Care Home: Brockworth House Care Centre

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What the care home does well The home has a good system in place for assessing the needs of potential residents, planning their care and working to meet their health and personal care needs. Care is delivered in such a way as to uphold resident`s privacy and dignity. The home provides a range of suitable activities and maintains strong links with residents` relatives and contact with the community. There is an excellent approach to dealing with complaints and the home is open about bringing this to the attention of residents` representatives. A high priority is given to training staff in recognising and preventing abuse to residents and good information is provided about this to both staff and residents` representatives. The home was well-maintained and clean providing residents with a safe and comfortable environment. It has been well staffed to meet their needs and well managed to provide good outcomes for residents. Residents are provided with a choice of meals and are enabled to make choices as to their preferences in relation to their abilities. The home is well managed and uses a variety of quality assurance methods to ensure that the home is run in the best interests of the residents. The home ensures that staff are trained in safe working practices and regular safety checks are carried out on the environment. Resident`s are protected from the risks of Legionella by an advanced water treatment system installed in the home. What has improved since the last inspection? There have been improvements with the records kept in relation to medication administration. Unpleasant odours have been eliminated from communal areas. There has been a general improvement with the procedures for staff recruitment in terms of the information and documentation checked before a person starts working at the home. What the care home could do better: The home must keep close checks on the storage temperatures for residents` medication. More staff should be trained to a minimum of NVQ level 2. Application forms should be improved to allow for the inclusion of more detailed information about dates of previous employment. Employment checks on the registration of nurses should be carried out using the Employer Confirmation Service provided by the NMC. CARE HOMES FOR OLDER PEOPLE Brockworth House Care Centre Mill Lane (off Shurdington Road) Brockworth Glos GL3 4QG Lead Inspector Mr Adam Parker Unannounced Inspection 09:15 2 & 4 February 2009 nd th 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 Brockworth House Care Centre DS0000035042.V374135.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. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brockworth House Care Centre Address Mill Lane (off Shurdington Road) Brockworth Glos GL3 4QG 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) 01452 864066 home.bro@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Deborah Margaret Phillips Care Home 55 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (55), Mental disorder, excluding learning of places disability or dementia (1) Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The Registered Manager’s Award is to be completed. A post registration course in dementia is to be completed by April 2007. The one DE place to be for a named individual only. This category will be removed from the registration once this service user reaches 65 years or leaves the home. All Service Users admitted to the home in the category of Dementia (DE) are over 55 years of age. 24th September 2007 Date of last inspection Brief Description of the Service: Brockworth House is a purpose built two-storied care home with nursing, situated on the A46 road between Stroud and Cheltenham, approximately 6 miles from both Gloucester and Cheltenham. There are local amenities available in the centre of Brockworth Village and a regular bus service to both Gloucester and Cheltenham. The home is set in large grounds which residents are able to access with the assistance of staff. There is an enclosed patio area for residents to access on their own if they are able. The home provides 53 single rooms and 1 double room, all with en-suite facilities. Some of the single rooms also have a connecting door between them to allow for a husband and wife to share. There are lounges and dining rooms on each floor and several seating areas in the wide corridors. There are assisted bathrooms and toilets on both the ground and first floor. The kitchen and laundry is situated on the ground floor. The home provides care for older people with dementia. Current fees are £555.40 to £715.00. Hairdressing and Chiropody are charged extra. The home makes information about the service, including CQC reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Brockworth House Care Centre DS0000035042.V374135.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 three stars. This means the people who use this service experience excellent quality outcomes. One inspector carried out the inspection visit over two days in February 2009. The registered manager was present for both days of the inspection visit that consisted of a tour of the premises and examination of residents’ care files. In addition training was looked at as well as medication storage and administration and documents relating to the management and safe running of the home. One resident and four visitors were spoken to during the inspection visit as well as three members of care staff. An Annual Quality Assurance Assessment (AQAA) form was received from the home prior to the inspection visit. This was comprehensive and gave us the information we asked for. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home has a good system in place for assessing the needs of potential residents, planning their care and working to meet their health and personal care needs. Care is delivered in such a way as to uphold resident’s privacy and dignity. The home provides a range of suitable activities and maintains strong links with residents’ relatives and contact with the community. There is an excellent approach to dealing with complaints and the home is open about bringing this to the attention of residents’ representatives. A high priority is given to training staff in recognising and preventing abuse to residents and good information is provided about this to both staff and residents’ representatives. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 6 The home was well-maintained and clean providing residents with a safe and comfortable environment. It has been well staffed to meet their needs and well managed to provide good outcomes for residents. Residents are provided with a choice of meals and are enabled to make choices as to their preferences in relation to their abilities. The home is well managed and uses a variety of quality assurance methods to ensure that the home is run in the best interests of the residents. The home ensures that staff are trained in safe working practices and regular safety checks are carried out on the environment. Resident’s are protected from the risks of Legionella by an advanced water treatment system installed in the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s assessment procedure ensures that all prospective residents receive a full assessment of their needs before they are admitted to the home so that they can receive the care that they require. EVIDENCE: The assessment documentation completed for a resident recently admitted to the home was looked at. A comprehensive pre-admission assessment had been completed and information had also been obtained from the hospital where the resident was before being admitted to the home. For other residents, who were funded by a local authority, the appropriate care plan generated by a needs assessment had been obtained. The home does not provide intermediate care and so Standard 6 does not apply. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 9 Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home works well to meet residents’ health and personal care needs although action must be taken to ensure that in the interests of residents’ health, their medication is always stored at the correct temperature. EVIDENCE: Residents had care plans written in the form of support plans for a variety of assessed needs. There was evidence that the support plans had been evaluated on an almost daily basis. With one resident who had recently been admitted to the home, it was noted that the support plans had been completed on the day that the resident had been admitted. One resident had a comprehensive support plan for meeting personal care needs. Where personal care had been given, then this was documented including information where residents had declined personal care such as a bath. Further examination of records of personal care showed that there were some days when care had not been recorded. This situation should be checked and Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 11 audited to ensure that accurate records are being made of the actual care given. A support plan had been drawn up for one resident for Health Promotion and demonstrated a pro-active approach to promoting the resident’s health with clear actions recorded for staff to follow relating to such areas as diet and medication. Risk assessments had been completed for falls that with some residents who were particularly at risk, had lead to an extended falls risk assessment being completed. Pressure area risk assessments had been subject to a monthly review. One resident had been receiving input from health care professionals for mental health needs. There was no evidence that the resident was under the Care Programme Approach arrangements, this should be checked with the mental health team so that the homes’ support plan for the resident can reflect this. Residents had been receiving input from health care professionals and the services of a reflexologist had been introduced to the home through a member of staff who had been training to provide this treatment. One relative of a resident spoke of how the General Practitioner (GP) was called to visit the resident whenever needed. Medication administration and storage arrangements were looked at and requirements issued following the previous inspection were checked. Medication is stored in two locations within the home. In the downstairs storage area temperatures had been monitored although these indicated that storage was above 25°C and on the day of the inspection visit was noted as being 26ºC. Records showed that on five days in December 2008 the temperature had been between 26ºC and 27ºC. Although some medication kept in the downstairs storage area could be stored at these temperatures, other medication was being stored above the correct temperature. Although some action had been taken in the home by the registered manager to improve the situation it was clear that the registered provider had not acted to improve the conditions for storing residents’ medication. However we were informed that on the day following the inspection visit action was taken to reduce the temperature in the medication storage area by installing a larger fan that was enough to bring the temperature down to below 25ºC. Medication stored in the refrigerator and in the first floor storage room was being kept at the correct temperature. Liquid and topical medication had been dated on opening as an indication of the expiry date. There was no controlled medication in use in the home during the inspection visit. Medication Administration Records (MAR) were in generally good order and any handwritten direction were signed by staff making the entry and also by staff checking this. However some lines had been drawn where medication had apparently been stopped. Any such lines on the MAR should be qualified by an explanation as well as being signed and checked. No gaps in recording were Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 12 seen and omission codes had been given correctly where medication had not been given. Brockworth House Care Centre DS0000035042.V374135.