Care Home: Brook House

Similar services:

• Ashlong House
• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)

What the care home does well The home is welcoming, and has a calm atmosphere. The environment is homely, warm and clean, well maintained. Feedback from residents was very positive about the staff. We were told that they were approachable and `friendly`. A person using the service told us that the staff were `A1`, and that he was very happy living in the home. Visitors also told us that they were happy with the staff who they found to be approachable. People using the service are supported to have the contact that they wish with relatives and friends. People using the service (including privately funded residents) each have a comprehensive contract of terms and conditions with Brook House. Care plans address the individual needs of people using the service. The care plans include written staff guidance to ensure staff know how to meet the needs of residents and include assessment of risk. People using the service (and/or their relatives) participate in the development and review of their care plans. Staff receive varied and appropriate training to ensure that they are skilled in carrying out their roles and responsibilities. Interaction between staff, and residents is positive and respectful. The bedrooms of people using the service are individually personalised, and most have en-suite facilities. Residents told us that they liked their bedrooms. Meals provided to people using the service are varied and wholesome, and meet the preferences and dietary needs of people. Comments included `the meals are nice`, and `I like the food`. People using the service have the opportunity to take part in a variety of activities and leisure pursuits. The manager is experienced and competent and it is evident that he cares about providing a quality service to residents, and is keen to continue to develop and improve the service provided by Brook House to people. Staff, residents and visitors told us that the manager was approachable and listened to them. What has improved since the last inspection? The requirements from the previous inspection which asked the home to have a system in place to monitor the pressure relief equipment in accordance with the individual resident`s needs, and have first aid equipment and suction machine be ready for use, were judged to have been met. The other requirements that we asked to be met by the home included; improvements to be made to medication administration systems, the need to review the level of engagement and interaction of staff with residents, and the home needing to assess resident`s ability to make decisions, were also judged to have been met by Brook House. The home has introduced medication stock checks and audits to improve the safe management of medication. This has resulted in an improvement in the recording of medication and has provided evidence that medication is being administered as prescribed. Some areas of the care home have been redecorated and some `old` beds have been replaced with new profile beds. It was evident that the manager and deputy manager have continued to work hard to develop and improve the service provided to people at Brook House. What the care home could do better: The home needs to ensure that all residents and relatives/next of kin/advocates have knowledge and understanding of the complaints procedure. `Concerns` received by the home from relatives and others should be recorded (including the action taken by staff to look into and resolve these concerns/issues). With regard to feedback received from people using the service, who told us that there seemed to be a shortage of staff at times, the home needs to carry out a review of the staffing needs in Brook House, relating the review to the dependency needs of residents. The home needs to maintain the improved standards in handling medication safely, and continue to robustly audit medication regularly, to prevent errors occurring. The home could look into improving the availability of storage space for equipment, (such as portable hoists used for transferring people with mobility needs) in the home. Key inspection report Care homes for older people Name: Address: Brook House 2-6 Forty Close Forty Avenue Wembley Middx HA9 7UU     The quality rating for this care home is:   two star good 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: Judith Brindle     Date: 1 9 0 4 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 33 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 33 Information about the care home Name of care home: Address: Brook House 2-6 Forty Close Forty Avenue Wembley Middx HA9 7UU 02089048371 02089048371 brook@barchester.net www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) John Alasdair Gilfillan Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 47 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 34) Physical disability - Code PD (maximum number of place: 29) Date of last inspection Brief description of the care home Brook House is part of Barchester Healthcare Limited, which is a national company providing care mostly for the elderly and physically disabled younger adults. Brook House is located in Wembley Park. It is easily accessible by buses that pass close to Care Homes for Older People Page 4 of 33 Over 65 34 0 0 29 Brief description of the care home the home. Wembley Park underground station is a few minutes walk from the home. The home has parking spaces for more than ten cars and there is additional parking outside the home, when the are no events in Wembley Stadium. The nearest shops and amenities are found in Wembley Park or Wembley, which are a short distance from the home by bus or by car. There is a petrol station with some shopping facilities about two minutes walk from Brook House. The home is purpose built and is registered to provide nursing care and accommodation for up to 47 people, (up to 29 young physically disabled residents and up to 34 older people). Accommodation