Care Home: Brook House

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• Claremont House
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What the care home does well The service provides a safe place for people to live where they are supported and protected by polite and dedicated staff and by a manager who sets a very clear example and ethos of putting people first. The home is very comfortable, spacious and light and has a real homely atmosphere that is very much liked by and suited to people`s expectations and aspirations of what a care home should be. The general atmosphere in the home is one of ease and calm. People are not restricted to their units and do not remain in their rooms but have access to the rest of the home. People who are dependent on assistance for their mobility are eagerly assisted by care staff to move around the home.Everybody is made welcome. Visitors know and use the `open door` policy that is promoted by the manager. Care plans are well written and practically presented for staff to use and to refer to for an accurate picture of what care should be given. Attention to nutrition, through good food and nutritional observation and record keeping is of a high standard and this ensures the home is aware of people`s changing eating patterns. Consultation and referrals for Community Health Services is consistently accessed when necessary. As a consequence, people are assured of a high standard of care at Brook House. The building was very clean and has plenty of natural light as well as sufficient electrical lighting. What has improved since the last inspection? The four requirements and two recommendations made at the previous inspection of 02/05/2007 have been met. Assessments carried out by the home are very comprehensive and contain sufficient information to make a care plan. The assessments are conducted with the person and family whenever possible. Care Plans are improved. The plans contain accurate and current information about what care is needed and how it should be offered and provided. The care plans are very practical working documents that staff refer to and can easily understand. Staff who are responsible for administering medication have received appropriate medication training. A new policy for administering medication has been written. Medication records are improved and all were accurate and correctly stored. The controlled drugs were appropriately stored in a new cabinet bolted to a main wall. The temperature of the room was appropriately below 25 degree C. The control and record keeping of the amounts of medication was accurate. The activities worker has brought a range of different interests and activities to people. Many photographs and items of craftwork that have been made are displayed around the home. The manager has made the environment more homely and comfortable. She has purchase items of furniture and furnishings that have created a brighter and better equipped home. New curtains, new bedcovers and new sofas have been purchased. The main corridors, lounges and dining rooms and entrance have been redecorated, as have most of the bedrooms. New indoor plants adorn the spacious main entrance and these enhance the homely environment. All dining tables were set with tablecloths and flowers. There were fresh cut flowers in different parts of the home. The garden area that is used has been improved. New Garden furniture had been bought. New plantings of different shrubs and herbs have been made in the secluded garden area and near to the main entrance. All staff have received adult abuse training. The home has promoted the reporting of any allegation or suspicion of abuse. Anyone can easily access the contact telephone numbers that are placed on the three notice boards in the home. There was other important information that included: advocacy, diverse leaflets about health care, the adult abuse policy of the home and Cambridgeshire County Council guidelines, `No Secrets` the Department of Health publication, documents about the Mental Capacity Act and previous CSCI inspection reports and the complaint procedure. Staff training had been improved. More people have achieved NVQ level 2 and 3 awards in care. The Team Leaders is an NVQ assessor and has started an NVQ level 4 award. All staff are offered the opportunity to undertake an NVQ award, including domestic and cooking staff. The induction training for new staff is structured and based on the Skills for Care standards. Registration with the Skills for Care Council is made for people who have competently completed their induction. What the care home could do better: All unused medication should be returned to the pharmacist as soon as possible. The home is worn and some fixtures and fitting are in need of maintenance or replacing. The flaking and faded exterior paintwork should be repainted. Some old and worn taps and mixer taps and hand held showers in three bathroom, toilets and sinks should be attended to and may need replacing. One bath that is losing its enamelling should be replaced, or kept maintained. Additional care staff are needed at key times. Currently, the Team Leader provides this additional personal care, whenever this is possible. It was observed that during lunchtime there was not sufficient staffing. The two faults showing on the fire alarm circuit must be corrected, or otherwise attended to. CARE HOMES FOR OLDER PEOPLE Brook House 45 Seymour Street Cambridge CB1 3DJ Lead Inspector Don Traylen Unannounced Inspection 30th April 2008 10:00 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 DS0000015239.V363468.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. DS0000015239.V363468.