Care Home: Brookdene House

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What the care home does well Brookdene House continues to provide a positive environment for people to live in and develop their independence and confidence to go out into the community. The experienced staff have created a comfortable, homely and relaxed atmosphere for people to live in. Residents told us `It`s good here`, `It is a caring careful care home`. They told us they enjoyed their meals. One person said they enjoyed going out for meals. Relatives told us, I`m always made to feel very welcome when I come on my visits. All the staff tell me how my relative is getting on and ask how I am doing`. They went on to say `my relative has come on very well and could not be in a better place`. Another relative said that living at Brookdene gives `service users the independence and privacy they wish` and `provides companionship and supportive assistance`. They said `staff are friendly and caring`. The health & social care professionals who gave us their views continue to be happy with the service provided at Brookdene House. They told us; `this is a valuable placement option with highly skilled professional staff`, the service `addresses the holistic needs of the residents`, they `provide a high quality homely service`, they `respect the service users dignity and individuality`, and respect people `rights to make choices and manage their own affairs`. The service is good at making sure people`s rights are supported and organising external advocacy services to promote this further where needed. One care professional said `I am impressed by the sensitivity shown by the management and staff at Brookdene House in dealing with a service users wishes to maintain their privacy and independence`. What has improved since the last inspection? The manager continues to make changes to the way the service is run as the home settles down with new service users and areas for development, because of changing practice, come to light. People are being supported by staff who have achieved NVQ qualifications in care. What the care home could do better: The challenge for a manager of a small service where staff work closely together is to make sure that the formal management systems and records are kept up to date. The manager has identified a need to look at how the supervision and appraisal systems operate so working practices and achievements are regularly reviewed. In line with changing practice the manager needs to ensure staff receive training on the implications of the Mental Capacity Act for the people living at Brookdene House so that they can continue to promote their rights. The manager needs to review one aspect of the medication storage systems and get the community pharmacist to confirm the fixings meet the required standard. Key inspection report Care homes for adults (18-65 years) Name: Address: Brookdene House 1 Watling Street Radlett Herts WD7 7NG     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: Sheila Knopp     Date: 0 7 0 7 2 0 0 9 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 Adults (18-65 years) Page 2 of 24 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 Adults (18-65 years) 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) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Brookdene House 1 Watling Street Radlett Herts WD7 7NG 01923857460 01923839892 nicola.janejones@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Andrew Enstone care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder - Code MD Date of last inspection Brief description of the care home Brookdene House is a modern 6 bedroom detached house which is registered to provide residential support to adults with mental health problems. There is a lounge/dining room, kitchen, utility area, toilet and bedroom with shower on the ground floor. The 5 other single bedrooms, bathroom and shower rooms are on the first and second floor. The main office and meeting room are in a seperate prefabricated building in the garden. Parking is available at the front of the property. The home does not have a lift and is therefore not suitable for people with mobility Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 6 Brief description of the care home problems. The house backs onto the railway embankment and is next to residential flats. Brookdene House is set back from the main road on the edge of Radlett. There is a bus stop outside the house. The main line station, shops and facilities in Radlett are within walking distance. The current fees range from 647- 850 pounds per week based on an individual assessment of needs (correct as of 07/07/09). No additional charges are made. Information about the home is contained in the Service User Guide & Statement of Purpose, which are available on request from the manager together with a copy of the latest inspection report. Care Homes for Adults (18-65 years) Page 5 of 24 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Our last inspection of Brookdene House took place on 10/7/07. It was assessed at that time that people were being provided with a good service. We carried out an annual service review during 2008 that did not involve a visit to the service. The information in this report is based on an unannounced visit to the service to meet with residents and staff. To make sure we have included a wide range of views in this assessment we sent survey forms to people living and working at Brookdene House. We also included relatives, doctors, social workers and community psychiatric nurses who have regular contact with the people who live at Brookdene House. We sent out 17 surveys and received replies from 4 residents, 2 relatives and 3 community health & social care professionals. Care Homes for Adults (18-65 years) Page 6 of 24 We have also reviewed the information we have received between our reviews. This includes the Annual Quality Assurance Assessment (AQAA) that managers of care services are required to provide. The AQAA focuses on outcomes for people using the service and provides us with numerical data. Care Homes for Adults (18-65 years) Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: The challenge for a manager of a small service where staff work closely together is to make sure that the formal management systems and records are kept up to date. The manager has identified a need to look at how the supervision and appraisal systems operate so working practices and achievements