is in 46 single bedrooms with 44 of these, ensuite. Information about the care home and the fees is available from the home. The fees charged by Brook House vary in accordance to the needs of people using the service. Care Homes for Older People Page 5 of 33 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced key inspection of Brook House took place within one day in April 2010. The previous key unannounced inspection took place on the 14th August 2010 and September 1st 2010. Prior to this unannounced key inspection the Commission received a completed Annual Quality Assurance Assessment (AQAA) document from the manager of the care home. The AQAA is pre-inspection paperwork, which is a selfassessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. This AQAA completed by the registered manager) told us what we needed to know about Brook House. We received two feedback questionnaires from people who use the service and three from relatives of residents. We also looked at other information received by us since Care Homes for Older People Page 6 of 33 the previous key inspection at Brook House. This included any information about incidents that the service has told us about that have happened in the home. These are called notifications, and are a legal requirement. Other documentation we looked at included; care plans of people using the service, risk assessments, staff training, staff personnel records, and some policies and procedures. We also spoke with people using the service, visitors, the manager and other staff on duty. Observation was a significant tool used during this inspection, particularly with regard to interaction between staff and residents. The inspection also included a tour of the premises. There were six vacancies at the time of this inspection. 25 National Minimum Standards for Older Persons, including Key Standards, were inspected. We thank the people living in the care home, staff, the manager, and all those who spoke with us during the inspection, for all their assistance in the key inspection of Brook House. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The requirements from the previous inspection which asked the home to have a system in place to monitor the pressure relief equipment in accordance with the individual residents needs, and have first aid equipment and suction machine be ready for use, were judged to have been met. The other requirements that we asked to be met by the home included; improvements to be made to medication administration systems, the need to review the level of engagement and interaction of staff with residents, and the home needing to assess residents ability to make decisions, were also judged to have been met by Brook House. The home has introduced medication stock checks and audits to improve the safe Care Homes for Older People Page 8 of 33 management of medication. This has resulted in an improvement in the recording of medication and has provided evidence that medication is being administered as prescribed. Some areas of the care home have been redecorated and some old beds have been replaced with new profile beds. It was evident that the manager and deputy manager have continued to work hard to develop and improve the service provided to people at Brook House. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service, and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Evidence: The care home has accessible information about the care home, and the service that it provides to people. The AQAA (Annual Quality Assurance Assessment) told us that the statement of purpose and service user guide provides comprehensive information for the residents and these are regularly reviewed to reflect any changes about the facility and services that the home provides and a brochure is available on request and sent by post, and is also given to all prospective residents, and relatives. Staff told us that residents are provided with a welcome pack, (which includes the service user Care Homes for Older People Page 11 of 33 Evidence: guide), when they move into the home, and staff including the administrator are available to answer any queries. Feedback from the two surveys that we received from people using the service told us that they did receive enough information to help them decide if Brook House was the right place for them before they moved in. A visitor confirmed that she had been provided with information about the home. The AQAA informed us that the home has an admissions policy/procedure, and that all residents needs are assessed prior to admission to the home to ensure that their needs can be met and that a pre assessment admission form is filled out obtaining information from the resident, care staff, and social services. The manager spoke of carrying out the initial assessment of prospective residents, either in hospital or in the persons own home. A visitor confirmed that an assessment of their relatives needs had been carried out and that both the visitor and the resident had been fully involved in the assessment process, and had been asked questions about the persons needs and preferences. We were told that the initial assessment (and further assessment once the person is admitted to Brook House) forms the basis of each residents care plan. The care plans looked at told us that people using the service receive assessment of their; health, personal care, emotional, hopes and concerns for the future, mobility, social, religious (and other equality and diversity) needs. The AQAA informed us that the clients care plans are put into place on admission and risk undertaken. Staff told us that the home encourages people to visit the home before moving in. A visitor spoke of having visited the home prior to her relative being admitted to Brook House. The AQAA told us that every resident has a written contract which incorporates a statement of terms and conditions of the home. We were shown some residents contracts/statement of terms and conditions, these include information about the fees, and any costs for extra items. The administrator told us that all residents including privately funded residents have a contract with Brook House, and that people using the service (and/or their relatives) receive their own copy of this contract. Feedback from people using the service told us that they had been given written information about the homes terms and conditions. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service has a plan of care, in which residents health, personal, and social needs are set out. People using the service are respected and their right to privacy upheld. People using the service are protected by the homes policies and procedures for managing and administrating medication, and need to continue to maintain the improved standards in handling medication safely. Evidence: Each person using the service has a plan of care. Four care plans were inspected. These included generally comprehensive assessment information about the persons individual needs. They included information about the residents communication, personal care, continence, nutrition, skin condition, sleeping, orientation and a number of other needs including dependency and sexuality needs. The care plans also included planned care for assessed needs staff guidance to support the person using the service to meet their needs. The care plans also addressed the cultural, religious and ethnic aspects of the needs of residents. The residents Life Story and end of life Care Homes for Older People Page 13 of 33 Evidence: wishes were recorded in the care plans looked at. Staff told us that audits of residents care plans, medication, nutrition, etc are carried out on a monthly basis by the deputy manager. It was also evident that risk assessments were carried out. These included the risk of the resident falling, risk of getting a pressure sore, choking, use of bed rails, moving and handling,and risk of behaviour that might challenge the service. Residents personal care needs, and preferences are recorded in the care plans. This record includes the level of assistance (with regard to residents personal care needs) needed to be given by care staff. During the inspection, staff provided assistance and support to residents in a sensitive and respectful manner. It was evident from observation and from talking with staff that they have an understanding of the importance of upholding residents right to privacy. Residents spoke of making choices, which included choosing their own clothes, and the times that they wished to go to bed, and get up in the morning. People were observed to be dressed appropriate to their culture and age. Care plans included evidence of peoples choice being acknowledged, and staff guidance (to meet these needs) was incorporated into their plan of care. We spoke to people using the service who told us that they are treated with respect and were told that staff knock on the door before they are entering a room. Care plans inspected informed us that the resident and/or their relatives were involved in their development, and that they are reviewed on a monthly basis, and more often as an when the residents needs changed. It was evident that an annual care profile review was also carried out. These records indicated that the resident was fully involved in this review and had signed the care plan review documentation. Feedback from the three feedback surveys told us that the home always, usually and sometimes meets the needs of their friend/relative, and are generally kept up to date with important issues affecting the person using the service. A visitor told us that she is always told about issues relating to her relative. In care plans that we looked at we noted detailed pressure sore assessments, which had been reviewed. Staff told us told us that the care home provides pressure relieving equipment to people using the service, and has contact with a tissue viability nurse, as and when required. We were told that one person had a small pressure sore, which was being treated, and that the home has preventative measures in place and investigation and close monitoring of any pressures sores that occur. Three requirements from the previous inspection which required that the home have a system in place to monitor the pressure relief equipment in accordance with the individual residents needs, first aid equipment and suction machine be ready for use, Care Homes for Older People Page 14 of 33 Evidence: and the home review the level of engagement and interaction of staff with residents, were judged to have been met by the service. Records, staff, residents, and feedback surveys told us that people using the service have access to care, and treatment from a variety of health professionals, and specialists. These include GP, dentist, continence adviser, community nurse, optician, tissue viability nurse, speech and language therapist, and chiropodist, and hospital appointments. Residents told us that they see their GP when they need to. We were told by staff that the GP reviews the needs of residents on a weekly basis, visits residents as and when needed, and makes referrals to specialists if required. Records told us that residents weight is monitored. The AQAA told us that monthly audits are carried out, which include monthly pressure sore checks, nutrition reports and infection control reports completed by management staff. The pharmacist Inspection was carried out to check requirements made on medication at a previous inspection. The pharmacist reviewed the homes medication policy, storage of medication, the recording and the safe administration of medication. The current medication cycle started on 29/3/10. We noticed that the home had a medication policy and local procedures in each unit. Storage was secure and medication was recorded on the medication administration record (MAR) when it was received into the home or carried forward from the previous medication cycle. Registered nurses administered medication and we observed that this was carried out