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Address 45 Seymour Street Cambridge CB1 3DJ 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) 01223 247864 01223 213055 Brook Healthcare Ltd Mrs Kathleen Skill Care Home 33 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (33) of places DS0000015239.V363468.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd May 2007 Brief Description of the Service: Brook Healthcare Ltd, a subsidiary of ExcelCare Holdings PLC, owns Brook House. The home provides care, support and accommodation for a maximum of thirty-three people older persons, including people who have Dementia related care needs. The home is located in a quiet area of Cambridge city and is close to a popular shopping area. Accommodation is on two levels and is divided in to four units named Primrose & Willow, on the ground floor and Bluebell & Woodlands on the upper floor. All rooms are for single occupancy and are fitted with sinks and hot and cold water. No rooms have full en-suite facilities but there are an adequate number of bathrooms and toilet on each unit. There are separate dining areas, sitting rooms and a kitchenette in each of the units. The upper floor is accessed by stairs or a shaft lift. Staff support is provided 24 hours a day and an on-call manager is always available. A Team Leader supports the management of the home and the personal care arrangements for people living there. The home has a cat, which provides company and affection for residents who are fond of animals. At the time of inspection the fees charged by the home ranged from £368 to £475 per week and vary according to needs and to funding status. Privately funding service users are asked to pay from £425 - £475 per week according to their needs. There are six rooms for privately paying service users, whilst Cambridgeshire County Council/PCT has a contract with the home to use the remaining 27 bedrooms for people whose care is part-funded by them. CSCI inspection reports are available at the home and can be accessed on the CSCI website. DS0000015239.V363468.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 “2 star”. This means the people who use this service experience good quality outcomes The inspection started at 10:00 am and ended at 5.30 pm. The registered manager and the team leader were available throughout the inspection and feedback was given to the manager at the end of the inspection. Two people’s care was tracked. Care plans, admission assessments and admission details were read. The administration of medication was observed in one unit and the records were checked in three units. The storage of medication and management of Controlled Drugs was assessed. Many of the people living at the home were spoken to during the inspection. Three visiting relatives were willing to discuss at length their impressions and awareness of the quality of care at Brook House. The activities arranged and taking place during the inspection were observed and people participating were spoken to. A lunchtime meal was briefly observed. A lengthy and careful tour of the premises was conducted and people rooms were seen when they were spoken to in their rooms. Six vacant rooms were seen. Care staff were spoken to and the recruitment details of one recently employed care worker was assessed and the training and development plans and training details of some courses were read. Policies read included the medication policy and the “Adult Abuse” policy. The home completed an Annual Quality Assurance Assessment prior to the inspection. 27 service users, 7 close relatives and 10 staff completed survey forms. A ‘Contract Monitoring’ report for February 2008, conducted by Cambridgeshire County Council, was read. What the service does well: The service provides a safe place for people to live where they are supported and protected by polite and dedicated staff and by a manager who sets a very clear example and ethos of putting people first. The home is very comfortable, spacious and light and has a real homely atmosphere that is very much liked by and suited to people’s expectations and aspirations of what a care home should be. The general atmosphere in the home is one of ease and calm. People are not restricted to their units and do not remain in their rooms but have access to the rest of the home. People who are dependent on assistance for their mobility are eagerly assisted by care staff to move around the home. DS0000015239.V363468.R01.S.doc Version 5.2 Page 6 Everybody is made welcome. Visitors know and use the ‘open door’ policy that is promoted by the manager. Care plans are well written and practically presented for staff to use and to refer to for an accurate picture of what care should be given. Attention to nutrition, through good food and nutritional observation and record keeping is of a high standard and this ensures the home is aware of people’s changing eating patterns. Consultation and referrals for Community Health Services is consistently accessed when necessary. As a consequence, people are assured of a high standard of care at Brook House. The building was very clean and has plenty of natural light as well as sufficient electrical lighting. What has improved since the last inspection? The four requirements and two recommendations made at the previous inspection of 02/05/2007 have been met. Assessments carried out by the home are very comprehensive and contain sufficient information to make a care plan. The assessments are conducted with the person and family whenever possible. Care Plans are improved. The plans contain accurate and current information about what care is needed and how it should be offered and provided. The care plans are very practical working documents that staff refer to and can easily understand. Staff who are responsible for administering medication have received appropriate medication training. A new policy for administering medication has been written. Medication records are improved