Care Home: Brooklands House

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What the care home does well Staff training is given high priority to make sure that the staff team are well trained in order to offer a consistent service that meets residents needs and requirements. There is a good system in place to make sure that the individual needs and requirements of each prospective new resident are known prior to admission. This helps to make sure that people are only admitted to the home if their individual strengths and needs can be met by the staff team. Residents spoken with told us that they liked the staff team. One person told us that the staff were, "very good" and another resident said that, "Staff excellent, will help with anything". What has improved since the last inspection? The home`s Statement of Purpose and Service User Guide that tells residents, prospective residents and any other interested people about the facilities and services available at the home, has been reviewed and updated. This now gives clear and up to date information so that people can make an informed decision as to whether to live at the home. The individual written care plan that tells staff about the the wants, wishes and requirements of each person living at the home has improved and now provides clearer detail, so that a consistent service can be offered. The in-house activity programme has been improved and expanded. This helps to provide residents with some social activity and stimulation that meets their individual needs and expectations. What the care home could do better: There is a good system in place at Brooklands House to make sure that the individual needs and requirements of each prospective resident is known before admission. This is to make sure that the home can provide the degree of care and support required. However there is a requirement that once the pre admission assessment is completed, the prospective resident must be informed in writing of the outcome of the assessment to confirm whether or not their needs, wants and wishes could be met there. There was no evidence that this had been happening. Generally medication is managed safely at this home by staff that have received appropriate medication training in order to protect the people living there. However, it was noted that when a hand written entry had been made on the drug administration record, this had not been signed and dated by the person making the entry or checked and countersigned by a second person to confirm accuracy of the recording. This would help to protect people and ensure that an accurate record had been maintained. There is a recently amended regulation, that says that controlled drug storage in care homes must now be as safe as controlled drug storage in nursing homes. The registered manager is to speak with the supplying pharmacist to make sure that the drug storage arrangements in the home meet the new standards for care homes.Care plans, that tell staff what a resident likes to do for themselves or what help and assistance is needed, are in the main good and provide staff with clear direction. However it is important that when a care plan tells staff to do something specific, such as place a resident in a safe position, it is clearly explained what this actually means. This would make sure that all staff knew exactly what they should do and help to ensure a consistent approach when assisting that person. Key inspection report Care homes for older people Name: Address: Brooklands House 3 Woodville Terrace Lytham St Annes Lancashire FY8 5QB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Upton     Date: 0 5 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brooklands House 3 Woodville Terrace Lytham St Annes Lancashire FY8 5QB 01253736393 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Carol Josephine Gilligan,Mr Patrick Joseph Gilligan care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Brooklands House is situated in a quiet residential area of Lytham but in close proximity to Lowther Gardens, the promenade, the main shopping area of the town and community facilities and resources. The home is arranged over two floors with the majority of residents accommodated in single bedroom accommodation. Only one bedroom is for shared occupancy. Brooklands House is a no smoking home and this is clearly stated in the homes Statement of Purpose and Service User Guide. This ensures that prospective residents can make an informed decision about living at the home. The home is registered to accommodate up to 25 older people who do not require nursing care. Mr and Mrs Gilligan are the registered providers and Mrs Gilligan Care Homes for Older People Page 4 of 32 0 Over 65 25 Brief description of the care home undertakes responsibility for the day-to-day management of the home including directing all professional issues and care practices. Training is viewed as a positive tool to improve standards and to provide a high quality service. All staff are expected to undertake relevant training including nationally recognised National Vocational Qualification (N.V.Q) training in care and become accredited to a minimum of Level 2. Personal care is provided as required and specialised needs can be catered for. Any nursing needs are referred to the community district nursing team. In house activities are arranged and residents can choose whether to participate or not. Visitors are welcome at any time of the residents choice and can be entertained in the privacy of the residents individual bedroom accommodation or any communal area of the home. Care Homes for Older People Page 5 of 32 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: This unannounced key inspection site visit took place during the morning and afternoon period of a mid week day and spanned a period of approximately eight hours. Twenty three of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the recommendations made at the last key inspection. We spoke with the registered manager and two members of the care staff team. In addition, three residents who were at home were also individually spoken with and brief discussion took place with several other residents in the lounge area of the home. Information was also gained from four residents and two members of staff who completed and returned a Care Quality Commission (CQC) survey prior to the site visit taking place. This all helped to form an opinion as to whether Brooklands House care home was meeting the needs and expectations of the people who live there. Care Homes for Older People Page 6 of 32 A number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation and the kitchen area. There is a passenger lift in place to assist those residents who cannot manage the stairs. Details of current fees and what is included in the fees is available from the home. The last key inspection at Brooklands House took place on 30th July 2007 and an Annual Service Review was undertaken on 23rd September 2008. The report relating to the service review is held at the CQC office and would be made available on request. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There is a good system in place at Brooklands House to make sure that the individual needs and requirements of each prospective resident is known before admission. This is to make sure that the home can provide the degree of care and support required. However there is a requirement that once the pre admission assessment is completed, the prospective resident must be informed in writing of the outcome of the assessment to confirm whether or not their needs, wants and wishes could be met there. There was no evidence that this had been happening. Generally medication is managed safely at this home by staff that have received appropriate medication training in order to protect the people living there. However, it was noted that when a hand written entry had been made on the drug administration record, this had not been signed and dated by the person making the entry or checked and countersigned by a second person to confirm accuracy of the recording. This would help to protect people and ensure that an accurate record had been maintained. There is a recently amended regulation, that says that controlled drug storage in care homes must now be as safe as controlled drug storage in nursing homes. The registered manager is to speak with the supplying pharmacist to make sure that the drug storage arrangements in the home meet the new standards for care homes. Care Homes for Older People Page 8 of 32 Care plans, that tell staff what a resident likes to do for themselves or what help and assistance is needed, are in the main good and provide staff with clear direction. However it is important that when a care plan tells staff to do something specific, such as place a resident in a safe position, it is clearly explained what this actually means. This would make sure that all staff knew exactly what they should do and help to ensure a consistent approach when assisting that person. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Brooklands House are given information about the home and have their needs assessed so they will know if their needs can be met. Evidence: Since the last inspection, the homes Statement of Purpose and Service User Guide have been reviewed and updated. These two booklets, that tell residents, prospective residents and other interested people about the home are now up to date and detailed. Brooklands House is a no smoking home and this is clearly identified in the booklets so that people can make a positive choice about moving into the home. In order to ensure that residents are only admitted to Brooklands House care home if their health, personal and social care needs could be met, prior to admission the registered manager undertakes an assessment of each prospective residents current strengths and needs. This is done in order to determine if the level of care and support required could be provided at the home. The prospective resident is visited in Care Homes for Older People Page 11 of 32 Evidence: their own home or in some cases, in hospital. This provides an opportunity for the prospective resident to find out more about the home and for the registered manager to undertake a formal assessment of current strengths and needs. Since the last inspection, the documents used to record this important pre admission information have been updated and more detail is now provided. As well as health and personal care needs, the pre admission assessment now contains more information about such things as dietary preferences, social interests and cultural and religious needs and requirements. Wherever possible, relatives are also involved in the pre admission assessment process and a visit to the home may be arranged depending on circumstances. This collective information is recorded, which in some cases is supported by a Health and/or Social Services assessment of current needs and requirements. This combined information, helps to make sure that as much information as possible is gained in order for the registered manager to make an informed judgment as to whether the home could provide the level of care and support required. Records were viewed in relation to two residents that had been admitted to the home in the last twelve months. Documentation included, a pre admission assessment undertaken by the registered manager that was quite detailed. The pre admission assessment had identified a number of risks. Appropriate risk assessments had been undertaken in relation to those risks. Information from other agencies were also on file, for one person this included the need for twice weekly physiotherapy appointments. Whilst this provided staff with initial written information about the care needs of the individual, a further more in-depth assessment is undertaken on admission. This combined information then formed the basis of the initial plan of care. Whilst it appeared that the needs and requirements of people living at the home were being met, there is a requirement that any person that has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective residents current needs and requirements could be met at the home or alternatively that they could not be met. This should be provided prior to admission. There was no evidence that this had occurred. Intermediate care is not provided at Brooklands House care home. Care Homes for Older People Page 12 of 32 