Care Home: Brookfield House Nursing Home

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What the care home does well The manager and staff make an effort to find out what people like to do during the day and try to make sure that they can do it. The management and staff work closely together to make sure that people living at the home are safe and comfortable. People told us that they are satisfied with the accommodation, activities, staff and the food provided. The home is clean and maintained, people told us that their rooms are cleaned very regularly. The recruitment and training of staff is of a high standard to ensure that people are cared for by suitable and competent staff. What has improved since the last inspection? Maintenance, redecoration and refurbishment continue on a rolling programme to ensure that the property remains at a high standard of decor and repair. The staffing levels have been reviewed and it appears there are now sufficient staff on duty to fully meet a persons needs in a timely way. What the care home could do better: It is considered that the service is currently performing well and setting its own objectives for continual improvement and providing effective outcomes for the people in residence. No requirements and recommendations have been made as a result of this unannounced inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brookfield House Nursing Home Forton Road Newport Shropshire TF10 7JL     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: Joy Hoelzel     Date: 2 2 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 House Nursing Home Forton Road Newport Shropshire TF10 7JL 01952810288 01952810029 irenepalmer75@hotmail.com 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) : Mrs Margaret Jones care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Additional conditions: 0 The home may accommodate a maximum of 18 Elderly persons of whom 5 may be suffering with dementia. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 25 June 2001. Date of last inspection Brief description of the care home Brookfield House is a nursing home situated in the market town of Newport, Shropshire. As it is close to the town centre, the home benefits from a good range of shops and other facilities, and can be easily accessed from neighbouring towns and villages via public or private transport. The original Victorian building has been extended and offers both single and double accommodation for older people, of whom 5 may have dementia related illness. A passenger lift provides access to the first floor bedrooms. There are two communal lounges one of which has dining facilities. Care Homes for Older People Page 4 of 26 Brief description of the care home Externally, the front of the home has a secluded well-maintained garden that provides safe and accessible areas for people to use and enjoy. The current fees charged vary between £505.00 and £404.00 per week depending on the care package required. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Care Quality Commission inspection reports for this service are available from the provider or can be obtained from www.cqc.org.uk 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 last key inspection was conducted on 9th May 2007 with an annual service review 8th December 2008. On this occasion the home did not know that we would be visiting to conduct a full inspection of the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. Care Homes for Older People Page 6 of 26 An Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion prior to the annual service review being completed. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us the areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it the commission. Comments from the AQAA were included in the annual service review and reference is made to the document in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 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 9 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. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Significant time and effort is spent planning to make admission to the home personal and well managed. Evidence: Information on the service is available in the form of a brochure and has recently been updated. The brochure is readily available on request and a copy is given to each person living at the home. The deputy manager confirmed the fees for this year as £505:00 per week for nursing care and £404:00 for residential care. The information provided by the service ensures that people can decide whether the care home can meet their support and accommodation needs. We looked at the case file of the person who recently moved into the home to see if Care Homes for Older People Page 10 of 26 Evidence: information had been sought regarding this persons needs prior to moving in. Information had been obtained from the previous health care setting and the manager of the service had visited this person prior to offering accommodation at the home. This person told us that although they would prefer to be in their own home, Brookfield was a good place to live as the staff were very kind and helpful and the food was good. We looked at other case files and they included pre admission assessments by the home in addition to social worker reviews, assessments from Primary Care Trusts, community care services and other social care settings. The deputy manager gave an account of the robust pre admission procedures that are in place. This gathering of information ensures that the service can be confident of meeting a persons care needs. The home does not provide an intermediate care service. Care Homes for Older People Page 11 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. The plan is person centred and focuses on the individuals strengths and personal preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. Evidence: All people living at the home have a plan of care that is initially generated from the assessments obtained prior to the person moving in. We looked at three plans of people who had been resident at the home for varying lengths of time. Some consent forms had been signed by the relative on behalf of the person. Each plan contained assessments for maintaining a persons safety and when a risk is identified it is linked with a corresponding plan of care. For example one person is currently at risk of developing pressure areas due to a specific condition, the care plan indicates the pressure relieving equipment to be used and the regular interventions needed by staff to reduce the risk. Another person required regular interventions from Care Homes for Older People Page 12 of 26 Evidence: the nursing and care staff for a specific condition. Records were seen for the monitoring of this and included the frequency of the interventions and any changes to the condition that may be observed. Staff discussed the care needs and described the way they helped this person each day. The Annual Quality Assurance Assessment completed by the manager discusses how the health and personal care needs of people are met by - The home encourages and supports each service user to make decisions about their own personal care and this is incorporated into their plan of care. The staff are trained in giving choices to the service users and to help them to make decisions. Care plans and risk assessments are in place to ensure the service user gets the best possible care and are not put at risk of anything that is detrimental to their care. These care plans and risk assessments are reviewed and updated at regular intervals. It goes on to identify ways of improvement by- Continually updating our care plan and risk assessment system. We will continue to work with all health care providers to ensure that all aspects of the service users care is met. Medication is administered to people by the registered nurses using a monitored dose system with additional boxes and bottles of medicines. We looked at the procedures in place, staff explained the processes and all evidence points to good arrangements being in place for the safe administration of medications. We observed staff through out the day being very patient, understanding, caring and assisting people with care needs in a discreet and respectful way. People were offered choices at every opportunity be which television programme to watch, selection of drinks or help with personal care. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. Evidence: Care staff told us that activities are arranged daily and at the request of residents. People told us that they enjoyed listening to music, playing bingo and participating in quizzes. A multi denominational service is arranged monthly, some people stated they enjoyed this and commented how religion and the participation in the short service was important to them. People can have the choice of whether to join in with the activities or not. One person told us that they were happy with my own company, and preferred not to participate within the group setting. The home has an open visiting policy with people able to visit at times suitable to their relative. People confirmed that their families visit often and that they looked forward to spending time with them. The main front door is kept locked for security reasons; entry to the home is gained by Care Homes for Older People Page 14 of 26 Evidence: staff answering the door. A domestic type lock is sited on the door for ease of exiting. No other doors around the home were seen to be locked, people can have free access to all communal areas if they so wish. Should people wish to obtain advice from the advocacy service, contact details are displayed of the local service at the entrance to the home. The meals are prepared by the catering staff and are served to people in their preferred place to eat. Some people had their meals in their bedrooms others in the lounge area. A dining table is available should anyone wish to use this but most people were having lunch in the communal areas, sitting in armchairs with tables in front of them. People told us that they enjoyed the food, and that there was always plenty to eat. Staff were observed to be sitting with people who required help to eat and drink and were very patient, discreet and encouraging. Care Homes for Older People Page 15 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. 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. Evidence: The information documents offer clear concise details of how to raise a concern or complaint about the service. The procedure is also displayed on the notice board in the home. The deputy manager confirmed that no concerns or complaints have been raised with the service during the last twelve months. The deputy manager feels this is due to the good relationships formed with residents and their families so that any niggles can be sorted out quickly. People living at the home told us that they would speak with their family or the staff if they had any concerns but everything was satisfactory at the moment. We, the commission have not received any correspondence in this area. One safeguarding referral has recently been made regarding the condition of a person on arrival at the home from a previous health care setting. The deputy manager discussed this and was offering fullest cooperation with the procedures. Staff have received and continue to have updates in the protection of vulnerable adults and adult abuse awareness. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. All transactions are recorded on individual balance Care Homes for Older People Page 16 of 26 Evidence: sheets with invoices and receipts kept. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is satisfactory to the specific needs of the people who live there. It is well furnished, comfortable and has a programme for the maintenance and redecoration of the premises. Evidence: Brookfield House is situated in a residential area close to Newport town centre. It is a two-storey building providing accommodation for up to 18 people. The redecoration and replacement of the fittings and fixtures occurs as the need arises. The communal areas are small but cosy and could become quite crowded if all eighteen people chose to be in the area all together. One person spoken with said that although nowhere is quite like your own home she is satisfied with the accommodation. Other people told us that they too are satisfied with the accommodation provided. They said that their bedrooms are warm, the beds comfortable and that they can personalise their own rooms with family photographs, pictures, ornaments and electrical items such as televisions and stereos, as seen during a brief tour of the home. The Environmental Health Officer visited in February 2009 and awarded the home a 4*, good, food hygiene rating. Recommendations have been made to further improve the kitchen area, with the deputy manager confirming that the work is in progress. The parts of the home we toured appeared clean and hygienic. People we spoke with Care Homes for Older People Page 18 of 26 Evidence: indicated they are satisfied with the cleanliness of their rooms and the communal areas. 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. The service has plentiful staff available at all times to support the needs, activities and aspirations of residents in an individualised and person centred way. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the deputy manager was in charge of the home and confirmed that sixteen people were in residence. The staff team consisted of four care staff and ancillary staff. People living at the home stated that the staff are very good, friendly will do anything for you, staff are kind and look after me very well. We observed staff working positively with the people in their care, they appeared motivated and committed and demonstrated a good understanding of the individual and diverse needs of each individual. General observations suggested that there was sufficient staff on duty to meet the care needs of people. People did not have to wait for assistance when they requested help. Care staff spoken with confirmed that there is opportunity for training at National Vocational Qualification (NVQ), in care levels 2&3. The Annual Quality Assurance Assessment indicates that over 50 of care staff have an NVQ, this ensures that staff are well trained and competent to do their job. Staff have their training and development needs identified through the annual Care Homes for Older People Page 20 of 26 Evidence: appraisal of their work performance. Staff discussed the sessions and courses that have been available and include dementia awareness, first aid, fire safety awareness and the Liverpool care pathway - care of the dying. The deputy manager confirmed that staff have received the required training and updates in the mandatory and specialist topic areas relevant to the service. 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. People can have confidence in the care home because it is led and managed appropriately. Evidence: Mrs Irene Palmer continues in her role as registered manager of the service. Mrs Palmer was not at the home on this occasion. The deputy manager Mrs Chris Parton was on the premises and in charge of the home. Throughout this inspection Mrs Parton offered the fullest cooperation with the inspection and demonstrated a good sound knowledge of the care of people and the day-to-day management of the home. Both Mrs Palmer and Mrs Parton have gained the Registered Managers Award and are committed to furthering their skills and knowledge. Mrs Parton stating that they had received training in the Liverpool Care Pathway (care of the dying), the mental capacity act and the deprivation of liberty safeguards. People living and working at the home offered positive comments about the management and commented that they would have no hesitation but to see either the manager or deputy if they felt unhappy Care Homes for Older People Page 22 of 26 Evidence: about anything. The AQAA contains good information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents. The home demonstrates a high level of self-awareness and recognises the areas that it still needs to improve, and has clearly detailed the ways in which they are planning to do this. The service has a quality assurance and monitoring system that makes certain the home is operating as it states it does and meets its stated aims and objectives. Satisfaction surveys are periodically sent to residents and their families with the results of the surveys considered and actioned. The deputy manager stated that the registered manager and the provider of the service meet each month to discuss the operation of the home. The home offers a facility for residents to deposit personal monies for safekeeping; we saw records relating to this which been maintained and fully receipted. We saw documents and certificates relating to the weekly, monthly and annual health and safety checks that are carried out. Risk assessments for the premises are maintained and reviewed annually. These checks ensure that the health, safety and welfare of people living in, working in and visiting the home are promoted and protected. 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. 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