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied activities programme, good social contact and a selection of meals that take into account choice and nutrition. EVIDENCE: Activities in the home are organised by the housekeeper and the newly appointed Chaplain. They offer a range of activities for residents seven days a week both inside and outside of the home. A number of musical entertainers visit the home including a choir. Physical exercises also feature in the activities programme. The home keeps a record of individual resident’s interests in a personal profile that includes a life history. A notice board on display in the home gave details of activities such as hand massage, manicures and dominoes. There was also a letter of introduction from the recently appointed Chaplain and details of a Christian service being held on Sundays. At Christmas, residents were able to take part in a range of festive activities. Recently Burn’s Night had been celebrated with a bagpiper playing in the home. In addition a celebration of Chinese New Year had taken place with Chinese food that was appropriate to a resident in the home from a Chinese ethnic background. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 14 Where residents had specific needs in relation to religious observance then these had been documented in a care plan for ‘spirituality and religious practice.’ The home enables residents to maintain contact with family, friends and representatives one relative of a resident spoken to during the inspection visit confirmed the ‘open’ visiting arrangements and how well he was treated when he visited the home. Other relatives of residents spoken to confirmed how they were made to feel welcome by staff in the home when they visited. The home maintains links with the local community in particular a group from the local Methodist Church who have on going involvement with the home supporting activities. There are also links with the chaplain of a Baptist Church in Cheltenham as well as an Evangelical Church. Due to the abilities of residents in the home, none are able to control their own finances relying on relatives and representatives for this. Evidence was seen of residents having their own personal possessions in the home. The menu changes every week for four weeks. It includes a choice of two main courses with extra alternatives such as salads, jacket potatoes and omelettes always available. Supper involves a choice of a cooked meal or sandwiches with a desert. Pureed meals are served with each portion pureed separately that makes for an attractive presentation. At lunchtime staff were seen to be attentive to residents’ needs with catering staff serving the meals and care staff offering assistance to those that needed it. There was a calm atmosphere during lunch. One resident was celebrating their wedding anniversary and having lunch with their husband who was visiting. Staff had set up a special table for them with candles. The relative described the organisation of the meal as “ impressive.” In one of the units upstairs staff that were assisting residents with eating their meal were sitting with them at the tables. The home has catered for special diets such as vegetarians in the past but was not doing so at the time of the inspection visit. The home helps residents to choose meals by showing them a small sample of each dish before the meal is served. This is good practice in relation to enabling choice in residents with dementia. It was reported that the catering manager meets with relatives and some residents to discuss meals and menus. As part of the quality assurance system in the home, action was taken regarding a number of points raised by residents and their representatives in relation to the meals provided. These included offering residents more than one piece of cake and improving the checks made on the temperature of hot food when it is served. One relative of a resident in the home spoke of the “ Very good standard of meals.” Brockworth House Care Centre DS0000035042.V374135.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Information is available if any resident or their representative should wish to make a complaint and the home’s approach to training staff and upholding residents’ legal rights should ensure that residents are protected from abuse. EVIDENCE: The home has a complaints procedure and a copy was prominently displayed in the entrance hall of the home. The procedure details a response to a complaint within 15 days and links complaints to providing the best possible service. The homes AQAA document stated, “ Our aim is to satisfy the complainant as quickly as possible.” A compliments and complaints folder contained plenty of written compliments from relatives of residents as well some complaints. Since the previous key inspection there had been three complaints and all of these were known to us through contact with the complainants or with the home. All the complaints had documents saved in the file showing how the investigations were conducted and of any findings. Complaints are reported to the registered provider’s governing board. In relation to resident’s legal rights, the home has information available on the Mental Capacity Act 2005 and has made use of an Independent Mental Capacity Advocate for one resident. The registered manager has also undertaken training in this area. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 16 The home has robust procedures for responding to suspicion or evidence of abuse. Staff are given written guidance on reporting suspected or actual abuse and Methodist homes has set up freephone numbers for both staff and residents and their representatives operated by an external agency for reporting abuse and this is publicised in a leaflet entitled “No Secrets Here”. All staff receive training on preventing and dealing with abuse and complete a questionnaire following the training to check their understanding. In addition annual refresher training is provided. The home also has the contact details for the local authority adult protection team and has demonstrated in the past how it is prepared to make direct contact with the local authority over adult protection issues. The home’s AQAA document stated, “ We have a policy on risk and restraint which is clear that we will never use any physical restraint when assisting and supporting residents.” Staff spoken to during the inspection visit were able to recount issues from the training they had received on preventing abuse to residents. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in an environment adapted to suit their needs that also promotes their independence. EVIDENCE: Since the previous key inspection the home had been organised into three separate areas named, ‘Painswick’, ‘Cranham’ and ‘Prinknash’. These areas generally have their own staff teams and residents have different level of need in each unit. A tour of the premises was conducted; this revealed that the home was well maintained, clean and smelt fresh. Since the previous inspection a hairdressing salon had been created with a hairdresser in the home for four days a week. There was also a small shop with the items displayed in a cabinet in ‘Painswick’. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 18 Improvements had been made to the enclosed patio area at the side of the home and the problem of uneven paving stones had been remedied. The area was laid out with seating, raised flower beds, shaded areas and a fish pond with a water fountain. It was noted that toilet and bathroom doors had pictorial signs attached to aid identification for residents. These included communal facilities as well as en suite toilets in individual rooms. The home was also starting to use ‘memory boxes’ on the walls outside individual rooms. These are planned to contain objects related to the life of each resident and as a way of them identifying their individual rooms. Dining areas in all three areas had been improved with the addition of ‘kitchenettes’ where breakfast, drinks and snacks could be prepared for residents. As well as the main lounge in ‘Painswick’ a ‘quiet’ lounge had been developed; this was being used by a group of residents and their relatives on the day of the inspection visit. The home gives a high priority to hygiene, providing staff with suitable hand washing facilities including anti bacterial soap and hygienic hand rub and reminders about hand hygiene. The laundry was clean and well organised with washable floor and wall surfaces. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are deployed and training is undertaken in a number of areas to meet residents’ needs with generally robust recruitment practices in place. EVIDENCE: Since the previous key inspection, the staffing in the home was been arranged to reflect the creation of the three areas. During the day, each area has a registered nurse on duty and care staff are deployed based on the numbers and needs of residents in each area. Care and nursing staff are supported by ancillary staff including a house keeping team who along with other duties help with meal times and with activities. The lunch is served to residents by the catering staff. At night there is a registered nurse on each floor of the home with a member of care staff in each area. The home reported in it’s AQAA document that the home had 20 of care staff qualified to NVQ although this would rise to 70 once all those staff currently undergoing the training had completed it. The recruitment documentation for three recently recruited members of staff was looked at. One of those recruited was a registered nurse and although the home had checked the nurses registration on the Nursing and Midwifery Council’s (NMC) website this had been done on the public ‘Search the Register’ Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 20 section. The home should make use of the ‘Employer Confirmation Service’ section that would give them more information about any registered nurse that they were considering for employment. Other staff had been recruited with all the required information and documentation being obtained. However as at the previous key inspection it is recommended that application forms should allow for the inclusion of more information about dates of previous employment as an aid to checking any possible gaps. Staff are provided with induction training in line with the Common induction Standards that is a nationally recognised standard of training. The progress of staff induction in the home is checked by the head office. Additional training had been provided to staff in such areas as dementia and bereavement as well as supervision and appraisal training for senior staff. Three members of staff spoken to confirmed the training they had received and spoke positively about working at the home. A relative of a resident, spoken to during the inspection visit spoke positively about the ability of the overseas staff employed in the home to speak English. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 21 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): 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 with a variety of quality assurance audits and safe working practices in operation to ensure that the home is run in the interests of residents. EVIDENCE: The registered manager is a registered nurse and has completed the Registered Managers Award as well as a training course in dementia care. She has past management experience in a care home and has recently completed relevant training in verification of death and disciplinaries and investigations. She works full time and is supernumerary to the care staffing. One relative of a resident spoken to during the inspection visit gave very positive feedback about how the home was managed. One relative stated that Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 22 the registered manager was making a “wonderful job” of managing the home. In addition three members of staff spoken to during the inspection visit all confirmed that the registered manager was “ approachable” if they had any concerns. The home has a quality assurance programme that consists of an annual selfassessment carried out by the registered provider and a six monthly internal audit that involves residents and staff. In addition an annual resident satisfaction survey and an internal management review take place. The internal audit report for May 2008 was looked at; this had involved questionnaires being sent to one resident, relatives of residents and members of staff. The audit was described by the registered manager as being led by the staff not by the management of the home. It was reported that the findings of the audit had led to an improvement in communication in the home particularly with the relatives of residents involving improved signage and a newsletter. The results of the November 2008 internal audit had not yet been produced by the head office of the registered provider. It was reported that this had involved a residents’ satisfaction survey that was being evaluated by an external agency. Other audits had taken place of medication, care planning and health and safety and the results of these were looked at during the inspection visit. Reports made of visits by a representative of the registered provider under the Care Homes Regulations 2001 were kept on file in the home. Meetings are also held for residents and their relatives, a group of visitors spoken to during the inspection visit were aware of these meetings and how they could make their views known to the registered manager. The home has arrangements for the safekeeping of residents’ money using a bank account that is specific for the purpose and separate from any account used for the running of the home. The home has a record of the amount of money held on behalf of each service user in the account and does not generally keep resident’s cash although facilities exist if needed. The home has ensured the servicing and maintenance of electrical and heating systems and appliances as well as hoists and the lift. Regular monthly checks are made on hot water temperatures and these are recorded along with a number of other safety checks such as on window restrictors. The home has an advanced ionization system of water treatment for managing the risk of Legionella and the maintenance man carries out actions in relation to this. The home keeps a record of accidents and incidents and monitors these with an audit. Cleaning substances are stored safely and securely in line with relevant regulations with a decanting system using correctly labelled containers which is wholly appropriate to protect the residents in the home. The home has a comprehensive set of risk assessments for the environment including security of the premises. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 23 Staff have received health and safety training as well as training in infection control, moving and handling, control of hazardous substances, food hygiene and fire training. During the inspection visit, staff were observed using a hoist for one resident to move them from a wheelchair in a chair for lunch. They took care with the procedure and explained to the resident what they were doing. A fire risk assessment had been completed in July 2008 that was due for review in April 2009. It was reported that the home had received a recent visit from a fire safety officer. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 4 4 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 X X 4 Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 25 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 registered person must monitor medication storage temperatures to ensure that residents’ medication is stored correctly. Timescale for action 31/05/09 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. Refer to Standard OP7 Good Practice Recommendations Where the home has copies of the care programme approach arrangements for service users receiving input from mental health services then these should be reflected in the appropriate care plan. Audit the recording of personal care to residents to check that accurate records are being made of the actual care given. Avoid the use of marks or lines drawn on medication administration records without a written explanation. The level of care staff trained to NVQ level 2 should be increased. Employment checks on the registration of nurses should be carried out using the Employer Confirmation Service DS0000035042.V374135.R01.S.doc Version 5.2 Page 26 2. 2. 3. 4. OP7 OP9 OP28 OP29 Brockworth House Care Centre 5. OP29 provided by the NMC. Application forms should allow for the inclusion of more detailed information regarding dates of previous employment. Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brockworth House Care Centre DS0000035042.V374135.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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