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. Personal and health care needs are met and people are treated with dignity and respect, promoting a feeling of well being and confidence that any health issue would be dealt with. Evidence: Individual plans of care were in place including the good practice of addressing religious, cultural and social care needs. This helps to confirm that peoples individual needs were being met. Three of the individual care plans were viewed. The pre admission assessment covered a wide variety of needs including personal care, dietary needs and requirements, sight, hearing and mobility. Separate care plans were written for each area of need identified in the pre admission assessment, such as personal care, mobility and health care. Residents and/or their relatives had been given opportunity to be involved in the care planning process, so that they could have some say about the care provided. Care plans evidenced gave clear instruction in order to guide and direct staff. This enabled Care Homes for Older People Page 13 of 32 Evidence: staff to provide an individualised, service that was delivered in a consistent way. This also helped to make sure that residents were encouraged to do what they could for themselves and promote independence whilst ensuring that all staff were giving the same amount of help when required. There was evidence of monthly reviews of the individual care plan taking place, with on-going amendments made to the care plan as necessary. This helped to make sure that a clear and up to date record was maintained of each residents current strengths and needs so that staff were aware of any changes that needed to be made to the level of support required. In addition, formal written risk assessments are undertaken whenever a risk is identified with significant outcomes identified in the care plan. For one person this included individual risk assessments in respect of bathing/showering, dressing, eating, communication, walking, nutrition and falls. The formal risk assessments are reviewed monthly along with the care plan. This makes sure that the risk remains current so as to not infringe on personal independence. Whilst in the main the quality of the formal risk assessments seen were good, in one instance, with regard to a resident that sometimes had epileptic fits, the risk assessment advised staff to put the resident in a safe position. It is recommended that this information be expanded upon so that all staff are very clear about what is a safe position for this individual person. This would make sure that a consistent, safe approach is taken when assisting this resident for the protection of the resident and the members of staff during these periods. Although somewhat vague as to the detail of her care plan, one resident spoken with was full of praise for the help and support she received from the staff team and confirmed that her needs were being well met. Another resident wrote in answer to the question, Do you receive the care and support you need said, The manager and care staff are always there to support, all very pleasant girls. Residents told us that they always got the medical care and support that they needed when they needed it. Records seen also confirmed that residents health care needs were being fully met . As this is a fairly small home, staff get to know people well and can spot any changes in health and well being. There is a good relationship with health and social care professionals in order to maintain residents health and social well-being. An individual record is maintained of all health professional visits for each resident. This ensures that a good record is kept of health care visits and the frequency of need. Care Homes for Older People Page 14 of 32 Evidence: There are good systems in place to make sure that medication is administered safely and as prescribed. All staff with responsibility for the administration and recording of medication have received appropriate training. This helps to keep people living at the home safe and to maintain their optimum health. Although at present only senior care staff administer prescribed medication, other care staff have asked if they could also receive medication training and this is in the process of being arranged. This shows that the staff group are clear about their own training needs and that the management team listen to staff in order to promote and expand their training opportunities and self development. The medication administration records of three people were viewed. These had been completed correctly and had a photograph of the person attached, this is good practice and helps prevent mistakes being made. Following a risk assessment, people are able to look after their own medication either totally or in part if this is deemed to be safe. Currently one resident is self administering their own prescribed medication in part. A locked facility is provided in this persons individual bedroom accommodation for the safe storage of personal items such as medication. Generally medication is well managed, however it was noted that hand written entries in the drug administration record were not signed, dated or countersigned by a second person. It is recommended that when ever a hand written entry is required on the drug administration record, as well as this being signed and dated by the person making the recording, a second member of staff should check the entry and countersign to confirm accuracy of the recording. This should be the exact replica of the pharmacist label. This would help to keep people safe. An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation was explained to the registered manager. Although there is currently no residents at Brooklands House requiring controlled drugs, these requirements must be put into place within a specified time scale. It is understood that the registered manager will contact the pharmacist that supplies the home with medication, to ascertain if the current medication storage facility is compliant with the amended controlled drug storage arrangements in care homes. Residents privacy and dignity is well respected at this home. The health and personal care that people receive is based on their individual