and all were accurate and correctly stored. The controlled drugs were appropriately stored in a new cabinet bolted to a main wall. The temperature of the room was appropriately below 25 degree C. The control and record keeping of the amounts of medication was accurate. The activities worker has brought a range of different interests and activities to people. Many photographs and items of craftwork that have been made are displayed around the home. The manager has made the environment more homely and comfortable. She has purchase items of furniture and furnishings that have created a brighter and better equipped home. New curtains, new bedcovers and new sofas have been purchased. The main corridors, lounges and dining rooms and entrance have been redecorated, as have most of the bedrooms. New indoor plants adorn the spacious main entrance and these enhance the homely environment. All dining tables were set with tablecloths and flowers. There were fresh cut flowers in different parts of the home. The garden area that is used has been DS0000015239.V363468.R01.S.doc Version 5.2 Page 7 improved. New Garden furniture had been bought. New plantings of different shrubs and herbs have been made in the secluded garden area and near to the main entrance. All staff have received adult abuse training. The home has promoted the reporting of any allegation or suspicion of abuse. Anyone can easily access the contact telephone numbers that are placed on the three notice boards in the home. There was other important information that included: advocacy, diverse leaflets about health care, the adult abuse policy of the home and Cambridgeshire County Council guidelines, ‘No Secrets’ the Department of Health publication, documents about the Mental Capacity Act and previous CSCI inspection reports and the complaint procedure. Staff training had been improved. More people have achieved NVQ level 2 and 3 awards in care. The Team Leaders is an NVQ assessor and has started an NVQ level 4 award. All staff are offered the opportunity to undertake an NVQ award, including domestic and cooking staff. The induction training for new staff is structured and based on the Skills for Care standards. Registration with the Skills for Care Council is made for people who have competently completed their induction. 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. DS0000015239.V363468.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000015239.V363468.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, Quality in this outcome area is good. People are assured they will live in a home that has ensured they have assessed and understood their needs and is prepared to meet these needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide have been rewritten and contain information about fees and charges. Every person has a Service User Guide in his or her room. There is an abundance of information about the home funding and financial advice, safety illnesses, protection policies and contacts for reporting abuse as well as previous inspection reports. Three visiting relatives each stated they had visited the home before their relative moved there. They each said they had read and agreed the assessment carried out by the home and had been present when this had DS0000015239.V363468.R01.S.doc Version 5.2 Page 10 taken place. One person said she was welcomed when she visited late at night to assess if the home was suitable for her mother. Another relative had used the CSCI website after speaking to the home who had offered to send her an inspection report. The manager said that she always assesses people prior to their admission to the home. Two people’s files revealed this process had taken place, as well as Cambridgeshire Primary Care Trust’s Care Management assessment. The home’s assessments were comprehensive and covered more than sufficient detail. For instance, one person’s assessment carried out by the home described in detail her fear, or phobia and this had prepared staff to meet her needs and wishes around this element of care. The 27 people resident at the home on the day of inspection were all funded by the Local Authority and had received their copy of the three-part contract. Intermediate care is not provided. DS0000015239.V363468.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. People are given high quality personal care that is recorded in detail and provided with respect. They are also assured their health needs will be noticed and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “When mum moved in she came straight from hospital and was very poorly and nervous. They took time to make her feel at home and explained everything to her. Her health and weight have improved tremendously since she has lived in the home” - comment made in a relative’s survey form. Two people’s care was tracked and their care plans read. The plans were split into two parts. One is used by care staff to read quickly and was very informative of all a person’s care needs to be provided and include the daily diary that was maintained in good detail and with three entries made for each day. The full care plan was numbered 1-10 for different elements of care if DS0000015239.V363468.R01.S.doc Version 5.2 Page 12 applicable. There was a dependency tool and a pre-admission assessment tool. There were weight and sleeping patterns recorded, as well as hourly night time checks. Any GP visits were entered in the plans by the GP and had been signed by the GP. The plans were clear, precise and uncumbersome. A clear picture of the person was possible to be extracted and this functional aspect of the plans is to be commended. A separate file for the notes made by the District/ Community Nurse is kept. There is a system for capturing information given by nurses and this is agreed with them to relay this to the