies and procedures regarding protection of the service users require updating to include information on when incidents need external input and who to refer the incident to. Staff require updated training in this area. The Brake Manor DS0000050568.V307942.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): 19,20,21,22,23,24,25 and 26 The quality outcome in this area is good. The standard of the environment within this home is good providing service users with an attractive and homely place to live. EVIDENCE: Improvements are ongoing externally and internally at the home. Many improvements have been made over the years by the current registered providers. The grounds around the home are very pleasant with attractive seating areas and walks. The service users have access to the grounds from the main entrance and the lounge area. Car parking is available in the grounds of the home. The home offers pleasant communal space comprising of a light and spacious garden room/lounge and a smaller lounge. The main dining area is also very pleasant with a smaller dining area provided primarily for day care provision. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 16 Lighting and furnishings in all communal areas is domestic in nature and furnishings are of a good quality. The home provides toilet, washing and bathing facilities that are suitable to meet the needs of the service users. The majority of the bedrooms have ensuite facilities comprising of a toilet and a wash hand basin. The home provides assisted bathing bathrooms and also a medic bath/shower. There are accessible toilets for service users close to the dining areas and lounge areas. All bathroom and toilets are clearly marked. There are clear signs in place when bathing is happening. The service users are provided with the specialist equipment that they require to maximise their independence. The home provides both stair and passenger lifts, hand and grab rails, bathroom aids and a wide range of mobility aids. There is a call bell system which is accessible in every room. The physical care needs of service users in a wheel chair can be met at the home. Many of the bedrooms are personalised by individual service users who have brought their own possessions with them. This is encouraged. The majority of the bedrooms offer single occupancy however screening is provided where a room is shared. Many of the bedrooms have very attractive views over the wooded valley. Some to the bedrooms at the rear of the home are a little dark. All rooms are naturally heated and naturally ventilated. Radiators are guarded and taps to baths and hand basins have pre set valves to ensure safe bathing water temperatures. The laundry facilities are satisfactory with all laundry duties undertaken by a housekeeper. The housekeeper also covers cleaning duties from a Monday to Saturday morning, with care staff undertaking additional cleaning as required. It was noted that although the home was generally very clean odour control could be improved in some areas of the home. It was also noted that two communal carpets are now badly stained and should be replaced. At this time the acting manager is working in a rented portakabin directly opposite to the entrance of the home. Although this is helpful at times it is suggested that an area in the home be considered for these purposes to ensure that the manager is available to the service users and staff when on duty. The Brake Manor DS0000050568.V307942.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): 27,28,28 and 30 The quality outcome in this area is adequate. Staffing levels are satisfactory to meet the needs of the service users. The decline in the robust recruitment and vetting of staff could leave the service users at risk. Some training requires updating to ensure that the staff have the skills to meet the care needs of the service users at all times. EVIDENCE: The service users spoken to during the course of the inspection expressed satisfaction that the staff can meet their care needs. The staffing rota evidences the correct number of staff on duty. Recent changes to the staffing have taken place to include the reduction of three team leaders to one. On the day of the inspection it was apparent that the absence of these senior staff has caused problems with documentation in particular. The acting manager explained that these posts are due to be filled soon. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 18 Recruitment procedures for staffing were found to be unsatisfactory on the day of the inspection. Protection of vulnerable adult checks (at a minimum) must be in place prior to the recruitment of any new staff. The service recognises the importance of training although at this time there are gaps in training that need attention. Moving and handling training is up to date, first aid training requires more staff to be trained in this area to ensure cover at all times. Some staff require fire drill training. A relatives/visitors comments card received directly at the CSCI indicated that the staff at the home are always “cheerful, helpful and pleasant”. The Brake Manor DS0000050568.V307942.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 The quality outcome in this area is adequate. There needs to be more support for the acting manager to allow her to undertake more work to meet the requirements of legislation. In particular care planning documentation should not be allowed to deteriorate. Systems for holding money in the home on behalf of service users are safe. EVIDENCE: The home is without a registered manager at this time but documentation has been received by the CSCI to progress an application by the acting manager. The acting manager is fully aware of the responsibilities of the job and is also fully aware that there are standards that have not been met on this inspection. She would appear to have had a difficult time recently as senior staff have left The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 20 and a number of capable staff are also on maternity leave. The previous registered manager had planned to offer help/support to the acting manager but due to her work commitments this has not happened. One of the directors of the Company is involved in the running of the home but has recently been very busy at another home in the Company and therefore the support to the acting manager has been less that it should have been. The acting manager ensures that the service users control their own money. If a service user does not wish to, or they lack capacity, a relative, power of attorney or trusted friend is appointed to act on their behalf wherever possible. Monies are held on behalf of several service users that are kept individually with receipts and records maintained. Two of these accounts were checked at random and found to be correct. The home has good documentation available in the entrance of the home to establish the feedback of visitors/relatives to the home on the running of the service. Written information provided to the inspector by the provider before the inspection indicates that all equipment at the home is regularly maintained and tested. All health and safety policy and procedure documentation requires updating. The Brake Manor DS0000050568.V307942.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 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 N/A 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 22 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. 2. Standard OP7 OP9 Regulation 15(2)(b) 13(2) Requirement Timescale for action 31/12/06 3. OP29 19(1) The registered person shall keep the service user plan under review. The registered person shall make 31/12/06 arrangements for the recording, handling safe keeping, safe administration and disposal of medicines into the care home. The registered person shall now 31/12/06 allow a person to work at the care home unless the person is fit to work at the care home. 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 OP8 OP18 Good Practice Recommendations To weigh the service users monthly and record this information. To update the adult protection policy and procedure and provide evidence that staff have read this important DS0000050568.V307942.R01.S.doc Version 5.2 Page 23 The Brake Manor documentation. To provide updated training. 3. 4. OP30 OP38 To ensure that all staff training is updated to ensure compliance with statutory training at all times. To ensure that all health and policy documentation is reviewed and updated. The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 The Brake Manor DS0000050568.V307942.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!