needs so they receive personal care in the way they prefer and in a way that shows respect for their privacy and dignity. One resident told us that, Staff are very good, and respectful. This same Care Homes for Older People Page 15 of 32 Evidence: resident said she felt her privacy and dignity was always well maintained by staff. Another person said that the home gave, Very good care, independence and encouragement. Policies and procedures are in place that guide staff to ensure residents privacy and dignity is respected at all times. These important topics also form part of the National Vocational Qualification (NVQ) training that has been undertaken by the majority of staff. The preferred term of address of each resident is identified at the time of admission and always respected. Care Homes for Older People Page 16 of 32 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 have choice and support to meet their expectations and preferences regarding their daily lifestyle. Evidence: Residents are supported to enjoy a lifestyle of their choice. Information in the AQAA confirmed that the in-house activity programme has been strengthened. Residents are encouraged to contribute articles for the homes newspaper that also contains information about birthdays, the appointment of new staff, outings, raffles and special events such as National Vegetarian Week. Themed events are now organised more frequently such as Valentines day celebrations, Easter celebrations and at other special occasions. The news letter also gave information about the range of in-house activities offered that includes, armchair exercises each Wednesday, a Monday art class, hairdresser and manicure session, happy hour, one to one chats with staff and a sherry, bingo and board games and Fridays are generally reserved for functions and outings. It was noted however that some of the individual activities enjoyed by residents identified on the pre admission assessment and individual care plan did not necessarily form part of the planned weekly programme of activities. Whilst it is acknowledged that residents Care Homes for Older People Page 17 of 32 Evidence: interests do change over time, it is important that reference is made to the already provided social care needs information so that expectations and requirements can be met. Residents were asked if they would like to attend a cookery class and this was arranged for a period of six weeks, residents however then wanted a change so this activity has been discontinued for the time being. It is also understood that three times a year, an outside entertainer visits to the home to entertain residents that is enjoyed. A barbecue is planned at the home that will take place during the summer and an Italian night recently took place that included the food and music of Italy. The registered manager explained that some residents also enjoy visiting local restaurants with staff to enjoy a meal out and a clothes show, that visits three times a year, where resident can purchase clothes, is also popular. One resident spoken with explained that she sometimes went out with the registered manager and her husband in the car and that she very much enjoyed this. Outside social activities also take place. Recently tea dances have been arranged at a local outside venue. This will give residents who choose to attend opportunity to meet new people and enjoy a dance. The art class has been well received and some residents recently had their art work displayed at a special exhibition for people aged 60 years and older at a London art gallery. Birthdays are celebrated and residents were looking forward to a lunch at a local public house that is also planned. However some residents clearly prefer their own company in the privacy of their individual bedroom accommodation and this is always respected. The registered manager explained that residents individual religious needs are also considered important. Residents are assisted to visit a church of their choice and attend services with the assistance of staff. This means that residents who choose to, can worship at a place and time of their choice. People are encouraged to maintain contact with their family, so that they can continue to be part of family life. Visitors are made welcome at any reasonable time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. One resident spoken with confirmed that a family member visited and was always made welcome. Wherever possible, people living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Residents are involved in choosing the decoration for their own bedroom Care Homes for Older People Page 18 of 32 Evidence: and encouraged to personalise this personal space with their own important things. Individuals are also supported to manage their own financial affairs for as long as they are able and wish to do so. For some people however, a family member takes on this responsibility. Details of advocacy services are also made available for residents and their family to access if and when they choose. People spoken with said they were happy with the meals provided. Residents that completed a CQC resident survey all said that they always enjoyed the meals served. This was confirmed by residents spoken with during the course of the inspection. One person told us that she was, Enjoying the meals and another person said that although the food was a bit basic confirmed that there was a choice and that she did enjoy the food. A vegetarian option is made available on a daily basis however during National Vegetarian Week, the majority of residents choose to eat only vegetarian meals and were encourage to try something new. Each resident is provided with an individual weekly menu sheet to complete to select their chosen meal options for the coming week. However residents are also individually asked if they would still like the choice they selected on a daily basis. This gives residents an opportunity to change their mind and have something different. It is understood that residents can choose a specific time for their meals especially if they had elected to have their meals in their individual bedroom. However on the day of the site visit, most residents were seen to be enjoying lunch in the