Care Home: Brockhurst

What the care home does well People who use the service are provided with information about the care home that will enable them to make a choice about living at the home. Residents are provided with opportunities to improve their lifestyle, and where possible they are able to maintain contact with family. Special dietary needs are catered for and meals are varied, take into account individual choices, and residents receive an appealing and balanced diet. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected from harm through the home`s provision of staff training and policies and procedures in regard to Safeguarding Adults. People who use the service live in a clean, pleasant, safe and well maintained environment. Recruitment procedures and practices ensure people who use the service are protected. What has improved since the last inspection? All Controlled Drugs are now stored at all times in a Controlled Drugs cupboard that meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. A robust system has been put in place so that the medicines that have been prescribed for people are available in the home and are given to them. What the care home could do better: The pre-admission assessments should be maintained in the care files so that cross referencing can be undertaken to ensure that the care plans have been produced from these assessments. Service user plans should include information in regard to their religion, ethnicity and medical needs. The service user plan must be reviewed on a monthly basis and any information in regard to the identified changes of need must be recorded in it. Risk assessments identifying a risk must be reviewed on a regular basis. If there is not an identified risk in a certain area then this must be recorded as opposed to leaving blank risk assessment documentation in the care plans. Hand written Medication Administration Record sheets should be signed by two members of staff to minimise the risk of errors being made. It is strongly recommended that the Controlled Drug register should be signed by two people when a Controlled Drug has been administered to residents. An annual survey must be undertaken to ascertain the views of residents, their families and other stakeholders of how the home is achieving good outcomes for residents. Evidence of training undertaken by care staff must be maintained, and available for inspection purposes. The identified member of staff must receive updated mandatory training. Key inspection report Care homes for older people Name: Address: Brockhurst Brox Road Ottershaw Surrey KT16 0HQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joseph Croft     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brockhurst Brox Road Ottershaw Surrey KT16 0HQ 01932872635 01932872862 tina.davis@surreycc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Surrey County Council - Adults & Community Care The registered provider is responsible for running the service care home 46 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 46 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Brockhurst provides care and accommodation for older people over the age of 65. It was purpose built in the 1970s and is owned and managed by Surrey County Council. It is located in Ottershaw, near Addlestone, in a quiet residential area, close to local Care Homes for Older People Page 4 of 32 Over 65 0 46 46 0 Brief description of the care home amenities. Accommodation is arranged in seven units on two floors, all rooms being single. Each unit has its own bathroom and toilet facilities, a kitchenette, and a communal lounge/dining area. The reception area, main kitchen and laundry are on the ground floor and there are offices on both floors. There is a lift and stairs to the first floor. The weekly fees are six hundred and two pounds. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is One star. This means the people who use this service experience adequate quality outcomes. The Care Quality Commission (CQC) (us, we) undertook an unannounced site visit to the service on the 11th June 2009 using the Inspecting for Better Lives (IBL) process. The site visit took over seven hours, commencing at 10:00 and concluding at 17:50. The manager assisted throughout the site visit. The key standards for older people were assessed during the site visit. The inspection process included a tour of four residential units currently being used. The following were sampled during the site visit. The Statement of Purpose, Service User Guide, menu, medication records, care plans, risk assessments, records of health care appointments, staff recruitment and staff training files. Discussions took place with the manager, four members of staff and eight residents. Residents told us that they like living at the home, the activities they do and the food they eat. They were happy with their bedrooms and having their own belongings with them. They know how to make a complaint if they wish to. Residents spoken to told us that they Care Homes for Older People Page 6 of 32 have not had the need to make a complaint, but they would talk to staff or the manager if they needed to make a complaint. Residents stated that the staff are very good, helpful and always available for them. Staff were observed interacting with residents in an appropriate manner and calling them by their preferred names. Surveys were received from nine residents, four members of staff and two social care professionals. All surveys were complimentary about the care home and have been used as a source of evidence throughout this report. The manager returned the Annual Quality Assurance Assessment when we asked for it. This document contained the information we asked for and has also been used as a source of evidence in this report. The inspector would like to thank the manager, staff and residents for their cooperation during the site visit. The last key inspection for this service was undertaken on the 13th June 2007. Weekly fees for the care home are six hundred and two pounds. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with information about the care home that will enable them to make a choice about living at the home. The needs of prospective residents would be assessed before they are offered a placement at the home. Evidence: The home has a Statement of Purpose and Service User Guide which the manager told us had been reviewed in March 2009. Information provided in these documents included the aims and objectives of the care home, qualifications of care staff working at the home, meals, activities, specialist care, health care and the complaints procedure. There was no information in regard to the fees charged by the care home, however, the manager has included this in the document since the site visit. The home has a copy of the last key inspection report that is displayed in the entrance to the home. Care Homes for Older People Page 10 of 32 Evidence: Two of the nine surveys returned from residents informed that they received information about the home before they decided to move in. The other surveys informed that they could not remember. During discussions most residents told us that it seems a long time since they were admitted into the home and could not recollect the information they received. The manager told us that the home obtains an initial assessment from placing managers when they receive a referral. The manager would then either visit the prospective resident at their current placement to undertake an assessment of their needs, or do the assessment when the resident visits the home. Prospective residents are encouraged, as far as possible, to visit the home with their families prior to moving in. However, these pre-admission assessments could not be located in the files we sampled during the site visit, and a recommendation has been made that preadmission assessments should be maintained in the care files. The home offers intermediate care through their Step Down Bed for residents. The manager told us that there are two residents using this provision, which is to assess and support residents to move back into their own homes, or into an appropriate residential provision if required. These placements last up to six weeks, and care plans are provided by care managers. The service is supported by the Surrey Community Assessment Team, and have access to the Occupational Therapy and Physiotherapy teams. One survey received from a social care professional informs that Brockhurst had worked well with their team to support a resident using the Step Down Bed service, and worked well to achieve good outcomes for the resident concerned, enabling them to return to their home. The Annual Quality Assurance Assessment (AQAA) informs that the home has a Statement of Purpose and Service User Guide. Initial assessments are requested from placing care managers for prospective residents, and a representative from home will carry out a pre-admission assessment. The home now provides a Step Down Bed service for residents to be assessed and supported to move back into their homes or move into an appropriate residential care support setting if required. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have care plans and risk assessments in place, however, these require further information, and need to be regularly reviewed to ensure residents needs are being met. Residents have access to all health care professionals to ensure their health care needs are being monitored. The homes records of administration of medication require improving to minimise the risk of medication errors in the home. Evidence: Three care plans were viewed during the site visit. Each included a photograph of the resident, however, as stated previously in this report there were no copies of the initial assessment documentation. Information in the care plans included personal care, social interaction, interests and activities, food, sight, hearing, memory orientation, mobility and night time behaviours. There was no information in regard to the medication residents were taking. There was a specific section for medication in the care file, however, none of the three files viewed had any information in this section in regard to their medication, medication risk assessments if required, or information in regard to homely remedies. One file viewed did not include information Care Homes for Older People Page 12 of 32 Evidence: in regard to the residents religion or ethnicity. Of the three care files, one had been reviewed on a monthly basis, however, there were no written records when a change of need had been identified. The other two care plans had not been reviewed on a monthly basis, and again, when a change of need had been identified, there were no written notes providing the details of the changes. The care plans were cumbersome, and not easy to cross reference with the monthly reviews. Discussions took place with the registered manager in regard to the care plans, and requirements have been made that care plans must contain all the information as required, be reviewed every month and records of the change of needs must be maintained in the care plans. The manager told us that she would look into how to make the care plans more user friendly. The care plans viewed contained risk assessments pertaining to individual residents. Identified risks included mobility, continence, social behaviour, mobility and falls. Two files had Moving and Handling risk assessments, the third was blank, therefore it was not possible to ascertain if this was required. This was discussed with the manager, and a recommendation has been made that if there is not a risk in a certain area then this must be recorded as opposed to leaving blank risk assessment documentation in the care plans. It was also noted that for one resident their risk assessments had not been reviewed since February 2008, and not all risk assessments had been signed by the assessor. A requirement in regard to this has been made. From discussions with staff and residents, and from viewing records, it was clear that residents have access to all health care professionals as required. These include a General Practitioner, Dentist, Optician and Chiropodist. These records were maintained at the back of the care plans, and again