Care Home: Brackley Fields Country House

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What the care home does well What has improved since the last inspection? The incidence of pressure sores, their treatment and outcome is recorded in the service users care plan and reviewed on a continual basis. Peoples needs in relation to moving and handling are assessed and recorded in their care plan. Staff sign the medication administration record when they administer medication. When people move to the home, following their `trial period` a review is held with the service user and/or their representative to decide whether the home is right for them. Weight recording charts were available for the people case tracked. What the care home could do better: The home must ensure that all medication, including any controlled drugs can be stored safely and in line with current requirements. Care plans should contain sufficient detail to ensure that care staff are aware of how to meet all aspects of the persons health, personal and social care needs. Where people have input from district nurses or other professionals in relation to pressure area care this should be recorded in their care plan. A separate record should be kept for each person detailing any health checks, medication reviews or appointments with other health care professionals to ensure that people are having the appropriate medical, dental, chiropody and other health appointments.When people have prescribed creams these should be dated when opened to ensure that they are used before their three month expiry date. CARE HOMES FOR OLDER PEOPLE Brackley Fields Country House Halse Road Brackley Northants NN13 6EA Lead Inspector Catherine Perrins Unannounced Inspection 21st January 2009 09:30 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 Brackley Fields Country House DS0000012716.V373977.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. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brackley Fields Country House Address Halse Road Brackley Northants NN13 6EA 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) 01280 704575 01280 704614 bfields@brackley32.fsnet.co.uk Lt Col John Richard McLennan Rayner Mrs Judith Rayner Lt Col John Richard McLennan Rayner Care Home 34 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (34) of places Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only: Care Home - PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Older Persons - Code OP Dementia - Code DE The maximum number of persons to be accommodated in the category Dementia (DE) is 5. The maximum number of persons to be accommodated in the home is: 34 5th March 2007 2. Date of last inspection Brief Description of the Service: Brackley Fields Country House is situated in a rural location on the edge of Brackley town. It stands in it’s own enclosed grounds set back from the road, with private car parking. Accommodation is in single or double rooms, either in the original house, single storey extension or new purpose built wing. This new wing was completed in November 2007 and increased the number of bedrooms from 24 to 34. There are currently four lounges, two conservatories, a library and a dining room. The home is owned and managed by Lt Col John Richard McLennan Rayner. Current fees range from £460.00 to £530.00 per week. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection which means that we focussed on the ‘key’ national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. As part of the preparation for this inspection a period of two hours was spent reviewing previous inspection reports the other information that CSCI has received about this service. The inspection visit lasted six hours during the morning and afternoon of a weekday. During the inspection three people were ‘case tracked’. This involves looking in detail at all aspects of their care and experiences at Brackley Fields Country House, including looking as their individual plans of care and other records, talking to them and talking to their care staff. A sample of staff files were also viewed as part of the inspection. The Registered Manager was present during the inspection. What the service does well: The home’s admission process is well managed to ensure that people are given good information and their needs are fully assessed. This ensures that people can be confident that they are making the right move. Individual plans of care are clearly presented and staff members signed them to show that they had read and understood all of the information. People told us that they enjoyed living at Brackley Fields. Comments included “I am very happy here.” “It’s a very good home.” “It’s lovely here.” The home offers people a very comprehensive range of activities. There are lots of examples of peoples artwork displayed around the home such as a woven wall hanging, framed pictures and floral displays – all look very attractive. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 6 One person said “Cook ought to be congratulated on food they serve. A good varied choice” People can move around the home as they wish and have a choice of lounges and communal areas as well as their bedrooms to spend their time in. This gives people the opportunity to spend time with others or to enjoy some peace and quiet. Staff turnover is low which helps to ensure that people can build a good relationship with the staff and receive consistent care. What has improved since the last inspection? What they could do better: The home must ensure that all medication, including any controlled drugs can be stored safely and in line with current requirements. Care plans should contain sufficient detail to ensure that care staff are aware of how to meet all aspects of the persons health, personal and social care needs. Where people have input from district nurses or other professionals in relation to pressure area care this should be recorded in their care plan. A separate record should be kept for each person detailing any health checks, medication reviews or appointments with other health care professionals to ensure that people are having the appropriate medical, dental, chiropody and other health appointments. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 7 When people have prescribed creams these should be dated when opened to ensure that they are used before their three month expiry date. 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. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 8 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 Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 9 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): 1,2,4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given good information about the home and their needs are fully assessed prior to moving in to ensure that the home is right for them. EVIDENCE: Before anyone moves into Brackley Fields Country House their needs are fully assessed to ensure that the home can meet their needs and preferences. The home has a brochure, comprehensive statement of purpose and service user guide which give people good information about what it is like to live at Brackley Fields Country House. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 10 When people first move in they have a four week trial period which allows everyone to be confident that the home is right for them. At the end of the four weeks people can decide if they would like to stay. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are generally well met although records would benefit from some more detail in places. EVIDENCE: Everyone who lives at Brackley Fields Country House has an individual plan of care. The registered manager explained that the home is currently in the process of putting a lot of the care home records, including individual plans of care on to a computerised record system. Paper care plans and daily notes will still be used as well to make sure that staff have access to all of the information that they need to care for people in the right way. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 12 Individual plans of care generally contain good information about people’s needs and preferences and include a general health assessment; mobility care plan; personal care care plan; eating and drinking care plan, continence care plan, communication needs care plan, medication care plan; and details of peoples emotional needs; religious needs; hobbies and last wishes. Details of people’s pressure area assessment and care plan are detailed in their general health assessment although this would benefit from some more information such as details of district nurse involvement. A district nurse spoken to during the inspection confirmed that she is happy with how home care for pressure areas. One person’s individual plan of care assessed them as needing assistance with walking because they are at risk of falling, however it did not how this assistance should be given. Individual plans of care are clearly presented and staff members signed them to show that they had read and understood all of the information. It is important for staff to know what is in each persons care plan to ensure that people are cared for in the right way. Details of people’s appointments with health and social care professionals such as general practitioners, district nurses, podiatrists, opticians and dentists are recorded in people’s daily notes, high lighted in red. No separate record is currently made of such appointments which can make it difficult to see whether people have had all of the necessary health checks. The administration of medication is generally well managed. All entries on the medication administration record were signed appropriately and a spot check on the actual medication showed all tablets to be accounted for. The home needs to ensure that prescribed creams are dated when opened to ensure that they are used within the three month expiry date from opening. Controlled drugs are prescribed medicines which some people abuse them by taking them when they have not been prescribed. There are laws and regulations about how these drugs should be stored and administered. No-one at the home is currently prescribed any controlled drugs but the home do need to review their medication storage facility to ensure that they are able to store controlled drugs safely should anyone be prescribed them in the future and to ensure compliance with the latest requirements of the 2007 amendment to the Misuse of Drugs (Safe Custody) Regulations. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 13 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 excellent. This judgement has been made using available evidence including a visit to this service. People enjoy a good quality of life and benefit from a comprehensive choice of activities. EVIDENCE: People told us that they enjoyed living at Brackley Fields. Comments included “I am very happy here.” “It’s a very good home.” “It’s lovely here.” The home employs an activities co-ordinator who works in both the mornings and afternoons during the week. People have a good variety of activities to chose from. A knitting group meets once a week following a suggestion from a resident, people tell us that this is a very popular and social group. A exercise group meets once a fortnight. Quizzes, word games, scrabble, card making, memory lane bingo, reminiscence, carpet bowls, quoits are also available. A creative writing group meetings and have produced a thought provoking poem Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 14 about Autumn. There is a Christian fellowship group and the local vicar holds communion once a month. An organist comes in once a month to do a singalong. A local artist comes in twice a month, there are lots of examples of peoples artwork displayed around the home such as a woven wall hanging, framed pictures and floral displays – all look very attractive. Professional entertainers are also arranged occasionally. A plan of the activities available is displayed on notice board in hall so that people can see what is on offer when. A canal boat trip is arranged each year in May on a canal boat that has full disabled access. People told us that the food was good. One person said that they had “never had a bad meal here.” Another person stated in a customer satisfaction survey sent out by the home “Cook ought to be congratulated on food they serve. A good varied choice” Lunch on the day of inspection was roast chicken with roast potatoes and fresh vegetables followed by ice cream. The cook told that she prepares all the food from scratch. There is a list of people’s likes and dislikes in the kitchen and the cook explained that she can provide alternatives if someone does not like what is on the menu. People can move around the home as they wish and have a choice of lounges and communal areas as well as their bedrooms to spend their time in. This gives people the opportunity to spend time with others or to enjoy some peace and quiet. People are able to bring their pets when they move to the home by prior arrangement with the manager. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People are encouraged to voice their opinions and are protected by the home’s policies, procedures and practices. EVIDENCE: The home has a complaints procedure and comments book which is left in the entrance hall to make it available to the people who live at the home and to their visitors. The home has received one complaint since the last inspection which was dealt with by the home to the satisfaction of all concerned. People spoken to were aware of how to raise any concerns that they may have. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. People have a comfortable, spacious and homely place to live. EVIDENCE: Brackley Fields Country House comprises of the original period farmhouse, a newer adjoining converted bungalow and a newly purpose built extension. The bedrooms vary in size and style depending on whether they are in the old house, bungalow or new wing, all have an en suite W.C. and wash basin. Some of the bedrooms in the new wing are fully accessible for people in wheelchairs. All of the bedrooms seen had been personalised with pictures, photographs and ornaments. Some people also bring in their own furniture. All rooms have Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 17 a telephone point. There is one twin bedded room which is currently occupied by a married couple another twin bedded room viewed had a curtain to maintain each persons privacy. There is a range of communal areas consisting of a dining room, four lounges, a library and two conservatories. All were comfortable and homely with pictures, ornaments and books adding a personal touch. The home is surrounded by level and secure grounds which people can enjoy in the warm weather. There are several bathrooms some with adaptations to help people with restricted mobility. The home appeared well maintained and clean throughout. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 18 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): 27,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are cared for by a consistent and competent staff team. EVIDENCE: The registered manager explained that there are four care staff on each shift during the day. Additional staff are employed to do the cleaning and laundry. Records show that the recruitment process is well managed with all the necessary pre-recruitment checks being completed to ensure that staff are suitable to work with older people. Staff turnover is low which helps to ensure that people can build a good relationship with the staff and receive consistent care. The home does not use any agency staff and cover for any staff sickness or holiday within the staff team. New staff have a three day induction where they spend time with the manager and shadowing experienced colleagues. This is followed by a programme of Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 19 training including health and safety, moving and handling, dementia, fire safety, medication and health and hygiene. One member of staff explained that “We try very hard to get it right.” Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 20 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): 33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of the people who live there. EVIDENCE: The home gives the people who live there chance to complete a satisfaction survey every six months. The results of the last two surveys were viewed and were generally very positive. One person commented “It’s the nicest home I could ever have found, it is wonderful.” Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 21 Staff tell us that they “ never get negative feedback from visitors, they like friendly atmosphere.” The registered manager explained that he works at the home most days and oversees the business aspects of the home. The deputy manager oversees the day to day running of the home. Records show that the health and safety of people at the home is safeguarded by risk assessments, fire checks and the provision of radiator covers and restrictors on the temperature of the hot water from the bath taps to ensure no one is burned or scalded. The lift and specialist equipment such as bath lifts are serviced regularly in line with manufacturers guidelines. Staff describe the manager and deputy as “very friendly.” Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 22 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 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X 2 3 Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The home must ensure that all medication, including controlled drugs, can be stored safely and in line with current guidelines and legislation. Timescale for action 01/05/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations Care plans should contain sufficient detail to ensure that care staff are aware of how to meet all aspects of the persons health, personal and social care needs. Care plans relating to pressure area care should include details of the involvement of other professionals such as district nurses to show that people’s needs in relation to pressure area care are being met. A separate record should be kept for each person detailing any health checks, medication reviews or appointments with other health care professionals to ensure that people are having the appropriate medical, dental, chiropody and other health appointments. All prescribed creams should be dated when opened to DS0000012716.V373977.R01.S.doc Version 5.2 Page 24 3. OP8 4. OP9 Brackley Fields Country House 5. OP18 6. OP33 ensure that they are used before their three month expiry date. All staff should receive training in the safeguarding of adults to ensure that they are aware of their responsibilities under the local multi agency safeguarding adults procedures. The home should seek feedback from relatives and involved professionals such as general practitioners to give a further perspective on how well the home is meeting the needs and preferences of the people who live there. Brackley Fields Country House DS0000012716.V373977.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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