dining area. Mealtimes are unhurried and staff offered assistance and encouragement. Specialist diets can be accommodated if required. There is also a chocolate and crisp machine for residents and staff to purchase these items as and when required. Care Homes for Older People Page 19 of 32 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. The home has a satisfactory complaints policy and adult protection policy in place. This, along with staff training helps to protect residents. Evidence: The Home has a recently updated complaint policy and procedures in place that includes details that any complaint would be investigated and responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to the site visit, a record of any complaints would be kept that includes details of any action/investigation taken. The complaint procedure is displayed in the home and written details of the complaint procedure are incorporated in the Service User Guide, a copy of which is provided to each resident. Residents spoken with were very clear about who they would speak with if they did have a concern or complaint but one resident spoken with told us that she Had nothing to complain about. There has been one complaint made about the home in the last twelve months. The records of this was viewed. It was clear that the complaint procedure had been used to investigate the complaint. This complaint was not upheld. People living at the home have formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. Care Homes for Older People Page 20 of 32 Evidence: Brooklands House continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have receive training regarding protection and abuse. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). The majority of staff have achieved this award. One alleged adult protection issue was referred to Social Services in line with the local protocols for reporting alleged abuse. The homeowner fully cooperated with this this matter and the issue is now resolved. Care Homes for Older People Page 21 of 32 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. A clean, pleasant and comfortable environment is provided. Evidence: Brooklands House is a detached property that is situated in a quiet residential area overlooking a local park. Accommodation is provided on the ground and first floor of the building and there is a passenger lift for ease of access to the upper floor. Although the internal environment is a little tired in places, the home is generally maintained to a good standard and comfortable. Recently planning permission has been approved to extend the home. The building work is scheduled to commence in the very near future. This will include a new kitchen, new laundry facilities, a new office and staff room and a further five en-suite bedrooms. In the existing building, eight bedrooms are to be redeveloped to include the provision of an en-suite facility and a new wet room and toilet facilities are to be built on the ground floor. All bedroom accommodation will then be provided with safe locks. Once the new build and building work to the existing building has been completed, the older part of the building will be redecorated and re carpeted throughout to match the internal environment of the new build. This will enhance the living environment for all residents as well as providing additional accommodation. Currently there is a combined lounge and dining room and a smaller quiet lounge giving people a choice of where to sit. A this home, a number of residents choose to Care Homes for Older People Page 22 of 32 Evidence: spend their waking day predominately in their bedroom accommodation. This is respected, however the registered manager explained that staff do keep going to see these residents during the course of the waking day so as to ensure that they are not too isolated. All residents are accommodated in single bedroom accommodation. A number of bedrooms were observed. These were personalised with photographs and items that the occupant had brought from home. The home was clean and free from offensive odours. People spoken with were pleased with the communal accommodation available and their individual bedroom accommodation and comments on the CQC surveys said that the home was always fresh and clean. There are a variety of policies and procedures in place for the control of infection and safe handling of waste products. Current laundry facilities are located in a designated area of the home and do not intrude on residents. However there will be new laundry facilities provided in the new build accommodation. All laundry is washed at an appropriate temperature. The AQAA confirmed that all staff have received infection control training meaning that they know how to reduce the risk of infection within the home. Information in the AQAA confirmed that infection control is given high priority with current best practice information being obtained through a local primary care trust initiative. Staff have been trained in the Code of Practice on the prevention and control of infection. Care Homes for Older People Page 23 of 32 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 people living at Brooklands House are supported by trained, effective staff that have gone through a thorough recruitment process, so peoples needs are met and they are safe from possible harm or poor practice. Evidence: Staffing levels at Brooklands House are determined by the assessed needs of residents accommodated. Additional staff are on duty during busy periods of the day and all night staff have waking watch responsibility. There are sufficient ancillary staff employed to ensure standards in respect of domestic tasks and catering are maintained. Two residents spoken with, one of whom spends a lot of time in her bedroom said that staff came quickly when the call bell was pressed and that, Night staff are good as well. Care staff spoken with also felt that there was always enough staff on duty to fulfill residents assessed needs and requirements. One member of staff told us that there was, A good staff group, good communication and all working together. Another member of the staff team had written on a CQC staff survey, We have a good staff team and work well together, gives