Inspection on 29/01/07 for The Rosemary Care Home

This inspection was carried out on 29th January 2007.

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

The Rosemary Care Home 29/03/10

The Rosemary Care Home 03/02/10

The Rosemary Care Home 08/10/09

The Rosemary Care Home 26/08/09

The Rosemary Care Home 26/06/08

The Rosemary Care Home 03/07/07

The Rosemary Care Home 11/07/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brooklands Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP Lead Inspector Jenny Andrew Unannounced Inspection 29th January 2007 08.30 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 Brooklands Care Home DS0000066311.V306093.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. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooklands Care Home Address 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP 01706 650429 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) Din T Vanat ** Post Vacant *** Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability over 65 years of age (1) of places Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 27 service users, to include: Up to 26 services users in the category of OP (Older People) Up to 1 service user in the category of PD(E) (Physical Disabilities over 65 years of age) The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection and whose performance is monitored and appraised at 4 monthly intervals from the date of this registration. This condition will be reviewed by the Commission for Social Care Inspection no later than February 2007. A maintenance and renewal plan must be produced by 01.04.2006 and met within a timescale agreed by the Commission for Social Care Inspection. This plan must include any outstanding environmental requirements. Planned activities both in-house and in the community must be provided to meet the assessed individual and group needs of all residents by 01.04.2006 Medication records must be completed in full, including staff signature on administration A quality assurance system must be developed and operated in the home by 01.08.2006 A Statement of Purpose and Service User Guide which accurately described the service and complies with Regulations 4 & 5 of the Care Home Regulations 2001 must be written by 01.04.2006 11th July 2006 2. 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: Brooklands is a privately owned residential home, which provides care for up to 27 older people and one person with a physical disability. The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. The home is on three floors and there is a passenger lift to all levels. Twenty one single and three double bedrooms are provided. Two of the bedrooms have the added provision of an en-suite. Two lounges and a dining area are provided on the ground floor and a lounge/dining area on the 1st floor. A bathroom is provided on each floor and a level access shower room on the ground floor. Two of the baths are fitted with fixed hoists. Toilets are located near to lounge areas and bedrooms. A well maintained garden is available to the front of the home, as is space for parking. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 5 The registered provider (i.e. the owner) agreed to make the most recent Commission for Social Care Inspection (CSCI) report available in the reception hall. It was currently being held in the office. As at January 2007, weekly fees ranged upwards from £328.41 - £340 per week, the higher rate being charged to residents who paid for themselves. Additional charges were for hairdressing, private chiropody, newspapers, toiletries, holidays, spectacles and hearing aid batteries. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection in July 2006, one further inspection in October 2006 had taken place, due to the concerns about requirements not being done within the timescales set by the Commission for Social Care Inspection (CSCI). This report has been written using the information held on CSCI records and information provided by people who live at Brooklands, their relatives/visitors, professionals who visit the home, the staff, acting manager and owner. This visit took place over one day by 1 inspector who stayed for 9 hours. The home had not been told beforehand when the inspector would visit. The inspector looked around the building and checked paperwork that has to be kept to show that the home is being run properly. To find out more about the home the inspector spoke with five residents, 2 relatives, the acting manager, two carers, the cook, the domestic and the owner. Questionnaires asking residents, relatives and professional visitors what they thought about the care at Brooklands had been given out a few weeks before the inspection. Five residents, four relatives/visitors and two GPs filled the cards in and returned them to the CSCI. A letter from a G.P. practice was also received. What the service does well: What has improved since the last inspection? The Service User Guide had been brought up to date and was at the printers. All the residents will be given a copy of the new guide when it is returned from the printers. In order that residents were able to know the terms and conditions of their stay at the home, they have now all been given new contracts which show how much the home charges and what is not included in the fees. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 7 The new manager and owner have now made sure that the way medication is given out is done safely and as stated in the homes policy. The owner had written a maintenance plan, which showed when re-decorating work and other work, would be done. He was keeping to the timescales he had given to the Commission for Social Care Inspection (CSCI). There were enough staff on all shifts to make sure that the health and personal care needs of the residents were able to be met. Before new staff started work, all the right checks were being done so that residents would be safely looked after. When new staff first started work, they were now doing the right training so they would be able to learn properly how to look after the residents in their care. A new manager was now in post and since she had started working at Brooklands, she had improved a lot of things, which needed to be done from the last two inspections. What they could do better: The residents’ care plans and risk assessments were not up to date and written in an easily understandable way, which meant that staff did not always have the right information about each person to meet their needs. Whilst some staff had done training in how to make sure residents were protected from harm (vulnerable adult training), others had not, which could place residents at risk. The hot water taps in two of the residents’ rooms were running too cold and residents were not able to have a comfortable wash. Whilst some of the care staff had done all the right training for example how to move/handle residents safely, the safe handling of food, making sure infections were not spread and fire training, others had not, which could place staff and residents at risk. Although a new manager was now working at the home, she had not yet applied to the Commission for Social Care Inspection to become the registered manager. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 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 Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had been issued with new contracts so they were clear about the terms and conditions of residence and the Service User Guide had been updated so that residents would have the right information to decide whether the home would be suitable for them. EVIDENCE: Since the last inspection, the Statement of Purpose and Service User Guide had been reviewed and updated to reflect the new owner and manager. The Statement of Purpose was displayed in several areas within the home and it was dated December 2006. The updated Service User Guide was currently at the printers. The manager said they expected to receive copies within the next week or so at which time each resident would be given a copy and the Commission for Social Care Inspection would also be sent a copy. All the residents had now received an updated contract/terms and conditions of their stay. Contracts for 3 residents, who had a solicitor acting for them, had not yet been returned signed but the manager was chasing these up on a Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 11 regular basis. All the remaining files checked showed updated terms and conditions were in place. The admission procedure was detailed in the Statement of Purpose and Service User Guide and the manager stated she would always do her own assessment of need either in the persons home or in hospital, in order to make sure the home would be able to meet each persons needs. Whilst the home had assessment documentation, the manager was in the process of updating them in order to ensure a more thorough assessment was done. The home had not had any new residents for a considerable time but the files inspected for those residents who had lived there for a while were seen to contain assessment documents. Standard 6 was not assessed, as the home does not provide intermediate care. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst feedback from residents’ indicated their health and personal care needs were being met, the care planning system was not clear and consistent to provide staff with the information they needed to meet service users needs. EVIDENCE: Four residents care plans were inspected but the content was not fully reflective of the care needs of the residents. The care plan documentation was not all up to date although care plans had been reviewed monthly since the new manager had started work in November. However, when reviewing the care plans, the risk assessments were not being done and this was seen on a moving/handling assessment that stated two carers were needed for all transfers. In fact staff were observed using the hoist for undertaking transfers and this had not been recorded. Another file showed the skin assessment (Waterlows) had not been updated for 3 months. From checking the file for this resident, it was evident from notes on the professional visitors log that her condition had improved. However, the risk assessment did not show this. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 13 The new manager was in the process of reviewing the care plan format as she felt the present tool was too complicated and not person centred. As part of this process, she was going to review each persons’ care, in consultation with the resident and/or their relatives in order they were fully involved in the care planning process. She expected to have completed this by the end of February 2007. When undertaking this task, she must ensure that all risk assessments are accurate, signed and dated and are then regularly reviewed and updated. She should also ensure that each persons’ religious/cultural needs are recorded. A personal care record sheet had been introduced which staff were expected to keep up to date when they had assisted with baths/showers, changed beds and checked finger nails. Whilst some files were up to date, others were not and the manager said she would address this at the staff meeting being held the day following the inspection. All the residents spoken to did however, confirm that they