are regularly reviewed. In line with changing practice the manager needs to ensure staff receive training on the implications of the Mental Capacity Act for the people living at Brookdene House so that they can continue to promote their rights. The manager needs to review one aspect of the medication storage systems and get the community pharmacist to confirm the fixings meet the required standard. Care Homes for Adults (18-65 years) Page 8 of 24 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 Adults (18-65 years) Page 9 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 24 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 looking to move into Brookdene House can be confident they will be involved in an assessment of their individual needs and offered the opportunity to visit, meet with the other people who live there and try out the service. Evidence: We looked at the experience of someone who had recently moved into Brookdene House and confirmed that the manager had assessed their needs before they had come to stay. The staff had a very good understanding of the individual support they needed. The comments we have received from health and social care professionals who arrange for people to come at live at Brookdene indicate that this is a service they value. One person told us This is a valuable placement option with highly skilled professional staff. The information available about the service provided at Brookdene House has been updated to include details of an additional room that takes the number of people who can live in the house to 6. Care Homes for Adults (18-65 years) Page 11 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 people living at Brookdene House are actively involved in deciding how they wish to live their lives and receive support to make decisions where needed. Evidence: People are involved in decisions about their lives and how they wish to spend their time. Risk assessments are used to promote independence within a safe environment. Where possible individuals are encouraged to set out their own goals. The health & social care professionals who have contact with people living at Brookdene House continue to tell us they are impressed with the way staff promote peoples rights and independence. The manager and her staff team have a good understanding of promoting peoples rights and involving independent advocacy services to support this. Care Homes for Adults (18-65 years) Page 12 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 are supported to lead the life they wish according to their individual circumstances. Evidence: From our contact with the people who live at Brookdene House and the information we have from relatives and health & social care professionals we are able to see that staff support residents to develop independent living skills, confidence to organise their own lives and become members of the local community. The people living at Brookdene House told us about things they like to do and how they organise their lives within the house. People who needed staff support to go out when they first arrived are now going out on their own, using local amenities and meeting people. The people we spoke to seem to be very happy with the current arrangements. A relative told us the staff provide companionship and supportive assistance. Staff Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: support people to keep in contact with their families. Relatives say they feel welcome when they visit. One relative felt that more colour good be brought into peoples lives if some activities were based on educational or craft based opportunities. Regular house meetings are held to involve people in managing their daily lives. Staff make arrangements for people to join in with things they are interested and provide support to follow religious and cultural observances. A social care professional told us the staff at Brookdene House were good at addressing the holistic needs of the residents. The people who live at Brookdene House are involved in planning menus, shopping and preparing meals as they wish. They are positive about the home cooked meals prepared for them. Arrangements are flexible to enable people to have their meals when they want and to provide options that support individual preferences. Care Homes for Adults (18-65 years) Page 14 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People receive the encouragement and support they need to look after their health, take their prescribed medicines and maintain their dignity. Evidence: Health & social care professionals who support people living at Brookdene House tells us people receive the individual support they need to maintain their health and sense of well-being. One person said staff respect the service users dignity and individuality. The information we have from staff indicates peoples physical and emotional needs are kept under review and individuals are encouraged to make decisions in their best interests to support their health. Following admission a support plan is put in place for each person. Information from other professionals involved in that persons life is included so a full picture of their needs is established. Peoples capacity to make decisions for themselves in different aspects of their lives are considered as part of the support plan and multi-disciplinary Care Progamme Approach (CPA) to their care. The support plans are kept under review. People visit the local GP and community health services as necessary. Appointments to attend specialist services for check ups and reviews are followed up and staff made Care Homes for Adults (18-65 years) Page 15 of 24 Evidence: available to support people attending appointments. There is a programme in place to support people to look after their own medication if this is assessed as being appropriate. Records of the medicines received into the home and administered to residents are kept. Since our last visit the medicine storage area has changed. The home does not currently have medicines that require additional storage in the form of a Controlled Drugs cupboard however a suitable area to fix this needs to be identified. The manager has been advised to get the dispensing pharmacist to confirm it has been secured in line with the requirements of the Misuse of Drugs Act Regulations 2001. Care Homes for Adults (18-65 years) Page 16 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 views and concerns of the people living at Brookdene House