Care Home: Brookfield

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What the care home does well Several users that were sitting in the lounge on our arrival, recognised us, the regulators and spontaneously spoke to us about weather, about their relatives and about good staff in the home that cared for them. Two users in the other lounge wanted the inspector to play music for them on the home`s electric organ. They commented on activities and stated that the activities provided their met their expectations: "We are getting old, my dear, and cannot do much. But we have occassional entertainers in, we play bingo, read and do what we can." Very positive comments provided by the relatives also included: "They are very good at their job, not hasted or hurried in anyway. They are always cheerfull and kind." The relaxed atmosphere and friendliness that shone throughout the home demonstrated that users saw the home as an excellent service. Remaining staff were commited and motivated and the staff atmosphere settled in after about six moths while some disciplinary procedures were implemented. There were no formal complaints, but the concerns and informal complaints were responded to by adjusting and changing practices to ensure that service users received appropriate care and were satisfied with the service. What has improved since the last inspection? The home introduced new care plans, based on Person Centred Planning, that provided more detail about individual service users` needs and allowed staff to learn quickly and accurately how to respond and ensure the assessed needs were met. The requirement set on the previous inspection was met: now the home had in place an audit process for users` money held securely by the home. All transactions were recorded and signed in doubled records. Audits were also recorded and signed. New boiler installed in the home resolved several on-going issues, such as the constant supply of hot water, but also the frequent tripping of the residual circuit device. Supervision of the manager was also brough to regular, monthly pattern, in addition to a good support from the owner whenever necessary. Two more bank staff were going through recruitment checks and would improve cover and relieve stress of permanent staff that used to cover for all absenses. Environmental changes also improved conditions for users of the service. New double glazing made the home not only better insulated, but more comfortable and nicer. Introduction of the new clinical, or as they call it, treatment room, improved the approach of the home to respect for privacy and dignity. To make full use of that room, the manager explained that users could use it if they want, as the room is equipped with a computer. What the care home could do better: Although new person centred care plans were generally detailed and good, a further improvement could be made if care plans contained entries relevant to the management of users` money, especially when the home helped them with this area of support. Medication process was safe, but in order to accommodate easy audit, the home should record the amount of medication on MAR sheets when medication was carried over from the previous delivery date. Some further improvements regarding the environment are necessary. The hot wateron taps in two toilets was too high and review of the functioning temperature control system was needed, possibly with the instalation of individual mixing valves. Some radiators were not covered to protect users from the risk of scalding. As service users` conditions were slowly and gradually deteriorating the cover for these radiators must be arranged. Service users were taking part in various external activities within local community, but the home planned to introduce volunteers to improve internal activities. This matter was in the home`s plan and there was no need to make a formal reccommendation or requirement. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brookfield Brookfield 1 High Street Somersham Cambridgeshire PE28 3JA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Brookfield 1 High Street Brookfield Somersham Cambridgeshire PE28 3JA 01487840900 01487840825 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brookfield Care Home Limited care home 14 Number of places (if applicable): Under 65 Over 65 7 14 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Brookfield provides personal care, support and accommodation for up to 14 older people, 7 of whom might suffer from dementia. The home is located in a quiet village location approximately 8 miles from Huntingdon and 15 miles from Cambridge; the village is well served with shops, pubs and other amenities. The home first opened in 1985 and consists of a two-storey building with a newer, purpose-built, ground-floor extension; the upper part of the building is accessed by a stair lift. The home has 12 single bedrooms (6 with en-suite facilities) and 1 double bedroom. Seven of the bedrooms are on the first floor of the older part of the building, the remaining 6 are on the ground floor. One of the bedrooms on the ground floor is shared. Residents have access to 3 communal sitting areas, two at the front of the house overlooking the end of the High Street, the third being to the rear of the building with views of the garden. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. After revieving the service through annual service review on 09/04/08, the home continued to provide good service for people that were cared for and supported in Brookfield. We monitored the service through reporting activities and events that affected users of the service. The home submitted their self assessment on AQAA (Annual Quality Assurance Assessment) form where they provided information about the operation of the home since the last review. Care Homes for Older People Page 6 of 26 We asked users of the service, their relatives and satff to fill in questionnaires about the quality of service and received a good response, 4 staff, 4 relatives and 5 users returned their comments. We visited the home on 08/04/09 and spoke to nine people who were in the lounge. Five poeple living there spoke in more detail on their experience of living in this home. The manager and her assistant manager provided explanations and cooperatively supported this inspection. We case tracked three people users of the service. This means we checked the information about them contained in records and observed staff offering them care. We observed lunch time in the dining room. We also observed care practices in the home, checked the environment by walking through the home and talked to the manager. We checked two staff files, medication storage, records and the procedure for administering medication and checked three users money records against the balances in their securely held money bags. What the care home does well: What has improved since the last inspection? What they could do better: Although new person centred care plans were generally detailed and good, a further improvement could be made if care plans contained entries relevant to the management of users money, especially when the home helped them with this area of support. Medication process was safe, but in order to accommodate easy audit, the home should record the amount of medication on MAR sheets when medication was carried over from the previous delivery date. Some further improvements regarding the environment are necessary. The hot water Care Homes for Older People Page 8 of 26 on taps in two toilets was too high and review of the functioning temperature control system was needed, possibly with the instalation of individual mixing valves. Some radiators were not covered to protect users from the risk of scalding. As service users conditions were slowly and gradually deteriorating the cover for these radiators must be arranged. Service users were taking part in various external activities within local community, but the home planned to introduce volunteers to improve internal activities. This matter was in the homes plan and there was no need to make a formal reccommendation or requirement. 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 set out 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 26 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 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Very good information about the home in written format, the homes brochure and service users guide and additional verbal supplementary information provided by the manager allowed users to choose if they wanted to become residents. Trial visits allowed users to choose the home, but also provided an opportunity for the management to start intial assessment to decide if the home could meet the assessed needs. These areas both exceeded minimum standards. Evidence: The home continued to offer good information in their statement of purpose, service users guide and their own brochure. The brochure contains pictures from the home and can be made available in electronic format for computers or produced in large print when required. Any prospective users could make an informed choice. Care Homes for Older People Page 11 of 26 Evidence: The admission to the home includes initial visit and, when necessary, the assessment in users home. Two checked files contained the form used for initial assessment, demonstrating that all these assessments were carried out properly and addressed all essential areas of users needs. The self assessment, AQAA, stated: When planning and delivering care to residents our staff take into account the different and special needs of residents. We have an in-depth initial assessment that identifies any need for care and possible further staff training. We also ensure that the resident is happy with our facilities and feel that their needs will be met successfully. Allocated key workers worked with new the residents from the first day making sure they get all information they need and could comment on anything they wanted straight away. Our observation showed that all users needs were met. Their comments confirmed this: I am very happy with support I get from staff. Records in the individual users files also confirmed that the work with them was carried out to achieve their set goals. Care Homes for Older People Page 12 of 26 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. An appropriate approach to healthcare needs, good records, good medication management and high respect for privacy and dignity ensured the full satisfaction of users of the service. Evidence: The home recently introduced a person centred planning process and reviewed and updated care plans in relation to this innovation. Checked files contained appropriate details of the needs and care that was planned to help users meet the set goals. Written in the first person, plans showed that users were involved in the planning process. Appropriate charts were used to record regularly monitored elements required to ensure users wellbeing and care. One of the checked files contained input from the users daughter, showing that families were involved, informed and included in the care process. Documented reviews demonstrated that the coditions of users were monitored and reviewed regularly, on a monthly basis or when it was necessary. A new part was