Care Home: Brook House Nursing Home

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What the care home does well The manager meets people who are considering moving to the home to assess their needs and agree with them that the home will be able to meet those needs before the prospective resident moves. The assessment considers people`s cultural, faith and healthcare needs. People told us that care staff were kind and friendly and families were welcomed to the home at any time. The activities coordinator arranges a programme of activities which brings interest and diversion to residents` days. Carers are involved in these enabling more people to have support to engage in an activity if they are unable to do so unaided. Staff have had training in safeguarding vulnerable adults and people knew who to speak to if they had concerns and how to make a formal complaint. The home cooperates with others to investigate concerns and takes the appropriate action on the findings. Recruitment procedures are thorough protecting residents from unsuitable staff. The home is homely and clean. There is an ongoing refurbishment programme, providing a pleasant environment for people to live in. What has improved since the last inspection? People`s health care needs are better met. There have been improvements in care planning and care issues are picked up early and addressed. There have been improvements in preventing pressure damage and in caring for people who do develop pressure damage. These improvements must be maintained. Medication records have been improved and people`s medication is recorded accurately. Controlled drugs are now stored securely. There has been an ongoing refurbishment programme. New carpeting has been laid in the corridors. Some new bedroom furniture has been provided and all rooms now have height adjustable profiling beds with a new mattresses which are more comfortable for residents. There has been a recruitment drive and staffing levels have improved enabling resident`s needs to be met in a timely way and allowing for greater reassurance and support for people with dementia who may be sitting in the lounge. All staff have now had a basic introduction to the care of people with dementia. All staff have had training in safe working practices and there is a programme in place to update that training on a regular basis. The day to day management of the home has improved with the appointment of a permanent manager who has registered with us. A deputy manager has also been appointed who can manage the home in her absence. Both are registered nurses. What the care home could do better: The manager should give people a copy of the statement of purpose and guide before they move to the home in order that they have the information they need to make an informed choice. The manager should ensure that residents risk of becoming malnourished is assessed competently and action is taken to address any unexplained weight loss. The home has met all the requirements of the previous report and no further formal requirements have been made following this inspection. Key inspection report Care homes for older people Name: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ     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: Chris Sidwell     Date: 3 0 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 27 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 27 Information about the care home Name of care home: Address: Brook House Nursing Home 28 The Green Wooburn Green Buckinghamshire HP10 0EJ 01628528228 01628529892 brookhousecare@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Centurion Health Care Ltd Name of registered manager (if applicable) Mrs Eileen May Oliver Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 35. The registered person may provide the following category/ies of service only:Care home with nursing - 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 - (OP) Dementia (DE) Physical Disability (PD) Date of last inspection Brief description of the care home Brook House provides nursing care for up to 35 older people. The home is located in the village of Wooburn Green and is close to pubs and local shops. There is a bus route into High Wycombe near by. Care Homes for Older People Page 4 of 27 Over 65 0 35 0 35 0 35 0 7 0 7 2 0 0 9 Brief description of the care home Accommodation is in mainly single bedrooms, some with en suite facilities. A few shared rooms are also available. There are communal bathrooms and toilets located around the building. The home has spacious lounge areas and an enclosed garden. Care Homes for Older People Page 5 of 27 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 inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home on the 29th and 30th April 2010. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it and their plans for improvement. This was completed in full and returned on time. Questionnaires were sent to the home for distribution to residents, staff and visiting professionals. Seven residents, two family members and three members of staff returned these. Residents and families were spoken to on the day of the unannounced visit. Discussions took place with the proprietor, manager, deputy manager, administrator, care and ancillary staff. Initial feedback was given at the end of the visit. Care practice was observed and Care Homes for Older People Page 6 of 27 the care of four residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? Peoples health care needs are better met. There have been improvements in care planning and care issues are picked up early and addressed. There have been improvements in preventing pressure damage and in caring for people who do develop pressure damage. These improvements must be maintained. Medication records have been improved and peoples medication is recorded accurately. Controlled drugs are now stored securely. There has been an ongoing refurbishment programme. New carpeting has been laid in the corridors. Some new bedroom furniture has been provided and all rooms now have height adjustable profiling beds with a new mattresses which are more comfortable for residents. There has been a recruitment drive and staffing levels have improved enabling residents needs to be met in a timely way and allowing for greater reassurance and support for people with dementia who may be sitting in the lounge. All staff have now had a basic introduction to the care of people with dementia. All staff have had training in safe working practices and there is a programme in place to update that training on a regular basis. The day to day management of the home has improved with the appointment of a permanent manager who has registered with us. A deputy manager has also been appointed who can manage the home in her absence. Both are registered nurses. Care Homes for Older People Page 8 of 27 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 27 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 27 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. There is information available to residents to help them decide whether they wish to move to the home. Peoples needs and wishes are assessed before they move to the home to ensure they can be met. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. Seven people returned the surveys of whom only two said they had received information about the home before they moved , four were unsure and one said that had not received any information. The home should ensure that people are given copies of the statement of purpose and any other relevant information before they move to help them make an informed choice Care Homes for Older People Page 11 of 27 Evidence: The assessment records of three people who had moved to the home since the last inspection were checked. They had been assessed by the manager, a qualified nurse, to identify with them their needs and wishes for care before they moved to the home. Their faith and cultural wishes as well as their health and social care needs were noted and incorporated in their initial care plan. The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 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. Residents healthcare, medication and personal care needs are met, promoting their wellbeing, dignity and self respect. Evidence: The care of four residents was looked at in detail. All had care plans which were completed in full and had been updated regularly. All had been assessed as to their risk of developing pressure damage, of falling or of losing weight and a care plan had been implemented. Two people had developed pressure damage, one in hospital and one in the home. The care records were not complete on the first day of the inspection but had been updated by the second day of the inspection. In both cases the care plans showed that the damage was healing. The nutritional risk assessments were not completed in full and it was unclear whether everyone knew how to use them Three of the four residents whose care was followed through had maintained their weight since moving to the home although one had not. When asked she said that she enjoyed her food but did not eat as much as she used to. The manager must ensure that all staff know how to complete the risk assessment tools and that a care plan is drawn up and implemented if someone loses weight for no apparent reason. Care Homes for Older People Page 13 of 27 Evidence: Seven residents returned the questionnaires of whom five said they always or usually received the care and support they needed and that staff were always or usually available. One commented that she had to wait to go to the toilet on occasions and that staff were only sometimes available. Two family members returned the surveys. One felt that their family member always received the care and support they needed and the other that they usually received it. They both felt that they were kept informed and made to feel welcome in the home. Three families were spoken to on the day of the unannounced visit and all said that their family member received the care they needed. They said that staffing levels were sometimes low but that they had improved recently with the recruitment of more staff. There were staff allocated to both lounge areas throughout the afternoon of the unannounced visit. Staff were talking with residents and helping them with a quiz and colouring activity which they were enjoying. Residents personal care needs were met and all were well presented with clothing in a good state of repair. There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly. There were two handwritten entries on the medication administration record which had not been signed by two people and the registered nurse managing the medication agreed to address this. Appropriate procedures were in place to deal with variable dose medication such as warfarin although the individual record book which held the latest dose instructions was not kept with the medication administration record but at the nurses desk. This should be reviewed and the nursing staff must always check the latest dose instructions when administering warfarin. None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. The broken lock on the controlled drug cupboard had been repaired. The home did not have any controlled drugs at the time of the unannounced visit. The excess medication Care Homes for Older People Page 14 of 27 Evidence: stock in the storeroom had been cleared and the area was tidy and clean. Care Homes for Older People Page 15 of 27 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 can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents nutritional needs. Evidence: Residents spoken to said that they had a choice as to when they got up and when they went they went to bed and how they spent their day. One resident said she preferred to stay in her room as she had a nice view, another that she went to the dining room for lunch but otherwise preferred to stay in her room. An activities coordinator is in post and she arranges a programme of daily activities and spends time on a one to one basis with residents who do not enjoy group activities. New flat screen televisions have been bought which are easier for residents to see. The chef was knowledgeable about residents likes and dislikes. There is a varied menu. Staff said that residents are offered an alternative if they do not like the main meal on offer. They said that the usual practice is for staff to ask residents the day before whether they liked the main meal or what they would like instead. This had not been done however on the day of the unannounced visit. The chef said that a cooked breakfast is available. Supper is a light cooked supper or soup and sandwiches. There was no one requiring a special diet for health or cultural reasons at the time but the Care Homes for Older People Page 16 of 27 Evidence: chef said she would be able to prepare one if necessary. Of those who returned the surveys, all said they always or usually liked the food. Most residents ate at dining tables which were well laid and mealtimes were seen to be a sociable occasion. Care Homes for Older People Page 17 of 27 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. Residents concerns are listened to and in most cases addressed. The home cooperates with others to investigate areas of concern and takes action when necessary, to protect residents from harm. Evidence: Residents told us that they knew who