had either one or two baths/showers each week and were satisfied with this. One resident said, “You can have your bath at whatever time of day you choose”. In order to make sure that the staff are aware of the changes made to all of the care plans and risk assessments, and in order to monitor this, they should be asked to sign when they have read each persons file. Whilst nutritional assessments were in place, these were not always the assessments approved by the community dietician and known as The Malnutrition Universal Screening Tool (MUST). The owner and staff had attended a teaching session given by a Rochdale PCT dietician about the importance of nutrition and in her previous role, the manager had also undertaken this training. The manager said that as each persons care plan was reviewed, she would be implementing the tool. Residents’ weights were recorded monthly and it was pleasing to note there had been increases in weight for two of the residents whose care plans were inspected. It was noted in one file that food/fluid charts had been consistently used over several weeks, but that due to the progress made by this person, they were no longer in use. The home had clearly worked in partnership with the dietician resulting in a positive outcome for the resident. Daily report sheets were in place and the recordings showed useful and relevant information to have been recorded rather than simply “good day” etc. From speaking to 2 care assistants, it was clear they fully understood what each residents’ personal care needs were and were clear about the importance of encouraging independence and promoting residents choice. None of the residents living at the home were poorly in bed and none had pressure sores. Care plans recorded GP, district Nurse, dietician and podiatry visits together with the outcomes. Four resident comment cards were received and the responses related to health care indicated they always received the medical Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 14 support they needed. Feedback from all 7 residents spoken to also indicated satisfaction in this respect. On the day of the inspection, the manager spoke to one resident who was clearly feeling unwell and she requested a G.P. visit on her behalf. This was made early in the day so that the surgery would have enough notice in order to make sure a visit could be done that day. Two GPs completing questionnaires in early December, expressed some concerns in respect of poor use of “as required” medication, language problems with the staff, some staff not having a clear understanding of the care needs of the residents and the home not working in partnership with them. The manager said the problems had been addressed with the G.P. practices and relationships had greatly improved. From observations made during the inspection, good practice was seen as follows: the manager asked a resident whether he wanted pain relief tablets; residents were able to understand what the staff on duty were saying; the staff clearly understood the residents needs and demonstrated this to the inspector; residents looked clean and well cared for. Three residents said they were happier living at the home since the new owner had taken over. Medication policies and procedures were in place and these were being followed. One resident was self-medicating and whilst there was a risk assessment in place, it had not been reviewed and updated since June 2005. The manager said this was because his needs had not changed and this was confirmed by speaking to the resident. Even where needs are unchanged, the risk assessment review should reflect this and indicate no changes needed. All medicines were stored both safely and orderly. A locked cupboard was provided and the locked trolley was kept in there when not in use. Controlled drugs were held in a locked cabinet in the office. A drugs fridge was provided, the owner said the temperature was monitored but a record was not kept. Handwritten entries were made on one of the medication sheets that was checked but it had not been signed and countersigned in order to ensure no mistakes had been made. Administration records were completed in full and codes used appropriately. GPs had previously been asked to review medication and there was evidence they had done so. Arrangements for the administration of controlled drugs were seen to be satisfactory. A safe system for the return of medication had been introduced and unused medication was being promptly returned to the pharmacy. As part of a quality audit, the manager had requested the supplying pharmacist visit the home to undertake a stock check and comment on the system. This had been done, the week before this inspection but the report had not been received. She said there had not been any major areas of concern identified. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 15 With the exception of the owner, who was a nurse, all staff responsible for the administration of medication had undertaken medication training. The new manager, whilst having already done this training, was undertaking a further distance learning course to ensure she kept herself updated. Staff were observed speaking to residents in a way which upheld their dignity and showed respect. The two staff spoken to were clearly enjoying their work and committed to caring well for the residents. Six of the residents spoken with were happy with the staff’s attitude. One person did however, comment about the attitude of the night staff but would not state exactly what the problems were. One of the returned questionnaires also recorded “I do not care for the night staff but on the whole, the care given is very good”. Given this feedback, the manager should undertake an internal investigation with the resident group to ascertain what the problems are and then address them within supervision. Should the investigation highlight concerns then the manager should follow the Vulnerable Adult Procedure. Residents and staff considered privacy needs were upheld and staff were able to give some examples from their practice. Observations were also noted of staff closing curtains before assisting a resident on a commode, closing doors and knocking before entering. Since the last inspection, some residents had had a lock fitted on their bedroom door. The manager said all residents would be asked about having locks fitted and if they refused, that this would be recorded on their files. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 : Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and food although activities were still in need of improvement. EVIDENCE: An activity co-ordinator was employed who worked at the home for 11 hours per week. However, on this inspection, she was away on leave and would not be returning for approximately 3 weeks and she had similarly been on holiday at the last random visit. The manager said the staff filled in during her absence. On the day of inspection, a sing-along had been planned and was displayed on the activity board but this did not take place. The staff member who should have done this activity was said to be feeling unwell and was planning to do it the following day. The activity board highlighted the activities for January, which included hand massages, board games, DVD films, mini darts tournament, bingo, stretching exercises and manicures. The owner had purchased a new DVD recorder and music centre so that residents could enjoy films and music. As part of the care planning process, the manager should find out what activities the residents would like to take part in, whether on an individual or group basis. Feedback Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 17 from residents indicated activities had improved since the change of ownership although two said the activity worker seemed to be away on holiday a lot. Of the 4 comment cards that were returned, 3 said activities were always offered and 1 said they sometimes took place. Approximately half of the residents spent much of the day in their rooms. Those spoken to said they would welcome more time being spent with them by the staff. Activity sheets kept in their files, showed that staff did spend some time chatting to them on a one to one basis, but again, not all these records had been kept up to date and a full picture could not be obtained. One care assistant described how she spent time reading the newspaper with one resident and reading out horoscopes to others. A reminiscence box was kept in the manager’s office but feedback from the residents indicated they could not remember it being used. The manager said she would be using this herself whilst the activity worker was away. Whilst the activity programme for January had included a walk into Milnrow, this had not been possible due to the bad weather. The manager did however, say that when the weather improved, she planned to include outings to the local shops as the home was well situated for this to happen. Everyone had really enjoyed the Christmas party when a singer had entertained them and a local church had also visited over the Christmas period. Feedback from residents indicated satisfaction in respect of their religious needs being met. Three residents had regular visitors from the church and a lay preacher and priest also visited on a less frequent basis. Relatives returning questionnaires all considered they were welcomed into the home and could visit the person they wished to see in private. The two visitors spoken to also confirmed this, with one saying he was always offered a drink and had been offered a plateful of fruit that day, by the staff, when they were handing it round to the residents. The choices residents made each day varied, dependent upon their mental frailty but residents who were able, generally chose what time to get up, go to bed, what clothes to wear, where to spend their day and whether or not to participate in activities. They were also able to choose what to eat and where to eat it. There was evidence of each of these choices being made on the day of inspection. Information in the form of leaflets regarding a national advocacy scheme was available in the reception hall. Four week menus were in place, which provided a balanced and nutritious diet. Of 4 residents returning questionnaires, 3 said they always liked their meals and 1 said they usually did. All the residents spoken to felt the quality of food had improved since the new owner had taken over. Specific comments included, “there’s always a choice”, another said, “the week-end cook is really good at making stews” and another said, “Overall, you can’t complain about the food”. The cook and manager were reviewing the menus to make them more varied and to respond to residents’ requests. One person had asked for tripe to be offered occasionally at tea-time. Sausages and fish cakes were Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 18 being served fairly frequently and the manager was looking at offering other dishes and making sure that a Sunday roast was always on the menu. A resident meeting had been arranged for the week following the inspection and the manager said that she would encourage the residents to say what new foods they would like to see on the menus before they were finalised. She had previously attended a session with the dietician and was mindful of her input when adjusting the menus. During