Care Home: Brockshill Woodlands

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What the care home does well People spoken with praised the staff working at Brockshill Woodlands. One person said `staff have tremendous patience and a good attitude`. There was a good range of recreational and social activities on offer including trips out of the home. The service has access to a wheelchair accessible vehicle twice a month. People living at Brockshill Woodlands were involved in organizing the activities where possible. People told us that the acting manager was approachable and would listen to any concerns and take appropriate action. What has improved since the last inspection? Since the last inspection the acting manager has introduced changes to meals and meal times. Full fat milk is now being used and bread and butter is on the table at every meal time. These changes have improved the nutritional status for some people living at Brockshill Woodlands, people who were previously losing weight have begun to put weight on and nutritional risk has been reduced. The acting manager has instructed staff to ensure that people who require assistance with their meals receive this assistance and this was evident during this inspection. People are enabled to make choices about how they spend their day, what time they go to bed and what time they get up in the morning. For some people who were identified as at risk of falling, incidents of falls and injuries had reduced since the last inspection, this was achieved by improved care planning and risk assessment. People also told us there seemed to be more staff around and that the atmosphere at the home had improved. Record keeping regarding accidents and incidents had improved. People told us that staff called their GP in as soon as this was required. The management of medication had improved and staff responsible for medication were following safe policies and procedures, the use of medicines which cause sedation had reduced significantly. What the care home could do better: Staff had not received training regarding the Mental Capacity Act and associated Deprivation of Liberty safeguards, this is required to ensure that the least restrictive method is used where people need to have their freedom curtailed in order to keep them safe. More detail was required in care plans for people who displayed behaviour that challenges such as verbal or physical aggression. Where people are aggressive towards staff or other residents then a safeguarding referral must be made to the local authority. Some areas of the home required maintenance work to ensure that all areas of the home are suitable and comfortable for people living there. Key inspection report Care homes for older people Name: Address: Brockshill Woodlands Briar Walk Oadby Leicestershire LE2 5UF     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: Debbie Williams     Date: 0 9 0 6 2 0 1 0 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Brockshill Woodlands Briar Walk Oadby Leicestershire LE2 5UF 01162716014 01162716014 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Prime Life Ltd Name of registered manager (if applicable) Michelle Lesley Cramp Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Brockshill Woodlands care home is registered to provide personal care to male and female service users who fall within the following categories: Old age, not falling within any other category (OP) 30. No one falling within category MD(E) should be accommodated at Brockshill Woodlands when there are already five persons of the category MD(E) accommodated in the home. No one falling within the category of DE(E) should be accommodated in Brockshill Woodlands when there are already 27 persons accommodated under the category of DE(E). No persons should be accommodated in the double-bedded bungalow situated in the grounds of Brockshill Woodlands unless they are an established co-habiting couple, or Care Homes for Older People Page 4 of 25 0 0 0 Over 65 27 5 30 have an established friendship/relationship, prior to being accommodated in the bungalow. Only persons falling within the category OP should be accommodated in the two single bedroom bungalows situated in the grounds of Brockshill Woodlands. Persons should only be accommodated in the double-bedded bungalow situated in the grounds of Brockshill Woodlands under categories OP, and DE(E). A maximum of one person falling within the category DE(E) should be accommodated at any one time. The maximum number of persons to be accommodated at Brockshill Woodlands is 30. Date of last inspection Brief description of the care home Brockshill Woodlands is a care home providing personal care and accommodation for up to thirty older persons who may have additional needs, which may include Mental Disorder or Dementia. Accommodation comprises of the main care home and three self-contained bungalows; bedrooms are both single and shared. Parking for visitors can be found to the front of the home. Brockshill Woodlands is located in a residential area of Oadby. Communal areas consist of a dining room and three lounges, and are located on the ground floor, with access to the garden from the lounge to the rear of the home. Bedroom and bathing facilities are located on the ground and first floor. Information is located on site detailing the range of services offered, which includes the Statement of Purpose and Service User Guide. Copies of the Care Quality Commissions Inspections Inspection Reports are available by request at Brockshill Woodlands. Information regarding the weekly fees at Brockshill Woodlands can be obtained from the registered provider. 2 9 1 2 2 0 0 9 Care Homes for Older People Page 5 of 25 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: This key inspection included a visit to the service. We visited the home on the 9th of June 2010. The main method of inspection used was case tracking which meant selecting four residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. We also spoke with two other residents and one visitor. We checked all the standards which the Care Quality Commission have decided are key standards during this inspection. In some sections we have also checked additional standards, these will be detailed in the main report. We also used information from the providers Annual Quality Assurance Assessment (AQAA) this provides information about any changes that have taken place at the Care Homes for Older People Page 6 of 25 service since the last key inspection. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: Staff had not received training regarding the Mental Capacity Act and associated Deprivation of Liberty safeguards, this is required to ensure that the least restrictive method is used where people need to have their freedom curtailed in order to keep them safe. More detail was required in care plans for people who displayed behaviour that challenges such as verbal or physical aggression. Where people are aggressive towards staff or other residents then a safeguarding referral must be made to the local authority. Some areas of the home required maintenance work to ensure that all areas of the Care Homes for Older People Page 8 of 25 home are suitable and comfortable for people living there. 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 9 of 25 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 10 of 25 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. Prospective residents are provided with the information they require to make an informed choice before moving in and have their needs assessed. Evidence: A service users guide and brochure is provided to all prospective residents before they move in, this provides people with the information they require about facilities and services offered. People have their needs assessed before moving in and this is to ensure the service can meet their needs. The needs assessment is carried out by the acting manager. A trial period of four weeks is offered when people move in before they decide whether to move in permanently. Assessment records are included within peoples care records and these inform staff about peoples needs, preferences and any risks to health and welfare. Care Homes for Older People Page 11 of 25 Evidence: The service is registered to accommodate people requiring care due to old age, mental health needs and dementia. The acting manager was in the process of planning the staff training and supervision programme to ensure that all care staff receive training in this area. Care Homes for Older People Page 12 of 25 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. The health and personal care needs of people living at Brockshill Woodlands were mostly met. Evidence: We looked at care records for four people we case tracked. Care plans were in place for all assessed needs but more detail was required in some peoples care plans where aggressive behaviour was identified. Access to health care services was generally good and staff and residents told us that GPs and community nurses were called in when required. However, one person who could become aggressive towards staff had not been seen by a GP or community psychiatric nurse for some time and further intervention from these health care professional was required in order to minimize risk and increase well being. Risk assessments were in place for risk of developing pressure sores, nutritional risk and risk of falls, for some people, incidents of falls and injury had reduced since the last key inspection. Care Homes for Older People Page 13 of 25 Evidence: A specialist CQC pharmacy inspector was present at this inspection and looked at medicines storage, stocks and records, care plans related to medicines and staff training in medicines handling. We found evidence that there has been a significant improvement in the way medicines are managed. All medicines are being stored safely, all prescribed medicines are available, people are getting their medicines on time, all medicines can be accounted for, and when changes have been made to someones medicines, it is now clear who has made the change, and when. Three staff have undertaken Prime Life medication training, and have been authorized to give medicines. Other staff are in the process of being trained to witness when controlled drugs are given. The member of staff in charge of medicines on the day of the inspection said she was supported by the Manager, and was able to answer all of our questions on peoples medicines, which was encouraging. Controlled drugs records and stocks were checked and tallied. There is evidence of good input from health care professionals in relation to medicines. The prescriber has reviewed peoples medicines, and as a result,there are only 3 people on sedating medicines for agitation, with protocols in place for when these should be used to ensure these are not used inappropriately. Some people are on eye drops. The optician was visiting the home on the day of the inspection to give staff training on the use of these medicines. The pharmacist who supplies medicines is also visiting the home to provide advice on medicines handling. Care Homes for Older People Page 14 of 25 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. Staff enabled people to make choices about their day to day lives and provided opportunities for social and recreational activities. Evidence: People spoken with told us they could choose how to spend their day, what time to get up and what time to go to bed. There were a range of activities on offer including trips outside of the home. Visitors spoken with told us there were no restrictions on visiting and that they were always made to feel welcome by staff. Since the last inspection, the acting manager has introduced full fat milk and porridge to the menu and bread and butter is now served with each meal. Staff were seen assisting people with their meals in a sensitive and respectful way, one person spoken with said that staff had tremendous patience and a good attitude. It was evident from care records that some people had benefited from the changes made and had gained weight and reduced any nutritional risk. Care Homes for Older People Page 15 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at and visiting Brockshill Woodlands were confident that the acting