it was cumbersome tracking through these sheets to evidence the medical appointments that had taken place. Records of weights were also being recorded for those residents who had an identified need in this area. Care plans also included fluid charts and body maps for those who required this monitoring. Of the surveys returned from residents, five informed that they always receive the medical support they require and four stated that they usually receive this. During discussions on the day of the site visit residents told us that they always see the GP and all other health care professionals as and when they require. They told us that the GP sees them in the privacy of their bedrooms. Staff follow the care homes Medication Policy and Procedure that was last reviewed in February 2009. No current resident is self medicating. Care Homes for Older People Page 13 of 32 Evidence: The home continues to use the blister packs and Medication Administration Record sheets (MARs) provided from the local pharmacist. The Commissions Pharmacist undertook a random inspection to inspect the medication procedures at the care home in September 2008. This was undertaken due to the amount of medication errors that were happening at the care home. At this visit, it was reported that medication was handled by trained staff who work to detailed written procedures. Clear records were kept of the medicines that are to be given and that have been given to people who use the service. Two requirements were made during the random inspection. Both these requirements have been complied with. The care home also had an inspection from the supplying Pharmacist on the 3rd June 2009. No issues were identified in the pharmacists report. The medication errors have since decreased, however, there has been one recent error that the manager has notified us about. The Medication Administration Record sheets (MARs) were sampled. All prescribed medication is checked in and signed by a senior member of staff, ensuring that all prescribed medication has been received at the home. This is in compliance with the requirement made during the random inspection of September 2008. It was noted that the handwritten MAR sheets for three residents had not been signed by two members of staff. A good practice recommendation has been made in regard to this. Some residents living at the home are taking a Controlled Drug (CD). The home has a locked metal medical cabinet that is fixed to a wall for the storage of Controlled Drugs. This was in compliance with a requirement made during the random inspection. The home maintains a CD register that is signed by two members of staff. However, it was noted that the administration of one CD had only been signed by one person. This omission was discussed with the Commissions pharmacist, and as a result of this, it is strongly recommended that the Controlled Drug register is signed by two people when a Controlled Drug has been administered. The AQAA informs that all staff are trained in appropriate medicine administration before they can administer medication. During discussions, the manager and staff told us that only staff who have received the appropriate training administer the medication. Six staff training records were sampled during this site visit. We could only evidence that three staff had received medication training, two of whom last did this training in 2005. Training in regard to medication was identified in a Regulation 26 visit undertaken at the home on the 20th February 2009, and records that medication training from a suitable trainer should take place for all staff administering medication every year. The manager told us all staff have in-house training, however, staff are now being provided with the three training modules from Lloyds pharmacy in regard to administering medication. Care Homes for Older People Page 14 of 32 Evidence: During discussions residents told us that staff treat them with respect at all times. They are able to make and receive telephone calls, and we were told that some residents have their own telephones. Residents receive their own mail. On the day of the site visit staff were observed knocking on bedroom doors, calling residents by their preferred names and attending to the personal care needs in private. One survey received from a social care professional informed that staff always respects the individuals privacy and dignity. Staff were observed to be wearing the appropriate protective clothing when attending to the personal care needs. The AQAA informs that residents have a network of health care support that includes the GP, Community Nurse who visits two to three times a week, Optician, Chiropodist and a visiting Dentist. Annual health checks and medical reviews are undertaken. All staff are trained in appropriate medicine administration before they can administer medication, however, we could not fully evidence this during the site visit. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are provided with opportunities to improve their lifestyle, and where possible they are able to maintain contact with family. Special dietary needs are catered for and meals are varied with individual choices ensuring that residents receive an appealing and balanced diet. Evidence: All three care files viewed had information in regard to residents activities and social relationships. Activities are recorded in the care plans. During discussions residents told us that there were enough activities to take part in that include walks, watching the television, quiz, reading, bingo, sing-a-long and going to the shops. External entertainers do visit the home. One resident told us that they do not join in the activities and this was their choice. Staff told us that activities took place in the afternoons. Surveys received from residents informed that there are usually or sometimes activities arranged by the home for them to take part in, and a survey returned from a social care professional informed that stimulation and activities are available during the week. Activities were discussed with the manager who told us that activities are discussed with residents during