Care Home: Brooklands Care Home

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What the care home does well During the visit people said they are generally satisfied with their care.They agree that staff give them the care and support they need and they listen and act on what they say. This is good because it means that staff are considering people`s feelings and wishes. The atmosphere at the home is friendly and homely and people can make choices about how they spend their day. People can have friends and relatives visit whenever they wish. This helps them to maintain good social links with people who are important to them and links with the local community. What the care home could do better: People`s needs must be assessed prior to admission to ensure the home can meet their needs. Care plans must be accurate and reflect the current and changing needs of the person. Supplementary records such as position charts and nutrition/ fluid intake charts must be consistently maintained so that the care people receive can be evaluated properly and changes in need can be identified and planned for. More person centred care plans should be developed which identify how people choose to receive their care. Recruitment practices need to improve to ensure people who use the service are properly protected from unsuitable workers. Lines of accountability and management responsibility need to be reviewed and improved to ensure the quality of service is maintained when the manager is absent. Random inspection report Care homes for older people Name: Address: Brooklands Care Home Springfield Road Grimsby North East Lincs DN33 3LE two star good service 18/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Lyons Date: 2 9 0 6 2 0 1 0 Information about the care home Name of care home: Address: Brooklands Care Home Springfield Road Grimsby North East Lincs DN33 3LE 01472753108 01472278023 brooklands@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Dorothy Marfleet Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Home Properties Limited care home 63 Number of places (if applicable): Under 65 Over 65 24 31 0 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 11 A new admission into any one of the three places in the main building shall not take place automatically, but only with the approval of the CSCI The Maximum number of service users to be accommodated in the home with a physical disability will remain at 11, and shall not be increased again. Three Physically Disabled service users to be accommodated in the main part of building until such time as a vacancy occurs in the designated unit. Date of last inspection Care Homes for Older People 1 8 1 1 2 0 0 9 Page 2 of 12 Brief description of the care home Brooklands is a purpose built care home in a residential area of Grimsby, providing residential and nursing care to a maximum of 63 people, being of old age or having dementia or a physical disability. The home has two floors and rooms are all single, access to the first floor is via stairs or passenger lift. There is a good range of communal facilities throughout the home. There is an attractive small rear garden and ample parking space available. The home is situated near to local shops and facilities, the centre of Grimsby or the Princess Diana General Hospital is only a bus ride away. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Current information about fees can be obtained from the manager. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Care Homes for Older People Page 3 of 12 What we found: We carried out this random inspection visit following receipt of a safeguarding report from an investigation carried out by the safeguarding team in May 2010. The report identified issues relating to recruitment practices, care planning and safeguarding reporting procedures. A more recent safeguarding allegation identified issues regarding the standard of care support provided to an individual recently admitted into the home for respite care support. Choice of Home. Evidence from care records showed that the home had recently admitted an individual for respite care support without assessing their needs prior to admission. Care notes and assessment information was in place to support previous admissions, the latest being the previous year. This person was now funded for nursing care support but the nursing staff were not aware of this change or the increase in care support the individual required. There was evidence that the individuals needs had changed since the previous admission however assessment records and care plans had not been updated to reflect these changes. Discussions with the manager and qualified staff confirmed that the admission had been arranged by the homes administrator, admissions to the home should be arranged by the nursing staff in charge to ensure that the home can meet the individuals needs, have capacity to do so and proper arrangements have been put in place to ensure care needs will be met. We looked at a sample of other assessment records through case tracking; preadmission assessments had been carried out, these were found to be detailed and supported the decision that the individuals care needs could be met in the home. Assessment records completed after admission were found to be less detailed, many sections were not completed and there was little information about how people choose to receive their care. Assessment records should contain more personalised information which will then assist the staff in writing more person centred care plans. Health and Personal Care. We looked at the care records for an individual admitted for short- term respite care. There was no evidence that the care plans had been updated to reflect changes in the individuals needs, particularly around continence and pressure damage. There were few supplementary records available such as daily records and positioning charts to support care delivery. It is important that peoples current needs are recorded in an up to date care plan which clearly identifies the tasks staff need to carry out to ensure the persons needs are met. We also looked at three other files for people with similar needs. Records showed that peoples risks of sustaining pressure damage had been accurately assessed and the risk assessments had been reviewed regularly. Records showed that peoples continence needs were properly assessed and planned for and appropriate support and equipment was in place where necessary. We found some inconsistent recording with the care plans to support peoples pressure Care Homes for Older People Page 4 of 12 damage needs, for example, in one file two- hourly turns were detailed on the care plan but daily records and repositioning charts identified that the individual had received fourhourly turns. There was good evidence in the records however that the individuals pressure damage was improving significantly. In another file, a support plan for pressure damage was out of date, although an up to date plan was in place in the wound care file this did not describe how often the person should be supported with repositioning. It is important that the care plans in all the files are up to date and supplementary records evidence the care that has been planned to ensure peoples needs are properly met. We also found that many of the supplementary records such as nutrition and fluid intake and repositioning charts had not been consistently maintained. Staff need to make accurate and consistent records to ensure peoples needs can be properly evaluated and changes in need are not missed. In general, improvements in care planning could be made with a more person centred approach. The manager confirmed that she had provided some of the senior staff with training in this area however evidence from the care records seen demonstrated further significant areas for improvement. We saw evidence that an issue identified in the safeguarding report around peoples preference for staff support had been addressed. Where individuals have made choices about support from male or female care staff this is clearly recorded and staff and people who use the service confirmed at interview that these choices were respected. Daily Life and Social Activities This area was not assessed at this visit. Complaints and Protection. The home had in place the