added to care plans addressing the end of life details and wishes of users and their families. Care Homes for Older People Page 13 of 26 Evidence: One of the files did not address that a user wished to be and was helped with his finances. Visits of external professionals were recorded. Liasing with GP, physiotherapists and occupational therapists ensured the home had appropriate equipment necessary for care of the users. Optician was called in once a year for regular check up for all users and those with extra needs could be seen more often. An audiologist was also called in when necessary and a chiropodist was visiting every 8-12 weeks. The home arranged marking new glasses with users names and dates, allowing staff to help users wear the newest pair of glasses and avoid mixing them with other users glasses. Medication process was observed and records were checked for 4 users. There were no prescribed controlled drugs in the home at the time of the site visit, but a staff member, the assistant manager, was fully confident in medication related issues, including special care with controlled drugs. The records were accurate, but for easier audit the home could introduce recording the amount when medication from one delivery sheet needed to be carried over to the next period. Privacy and dignity were respected. Several users spoken to us confirmed that they felt respected in a friendly atmosphere and, as a user stated : The staff are really respectful to us. The new part of the care plan clearly described the wishes of users in the section on the end of life. Care Homes for Older People Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users autonomy, independence and wishes were respected and promoted and the feedback from users of the service determined the excellent rating for this group of standards. Evidence: Service users were encouraged to remain active and were offered opportunity to contribute to everyday life in the home. The users had risk assessed access to cleaning equipment if they wanted to contribute to maintaining their own space clean. Some users also took part in dusting and washing up, as they wanted. About 50 of users attended a day centre and demonstrated that the home had a very good community contacts. Day trips and outings were regularly organised. One of the users spoken to stated: We have plenty of activities here. We have now regular bingo, talks and games. We go out to the garden whenever we want, I had a lovely time there yesterday. Brookfield also has an excercise programme that staff run with the residents and exercises are adapted to each individuals ability, stated the homes self assessment, AQAA. The home recognised that service users had a choice of varied external activities and Care Homes for Older People Page 15 of 26 Evidence: planned to include volunters in the home to increase internal activity programme. Lunch time was observed and looked very relaxed, users were chating to each other and nicely presented food helped create a social event of the meal times. The AQAA desribed the meal times and food: Menus offer a varied and balanced diet agreed in conjunction with the residents to include their favourite food types, whilst ensuring that all meals include key food groups. Kitchen and food stock was checked and seemed appropriate, contained fresh fruit such as bananas, apples and oranges and vegetables, broccoli, potatoes and onions. Users spoken to stated that food was very good. Care Homes for Older People Page 16 of 26 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. An effective and accessible procedure was in place to protect service users through safe working practices. Evidence: The AQAA, a self assessment stated: A copy of the complaints procedure is made available to all residents with copies being available in large print. The procedure clearly explained time scale for responses at different stages. the procedure was displayed at two places in communal areas allowing both users and visitors to read it and raise a complaint if they wanted. Advocacy was also promoted and leaflets and a poster about the services were available on the board in the home. Staff and the management were fully aware of the Protection of Vulnerable Adults procedure and ensured good protection of service users. Regular in-depth staff training was added to the regular, mandatory training. The home did not use any kind of restraint, but were prepared to discuss with external professionals any measure that would be used to protect service users and were aware of the need to first train staff for it and to record any such instance when this would be used. Records of service users money held by the home were much improved as required on the previous inspection and ensured better protection of service users. Care Homes for Older People Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered a nice, bright and appropriately equipped and maintained environment making the place a pleasant home for users of the service. However, some safety measures were necessary regarding hot water and heating control to prevent hazards for users of the service. Evidence: The environment was significantly improved since the last inspection. A new boiler was installed and the problems the home had experienced with the hot water supply had been rectified. This action also improved electrics within the home as the residual circuit device, a safety equipment, stopped tripping. Decoration was also carried out according to the regular maintenance programme and included re-carpeting some areas. The kitchen, arranged in a fully domestic style, was made available to service users if they wanted to