the resident meetings held on each unit. Evidence of the minutes of these meetings was viewed. The acting service manager told us that an activity coordinator is being recruited for the home, and their Care Homes for Older People Page 16 of 32 Evidence: remit will be to organise and publish activities for residents. There were photographs of the Christmas and New Year activities that took place at the care home. During the site visit residents were observed to be reading, talking with each other, watching television, walking on a one to one in the garden with a member of staff, and sitting in their bedrooms doing their own things. Residents told us that they make their own choices of what they want to do that include when to go to bed and when to get up in the morning. Residents and staff told us that there are no restrictions to visitors at the care home, and residents can see their visitors in the privacy of their bedrooms, and can go out with them. The home uses a four week menu that includes fresh meat, fish, pasta, rice, fresh and frozen vegetables and fresh fruit. The chef was not present at on the day of the site visit, however, discussions took place with the agency chef who has been working at the care home for many years. During discussions the chef told us that they do provide for special diets that include diabetics, and a list of these are maintained in the kitchen. There is always a choice of meal, and alternatives are provided when a resident does not like what is on the menu. Residents decide their choice of meal on the day before, and all residents complete surveys in regard to the meals they have taken. This helps the chef to know what residents prefer on the menus. We were also told that the kitchen is being upgraded, and the cooking utensils are to be replaced. During discussions all residents told us that they like the meals provided, and there is always a choice. One resident told us that sometimes they are provided with too much food, another told us that they would prefer less fish, but they do choose an alternative meal on the occasions that fish is on the menu. The home was awarded the Food Safety Award from the Environmental Health Office on the 24th February 2009 that will be reviewed in August 2010. Residents are able to eat their meals in the dining room on the individual units, or have them in their bedrooms. On the day of the site visit the meal in one of the units was observed. Residents were eating their meal in a relaxed atmosphere in the dining area with a member of staff available to offer support as and when required. During discussions residents told us that they did not practice their religion, but would be able to attend church if they wanted to, or could request a visit from a church representative. We were told that a representative from the local church used to visit regularly but they had since retired. These visits are now less frequent. Care Homes for Older People Page 17 of 32 Evidence: The AQAA informs that activities are drawn up from residents interest, there are regular activities in each unit and external entertainers visit the home. Families are encouraged to take part in events at the home and to have meals with their relative if they wish. There are no restrictions on visitors to the home. Meals are nutritionally balanced and take into account the individual dietary needs of residents. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a satisfactory complaints system that enables residents and their families to raise concerns. Residents are protected from harm through the homes provision of staff training and policies and procedures in regard to Safeguarding Adults. Evidence: The Commission has not received any concerns, complaints or allegations in regard to the care home since the last key inspection. The home has a Complaints procedure that was last reviewed in March 2009. This document includes the timescale for responding to complainants and the procedures to be followed. A copy of the complaints procedure is available in the entrance to the care home, and a copy is included in the Service User Guide. The manager told us that they have not received any complaints since the last key inspection. The home has a book for the recording of complaints. During discussions residents told us they would talk to staff or the manager if they wanted to make a complaint, and stated that they have never had the need to make a complaint. Some residents told us that staff at the home look after them very well, therefore they would never have the need to make a complaint. Six surveys received from residents informed that they do know how to make a complaint, three informed that they did not know. Care Homes for Older People Page 19 of 32 Evidence: All staff surveys informed that they know what to do if a concern was raised about the care home. Staff follow the homes Safeguarding Policy and the home has a copy of the recent local authority Safeguarding procedures. During the site visit we saw postcards with Safeguarding Alert information throughout the home that are easily accessible to staff, residents and visitors. Scenarios were discussed with the manager and four members of staff. All were knowledgeable of the different types of abuse and stated they would not hesitate in reporting bad practice. The manager was aware of the process for reporting all allegations of abuse to the local authority Safeguarding Team. The home has made two Safeguarding referrals during the last twelve months, one of which is currently ongoing. The viewing of six staff training files provided evidence that staff had received training in regard to the Protection of Vulnerable Adults in 2009, 2008 and 2007. One bank staff had last received this training in 2005. The manager told us that all staff are to attend refresher training this year. The AQAA informs that Surrey County Council has a clear and simple complaints procedure that all residents and visitors have access to. All staff are alerted to the awareness of abuse from the time of their interview, through regular discussions and formal training. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a clean, pleasant, safe and well maintained environment. Evidence: A tour of the premises was undertaken. The home was purpose built in the 1970s and the accommodation consists of seven residential units, two of which are not currently in use. The five units are on two floors that are accessible by stairs and a lift. We visited four of the five units. Each unit had two toilets, bathroom with an assisted bath, lounge, dining area, kitchenette and single bedrooms. The bedrooms viewed were appropriately decorated and included residents own belongings such as furniture, televisions and family photographs. Residents have lockable facilities in their bedrooms, and could have a key for their bedroom door if they so desired. Some units visited had residents art work displayed on the walls. Each of the units visited were appropriately decorated and homely. The communal bathrooms and toilets had liquid soap dispensers and paper towels, and alcohol hand gel dispensers were situated throughout the home. The lounge/dining rooms were brightly decorated, clean and tidy, and residents were observed sitting and relaxing in the lounge areas. Care Homes for Older People Page 21 of 32 Evidence: The entrance hall of the home has information pertaining to the care home displayed, which includes a copy of the last key inspection report and the complaints procedure. There is a large dining room that can be used by residents during the evenings and at weekends for larger functions. Residents were observed to have unrestricted access to communal parts of the home. There is a large secure garden to the rear of the premises that was appropriately maintained. During discussions residents told us that they like their bedrooms, and having their own belongings with them. Eight surveys returned by residents informed that the home is always clean and fresh, one informed that it is usually clean and fresh. One staff survey informed that the cleaning of the home could be better. However, on the day of the site visit the home was very clean, tidy and free from offensive odours. Some windows were noted to be old, and some of the wooden frames were beginning to rot. The acting service manager and the manager told us that the windows are being replaced in August 2009. The AQAA informs that there has been a vast improvement within the environment with the fencing of the garden, carpeting and decoration in requested areas. Outside lighting has been installed. There is an Infection Control policy in place, and there are hand washing facilities with alcohol dispensers. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing are satisfactory, ensuring staff have the qualities and training to meet the needs of people using the service. Recruitment procedures and practices ensure people who use the service are protected. Evidence: The home currently has thirty five residents accommodated in five units. Two units continue not to be used. The manager told us that there are seven members of staff on duty that includes two staff who float between the five units, one of who is always a senior care officer. The manager told us that she is confident that the numbers and skill mix of staff on duty are sufficient to meet the needs of the current residents living at the home. The night time duties are covered by two care assistants and one senior care officer. The manager plans the duty rotas six weeks in advance and these were seen in the main office. The AQAA informs that there are currently twenty seven care staff working at the home, of which seventy percent hold the minimum of an NVQ level two and above, and a further four staff are currently undertaking this training. All new staff attend a six week induction period that is organised by Surrey County Council. The manager told us was is line with the Skills for Care Induction Standards. Care Homes for Older People Page 23 of 32 Evidence: Three of the most recent recruited staff files were viewed during the site visit. All these files included an application form with a full employment history, two written references, health declarations, proof of identity and Criminal Record Bureau checks had been undertaken. Notes taken during interviews were maintained in the three recruitment files sampled. Agency staff are used at the care home. The manager showed us evidence that they had obtained a declaration from the supplying agency that all the required recruitment checks had been undertaken, including the Criminal Record Bureau checks. All staff have individual training files that should include certificates and confirmation of training they had undertaken, however, the six staff training files sampled did not include all the up to date information. A requirement has been made in regard to this under the Management and Administration section of this report. The manager told us that other training staff had attended included Dementia, End of Life, head injuries, Diabetes and Working in activities with Dementia. During discussions staff told us that they thought their recruitment was fair, they attended induction training, and they receive training as and when required. Staff surveys informed that their induction covered everything they needed to know about the job, and that they are receiving training that is relevant to their role, helps them to understand and meet the needs of residents and keeps them up to date with new ways of working. Resident surveys inform that staff are always or usually available when they need them. During the site visit residents spoken to told us that the staff are very good, always available and help with anything they require. Staff always listen to them. This was observed during the site visit. Staff surveys inform that training from Surrey County Council is very helpful and there are good supportive colleagues working together at the home. The AQAA informs that recruitment is still a challenge for the home, and agency staff are still being used. Daily allocation sheets are completed for care assistants to ensure continuity of cover in the units, and these are altered as and when required to ensure there is the right skill mix of staff in each unit. A verbal offer of a position at the home is made when the home has received all the recruitment documents as required. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced and qualified manager, however, the identified issues raised in this report must be addressed to ensure the home is run in the best interests of people who use the service. Evidence: The registered manager told us that she holds the NVQ level 4 and the Registered Managers Award (RMA). She has fifteen years experience in management with Surrey County Council, and has been the manager of Brockhurst for nine years. The manager had undertaken the Surrey Safeguarding training on 15 March 2006, which is now due to be updated. Other training undertaken by the manager includes The Mental Capacity Act, Deprivation of Liberty and End of Life training. During discussions staff were complimentary about the manager of the home, stating that she was supportive and had an open door style of management. Three staff surveys informed that the manager regularly meets with them to give support and discuss how they are working, one informed that this sometimes happens. Care Homes for Older People Page 25 of 32 Evidence: The manager must address the identified issues raised in this report in regard to care plans, risk assessments, quality assurance and staff training and training files. The manager told us that there are regular residents meetings held in each unit. Evidence of the minutes of these meetings were sampled during the site visit. The home has Regulation 26 visits undertaken by the acting service manager. The Annual Quality Assurance Assessment informs that there is a plan for an annual quality audit where the service bench marks themselves against another home, however, due to service difficulties there has been a delay and this years plan has been postponed. The manager told us that they have not been undertaking annual surveys to ascertain the views of residents, their relatives, health care and other associated professionals in regard to the care provided by the staff to the residents. A requirement has been made in regard to this. The manager returned the Annual Quality Assurance Assessment when we asked for it. The information provided in this document was clear and provided the information we asked for. The manager told us that residents and their families are responsible for their finances, and no one at the care home is an appointee for any resident. Residents are supported to manage their finances and the home holds small amounts of money. All transactions are recorded and receipts are maintained. The Bursar documents all accounts which are then checked by the manager. These were not viewed during this site visit. The manager told us that all staff attend the mandatory training as required. Six staff training files were viewed. It was noted that for two staff that there was no evidence to support that they had attended training in regard to moving and handling or fire, and no evidence for training for another two members of staff in regard to food hygiene and handling or infection control. One member of bank staff had not received any mandatory training since 2005. A requirement has been made that evidence of training undertaken by care staff must be maintained, and available for inspection purposes. The identified member of staff must receive updated mandatory training as required. The AQAA informs that the annual maintenance checks have been undertaken as required by the manufacturers recommendations. The AQAA also informs that the manager understands their responsibilities and undertakes frequent training. Each resident has an individual accounts record for Care Homes for Older People Page 26 of 32 Evidence: personal use that are documented by the Bursar and certified by the manager. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Unless it is impracticable to 11/07/2009 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service user plan) as to how the service users needs in respect of his health and welfare are to be met. The registered person shall keep the service users plan under review. The service user plan must be reviewed on a monthly basis and any information in regard to the identified changes of need must be recorded in the service user plan. 2 9 13 The registered person shall ensure that unnecessary risks to the health or safety of service users are 11/07/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action identified and so far as possible eliminated. Risk assessments identifying a risk must be reviewed on a regular basis. 3 33 24 The registered person shall establish and maintain a system for evaluating the quality of the service at the care home. An annual survey must be undertaken to ascertain the views of residents, their families and other stakeholders of how well the home is achieving good outcomes for residents. 4 38 17 The registered person shall maintain in the care home the records specified in Schedule 4, a record of all training undertaken, including induction training. Evidence of training undertaken by care staff must be maintained, and available for inspection purposes. The identified member of staff must receive updated mandatory training. 11/08/2009 11/08/2009 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The pre-admission assessments should be maintained in the care files so that cross referencing can be undertaken to ensure that the care plans have been produced from these assessments. All service user plans should include information in regard to their religion, ethnicity and medical needs. If there is not an identified risk in a certain area then this should be recorded as opposed to leaving blank risk assessment documentation in the care plans. It is strongly recommended that the Control Drug register should be signed by two people when a Controlled Drug has been administered to residents. Hand written Medication Administration Record sheets should be signed by two members of staff to minimise the risk of errors being made. 2 3 7 7 4 9 5 9 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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