manager would listen to their concerns and take appropriate action. National safeguarding policies were not always adhered to and therefore some people living at Brockshill Woodlands may not be protected from harm. Evidence: People spoken with told us they had confidence in the acting manager and that she would listen to their concerns and take appropriate action. All staff have received in house training regarding complaints and safeguarding vulnerable people. The acting manager told us she and a senior carer at the home where booked to attend the Local Authorities safeguarding training in September 2010. Not all incidents of aggressive behaviour had been reported to social services as a safeguarding concern, we made a requirement about this. Care Homes for Older People Page 16 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most areas of the home were accessible, homely and comfortable but some areas of the home required maintenance work or repair. Evidence: We looked around all the communal areas in the home and at the rooms of people we case tracked. Communal areas were furnished and decorated in a homely way and provided comfortable space which was accessible and met the needs of people living at Brockshill Woodlands. There was an unpleasant odour in the reception area and in some of the bedrooms near the cellar. All staff had completed training in infection control, this minimizes the risk of cross infection for people living at Brockshill Woodlands. Care Homes for Older People Page 17 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Brockshill Woodlands are protected by the homes recruitment policies. Staff are mostly trained and competent to do their jobs Evidence: We looked at staffing rosters and spoke with staff and visitors about staffing numbers and staff competence. People told us that staff were competent and they were not kept waiting for staff to attend to their needs. One visitor told us that there were more staff around than there used to be. The providers told us that this was because the acting manager had changed the way staff work on each shift in order to ensure that staff were always deployed in communal areas and therefore available to attend to residents needs. We looked at staff training records and spoke with staff about the training they received. Staff told us they were provided with the training they needed to do their job. The acting manager was in the process of planning a programme of staff supervision and training in order to ensure all required training was provided and up to date. All staff were due to commence National Vocational Qualifications in care. Staff had not received training regarding the Mental Capacity Act and associated Deprivation of Liberty safeguards, this training is required to ensure that where people have their freedom curtailed in order to protect them from harm, then the least Care Homes for Older People Page 18 of 25 Evidence: restrictive method is used. The providers told us that training regarding the Mental Capacity Act and associated Deprivation of Liberty safeguards had been booked and that staff would attend this later in the year. We looked at staff records and found that all recruitment checks and references had been obtained in order to ensure that people working at Brockshill Woodlands were suitable. All new staff receive induction training when they first commence employment. Care Homes for Older People Page 19 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Brockshill Woodlands was run in the best interests of people living there. Evidence: At the time of this inspection the home was being run by an acting manager. People spoken with said they felt supported by the acting manager and that she was open and approachable. A programme of quality monitoring was in place and this included consulting with relatives and visitors to the home. Where staff managed peoples personal money, two signatures were obtained for each transaction and receipts where kept, this minimizes the risk of financial abuse. All staff had received mandatory health and safety training such as moving and handling, first aid and infection control. Information provided within the Annual Quality Assurance Assessment (AQAA) confirmed that all routine maintenance and safety Care Homes for Older People Page 20 of 25 Evidence: checks had been carried out, this minimizes risk for people living and working at Brockshill Woodlands. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 18 12 All care staff must receive training in the management of challenging behaviour. This is to ensure that people are protected from harm. 30/04/2010 2 18 12 Staff must follow national 10/04/2010 safeguarding adults policies and procedures and must refer all incidents of abuse or suspected abuse to the appropriate agency to investigate. This is to ensure that people living at Brockshill Woodlands are protected from harm. Care Homes for Older People Page 22 of 25 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 8 13 People must have access to all appropriate health care services when required such as GPs and community psychiatric nurses. This is to ensure that people receive the treatment and care they require to meet their needs and promote safety. 30/07/2010 2 18 13 All incidents of aggressive behaviour must be referred to social services as a safeguarding concern. This is to ensure that people are protected from harm. 05/07/2010 3 19 23 Unpleasant odours must be eradicated. This is to ensure that all parts of the home are comfortable for people living at Brockshill Woodlands. 30/07/2010 Care Homes for Older People Page 23 of 25 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 4 30 18 All staff must receive training regarding the Mental Capacity Act and associated Deprivation of Liberty safeguards. This is to ensure that the least restrictive method is used when minimizing risk and people do not have their freedom unnecessarily curtailed. 27/08/2010 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 Care Homes for Older People Page 24 of 25 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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