professionally and with great attention to the individual residents needs. Nurses recorded on the MAR after they gave the medicines. If the resident was in hospital or refused their medicine then this was recorded appropriately. We counted 17 samples of medication and all could be reconciled with signatures for administration or the appropriate endorsement. We noticed three gaps where a code had indicated selection of the medication but the signature had been omitted. We were unable to reconcile a further two samples of medication. For one it appeared that the record of a receipt from hospital was incorrect. For the other there was one too many tablets left. The home was carrying out its own audits-daily checks of the MAR and weekly checks by managers.They had recently started checking nightly stock levels of medicines dispensed in their original packs. Residents who were prescribed warfarin medication had their anticoagulant books kept with the MAR for cross checking and to prevent error. There were risk assessments in place for residents who wished to self-medicate or apply their own creams. Several were fed by enteral (feeding) tube and the medicines were given through the tube.The GP and pharmacist had been consulted about the correct formulation of medicines to be given in the tube and this was documented. We saw the protocols for these feeds and noted the records of review by the dietitian in the care plan. There were care plans on how to manage seizures and Care Homes for Older People Page 15 of 33 Evidence: residents with diabetes. We saw that throughout the home, staff were using lancets for professional use when checking blood glucose. Many of the residents had had medication reviews or changes in medication following a period in hospital.These changes were signed and dated on the MAR and we were able to track the changes to the daily notes, records of visits by health care professionals and discharge letters from hospital. Medication was organised and secure in locked trolleys in locked clinical rooms. Waste medicines were recorded and disposed of via a licensed waste carrier, The controlled drug cupboards were secure and we looked at the controlled drug register and noted that the balances tallied with controlled drugs stored in the home. Overall, we were satisfied that medication was handled safely in the home. The home needs to maintain the improved standards in handling medication safely, and continue to robustly audit medication regularly, to prevent errors occurring. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a variety of preferred activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. Meals provided are varied, and wholesome, and meet the cultural and faith needs of people using the service. Evidence: The home employs an activity co-ordinator, who told us about the variety of activities that are available for people to participate in. These include playing darts, board games, general knowledge quizzes, painting, music sessions,and discussing a variety of subjects. She told us about asking people what they want to do and of her role in encouraging residents to take part in an activity whether it be a one to one leisure pursuit for a few minutes or a community outing with other people using the service. We were told that local school children visited the home, and invite residents to concerts. Activities are grouped in to various types that met peoples educational, emotional, sensory, social, and physical needs. The AQAA told us that people using Care Homes for Older People Page 17 of 33 Evidence: the service have access to a computer. The care plans included information about the activity preferences of people using the service, and their social interests. Records of daily activities that each resident had participated in, were written in each persons care plan. It was also evident that residents activity needs are reviewed monthly. Younger residents spoke of going out and about in the local community. Going to shops and using other local facilities. The home has a minibus that is used for community activities. The activity co-ordinator told us that there were regularly half day trips out to places of interest, garden centres, the London Eye, Ten Pin bowling, Kew gardens, and the RAF centre. Residents were seen to freely access the garden. Staff told us that in the warm weather a number of residents enjoy the garden, and that there have been barbeques. A person using the service told us that he can go out and about freely, and just has to tell staff that he is going out. Representatives from the main local churches visit the home on a regular basis to offer spiritual support to residents. The AQAA told us that the home could utilise more outside agencies for developing and sustaining more activities to elevate boredom and that there were plans to develop a sensory room. Visitors spoke of visiting their relative at any time of the day, and told us that they felt welcomed. A visitor informed us that she felt that her relative living in the home was safe and happy. The home has a four week menu. This recorded a variety of wholesome meals. We were told that peoples preferences, cultural and religious dietary needs were met by the home. On the first floor it was noted that on each table there was a menu, but that these were dated for the 16/04/10 not the 19th April which was the date of this inspection. This was pointed out to staff and the menus were removed. We were told that there had been issues with printing the daily menus, but it was acknowledge by staff that it would have been more appropriate to remove these documents rather than have the wrong information displayed. The menus are in written format. The home should look at ways of developing and improving the accessibility of the menu information to people using the service. Displaying photographs of the meals planned for each day was one format discussed. Breakfast on the 1st floor was served for residents in the dining room at approximately 09.15am. We were told