Care Home: Brook House Care Centre

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What the care home does well Requirements and recommendations made by the Commission were addressed. Residents were admitted to the home based on a pre-admission assessment of care needs. Medicines were safely managed. Systems were in place to meet resident`s healthcare needs. Age appropriate activities were provided for residents of different age groups. Domestic staff worked together to provide a clean environment for residents. Attention was given to providing a safe environment. Safe systems were in place to manage resident`s personal allowance money.Relatives could visit at any time and contribute to resident care. Residents were able to personalise their bedrooms. What has improved since the last inspection? Numerous improvements had been made to the service since the last inspection. All but one of the requirements made at the last inspection had been addressed. The standard of care and activities had improved throughout the service. Care plans had improved and reflected resident`s identified needs. Wound management records had improved. The organisation of meal times and serving meals had improved. Adequate staffing levels were maintained. Moving & handling equipment was serviced and staff had access to the equipment required to meet resident needs. Staff training and supervision had improved. A system was in place to monitor hot water temperatures. Staff morale and attitude had improved and staff were positive and supportive about the current management arrangements and changes made to the service. The home looked brighter, cleaner and homely due to the on-going redecoration programme. Staff were keen to show us the changes and were proud of the work they were involved in to improve the environment. What the care home could do better: Hand written entries made by staff on medicine charts must be signed by two people to ensure no errors are made. Accurate records must be kept for all medicines bought into the home so that an audit trail can be completed. Staff must check and record the resident`s pulse prior to giving specific prescribed medicine. Staff must take time to feed residents and ensure they enjoy their food while maintaining their dignity. All bathing facilities must be maintained in working order and available to residents at all times. The person managing the service must register with the Commission to ensure compliance with the Care Standards Act. The commission must be informed in writing of the action taken to comply with this requirement. A copy of the quality review of the service must be supplied to the Commission and made available to residents and others. CARE HOMES FOR OLDER PEOPLE Brook House Care Centre 20 Meadowford Close Off Thamesmere Drive Thamesmead London SE28 8GA Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 12th June 2008 09:25 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 Brook House Care Centre DS0000006776.V365259.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. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brook House Care Centre Address 20 Meadowford Close Off Thamesmere Drive Thamesmead London SE28 8GA 020 8320 5600 020 8310 6363 brookhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd 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) Post vacant Care Home 74 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (14) of places Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (CRH - 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: 60) 2. Physical disability - Code PD (maximum number of places: 14) The maximum number of service users who can be accommodated is: 74 9th January 2008 Date of last inspection Brief Description of the Service: Brook House Care Centre is registered with the Commission for Social Care Inspection to provide nursing care for 60 older people and 14 young adults with a physical disability. The registered care provider is Southern Cross Healthcare. The three-storey building is located close to Thamesmead town centre, shops and local bus routes and was purpose built. The home consists of a kitchen, laundry, administration facilities, a fourteen bed unit for young physically disabled people on the ground floor and two thirty bed units for older people requiring nursing care on the first and second floors. Each unit has its own lounge, dining area and kitchenette. All bedrooms are for single occupancy with en suite toilet and hand basins. There is a car park in front of the home and a garden to the rear with a patio and garden seating. Current weekly fees on the older person units’ ranged from £588.00 to £750.00 and from £800.00 to £1200.00 on the younger persons unit. Residents paid privately for personal items such as hairdressing, newspapers and toiletries. Brook House Care Centre DS0000006776.V365259.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 site visit for this unannounced key inspection was carried out over two dates. On 12th June 2008 two inspectors did a site visit and one inspector completed the inspection visit on 23rd June 2008. The service had a key unannounced inspection on 9th January 2008. The acting manager and staff assisted with the inspection. The service had a high number of vacancies as the local authorities had taken the decision to suspended placements however at the time of the site visits this decision was reversed based on improvements in standards and new residents were being placed in the home. This inspection process included a review of information held on the service file, a tour of the premises, a review of records, talking to residents, staff, management and reviewing compliance with previous requirements. Information provided in the Annual Quality Assurance Assessment (AQAA) was viewed. Although feedback surveys were sent to the home to distribute to staff and residents these were not received. Therefore limited feedback was obtained from residents, relatives and staff during the inspection visits. Since the last inspection management and staff had worked together to raise standards in the home and ensure stability for residents. Many areas of the service had improved and most noticeable was staff morale and management commitment. Plans were being developed to change the current registration for the top floor of the home to enable people suffering from dementia to be cared for. In planning for this change staff had received dementia care training and a bedroom on the top floor had been converted to an activity room for residents. What the service does well: Requirements and recommendations made by the Commission were addressed. Residents were admitted to the home based on a pre-admission assessment of care needs. Medicines were safely managed. Systems were in place to meet resident’s healthcare needs. Age appropriate activities were provided for residents of different age groups. Domestic staff worked together to provide a clean environment for residents. Attention was given to providing a safe environment. Safe systems were in place to manage resident’s personal allowance money. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 6 Relatives could visit at any time and contribute to resident care. Residents were able to personalise their bedrooms. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 did not apply to the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre admission assessments were completed for residents and they received written confirmation as to the suitability of the placement. EVIDENCE: Care records for six residents were inspected. The records included preadmission assessments and some included care manager assessments. There was evidence to show that residents received written confirmation that based on assessment the home was suited to meeting their needs. At the last inspection it was noted that a number of residents outside the home’s category of registration had been admitted over time and in particular residents suffering with dementia. Since then senior management had taken the decision to apply to the Commission for a variation to registration to provide dementia nursing care on one floor of the home. Plans in place to make this application included staff training and recruitment and making the Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 9 environment more suited to residents in this category. In view of this no requirements have been made in relation to this issue and the Commission will monitor the situation at future inspections. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans had improved and systems were in place to meet resident’s healthcare needs. Medicine management had improved was assessed as safe. Residents were referred appropriately to healthcare professionals. No concerns were identified in relation to respecting resident’s privacy. EVIDENCE: Care records were inspected for a total of six residents. The records seen included care plans, risk assessments and other relevant care documents. Risk assessments had been completed in relation to areas such as moving & handling, continence care, nutrition, safety and pressure sore prevention. The care plans and risk assessments seen were kept under review. In general care plans seen were satisfactory and provided guidance for staff as to how care needs were to be met. Some of the care plans seen were personalised and included information on recognising signs of stress or contentment for residents who lacked capacity. There was evidence in the care records seen that these had been discussed with residents and family. Bathing records had improved and it was possible to see when residents had a bath or shower. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 11 Care plans had been prepared for residents in relation to meeting their care needs in respect of dementia care, communication and confusion. The care plans seen showed how staff should communicate with the person, how they should read body language and the need to reassure people. Residents with ability to provide feedback and relatives spoken with were satisfied with how their care was provided. The daily and weekly progress reports for residents could be more informative, support the implementation of care plans and show the quality of life for the resident. Based on information provided by staff two residents had pressure sores. Both sets of care records were inspected. One resident was admitted with the wound and the other person’s wound developed in the home. The tissue viability nurse and the dietician had seen both residents and care plans were prepared in relation to wound care and nutrition. Wound care records showed the type of dressing used, the frequency of dressing and on-going assessments were completed to show how the wound was responding to treatment. Where assessed as necessary residents were provided with pressure relief mattresses and cushions. Residents assessed as being at risk of developing pressure sores had care plans prepared to show the action staff should take to prevent these developing. There was evidence in care records seen to show that resident’s were referred to health care professionals such as the GP, podiatrist, tissue viability nurse, dietician, chiropodist and audiologist as needed. Comments from relatives included “I am happy with the care provided”, “ the home has improved greatly recently” and “I was very happy with the care provided to my relative during a respite break”. Medicine management was inspected on all floors. Medicine storage facilities were satisfactory and the temperature of medicine rooms and fridges monitored. Trolleys were used to administer medicines and medicines were supplied in blister packs for 28days with pre-printed administration charts. Adequate means of identifying residents were attached to administration charts and records were kept for receipt, administration and disposal of medicines. Medication records were checked for two residents on the ground floor and were correct, records were checked for three residents on the first floor and were correct but staff had not recorded the persons pulse when giving a specific medicine and hand written entries made by staff for one resident had not been countersigned. On the second floor records were checked for three people and one error was noted, there was one extra dose for one medicine when the amount remaining was tallied with the amount administered and dispensed. A recommendation made in relation to medicine profiles, protocols and staff assessment had not been addressed. As this was a recommendation made at the last inspection and the manager had numerous issues to address at that time it was agreed to repeat this recommendation on this occasion and management was aware of the need to address this recommendation. Requirement 1 and recommendation 1. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 12 From observation staff were seen to respect residents privacy when assisting with personal care, were speaking to residents respectfully and addressing them by their preferred name. Residents were appropriately dressed and presented. On the ground floor residents were wearing age appropriate clothing and staff had helped residents to maintain their preferred personal appearance. None of the residents or relatives spoken with raised concerns about the way staff respected people. One relative said staff were kind and caring and one resident said that generally staff were very good but that some were better than others. However the resident said if they had a concern they would discuss this with the nurse or home manager. On the ground floor unit it was noted that staff had arranged for advocates to support two of the people living there. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements had been made to activities and meal times. Relatives and friends said they were welcome to visit the home. Some care plans seen supported residents ability to make choices in about their lives. EVIDENCE: Time was spent talking to the activity person for the younger persons unit on the ground floor. This area of the service had improved greatly and work had started on preparing individual activity programmes for each person. There was evidence of an increase in age appropriate activity for the people on this unit. For example one person was due to start a college course in September 2008 and staff had helped the person to attend a weekly Scout group and join a gym. Another resident had recently been to a concert, had enjoyed inhouse activities such as a film afternoon, cooking, alternative therapy and plans were in place for the person to go swimming. Staff ensured a person with a visual impairment had access to the talking books scheme. The unit environment had been improved through re-decorated and refurbished and included a room designated and decorated for residents to use for activities. From discussion with the activity coordinator it was apparent that they had good ideas about age appropriate activities and equipment for people on the Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 14 unit. However staff must ensure that the equipment provided in the activity room is age appropriate as a small number of items seen were considered a bit too child like for the residents. Staff involved residents with the decoration programme and encouraged them to choose patterns and colours. On the other units an activity programme was prepared and delivered flexibly. Residents had the opportunity to take part in activities such as quizzes, bingo, music session, film afternoons and arts and crafts. Staff acknowledged resident’s birthdays by organising a party if that suited the person. A resident, their family and other residents were seen enjoying such an event during the inspection. A bedroom on the second floor had been converted to an activity room and was nicely decorated and fitted for this purpose. Staff were complimented on the efforts they had made to enhance the environment for residents particularly in relation to activities and bathing areas. Residents spoken with were satisfied with the activities provided. The service had an open visiting policy and residents who could comment said they enjoyed family and friend visits. Residents could see visitors in their bedrooms or in the communal areas. Staff should encourage more use of the small lounges on the first and second floor for residents and visitors. Six relatives were seen during the course of the inspection and said they were able to visit when they wanted, contribute to their family members care and found staff welcoming and approachable. Some care plans seen included the resident’s preferred time for going to bed, getting up and preferences for a bath or shower. Residents spoken with said staff involved them in decisions about their care and lives. However a high number of residents in the home were unable to make informed choices or to voice their views of the service. The cook had been in post for about nine months and was positive about her role, how the kitchen was managed and the quality of the meals provided. The cook worked with management to provide a varied and nutritious menu suited to residents and included meals they liked. Lunch was observed on all units over the two site visits. Tables were nicely laid for lunch and had suitable crockery, drinks, cutlery and condiments. Residents were offered a choice from two meals but could have an alternative if neither meal appealed to them. Senior staff served the meal and staff provided residents with help where needed. Overall meals were well managed. The meals looked and smelled appetising and foods were pureed separately to ensure they looked as appetising as possible. Residents were observed and some said they enjoyed their meal. On the ground floor younger person unit residents were offered a choice of meal. On the first day of the inspection a resident did not want either option and agreed to have an omelette as an alternative. Only two people sat in the dining room for lunch. One resident sat in the same position in a wheelchair all day and was fed by a member of staff who stood over them and rapidly spooned pureed food into their mouth. The person was given the first course Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 15 in less than five minutes. This matter was discussed with the team leader who stated that the member of staff concerned was a bank member of staff and this issue would be raised with them. Requirement 2. Brook House Care Centre DS0000006776.V365259.