the inspection, the cook went round to each resident to find out what meal choices they wanted for both lunch and tea. Food served during the inspection was well cooked and looked, smelt and tasted appetising. Portions varied dependent upon each person’s appetite. The lunch choice was cheese and onion quiche with boiled potatoes and baked beans or cottage pie with carrots, mushrooms and cabbage. Fruit crumble or ice cream were offered as the dessert. One resident was assisted with her meals and others were gently encouraged. Those residents who wished to eat in their rooms were able to do so. Food was taken to bedrooms on trays with covers being put over the meal. Before one resident received her meal, the cook placed it in the microwave for a couple of minutes saying “this person likes piping hot food so I make sure its hot before staff serve it to her”. Jugs of juice or water were provided in lounges and residents rooms, and residents and staff said the cook cut up and served fruit in the afternoon each day. This was seen during the inspection when a varied selection of sliced apples, bananas, grapes and melon was handed around. Suitable provision was made for those needing special diets i.e. diabetic and soft diets. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a satisfactory complaints system with some evidence that residents felt their views were listened to and acted upon but not all staff had received training in what to do to make sure residents were protected from harm. EVIDENCE: The home had a complaints procedure, which was displayed within the home. As the updated service user guide was currently at the printers, the manager had copied the complaints procedure and put one in every bedroom to make sure that residents were clear about what to do if they needed to complain. Three of the four returned resident questionnaires identified they knew how to make a complaint and 1 said they usually did. All 4 knew who to speak to if they were not happy about anything and 3 said that staff listened and acted on what they said. One person said this happened sometimes, but it depended on the member of staff. Residents spoken to during the inspection said they would feel able to complain to the owner if needed and that they felt any problems would be dealt with. The CSCI had received no complaints about the home since the last inspection. A complaints log book was in place although very few entries were evident. It was stressed to the manager that she should take all concerns seriously, log them and ensure action taken to resolve them was clearly recorded. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 20 A procedure for reporting and responding to allegations of abuse was available as was the Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure. Since the last inspection, both the provider and the deputy had attended POVA training provided by Rochdale Social Services Department. Not all staff had done POVA training but the manager was mindful of this and was waiting for the new training programme so that she could book staff on to the relevant course. Staff spoken with understood the importance of reporting malpractice and said they would either speak to the owner or the manager. The manager was advised to reinforce protection and whistle blowing procedures at staff meetings until all staff had received the appropriate training. Recruitment practice had improved since the last inspection, with all staff now having had a Criminal Record Bureau Check or as a minimum a POVA first check before starting employment at the home. One care assistant was working with another worker until her full CRB check had been returned. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean, hygienic and maintenance issues were continuing to be addressed so residents felt comfortable in their surroundings. EVIDENCE: At the last inspection, a requirement was made for the home owner to submit an updated maintenance and renewal plan, as there were areas in the home in need of upgrading. This had been complied with and the timescales had so far been adhered to. The entrance hall had been re-decorated and a carpet had been fitted, as he had identified the tiles previously in the hallway could become slippery and present a health and safety hazard to residents. The carpet had been continued up the stairs on to both first and second floor levels of the home. New carpets had been fitted in bedrooms 1 and 24 and the carpet for bedroom 5 was awaiting fitting. Room 24 together with the staff room and main office had been redecorated. It was stressed to both the owner and manager that they must continue to adhere to the timescales submitted in the maintenance plan. One resident had refused to have their bedroom decorated Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 22 and did not wish to move to another room whilst the work was being carried out. The inspector spoke to this resident who confirmed this was so. The work had been re-scheduled on the maintenance plan for spring. Sufficient aids and adaptations were provided in the home to ensure residents could move about freely and retain their independence. All areas of the home were clean and there were no unpleasant smells around the building. In order to try and cut down on the spread of infection, there was alcohol based hand wash available and the toilets and bathrooms contained liquid soap and paper towels. Staff wore different coloured protective disposable aprons for assisting with personal care and at meal times. The laundry, which was in the basement, was clean and tidy and the door leading to this area was kept locked. The domestic clearly took pride in her work and she is to be