by staff that some residents chose to eat their meals in their rooms. The tables in the dining room were well laid, table cloths were clean, and condiments accessible to people. People using the service were offered choice of porridge or cereal, and some residents had a cooked breakfast. Residents told us that they enjoyed the food. A variety of hot drinks were available via a vending machine (at no cost) in the reception area to residents, staff, and visitors. A resident Care Homes for Older People Page 18 of 33 Evidence: was seen to make use of this facility. It was evident that the care plans included details about resident dietary needs and preferences. There was also comprehensive guidance with regard to assisting residents with their meals. We spoke with a cook. She told us about how she gains up to date information about residents dietary needs, choice, and food preferences. She told us that she makes makes most meals from scratch. She was making a vegetable quiche/flan when we spoke. People who needs help with their meals, were supported by staff, in a sensitive manner. Meals were not rushed, and drinks were offered frequently to residents during the inspection. The kitchen was clean and appropriate required safety checks (including fridge and freezer temperature monitoring) were carried out. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action taken to put things right, but there could be development in the recording of comments/concerns. Residents are protected from abuse, neglect and self-harm. Evidence: We were told that the home has a complaints policy, and that it is included in the service user guide. The AQAA informed us that there had been one complaint in the last twelve months which was resolved within 28 days. The AQAA also told us that we follow the complaints procedure in a timely manner in accordance with the organisations policies and procedures and we make the complaints procedure available to service users, and visitors to the home. The manager told us that complaints are treated with all due importance even the smallest thing. The AQAA informed us that the home has an open door policy in dealing with any issues as soon as they arise. The recording of concerns and the action taken to resolve them was discussed with the manager. All concerns brought to the attention of staff from residents, visitors and others, should be recorded, to ensure that it is evident that all concerns are responded to and managed appropriately. Two of the three feedback forms from relatives and two from people using the service told us that they didnt know how to make a formal complaint. The manager told us Care Homes for Older People Page 20 of 33 Evidence: that he was surprised at this as he had tried to ensure that everyone knew how to make a complaint. He spoke of taking further action to ensure that all the people using the service, and relatives/friends/advocates were aware of the complaints procedure. During the inspection residents told us that they would speak to the manager or care staff if they had a concern or complaint. Records and the AQAA told us that staff receive safeguarding adults training, and have an awareness of the whistle blowing policy. We were told that the staff handbook includes a summary of the whistle blowing policy as well as other policies and procedures. Staff who spoke to us were knowledgeable of the reporting and recording of complaints, and of the procedures with regard to responding to an allegation or suspicion of abuse. The manager had an awareness of the Mental Capacity Act 2005/ Deprivation of Liberty Safeguards. He told us that all residents had been looked at with regard to the Deprivation of Liberty Safeguards. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care homes stated purpose. Residents bedrooms are individually personalised and meet their individual needs. Evidence: The home is purpose built, and accessible to wheelchair users. It is located within a few minutes walk from Wembley Park, and is close to a variety of amenities including shops, restaurants, banks, and cafes. Public train and bus transport facilities are accessible close to the home. The front of the property is tidy and attractive, and the garden area is enclosed and generally well maintained. Residents told us that they enjoy the garden facility and make use of it frequently during nice weather. During the inspection we saw people using the service freely accessing the garden, spending time sitting outside. The home has a welcoming and has a calm atmosphere. The living environment is bright, and appropriate for the particular lifestyle, and needs of people living in the home. Pictures, and plants are located in the communal sitting/dining room areas of the home. The interior of the home is well maintained, and attractive. Furnishings and fittings are appropriate and of quality. Feedback surveys from people using the service told us that Brook House is always fresh and clean. Residents we spoke with during Care Homes for Older People Page 22 of 33 Evidence: the inspection confirmed this. The home employs a maintenance person. We were told that there is on-going redecoration and maintenance of the home. The maintenance person told us about his role in the home. Equipment for supporting people with their mobility needs, was accessible to residents. We were told from the AQAA that required safety checks are carried out. We noted that some hoists were located in a bathroom (2nd floor). Staff told us that storage space was lacking in the home. The AQAA told us that the home was looking at ways to improve its storage space. This should be looked into, so as to ensure that hoists etc do not impede peoples access to the bathroom and possibly cause risk to their safety. The AQAA told us that the home has replaced old beds with profile beds, and has bought more pressure relieving mattresses. We looked at several bedrooms. These included personal items such as photographs, ornaments, and television. People using the service spoke positively