Team Leader who then includes it in the handover notes at each shift change. These notes were read. The District Nurse calls twice a day to administer insulin and monitor blood sugars for one of the two people whose care was tracked. Three relative each confirmed that the home always contacts them and keeps them informed of any event or concern they have. This element of follow-up care was valued and appreciated and wanted by the relatives. The same relatives each confirmed they had seen the care plans and one said she had helped to write some of the detail in her mother’s plan. Nobody at the home had any pressure sores. Comments were made about the quality of the care were stated either verbally or written in the survey forms returned to the CSCI: One person said during the inspection, “if it wasn’t for the care mum receives, she would not be as well as she is”. She added that she could go home and be assured her mother is being well cared for and “we are back on a mother and daughter relationship”. Comments by people living at the home included the following: “the carers are lovely”, “it’s very good care here”, “carers always come when you call them”. “staff are very caring and do listen to me” “too much, they watch me like a hawk” “carers are very kind and do everything for me that I need” Comments by relatives included: “they monitor for any changes and additional care that may be required” “My mother has been in Brook House for less than a year, but in this short time they have changed her from a depressed person into a happy outgoing person, so with this change in my mother I have nothing but praise for all the managers and care staff …” Medication Administration Record (MAR) charts were checked, as were amounts of medication in three units and in the Controlled drugs supply cabinet. The cabinet was a new appropriate piece of equipment secured safely to a main load-bearing wall. The amounts of medication were accurate when checked against the records. Medication is kept in mobile drug trolleys secured to a wall in each of the four units. Only a trained person administers DS0000015239.V363468.R01.S.doc Version 5.2 Page 13 medication and enough staff have received this training. ‘As required’ or PRN prescribed medication is approiately offered and recorded. The home’s policy for administering medication is appropriate. Privacy and dignity were upheld. People were spoken to directly and were asked for there opinions and listened to. Observations were made of people being spoken to when being pushed by carers in their wheelchairs. One lady entered the manager’s office to ask for something and this was an accepted aspect of the home’s ‘open door’ policy that she knew as a right. A visiting relative used this open door policy when she spoke to the manager. People were observed being treated with respect and this was confirmed by the views of at least ten people who were asked if they felt respected by staff. Care plans included wishes about dying, although not all people had been approached about this subject. The manager showed details of the palliative care training she is arranging for staff and she is aware of the likelihood of needing these associated skills to address the reality of care. DS0000015239.V363468.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. People are assured the home tries to meet their expectations and preferences and they are given choices and decent food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were many verbal comments made by people living at the home and visiting relative during the inspection that expressed satisfaction with life at Brook House. People said they felt safe and enjoyed unrestricted access by their family and this was confirmed by three relative during the inspection and by the number of entries seen in the visitor’s book. The survey forms gave further positive statements of satisfaction with care and the amount of freedom and choices that people have. People are consulted for their opinions about a range of issues including where to be in the home, what activities to participate in, choice of meals and food and the basic daily routine they want to follow, which is recorded in their care plan. An activities worker is employed. She was running a painting session on DS0000015239.V363468.R01.S.doc Version 5.2 Page 15 the morning of the inspection that eight people were enjoying. There were many photographs around the home of the music sessions, the visits by a wildlife centre, parties and event such as the open day and garden party. The home has made a series of DVDs of these events and these were briefly looked at during the inspection. There were many paintings hanging on the walls around the home of the work people had made. Further activities around making types of meals and fruit drinks are planned. An exercise session is organised for once each week. People said they wanted these activities and some people were happy not to participate. One outcome of people joining in these activities is they are socialising with other people in other parts of the home and do not stay in their units. It was encouraging to see that nobody was in the dementia related care unit because everybody was busy painting or engaging in a music video that they had chosen to watch on a large screen. This freedom of movement was also observed in other people who clearly wanted to enjoy the spaciousness of the environment and to be with other people. It was observed that in doing this people were able to exercise a choice. All of the people were free to come and go into the area of the home where their rooms were. One person whose room is in the dementia care part of the home spoke of his choice to go to his room and to return to the painting he was doing. The meal served on the day of inspection was nutritious and plentiful. At least twelve people said the food was good and they had enough to eat. One person said, “the food is wonderful” and “I get too much”. Comments written in survey forms also confirmed this view. The lunchtime meal of roast turkey was served in individual dining rooms where there are usually small group of eight people. The outcome is a relaxed and uninterrupted dining period. The tables are set with flowers and tablecloths are laid. The dining rooms are inviting and very clean. A hairdresser visits the home every week. DS0000015239.V363468.