complimented on her achievement. She also knew all the residents well and spent time chatting to them as she was going about her work. She clearly had very good relationships with them. She was well supported by the owner and the deputy who did some additional cleaning to make sure the home remained fresh and clean when she was not at work. The gas boiler had been serviced but for some reason the engineer had not serviced the cooker. The home had now addressed this and the cooker was to be serviced within the next few days. Since the last inspection, the other outstanding work e.g. testing for legionella and servicing of the thermostatic mixing valves had been done. The report identified problems with hot water in two of the rooms. The inspector tested the hot water temperatures in both rooms and found the water coming from the hand wash basins was only tepid. The owner must now take steps to ensure that all hot water outlets are of the correct temperature so that residents can have hot water in which to wash. All requirements made at the last Greater Manchester Fire Inspection had been done. However, from checking the fire book, it was noted that not all staff had received fire training and the owner said he would arrange this. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment and selection procedures had improved but not all staff had yet received all the health and safety training they needed in order to ensure residents were cared for safely at all times. EVIDENCE: From checking the staff rotas, it was identified there were sufficient staff on duty, both during the day and at night, to meet the needs of the 13 residents currently living at the home. Since the last inspection, a new manager had been appointed and the owner, who had a nursing qualification, was now working on the floor as a carer. Whilst only 1 domestic was employed, the owner and deputy also spent time cleaning to ensure a good standard of cleanliness was maintained when the domestic was not working. A laundry assistant was also employed for 20 hours a week, which included weekends. Agency staff were no longer used at the home which ensured that residents were cared for by a consistent group of carers who had built up relationships with them and were more familiar with their wishes. Since the change of ownership, there had been some turnover of staff. This now appeared to have stabilised and there was a multi-cultural staff team in place. From speaking to staff, it was established they felt the team worked well together. From observing their interaction with the residents, it was noted they could communicate well and were conversant with each persons needs. The residents spoken to also said they were satisfied with the care they were receiving, although as previously stated one resident and feedback from one Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 24 questionnaire did comment about attitude of night staff, which the manager should follow up. The staff spoken to confirmed that a key worker system was in place and described their role as making sure the needs of their residents were met. They gave examples of doing errands, making sure their residents did not run out of toiletries and checking that all personal care needs were being met. They did not however, see their role as spending time getting to know more about their residents so that this information could be included in the care planning process. When undertaking staff supervision, the role of key worker should be discussed in order to expand the key worker role. This role could be further extended to enabling key workers to sit in at review and planning meetings so they can make contributions about their residents’ care needs. Inspection of 3 staff files showed that the home’s recruitment and selection procedures and the Care Homes Regulations 2001 were now being followed with CRB and Pova First checks having been carried out for all staff. However, retrospective references were still not in place. The manager had been responsible for employing one carer and all the appropriate paperwork was in order. Other improvements seen, on the files, which were checked included, the issuing of contracts of employment, photographs for identity purposes and the recording of dates when employment had commenced. Job descriptions were also now being given out to new staff. The new manager’s file was checked and seen to contain a full CRB check, two references, an application form and some details of training. However, original training certificates were not evidenced and this was discussed. The manager should ensure that all her original training certificates are obtained from her previous employer, as they will be required when she attends for her interview at the Commission for Social Care Inspection. Skills for Care induction training had recently been introduced for new employees. The most recently recruited care assistant was in the process of undertaking this training. It was stressed to the manager that she should implement this training for all the new staff who had not done NVQ training and for those who had done the training, she should address the units which relate to the practices and policies of the home. Of the 10 carers employed, 4 had completed NVQ level 2 training and one had successfully completed her NVQ 3. The deputy manager was undertaking her Registered Managers Award and 3 care assistants were in the process of doing their NVQ level 2. On the day of inspection, the manager received a phone call about the possibility of funding for more staff and she was pursuing this. It was difficult to establish exactly what training staff had done, due to no training matrix being in place. However, from checking 7 staff files, it was evidenced that many of the staff had not done all relevant health and safety Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 25 training such as moving and handling, first aid, food hygiene, fire and infection control. The manager had however, already partly addressed this shortfall and showed the inspector confirmation of training courses that had been booked. 