of their bedrooms. Comments included Im happy with my room. The AQAA informed us that home has an infection control policy/procedure. Laundry facilities are located away from food storage, and food preparation areas. The AQAA told us that our standards of hygiene and cleanness throughout the home are good and our premises are kept clean, hygienic and free from offensive odours throughout the building and we have a system in place to control the spread of infection in accordance with the relevant legislation and published professional guidance. Brook House employs domestic staff. We were told that there are two domestic staff working during the week days and one who works at the weekend. The AQAA told us that Brook House has a dedicated housekeeping team who are always being complemented by outside visitors. We noted that domestic staff were seen cleaning various rooms of the home during the inspection. Hand washing facilities are located throughout the home. There are accessible paper hand towels and soap in bathrooms inspected. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records confirmed that staff had received infection control training. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and competent to support people who use the service, and the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. Evidence: The AQAA told us that Brook House staffing levels and skill mix are appropriate for the assessed needs of the resident. We were told that there was a trained nurse on duty on each floor of the home during the day, with two to three care workers. There is also the deputy manager, and administration staff. At night there is a trained nurse and a carer for each floor. From looking at records, meeting residents, and talking with staff it was evident that Brook House provides care and support for several residents who have multiple complex needs. We received feedback from people using the service that they believed that there had been some cuts in staffing numbers and there sometimes felt to be a shortage of staff. Residents told us that the staff were very good but were very busy and one person told us that he had to sometimes wait a while for support from staff with a shower. Another person using the service informed us that staff do not stop all day. A feedback survey from a person using the service told us that staff were usually available when they need them. We noted that staff did seem very busy throughout the inspection, and though they interacted positively Care Homes for Older People Page 24 of 33 Evidence: with residents they had little time to spend more than a few minutes with them. We discussed staffing with the manager, who told us that there was flexibility in staffing numbers to meet peoples needs. AQAA told us we use a dependency tool as an aid to determine staffing levels and the the general manager ensures that the home is adequately staffed at all times. In view of the feedback from people using the service, the home needs to carry out a review of the staffing needs in Brook House, to ensure that the staffing levels meet the dependency needs of people using the service, and to support them to lead a quality life. The manager spoke positively of the staff team, and told us that he would be recommending some staff for an award from the Organisation. Staff told us that they liked working in a team, and enjoyed their job. During the inspection staff worked well together. Staff were observed to be very approachable and interacted with residents in a particularly sensitive manner during the inspection. Feedback from residents was very positive about the staff. We were told that they were approachable and friendly. A person using the service told us that the staff were A1, and that he was very happy living in the home. Residents knew the name of their key worker, and a visitor spoke positively of her relatives key worker. During the inspection call bells and the telephone were answered promptly. Staff told us that communication about the needs of residents was good. A care worker told us that there was a handover about each persons needs at the start of each shift. We were informed that the home has a trainer. Staff told us that the home provides good induction training, and other training to ensure that they have the essential skills for carrying out their roles and responsibilities. Records told us that staff training included, medication training, customer care nutrition, specialist clinical nurse training such as tracheostomy care, fire, First Aid, food safety, moving and handling, health and safety, safe use of bed rails, infection control, dignity, catheter care, and safeguarding adults training. We were also told by the deputy manager that nurses receive additional palliative care training to facilitate responsive provision of end of life care. We were informed that the local hospice provides regular educational sessions with regard to understanding palliative care. Staff confirmed that they had appropriate training, and were positive about the staff induction that included a wide range of relevant subjects related to their role in supporting and caring for people using the service. Staff confirmed that they have the opportunity to achieve National Vocational Qualifications (NVQ) level 2 care. AQAA information told us that 17 out of 31 care staff have achieved this qualification. Care Homes for Older People Page 25 of 33 Evidence: The care home has a recruitment and selection procedure. Three staff personnel files were inspected. These contained required checks and references, and confirmation that staff have received an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record. We were told that these checks are carried out every three years. This is good practice. Staff job descriptions were available for inspection, and we were told that each staff member is provided with a staff handbook and welcome pack,when they start their job. Care Homes for Older People Page 26 of 33 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. The