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People are assured they are safeguarded from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedures that is advertised in the Statement of Purpose and in the main entrance area. A logbook of complaints is maintained by the home. The ability to raise a complaint or concern with the manager is an option for anybody and was seen to be an open and easy process. Staff are aware of the potential for abuse and are clear about reporting an allegation or suspicion. The home has advertised the telephone contact points for anyone to report an allegation to Cambridgeshire County Council or the Police. The telephone contact points are also posted in the manager’s office and the Team Leader’s office. Copies of the abuse policy and the ‘No Secrets’ document and Cambridgeshire County Council guidelines are available to read in the main entrance. All staff have received training in adult protection. One person stated that she was safer in the home than she had previously been in her own home. DS0000015239.V363468.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): 19,20,21,22,23,24,25,26, Quality in this outcome area is good. People are assured of a happy, welcoming and comfortable home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in need of some maintenance and further improvements to the flaking exterior paintwork. Some old and worn taps and mixer taps and hand held showers in three bathroom, toilets and sinks should be replaced. One bath that is loosing it enamelling should be replaced. There is an old and unused shower cubicle on the upper floor that is no longer used. It is noteworthy that on the day of inspection there was heavy rainfall. The flat roof over the walkway at the front of the home was not allowing water to drain away and the guttering to the front of the building was overflowing and a lot of DS0000015239.V363468.R01.S.doc Version 5.2 Page 18 rainwater was splashing on to the underneath bedrooms widows. One slightly open bedroom window had to be closed because of this. It appeared that the guttering was blocked. All sinks had a well-stocked supply of paper hand towels nearby. No cloth towels were used in any of the communal washing places. There are bathrooms on each unit and more than adequate number of toilets that each had large signs. Bathrooms are fitted with assisted seats. The temperature of hot water from the sinks was below 43 degree C. Two faults were showing on the fire alarm system control panel. Despite the above points, there is an atmosphere of warmth and homeliness. The home was very clean, warm and comfortable and is a happy place to live. One relative remarked: “it may not be the most posh building but as a care home it is the best”. People living at the home made comments that the home is suitable and acceptable to them in its build style. The style suits people. It is individually furnished and is of a style that assists many people to recognise their surroundings. The spaciousness and wide corridors adds to the charm and practicality. The entire interior has been repainted and fitted with new curtains, new sofas and many other items such as tablecloths, flowers, indoor plants and notice boards and new TVs. Carpets are clean. Bedrooms were personalised to individual choices. There was no hazards or obstacles noticed. The home has a maintenance worker and gardener whose labour is shared between other local care homes owned by the organisation. The atmosphere is partially created by the friendliness and the steady approach to attention is the most beneficial aspect of the environment. One person said, “I feel safe” and “am never alone”. DS0000015239.V363468.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): 27,28,29,30, Quality in this outcome area is good. People are assured they are in safe hands at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Additional care staff are needed at key times such as when medication and meals are being provided. Currently, the Team Leader provides this additional personal care whenever this is possible. It was observed that this is not always possible. After a lunchtime meal was eaten in the Bluebell unit, a care assistant who was working alone with a ‘support worker’ who was not trained to give personal care, had to stop administering medication because she urgently attended to the personal care needs of somebody. Throughout this episode, another immobile person was verbally requesting assistance. The usual staffing is four care assistants supported by the team leader to give personal care to up to 33 people in four separate parts of the home. A support worker helps between these units but cannot give personal care. These means the staffing situation is minimal and when lunch breaks are included there are shortages to cover. Staff work 12- hour shifts from 8 am to 8 pm or 8pm to 8 am. The activities co-ordinator also helps as a care assistant during the lunchtime period. Three staff are employed at night time. The home also employs two cooks, although there was a vacancy for one at the time of DS0000015239.V363468.R01.S.doc Version 5.2 Page 20 inspection. Two cleaners and a laundry worker are usually employed, although the laundry position was also vacant at the time of inspection and