6 places had been arranged for first aid and 4 places for moving and handling training. Both cooks had undertaken food hygiene training and one had done infection control. The staff who had worked at the home for a while had done all the relevant training but in some instances, were now in need of refresher training. The manager said she was awaiting the Rochdale MBC training department issuing the new programme for 2007 when she would ensure that all staff were booked on the necessary courses. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were now benefiting from living at a better run home, with the manager taking steps to promote and safeguard their health, safety and welfare. EVIDENCE: A new manager had been recruited and had started work In November 2006. The owner of the home had recruited her on a trial basis and had not yet submitted an application for her to be registered with the Commission for Social Care Inspection. Given the home had been without a manager for over 9 months, the owner was advised to submit an application without further delay. The new manager had several years of experience in managing a care home and had, in 2006, started the Registered Managers Award (RMA). However, due to personal reasons this had not been completed. She was now arranging to start this course again, from the beginning and expected this to Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 27 be very soon. She had undertaken all the required mandatory training and other additional training but original training certificates were not in place. As stated in the staffing section above, these should be obtained. It was evident that since her appointment in November 2006, the manager had started to work towards putting right, some of the poor practice that had been evidenced at the last two inspections. Due to the large number of areas needing to be improved, she had prioritised areas in relation to the health and safety of residents and still had outstanding things that she had not yet had time to address. Progress had been made in servicing of equipment, arranging staff training, implementing the Skills for Care induction training, reviewing of the medication, ensuring all fire requirements were implemented, making sure the homes policy and procedures on staff recruitment were followed and holding both staff and residents meetings. Areas currently being addressed were the reviewing and updating of care plans and risk assessments, introduction of staff supervision and ensuring the maintenance programme timescales were being adhered to. Residents knew who the manager was and said they would go to her or the owner if there was a matter they needed addressing. Residents described the manager as “friendly”, “fine” and one person said “she sometimes has a chat with us”. Positive comments about the owner were also made with one resident saying “the home has improved 100 since he took over” and another commenting on the amount of time he was spending in the home. Staff considered the manager to be open and approachable and felt she had already made changes within the home that benefited the residents and themselves. One staff said, “the manager is very organised and wants things doing properly”. Quality assurance systems had improved since the last inspection. Of the 18 requirements made at the last key inspection on 11 July 2006, 15 had been met. Those which had not were currently being addressed i.e. the care planning format was presently being reviewed and all care plans and risk assessments were to be re-written, in consultation with the residents and or their relatives and a manager had been appointed although not yet registered with the Commission for Social Care Inspection. Residents were now being circulated with satisfaction questionnaires and the manager said feedback about the home and the service was also established at residents meetings. Another resident meeting had been arranged for the week after the inspection. Questionnaires should be extended to other interested parties i.e. relatives, staff, care managers etc and their views used as contributions to the annual development plan. A key worker system was now in place and some recommendations in respect of this have been made in the staffing section above. More staff meetings were taking place and minutes of the meeting held on 30 November 2006 were seen. At this meeting job descriptions had been given out, the manager had reinforced the importance of making accurate daily recordings about each persons care, including the use of fluid and intake Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 28 charts. Confidentiality was also discussed. Another staff meeting was due to be held the day following the inspection and a notice was displayed in the home about the meeting. Other quality assurance measures that will shortly be taking place were to include resident and/or relative consultation regarding care plans and regular formal staff supervision and appraisal. The rota for the week of the inspection recorded the manager had arranged first supervision sessions with two of the night staff and two day care assistants. She acknowledged staff supervision and appraisals were only just being started but intended to get around the whole staff team over the next