management and administration of the home is based on openness and respect, and has effective quality assurance systems to monitor and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. Evidence: The manager was appointed in April 2008 and since then has been registered with us. He has a significant number of years experience managing care services and is a trained nurse and has achieved the Registered Managers Award. He is supported by a deputy manager and the line management from Barchester Healthcare Homes Ltd. He told us that he works flexibly working in the home during some weekends and evenings to ensure that he can monitor the home closely and gain more knowledge and understanding of what working each shift entails for staff. He was working in the home when we commenced the inspection at 08.15am, and he told us that he had Care Homes for Older People Page 27 of 33 Evidence: been there for some hours prior to our arrival. It was noted that during the inspection that the manager was seen out and about in several areas of the home speaking to residents and staff. It was evident from AQAA information, feedback from people using the service, staff, and from talking to the manager that he has put in place a significant number of improvements to the service to develop the quality of the service provided to residents. Staff and residents told us that the manager was very approachable and listened to what they said. A visitor confirmed that the manager responded appropriately to any issues and/or concerns that she had had. Records told us that resident , relatives, and staff meetings take place. The care home has a number of systems in place to ensure that the quality of the service is monitored closely and that action is taken to continue to develop and improve the service provided to residents. The AQAA told us that Brook House has monthly internal audits undertaken by the General Manager and the Clinical Nurse. Records told us that required unannounced monthly visits to the home by a representative of the owner are carried out. The AQAA also told us that the organisation has a compliance officer who undertakes audits in line with the NMS (National Minimum Standards) and Care Home Regulations and these audits and actions ensures that the home provides effective quality assurance and assists the home in achieving the aims and objectives in ensuring good outcomes for people. There are robust systems in place to ensure that each person using the service has their finances (if not managed by themselves and/or their relative) monitored and managed appropriately. We were told that the home invoices the person managing the residents money when purchases take place. We were told that only small amounts of residents money are kept in the home. Records confirmed that comprehensive recording of deposits and expenditure is carried out. The AQAA told us that a financial audit is undertaken by the head office to maintain the the financial aspects and records and month end returns and reconciliations are completed. The home has a staff supervision policy. Staff confirmed that they receive regular staff one to one staff supervision, which ensures that they are supported in carrying out their role and responsibilities for meeting the care and support needs of people using the service. Records of recent staff supervisions were seen. The AQAA told us that the home has health and safety policies, and required health and safety checks are carried out. The AQAA also told us that the organisation employs an external body to carry out Health and Safety inspections in the home. We were told that there is monthly monitoring of health and safety systems. The manager told us that a relative of a resident would be invited to the next health and safety Care Homes for Older People Page 28 of 33 Evidence: meeting. Fire safety guidance is displayed in the home. Required fire safety checks and fire drills are carried out, and there is a fire risk assessment. Fire safety guidance is displayed. There is a personal evacuation plan in place. The home lets us know about things that have happened; they have shown us that they have managed issues appropriately. The home has an accident policy/procedure. Incidents and accidents are recorded as required. Records confirmed that the manager and organisation monitor accidents/incidents closely. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 9 13 To continue to robustly audit 01/08/2010 medication so that errors in recording and administration are quickly identified to prevent re-occurrence. This is to provide on going evidence that the health needs of residents is maintained. 2 16 22 The home needs to ensure that all the people using the service and their relatives know of the complaints procedure. To ensure that all residents, relatives, and others know how to make a complaint. 01/08/2010 3 27 18 The home needs to carry out 01/08/2010 a review of the staffing needs in Brook House. To ensure that it is evident that staffing numbers and skill mix of qualified and unqualified staff are Care Homes for Older People Page 31 of 33 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 appropriate to the assessed needs of the people using the service, the size, layout and purpose of the home, at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 The home should look at ways of developing and improving the accessibility of the menu information to people using the service who might have difficulty in reading, understanding the written word, or have English as a second language. All concerns brought to the attention of staff from residents, visitors and others, should be recorded, to ensure that it is evident that all concerns are responded to and managed appropriately. Storage space in the home should be reviewed, and if needed systems be put in place to ensure that hoists etc do not impede peoples access to the bathroom and possibly cause risk to their safety. 2 16 3 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!