Care Home: Brookfield

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What the care home does well There has been a consistent management team in Brookfield for a number of years, and staff said they get the support and training they need. We received positive comments on the service through speaking with residents and by reading what was written in questionnaires written by residents, relatives, staff and visiting health professionals. Residents said, "I enjoy the outings we are taken on." Another person wrote "We get nice fresh bedding regularly." Residents looked well cared for and appeared relaxed during the visit, and they were spending time as they chose, in the lounges or in their bedrooms. A resident told us she prefers to remain in her bedroom and she chooses when to get up and when to go to bed. She said the meals are good. A visiting professional wrote in a questionnaire, " I have seen staff going beyond their expected duty to provide variety of meals and times of meals for individuals to try and meet their needs." What has improved since the last inspection? To ensure the safe management of medication, a requirement from the last inspection has been met. Medication administration records, which were seen, were in order, medication had been signed for as administered and there were no unexplained gaps in the records.To ensure easy access for residents throughout the building, the lift has been refurbished and was in good working order during the visit. Two toilets on the ground floor have been extended and made suitable for people who have physical disabilities. What the care home could do better: The kitchen was clean and well-organised, but in poor condition having flooring and surfaces, which were worn, and units in need of upgrading. The manager said that the kitchen is to be completely refurbished, (including replacement units and floor covering) in the near future. The manager confirmed that there will be alternative arrangements in place for cooking residents` meals during the time the kitchen will be out of commission. Work is due to be carried on the alarm system and fireguards are to be fitted to internal doors. On walking around, the home, we noticed that some bedroom doors were held open with wooden wedges. It is recommended that doors are not wedged open. By ensuring that fire doors, which do not have automatic closers, are kept closed, residents will be protected in case of fire. We read in residents` care files, that due to mental frailty, some people may become agitated when being assisted by staff. It is advised that staff be given training in managing challenging behaviour, to ensure that they can fully support residents` behavioural needs. CARE HOMES FOR OLDER PEOPLE Brookfield 71 Crofts Bank Road Urmston Manchester M41 0UB Lead Inspector Patricia Thomas Unannounced Inspection 10:00 6 March 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookfield Address 71 Crofts Bank Road Urmston Manchester M41 0UB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0161 747 5365 0161 748 2626 Mrs M.J. Chell Mrs Catherine Ann Shea Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users shall be 21, all of whom require nursing care. Registration is subject to compliance with the minimum staffing levels indicated in the Notice served in accordance Section 25(3) of the Registered Homes Act 1984 on 20 October 1999. 28th July 2006 Date of last inspection Brief Description of the Service: Brookfield Nursing Home is registered to provide accommodation and nursing care for up to twenty-one people. The responsible individual is Mrs M.J. Chell. Brookfield is located in a residential area of Urmston and is within easy walking distance of local shops, market and public transport links. Brookfield is a detached converted family home having eight double bedrooms and five single bedrooms. The lounge, dining room and bedrooms are furnished to create a comfortable homely environment. There is a well-maintained garden to the rear of the property. Ample parking facilities are provided at the front and rear of the building. The weekly charge at Brookfield is £510 per week and there are no additional charges. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means that people who use the service receive good quality outcomes. The inspection was un-announced and took place over a six-hour period. The methods we (the commission) used to assess Brookfield against National Minimum Standards are as follows. Discussion took place with residents, the manager, Mrs. Shea, and with staff who were on duty, and a tour of the premises was carried out. Mrs. Shea, had returned the Annual Quality Assurance Assessment (AQAA) to CSCI before the date of the visit. This is a self- assessment of the service against National minimum standards and it also gives us some numerical information about the home. We read records relating to staffing and health & safety, and the care plans of three residents were tracked. Questionnaires returned to us by residents, relatives, staff and health professionals were read and their comments on the quality of service are included in the report. What the service does well: What has improved since the last inspection? To ensure the safe management of medication, a requirement from the last inspection has been met. Medication administration records, which were seen, were in order, medication had been signed for as administered and there were no unexplained gaps in the records. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 6 To ensure easy access for residents throughout the building, the lift has been refurbished and was in good working order during the visit. Two toilets on the ground floor have been extended and made suitable for people who have physical disabilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Quality in this outcome area is good. To ensure that residents’ needs will be met and they are well informed before moving in, they have had their needs assessed and are given plenty of information about Brookfield. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a service user guide given out to people before they move in to help them make the decision as to whether Brookfield will be a suitable home for them. All prospective residents have had their needs assessed by relevant professionals before they move in, and staff from Brookfield carry out preadmission assessments. This is to make sure that the service has the facilities and skills to meet each person’s health, cultural and personal care needs. Assessments, which we read, were in depth and formed the basis of the person’s care plan. People are invited to visit Brookfield before moving in to meet with residents and staff and to make sure they will feel relaxed and at home. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 9 Service user surveys were mainly positive about their experience of moving in to Brookfield, however some, who were admitted from hospital, felt their choices were limited. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Care plans in Brookfield provide staff with the guidance they need, to ensure that each resident’s health and personal care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9 and 10. Care plans for three residents were read. They gave clear guidance for staff as to how each person’s needs will be met in Brookfield. They had been signed by residents or their representatives to ensure their full involvement. To ensure that support is responsive to the needs of each person, there are systems for assessing risk and reviewing and writing down each person’s support needs as they change. A resident said, “Everyone is very kind, they care for us very well.” All the responses received in surveys were positive regarding care and support for residents. Two visiting health professionals who returned surveys said that Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 11 the care and support for residents is always good in their experience. A comment received regarding care giving and treatment of residents is, “In my experience at the home, privacy and dignity have been respected.” To ensure their healthcare needs are addressed, residents of Brookfield are registered with local G.P.s and receive support from staff in the home and through specialist visits to their home. The manager writes about health support in the AQQA, “All health issues are referred immediatley to the GP. The chiropodist, dietician, speech therapist etc are referred to for advice when required and their involvement in a resident’s care is encouraged and documented.” Records of medical visits and treatment were seen in residents’ care files. A visiting health professional stated in a survey, “The clients referred to me have the nutritional recommendations I have given implemented by the staff and matron contacts me for further advice if necessary.” For staff guidance and residents’ safety, there is a procedure for managing and auditing medication. The procedure and systems for storage, record keeping and returns were in order at the time of this visit. A requirement from the last inspection has been met, as there were no “gaps” in medication records, which were read. Systems for returns of unwanted medication were discussed with Mrs. Shea who confirmed that stocks are counted and a record kept of all returns to pharmacy. In this way an audit of medication is carried out and stocks are checked at the end of each month. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents have the lifestyle they prefer and their diverse needs are catered for in Brookfield. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. A record is kept of all leisure events provided in Brookfield and a range of inhouse activities, visiting entertainers and outings is offered to residents. Residents’ diversity is respected through recording their religion in their care plans and making arrangements for visiting ministers as necessary. The manager writes in the AQAA, that Brookfield is managed in a way that satisfies residents’ social, cultural, religious and recreational interests and helps them to exercise choice and control over their lives. There was a relaxed atmosphere in Brookfield during the visit, and residents were spending time either in the lounges or in their bedrooms. A resident said, “I like being up here in my room most of the time, that is my choice. No one bothers me, I get plenty of drinks during the day. The meals are usually good.” Residents’ responses in the surveys, which were received, were generally positive in the comments received regarding their experiences and meals in Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 13 Brookfield. A visiting professional writes in a survey, “ I have seen care staff going beyond their expected duty to provide variety of meals and times of meals for individuals to try and meet their needs.” From speaking with staff, it was evident that there are no unreasonable restrictions on visiting times for family and friends of people who live in Brookfield. A resident said that staff had taken her to visit a relative who lives out of the area. It was evident in care files that the details of family and friends are written down and ongoing contact is supported. A relative writes in a survey, “Good communication with both resident and relatives is a strong point.” There were good stocks of food in store and the kitchen, though due to be refurbished, was clean and in good order. Catering records had been well maintained. The main meal of the day which was served during the visit, looked appetising and special dietary needs such as diabetic and soft diets were being catered for. There were plenty of staff to support residents who need assistance at mealtimes and they were served in the dining areas, in their bedrooms or in the lounge, as they preferred or as needed. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through training and guidance provided for staff in Brookfield. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16 and 18. Brookfield has a complaints procedure, which is given to residents as they move in and to staff during their induction training. In this way, residents will know how complaints are dealt with and staff will be aware of their role in the complaints procedure. There were no complaints recorded since the last visit. In the surveys received from residents, they said they knew how to go about making a complaint. The Adult Protection procedure of Cheshire Council is used for staff guidance in addressing incidents of suspected abuse and training schedules record that POVA training (Protection of Vulnerable Adults), is provided for staff. There has been one safeguarding investigation since the last visit, referred to Cheshire social services by the manager following information received from a resident. The outcome of the investigation has resulted in a member of staff who had been suspended from duty, being allowed to return to Brookfield, and to have no one to one contact with a resident. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents live in a clean and well maintained home, which has a range of aids and facilities in place for their comfort and convenience. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19 and 26. The building was clean and odour free during the visit. There are two homely lounges and two dining areas for residents and the rear garden and car park were in good condition. The manager said that residents use the garden often in fine weather. The majority of bedrooms are doubles with screening provided to respect residents’ privacy. Bedrooms, which were visited, were comfortable and highly personalised. Domestic staff are employed in Brookfield, they are provided with protective clothing, and there are procedures and guidance for infection control. Domestic staff on duty and said there is always a good stock of cleaning Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 16 materials and these are locked away when not in use, in accordance with COSHH procedures. Staff are employed for laundry duties and the laundry is well organised during the visit, and equipment was in working order. To ensure that residents’ clothing is returned to them in good condition, there are systems for returning laundered items to their bedrooms. Infection control in the laundry is managed through colour coded laundry bags and use of a washing machine which has sluicing facilities. The kitchen was clean but in poor condition, the flooring and surfaces were pitted and the units in need of replacement. Mrs. Shea said that the kitchen is to be completely refurbished, (including replacement units and floor covering) in the near future. Since the last visit, two toilets on the ground floor have been improved and adapted to meet residents’ mobility needs. The lift has been refurbished and was in good working order during the visit. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents are protected through the recruitment, training and staff support systems followed in Brookfield. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. The staff rosters were seen and gave an accurate record of the staff who were on duty during the visit. Training schedules were read and show of a range of mandatory training (such as moving and handling and food hygiene). This is in addition to NVQ training and courses which are specific to residents’ needs. Brookfield has a training and development plan and has access to training courses provided by the local authority. It is advised that staff be given training in managing challenging behaviour to ensure that they can fully support residents’ behavioural needs. The staff files for the two most recently appointed staff were seen. The records gave evidence of the vetting and clearances carried out before staff take up their posts in Brookfield. The staff surveys received expressed satisfaction with the training and support they receive in Brookfield and the outcomes to residents. Some of the comments are as follows: Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 18 “There is a handover before every shift commences. We are encouraged to read individual’s care plans as often as possible.” “My induction was very thorough to a very high standard. We are fortunate in being offered frequent updates and relevant courses which are ongoing. We do have staff appraisals carried out when possible by matron. We can however discuss anything informally in between times.” “We give a high standard of day to day care of residents.” Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Brookfield is managed in a way, which supports residents’ wishes, health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35,38. The manager, Mrs. Shea, has worked in Brookfield for many years and has a management qualification. Mrs. Shea writes about management arrangements in the AQAA as follows, “The management team consists of the home owner, matron/manager and administrator all of whom are approachable at all times should the staff, service users, relatives or visitors require their attention. The team works closely together to ensure the home is well run and well maintained.” Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 20 To ensure that residents’ opinions are central to the ongoing improvement and development of Brookfield, there is a quality assurance system, which is based on seeking their views. We discussed the arrangements with the manager, who confirmed that quality questionnaires are given out to residents and their families twice a year. She said that their needs and opinions are important to service development. She gave an example of the way in which a resident’s needs and opinions had been supported by staff. This was later confirmed by speaking with the person. Mrs. Shea confirmed that staff of Brookfield, have no involvement in residents’ personal finances. In instances where small sums of personal allowance are held in safekeeping, records of each transaction are kept and receipts for purchases are retained. The records were made available and were in order. On walking around, the home, it was noticed that some bedroom doors were held open with wooden wedges. We were informed by staff that works are due to be carried out on the fire alarm system and fireguards will be fitted to doors on a priority basis. It is recommended that fire doors are not wedged open. By ensuring that fire doors, which do not have automatic closers, are kept closed, residents will be protected in case of fire. To ensure that the building is safe and staff, have the guidance and training to follow health & safety procedures, we looked at health and safety certificates, relating policies and procedures and training schedules. These were satisfactory at the time of the visit. Records of accidents to residents and staff were seen and these had been well maintained with sufficient detail written about each incident. This will help to ensure that risk assessments will be put in place for use of equipment and for residents who are at risk of falls and/or accidents. Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is recommended that staff be given training in managing challenging behaviour. In this way staff will have the skills to fully support residents’ behavioural needs. It is recommended that fire doors in Brookfield are not wedged open. By ensuring that fire doors, which do not have automatic closers, are kept closed, residents will be protected in case of fire. 2. OP38 Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brookfield DS0000006700.V357747.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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