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): Standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures were provided in relation to safeguarding adults and complaints. Satisfactory systems were in place to manage these issues. EVIDENCE: A complaints policy and procedure was provided. From the information provided in the AQAA 17 complaints were made about the service and 11 were upheld. A system was in place to record complaints and keep details of the complaint, investigation and outcome. Complaint records were inspected and showed that the complaint had been recorded and the action taken and outcome recorded. One complaint made verbally to the manager had not been fully recorded. This matter was discussed with the manager who confirmed that complaints made verbally would be recorded in the future. A policy and procedure was provided in relation to safeguarding adults. A copy of the local authority procedures was also provided. Local authority leaflets providing information regarding safeguarding issues were seen around the home. Staff spoken with displayed a good understanding of safeguarding and knew how to manage an allegation or suspicion of abuse. Staff said they received training on safeguarding and the staff training matrix provided showed that in the last 12 months 19 members of staff received this training. Brook House Care Centre DS0000006776.V365259.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): Standards 19, 20, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Work was progressing well with the redecoration and refurbishment programme. Units had enough pillows and bed linen. Some repairs were needed to bathing facilities on the first floor unit. Overall the environment was well maintained and standards improving. EVIDENCE: The home was clean, tidy and free of offensive odours. The redecoration and refurbishment programme was progressing well and new flooring had been provided in the ground floor unit, many bedrooms and bathrooms and communal areas had been decorated. Staff and residents were involved in choosing colours for the paintwork. Plans were in place to fit new carpets to the first and second floor corridors. Residents were satisfied with the environment and with their personal space. The maintenance technician completed regular safety and maintenance checks on the home. Staff recorded repairs and safety issues for the maintenance person to address. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 18 The ground floor unit continued to benefit from the redecoration programme. The replacement of corridor carpets with wood effect flooring and repainting of corridor walls had helped to make the unit feel fresh and bright and the addition of floral displays helped to make the unit more homely. Plans were in place on this unit to turn a small lounge into a sensory room. The main lounge had a widescreen television, video and DVD player. The garden area was well maintained and used by residents during the warm weather. Since our last visit a sensory garden had been planted and included a paved area and seating for residents. The ground floor unit manager said that they hoped to arrange barbecues for the residents later in the summer. The redecoration programme included the bathrooms and some had been repainted and had pictures added to make them more homely. On the top floor the shower room needed attention as the seal was coming away from the wall and the area needed repainting. One bathroom was out of order staff and the manager said that that they were waiting for a part to complete the repairs. As this bathroom was leaking and causing damage to a bathroom on the first floor a second bathroom was out of order. As neither floor were fully occupied this was not a problem for residents and staff. The manager gave assurance that the matter would be addressed. At the last inspection issues were also noted in relation to maintenance of bathrooms. A housekeeper was employed and worked with the domestic team to ensure the home was kept clean and a satisfactory laundry service maintained. Laundry staff spoken with said they had adequate time to complete their daily work and all the laundry equipment was in working order. Adequate supplies of linen and pillows were provided. Residents spoken with said there bedrooms were kept clean. Staff had access to adequate supplies of protective clothing and hand-washing facilities were provided in areas where waste was handled. Sluice rooms were provided on all floors. Brook House Care Centre DS0000006776.V365259.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): Standards 27 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were maintained both in relation to skill mix and numbers. Staff received training relevant to their work and recruitment procedures were satisfactory EVIDENCE: The staff team comprised of an acting manager, two deputy managers, trained nurses, care assistants and ancillary staff. Since the last inspection the local authority placed an embargo on the service and due to this occupancy was low. This gave the manager and staff time to address the concerns identified about the service and address staffing levels. The acting manager completed an audit of resident dependency and used this to arrange staffing levels. The local authority had removed the embargo at the time of this inspection and the new residents were being admitted again. Staffing rosters seen showed that adequate staffing levels were maintained both in relation to skill mix and numbers and reflected the staff on duty at the time of the inspection. Staff, residents and relatives spoken with were satisfied with the current staffing levels. Comments from residents and relatives included “staff are mostly kind”, “staff were kind, caring to my relative and overall were marvellous” and “staff are fantastic”. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 20 From information provided in the AQAA and checked with the acting manager 64 care staff were employed, 26 had achieved NVQ level 2 and 18 were working towards this qualification. Four staff files were viewed for staff employed since the last inspection. All of the people had been transferred from other homes in the organisation and files contained the information required by regulation. One issue identified was that for one person the current manager knew the person and had interviewed them and written a reference. This could be considered a conflict of interest and was not seen as good practice. Six employee files inspected included evidence of induction programmes. Recommendation 2. Staff spoken with said they were pleased with the increased level of training provided since the current acting manager was in post. Internal and external training was provided and a staff training matrix maintained. A training programme was provided and training needs were identified through supervision. The training matrix provided showed that since the last inspection staff had access to training on areas such as fire safety, fire drills, food hygiene, moving & handling, health & safety, infection control, safeguarding adults, nutrition, pressure area care, customer care, dementia awareness, a dementia training course titled ‘yesterday, today & tomorrow’ and bed rail safety. Management are to be commended on the training opportunities provided for staff and the implementation of the training programme. Brook House Care Centre DS0000006776.V365259.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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the service had greatly improved and was reflected in improved standards. Satisfactory systems were in place to address safety for residents and others and to manage resident’s personal allowances. Staff received formal supervision. EVIDENCE: The acting manager took up post on 20th December 2007 and had been effective in improving standards and staff morale. The acting manager had not yet applied to the Commission for registration. Two full time deputy managers supported the manager in her role. Positive feedback was received from the residents, relatives and staff seen about the improvements the acting manager has made to the service and people spoken with that she was approachable, supportive and effective. Requirement 3. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 22 Records seen showed that the provider undertook regular 26 visits. These included evidence that the person doing the visit sought the views of residents, staff and where possible visiting relatives. There was written evidence that the manager held heads of department monthly meetings, staff meetings and residents and relatives meetings were held approximately every three months. A system was in place to carry out in-house audits on areas such as medicine management, care plans, infection control, catering, accidents and pressure sore management. Copies of these audits were seen. Management carried out night visits and took steps to address any issues identified. Although systems were in place to review the quality of the service and an annual report was prepared for the organisation overall, a report on the quality of individual services were not completed or provided to the Commission and others. Requirement 4. Since the last inspection the system for managing residents finances had been computerised. All money received by staff was processed and held centrally. A receipt was given for money received and obtained for money spent. From the records it was possible to see how much money was being held for individual residents and a float was held in the home to enable residents to withdraw money when they wish to. Southern Cross completed monthly audits of the system. Staff spoken with said they received regular formal supervision. A planned programme for staff supervision was seen. Records seen for 6 people showed that supervision was provided two monthly. Occasionally group supervision was provided for specific staff groups where the opportunity was taken to discuss topics of concern or interest raised by staff. Safety systems were inspected and showed that attention was given to providing a safe environment for residents and others. The maintenance technician completed regular safety checks on items such as bed rails, window restrictors, hot water temperatures, fire prevention and safety equipment. Accidents involving residents and staff were recorded and monitored by management monthly. Staff should take care when completing forms to ensure they record accidents and incidents separately. Other records inspected were service reports for the fire alarm, lift, baths and moving and handling equipment and the gas certificate. All records were up to date and the last fire drill for day staff was held on 20/6/08 and for night staff on 6/6/08. Brook House Care Centre DS0000006776.V365259.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 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 3 Brook House Care Centre DS0000006776.V365259.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 OP9 Regulation 13 Requirement Timescale for action 22/08/08 2 OP15 3 OP31 4 OP33 Hand written entries made by staff on medicine charts must be signed by two people to ensure no errors are made. Accurate records must be kept for all medicines bought into the home so that an audit trail can be completed. Staff must check and record the resident’s pulse prior to giving specific prescribed medicine. 16 Staff must take time to feed 15/08/08 residents and ensure they enjoy their food while maintaining their dignity. Care The person managing the service 22/08/08 Standards must register with the Act 2000, Commission to ensure Part II (11 compliance with this section of – (1)) the Care Standards Act. The Commission must be informed in writing of any action taken to comply with this requirement. 24 A copy of the quality review of 22/08/08 the service must be supplied to the Commission and made available to residents and others. Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations A medicine profile should be prepared for each resident, a protocol should be prepared for residents requiring ‘as required medicines’ particularly when a resident cannot verbalise this need and an annual competency assessment should be completed for all staff responsible for medicine management. Management should not interview or provide a reference for people they know who apply to work in the home. 2 OP29 Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Brook House Care Centre DS0000006776.V365259.R01.S.doc Version 5.2 Page 27 - 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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