use it to make drinks and food. It was still well equipped to accommodate communal cooking for all users. Many communal areas both on the ground and upper floor served very well, as users were sociable and liked to sit in these bright, sunny areas with views to the green fields accross the road, to the village from upstairs and to the nicely arranged back garden. Six en-suite bedrooms had toilets and showers and a sufficient number of communal Care Homes for Older People Page 18 of 26 Evidence: toilets were provided for those that did not have these facilities in their bedrooms. The upstairs bathroom also offered choice to those that preferred baths to showers. Two users showed us their bedrooms expressing their satisfaction with the standard and cleanliness of the environment. Introducing the treatment room, the home improved respect for the privacy for users. This room was also made available to those that expressed an interest in computing, as the computer was available there. Appropriate risk assessments were conducted to expand the use of both private and communal areas within the home, thus creating a real homely atmosphere and generating a feeling of belonging to users of the service. Risk assessments also helped the home maintain good infection control measures without resticting users within the home. Further improvements, some of whom were planned, such as installing double glazing on some remaining windows, and some addressed in this report were needed. The hot water in two checked toilets exceeded maximum allowed temperature and installation of mixing valves on individual taps could be the measure to reduce risk of scalding to the users of the service. Another necessary improvement needed to be carried out: to arrange appropriate covers for uncovered radiators, or replacement with the low surface panelled radiators, as some, such as the one in the main lounge were causing a potential risk. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff complement was appropriate for the service users and homes needs. Staff were knowledgeable, trained and open, and made service users more comfortable. Evidence: Two staff files were checked and contained all required documents to show that the recruitment procedure was carried out so that the servicse ensured protection of users. The new induction procedure worked well, equipping staff with the knowledge and skills to support and care for users of the service. The manager reported in her AQAA: It is important for us at Brookfields for the potential staff to introduced during the interview process to our residents, as residents opinion is viewed as being crucial to our decision. All comments received about the staff and their performance were positive and praised staff for respecting dignity of users of the service. Currently employing 14 staff, the home ensured that 3 care staff worked at each peak period to ensure that all assessed users needs were met. Nine staff were either holding or attending the NVQ training, thus exceeding the minimum standards. After an unsetlled period of several months while some disciplinary measures were investigated and finally resolved, the staff team regained its stability and commitment, bringing the atmosphere in the home back to a cheerful, happy and healthy status. Care Homes for Older People Page 20 of 26 Evidence: Regularity of supervisions, as seen in files and confirmed by staffing comments, helped resolve the previous issues and strenghten the staff team. Care Homes for Older People Page 21 of 26 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. Service users welfare and wellbeing were ensured by safe working practices and principles of the homes provision of service. Service users could influence the management of the home and make decisions. Evidence: A stable, skilled qualified manager created the atmosphere whereby service users were put in focus regarding daily life of the home. Her attitude was also accepted and welcomed by the users of the service. They trusted the management team and expected this level of care and support, while the respect for their privacy and dignity was encouraged and required from all staff members. Staff were regularly supervised. In relation to the suggested staffing restructure and introduction of an assistant manager, a supervision plan was made, allowing shared responsibility for supervision between the manager and assistant manager. Records were kept in staff files and confirmed regular sessions did take place. The manager Care Homes for Older People Page 22 of 26 Evidence: also explained that she was supervised by the owner. Regular audits of users money held by the home were introduced. Four records and money boxes were checked and all were appropriate and accurate. The home implemented their safe working practices according to the plan and objectives, thus ensuring users were both satisfied with care and safeguarded. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 25 13 Hot water taps must deliver water within the prescribed safe temerature. This will prevent potential scalding to users of the service. 29/05/2009 2 25 13 Radiators must have guards or low temerature surface. This will protect users from scalding. 15/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should address when users needed help with their finances and explain how this part of care is organised to better protect them. Medication brought forward from sheet to sheet should be recorded on the newest sheet to ensure easy audit and improve safety for users of the service. 2 9 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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