month. Progress with these areas will be assessed at the next inspection. On the day of inspection, telephone engineers visited the home to look at what work had to be done in order to install Broadband. The owner had agreed to purchase a new computer and fax so that both he and the manager would be able to keep up to date with the changes in social care and be able to communicate more effectively with the Commission for Social Care Inspection and other parties. All residents spoken with were happy with the arrangements regarding personal monies. The registered provider did not act as appointee for any residents. Three residents had a solicitor acting for them and one person had an Age Concern advocate who visited regularly. Where the home had involvement with residents’ monies, appropriate records and receipts were held. When checking the money held for 3 residents, the amounts were all slightly in excess of what should have been in place and may have been because of staff rounding up amounts. The manager said she would check all the accounts to make sure the right balances were in place. Information recorded on the pre-inspection questionnaire indicated that all the required policies were now in place. The majority of maintenance inspections were undertaken as required. The small electrical appliances were in need of checking and the provider had purchased a tester so that he could undertake this work himself. He had already started the testing of the equipment in the basement. The only other outstanding issue was the servicing of the gas cooker, which had been arranged. All the requirements made by the GMC Fire Department had been met. Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 29 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 Requirement Accurate, up to date and regularly reviewed care plans must be written and agreed with each resident and/or their relative and read by carers to ensure their understanding of each person’s needs and how best they should be met. (Previous timescales of 30/09/06 and 31/01/07 not met). Timescale for action 28/02/07 2. OP8 13 Accurate, up to date and 28/02/07 regularly reviewed risk assessments and management strategies must be written and agreed with residents and/or their relatives and read by carers to ensure their understanding and implementation of the strategy. (Previous timescales of 30/09/06 and 30/11/06 not met). All staff must receive vulnerable adult training in order they have the knowledge to prevent residents being harmed or suffering abuse (previously DS0000066311.V306093.R01.S.doc 3. OP18 13(6) 31/03/07 Brooklands Care Home Version 5.2 Page 31 4. OP19 23 5. OP19 23(2)(j) 6. 7. 8. OP19 OP29 OP30 23(2)(c) 19(1)(b) 18(1)©(i) 9. 10. OP30 OP31 13(5) 8 timescale of 30/09/06 not met. The maintenance programme must be adhered to within the stipulated timescales in order to ensure the home is a comfortable place for residents to live in. Residents in the two rooms, identified on a recent plumbing report as needing new thermostatic mixer valves must have access to sufficiently warm water in which to be able to wash. When the gas cooker has been serviced a copy of the invoice must be sent to the CSCI office. A minimum of 2 written references must be obtained for all past employees. Staff must take all the mandatory health and safety training such as food hygiene, infection control, fire etc. so they are able to do their jobs and care for residents safely. All staff must receive moving/handling training so they are able to do their jobs safely. The service must employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection (Previous timescale of 31/10/06 not met.) 30/06/07 28/02/07 28/02/07 31/03/07 31/05/07 31/03/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 32 1. 2. 3. 4. 5. 6. 7. OP2 OP7 OP8 OP9 OP9 OP10 OP12 Terms and conditions of residence for the 3 residents with an advocate should be chased up and copies held on the individuals’ files. Residents’ daily personal care sheets should be kept up to date. All residents should be assessed using the MUST tool. A record should be kept of the drug refrigerator temperature. Handwritten entries should be checked, signed and countersigned. The manager should undertake an investigation into the allegations about the attitude of night staff. The owner should clearly establish the role of the activities co-ordinator and that of care staff and encourage the activities co-ordinator to offer a more suitable and varied activities programme including trips within the local area. Activity sheets should be completed by all staff, when any one to one or group activities have been done. All complaints, however small, should be logged and record what action has been taken to address them. Safety locks should be fitted to bedroom doors and each person given a key to their door and lockable space on admission unless risk assessment indicates otherwise. Key workers should be encouraged to spend more time with their residents in order to build up more knowledge and awareness of their needs so they can become more involved in the care planning process. All recently recruited staff should undertake Skills for Care Training. A training matrix should be formulated so that the manager will know, at a glance, which staff still require mandatory and refresher training. Original certificates of the manager’s training and qualifications should be held on file. 8. 9. 10. OP12 OP16 OP24 11. OP27 12. 13. 14. OP30 OP30 OP31 Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brooklands Care Home DS0000066311.V306093.R01.S.doc Version 5.2 Page 34 - 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. 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