are listened to and acted on so they are protected and their rights promoted and upheld. Evidence: The people living at Brookdene House have a good rapport with staff that enables them to pick up any worries and concerns at an early stage. People have regular reviews with their care managers in the community who can also raise things on their behalf. They have access to a telephone and help-line numbers should they wish to call anyone. Concerns raised by individuals are dealt with in a considerate manner by the experienced staff. The manager has taken action when it has felt peoples rights have been compromised by people they know. This has included making referrals to the services responsible for safeguarding vulnerable adults so people living in the home are protected. We have not received any complaints about this service between our inspections. Care Homes for Adults (18-65 years) Page 17 of 24 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Brookdene House provides people with fresh clean accommodation in a bright modern family style house close to the centre of Radlett with its amenities and transport links. Evidence: Each person living at Brookdene House has their own bedroom which they have added their personal possessions and areas of interest to over time. They a key to their room and a lockable keypad safe to keep valuables in. The bedroom on the ground floor has its own shower. The managers self assessment tells us each resident is encouraged to make their room as they would like it, football theme etc own chairs or stereo systems, pictures, what ever they would like they are encouraged to buy or get, when the rooms need decorating then it will be the residents choice of what color they would like. There is a shared lounge / dining room running down the full length of the house and a large kitchen. A utility room on the ground floor enables people to do their laundry. All areas we visited were fresh and clean. There is a small neat garden at the back of the house. The manager tells us the aim is to maintain Brookdene as a warm and welcoming and safe environment. The house has been well maintained and we did not identify any areas for further attention. Care Homes for Adults (18-65 years) Page 18 of 24 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 are supported by staff who understand their needs and work flexibly to enable them to lead interesting lives. Evidence: The staff at Brookdene House are positive about their involvement in making sure people lead fulfilling lives and enjoy the work they do and feel proud of. Staff work flexibly so people living in the home can go out or join in activities of interest to them. Staff receive the training they need from the time they start work through from induction to National Vocational Qualifications (NVQ) training in care practices and regular updates and refresher courses. The manager has training updates booked through 2009. We discussed focusing on staff understanding of the Mental Capacity Act as this is an area they need to be familiar with. We have not been able to test out the recruitment process as no new staff have been recruited between our inspections. Previous checks have confirmed that staff are checked for their suitability to work with vulnerable people. This includes a criminal records checks and references. The manager is aware of the need to make sure the application form details the reason people have left their previous areas of employment as this was an area raised at our last inspection. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 are living in a safe well managed home that supports their individual needs. Evidence: The registered manager is experienced in working with people with mental health problems in the community and has a good working knowledge of local services. She returned the AQAA self assessment when we asked for it. The information focused on achieving positive outcomes for people using the service and areas for future development. The quality monitoring systems continue to develop so that the views of people using the service and who have contact with the people living at Brookdene House are listened to and taken into consideration when making decisions about the service. The health & social care professionals who completed our survey continue to tell us that there is a positive management approach to meeting the needs of people living at Brookdene House. The owner of the home continues to visit regularly and provides the manager with reports on the conduct of the service. In addition to this an experienced care professional carries out an annual audit and gives the proprietor a report. This is to Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: make sure that standards are externally reviewed in line with good mental health practice and the provider can be guided on what action needs to be taken. Staff continue to receive formal supervision at infrequent intervals with the manager so they can discuss their work but these need to take place more often. The manager acknowledges that annual appraisals have not taken place and identifies this in the AQAA as an area for further development. The systems in place to enable residents to have access to their finances are based on the principles of developing greater independence for the people concerned. When people first come to stay the manager spends time helping them to sort out their finances as many people have come from varied services where systems have not been clear and people have not had access to their own finances. This means individuals are now managing their own money and using banks. There are systems in place to make sure services are well maintained to protect the health and safety of the people living and working at Brookdene House. The servicing records we saw, including fire safety records, were up to date. Staff receive relevant health & safety training appropriate to their jobs. We have not been concerned about the number or range of notifications we receive about accidents, incidents and events within the service. Care Homes for Adults (18-65 years) Page 21 of 24 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 Adults (18-65 years) Page 22 of 24 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 Adults (18-65 years) Page 23 of 24 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 Adults (18-65 years) Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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