this was necessary to be managed by care staff. The recruitment records for one recently employed person were assessed. The records were satisfactory and included a CRB disclosure prior to commencing employment. Training arrangements have improved significantly since the last inspection. The induction arrangements are the responsibility of one of the Team Leaders. Induction is documented in two stages. An initial induction is followed by the full Skills for Care Based induction. Both models are based around the 6 standard set by Skills for Care. Workbooks are made for each model and people are assessed and signed off for their level of competency. The full induction programme lasts twelve weeks and a complete structured workbook approved by Skills for Care is used. Staff details are registered with the Skills for Care Council when they have successfully completed this induction. All staff had been offered the opportunity to undertake an NVQ qualification in care, or in cooking, or a domestic award. All bar three staff have either achieved, or were doing an NVQ award at the time of inspection. A team leader was doing an NVQ level 4 award in care and is also a level 3 assessor. Two staff were doing an NVQ level 3 award. All care staff have received basic training in Health & Safety, First Aid Fire Training and Moving & Handling. Adult protection training had been given to all staff. Further training in dementia care and Palliative care was being planned for some staff. The manager has sought out training and has encouraged care assistants to aim for higher standards and has been responsible for much of the improved training arrangements. This was confirmed by other staff who She has encouraged people to be more positive about accepting training opportunities. Training information details and programme from Cambridgeshire County Council and the Cambridgeshire NHS directory of training, was being considered and planned. DS0000015239.V363468.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): 31,32,33, 38, Quality in this outcome area is good. People can be assured that this home puts their interests first. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager became registered with the CSCI in June 2007. Since starting as a manager at the home in June 2006 she has achieved the Registered Manager’s Award. She has made a significant effort and achievement in bringing about improvements in the approach to giving care, recording care, having open and transparent communications and an open door policy and to altering the interior environment. She has also instigated interest and effort into using the external grounds as garden for people to sit out in and to enjoy DS0000015239.V363468.R01.S.doc Version 5.2 Page 22 when weather permits. Many of the furnishing, such as the large TV screen; the DVD player in the entrance area; the many curtains that have been added and replaced; new bedcovers and a variety of indoor and outdoor plants, have all been purchased by the home’s comfort fund. The fund has been successfully financed and managed to bring about improvement for everybody living at Brook House. The manager has led by example and has set people’s interests first. She has sought out training and has encouraged care assistants to aim for higher standards and has been responsible for much of the improved training arrangements. Staff who felt she supports them confirmed this. She has encouraged some staff to be more positive and less fearful of accepting training opportunities. The fire alarm control panel was showing two faults and these must be attended to. The manager stated that the organisation had investigated this and claimed it was fully operative. However an assessment by the Fire Safety Officer on 15/01/2008 had reported these as faults to be corrected. There was no documentation to show a specialist fire safety engineer had investigated, although the organisation had emailed the manager informing her this panel had been investigated and was safe. The fire alarm was tested during the inspection. The fire alarm system and electrical lighting and nurse call system were certificated in working order on 26/09/2007. The lift had recently been serviced and certificated as working. Regulation 37 notifications were kept at the home and copies had been timely sent to the Commission as required. The Annual Quality Assurance Assessment that was completed by the manager was informative and accurately reflected the quality and activity of the service found in this inspection. It also contained information that suggested the home will continued to make improvements that are both realistic and achievable. This is a good indicator of even better outcomes for people living at Brook House. DS0000015239.V363468.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X N/A X X 2 DS0000015239.V363468.R01.S.doc Version 5.2 Page 24 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 OP27 Regulation 18(1)(a) Requirement Timescale for action 31/08/08 2 OP38 23(4)(c) There must be sufficient and appropriately trained care staff working to meet people’s needs when medication is being administered, so people are assured of the care they need. The faults showing on the fire 31/08/08 alarm circuit must be corrected, so that people are protected by a fully operative fire alarm system. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP19 Good Practice Recommendations Unused medication should be returned to the pharmacist as soon as possible. The worn taps and bath should either be repaired replaced. DS0000015239.V363468.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1 Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000015239.V363468.R01.S.doc Version 5.2 Page 26 - 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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