Southern Cross safeguarding and whistle blowing policies and procedures, a copy of the multi- agency policy and procedures was also available. Records in staff files show that staff had signed for receipt of the staff handbook which includes information on reporting incidents and whistleblowing. The safeguarding report identified concerns that there had been delays with a number of care staff reporting a serious incident which they had witnessed. The manager had reported the incident to the safeguarding team when she had been informed. At this visit, we saw good evidence that the manager had taken steps to address this issue, for example the staff members concerned had received an individual counselling session with the manager to ensure they recognised issues of potential abuse and understood reporting procedures. Although the majority of staff in the home have attended in - house safeguarding courses in the last twelve months, all staff have now been booked on a safeguarding course provided by the local Care Trust Plus, which will ensure they are able to recognise issues of abuse and know how to refer these to the local authority for investigation. There was also evidence from staff meeting minutes and individual staff supervision records that safeguarding people from abuse and reporting procedures had been discussed. Those staff members spoken with during the visit were clear about what action they would take if they had concerns about an individual. There was evidence that the manager had recently reported concerns raised by a relative regarding a staff members attitude and practice to the safeguarding team. These issues are currently being investigated. Care Homes for Older People Page 5 of 12 Environment This area was not assessed at this visit. Staffing Discussions with the manager evidenced that staff turnover was moderate. We looked at a selection of recruitment records, the majority for staff employed since the last inspection visit in November. The files showed that the homes recruitment processes were not consistent with Southern Cross recruitment policy and procedures. A number of records showed that gaps in employment history had not been explored, references were not always obtained from the current or previous employer and one reference had been accepted from a common-law relative.The risk assessment was not in place and decision about employment was not recorded to support recruitment of a worker with a positive CRB check. The file for a qualified member of staff recently recruited and working their first day at the time of the visit showed that the ISA First check had not been received (although this arrived at the end of the visit) and the staff member was being supervised by the manager, the two written references were addressed To whom it may concern and provided by the staff member, there were copies of recent requests for references in the file and a verbal reference had been obtained during the visit from one of the referees. There was no evidence in the file that the RGNs Professional Identification Number (PIN )had been checked to ensure the individual was currently registered with the NMC. We also looked at the recruitment file for the staff member identified in the safeguarding report from May 2010. This showed that the CRB check was not in place, information was received from the Human Resources department during the visit which demonstrated that the check had been received in September 2009 however the home had not followed this up and ensured the record was held in the home. There was no evidence that the home had ensured the staff member had been supervised with their contact with people who use the service since their employment. There was no evidence in the file that the reasons for dismissal from the previous employer had been explored and discussed. A reference from the previous employer was not obtained, although requested, with no evidence that this had been chased up. It is important that the recruitment policies and procedures in place are followed to ensure people who use the service are properly protected. Checks of staff files also identified deficiencies and a lack of consistency with staff induction training. Of the eight files seen, two files contained records of first day checks and four staff had completed various health and safety modules and a safeguarding training module. The manager confirmed that staff were completing the more in depth induction programme in line with skills for care and had been issued with work books, but there was no evidence available to support this. New staff need to complete induction training so that their skills and competencies can be properly assessed to ensure they are equipped to provide appropriate care support. Management and Administration There was clear evidence from discussion with staff, observation during the day and from records seen that the manager has a very hands on approach. The manager confirmed Care Homes for Older People Page 6 of 12 that one of the qualified staff had recently left the home and that this staff member had provided a lot of support with aspects of the management and administration systems in the home and she was struggling to manage this now. Issues arising from the recent admission to the home for respite care support highlights some deficiencies in the overall management of the service when the registered manager is absent. We looked at a number of staff supervision records, these demonstrated that staff were receiving sessions every two months and the sessions covered areas such as training, practice and areas of concern. What the care home does well: 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 2. Care Homes for Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 12 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, 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 2 14 There must be an up to date 30/08/2010 assessment of the persons needs either by the local placing authority or by the home. This would ensure that people have had their needs looked at prior to being offered a place and the home would be sure it could meet those assessed needs. 2 7 15 Peoples care plans must accurately reflect their current needs and how their needs are to be met. This is so people are cared for in a safe, consistent way. 30/08/2010 3 8 12 Supplementary records such 30/08/2010 as repositioning charts, nutrition and fluid charts must be properly maintained to evidence the care support that has been given. This will ensure peoples health care needs can be properly assessed and any Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 changes in need can be planned for. 4 29 19 New staff must be recruited 30/08/2010 in line with the homes policies and procedures; which includes obtaining written references from appropriate persons, exploring gaps in employment, risk assessing recruitment of individuals with positive police checks and obtaining relevant police and professional regististration checks prior to the individual commencing work at the home. This will protect people who use the service from potentially unsuitable workers. 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 2 More detailed assessment information should be recorded to provide staff with information about how people choose to receive their care. Care plans should follow more person centred planning principles. These need to reflect peoples real experiences, their needs, wants and aspirations. Where new staff are working at the home under an Isa First check and prior to the full CRB check in place, records need to be in place to demonstrate that the worker is supervised in all contact with people who use the service. Records should be in place to support the induction training Page 10 of 12 2 7 3 29 4 30 Care Homes for Older People 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 programme provided for new staff. 5 31 Consideration should be given to the recruitment of a deputy manager/ clinical lead to support the registered manager in ensuring the quality of service is maintained. Clearer lines of accountability need to be identified to ensure that the home is managed appropriately in the absence of the registered manager. 6 31 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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