to speak to if they had a concern and how to make a formal complaint. There is a copy of the complaints procedures in the home. The complaints records were checked and showed that verbal and written complaints are recorded. The records showed that no written complaints had been received since the last inspection. We are aware of on complaint about a lost hearing aid which is being handled by the home and the local authority. Personal aids such as hearing aids are seen by the home as valuables for which they cannot take responsibility. The proprietor has agreed to review their procedures and insurance policies as clearly a hearing aid whilst valuable is also essential and cannot be given to relatives for safekeeping. The home needs to be clear in its literature and advise residents and families about the extent of their insurance policies to enable them to make alternative arrangements if they so wish for expensive items which must remain in the home. The home has a copy of the local multi agency safeguarding policies and procedures and staff have received training in safeguarding vulnerable people. There are whistle Care Homes for Older People Page 18 of 27 Evidence: blowing policies and procedures in place and the staff spoken to said that would have no hesitation in reporting any concerns. There have been two safeguarding referrals, made since the last inspection, one initiated by the ambulance trust and one by the home itself. Both were investigated by the local authority. The home cooperated fully with the investigation and took action to address the quality issues that emerged. Care Homes for Older People Page 19 of 27 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 home is homely and clean, providing a pleasant place for people to live in. Evidence: The home is an older building overlooking a village green. The bedrooms vary in size and outlook. There is an ongoing programme of refurbishment. New carpets have been laid in the halls and a programme to replace bedroom furniture, bed tables and bed linen has been has been started. Most beds have been replaced with height adjustable beds and new mattresses. The proprietor said in the annual quality assurance assessment that she was planning to replace the call bell system and purchase two more hoists and ten sets of hoist slings during the next twelve months. The hoists have now been purchased. There are control of infection policies and procedures in place. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. Hand washing facilities are available for staff and visiting professionals. Staff said that people shared hoist slings but plans are in place to address this. Care Homes for Older People Page 20 of 27 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. The staffing levels have improved since the last inspection and there are sufficient staff with a basic understanding of the needs of older people and those with dementia to meet residents needs in an knowledgeable, timely and safe way. Evidence: There is a staffing rota in place to show the staff on duty. The manager said that the home aimed to have two Registered Nurses and six carers on duty in the morning, one Registered Nurse and five carers in the afternoon and one Registered Nurse and two carers at night. The numbers of staff in post to meet the planned rota has improved since the last inspection and there were no shortages on the day of the unannounced visit. The previous rotas showed that most shifts had been covered and there was less need for people to do overtime to meet the preferred staffing levels. Two families spoken to said that they felt that staffing levels had improved one saying there seem to more people about. Residents spoken to said that staff were kind and caring and were usually available when they were needed. The training records showed that staff have had training in safe working practices. The manager said that all staff had now had a one day training course in dementia care to give them the understanding they need to care for people with dementia. The recruitment files of three members of staff who had started at the home since the last inspection were checked. All had the required documents. There was evidence of Care Homes for Older People Page 21 of 27 Evidence: the staff members identity and work permits were in place where necessary. Criminal Records Bureau disclosures and references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Care Homes for Older People Page 22 of 27 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 arrangements in the home have improved with the appointment of a permanent manager and deputy to provide stability for residents and their families. Evidence: The manager is an experienced nurse who has experience of managing a care home. She holds the National Vocational Qualifications in Management at level 4. Residents, families and staff said she was approachable and two families felt she had made a difference to the home and that residents received better care as a result of her interventions. She has appointed an experienced nurse as deputy. She has also registered with us. The manager said that a regular monthly reporting system was in place whereby the proprietor would be told of any untoward events in the home. Regular checks of care plans, medication and food hygiene standards are undertaken. The manager said that she holds residents and family meetings and minutes are taken and shared with families who cannot attend if they wish. Care Homes for Older People Page 23 of 27 Evidence: The home does not manage any money on behalf of residents. All expenditure is invoiced to families. The manager has now had training to understand the new regulations relating to the Mental Capacity Act and the Deprivation of Liberty regulations. There are health and safety policies and procedures in place. Maintenance records were up to date and the training records showed that staff had had training in safe working practices, including moving and handling, fire safety and infection control. Six requirements for improvement were made at the last inspection and all have been met in full or substantial progress has been made towards achieving them. There is a need to ensure that the improvements in care plans are maintained and consolidated and that if a resident develops pressure damage it is recorded promptly and the action needed and taken is described in the care plan. Care Homes for Older People Page 24 of 27 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 25 of 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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. © 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. 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