out a friendly and happy environment. This means a lot because its hard to find everyone getting along well makes the service user feel good and join in with the fun. National Vocational Qualification (NVQ) training is promoted, with 6 of the 11 members of the care staff team having achieved Level 2 of this award. In addition, Care Homes for Older People Page 24 of 32 Evidence: three members of staff have achieved the more advanced level 3 of this award and two members of the management team and a senior carer are currently undertaking an NVQ Level 4 qualification. The remaining care staff that have not yet achieved the Level 2 of this award are currently undertaking this training. NVQ training is a nationally recognised qualification for care staff and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. From discussion with the registered manager, it is understood that any newly appointed members of the care staff team are routinely provided with nationally recognised Skills for Care induction training. This makes sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provided an appropriate level of care and support. Brooklands House has a structured recruitment policy and procedure in place for the employment of new staff. This helps to protect residents and to ensure that only suitable people are employed at the home. The staff files of three members of staff were viewed, two of which were of staff that had been recently appointed. Records included an application form, two references including one from the previous employer, a criminal records bureau disclosure and a check against the nationally held list of people that have been deemed unsuitable to work with vulnerable people. Copies of certificates relating to training completed with their previous employer were also available. A recently appointed member of staff confirmed that the procedure had been followed and that she had not been allowed to take up her post at the home until the required clearances and references had been obtained and deemed satisfactory. Residents spoken with and comments on the CQC residents survey were all very complementary about the staff team. One resident said that the staff were, Very good and another person described the staff as, Excellent. Care Homes for Older People Page 25 of 32 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. Brooklands House is managed with systems, policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. Evidence: The homeowner, who is also the registered manager at Brooklands House is experienced in running the home and has successfully completed the Registered Managers Award. This is a qualification that all managers of care homes are expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. The registered manager continues to attend a variety of courses to make sure that her knowledge is up to date in order to advise and guide staff appropriately. Staff and residents spoke highly of the registered manager. One resident told us, Atmosphere good here, I am happy with Carole (registered manager) we get on well together. A member of staff said, Everybody is very supportive here, Carole makes time for staff. Care Homes for Older People Page 26 of 32 Evidence: Internal quality monitoring is considered important at Brooklands House and there are a variety of systems in place to make sure that the views and opinions of residents, their relatives, the staff team and other interested individuals are known. Separate questionnaires for residents, staff and relatives/professionals are provided annually. The registered manager explained that although some good feedback had been received from residents, relatives and staff, the number of questionnaires completed by professional staff had been disappointing. Never the less, the information that had been received was used to make positive changes. A report is produced outlining the outcome of the questionnaires. It is understood that each resident is given an individual copy of this, a copy is posted out to relatives and staff are informed of the outcomes in the staff communication book. Residents had voted to re-introduce resident meetings, and this has been done. This is another way that residents can have their say and bring about change. Residents are also encouraged to express their views and opinions through informal discussion with the staff team. This helps to establish whether people living at Brooklands House think that the home is adequately meeting their needs and expectation. Staff spoken with confirmed that formal staff meetings take place on a regular basis, however staff also considered that there was a good staff team at the home, there was good communication between the staff and that their views were valued. In addition, Brooklands House has also achieved the Investor in People award. This is a national quality standard which sets a level of good practice for improving performance, with effective management bring the key. This is only awarded when a high standard has been achieved. People living at the home are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. In consequence, the home currently only holds a small amount of money in safe keeping for one resident. This was appropriately documented and held in a secure safe. Staff spoken with confirmed that they did receive regular one to one supervision and also a periodic formal appraisal of their work performance. This included identifying future training needs. The supervision records seen on staff files were signed and dated by the supervisor and supervisee. This is good practice and helps to promote the development of the care worker, shows that the topics discussed were agreed and that a good supervision record was maintained so that progress could be monitored. However it was sometimes difficult to separate out just what was a supervision record and an appraisal record. This is important, as supervision is different from appraisal and often addresses different issues. The registered manager explained that both Care Homes for Older People Page 27 of 32 Evidence: supervision and appraisal record forms are to be redeveloped in the near future. This should provide a clearer distinction of what was a supervision record, what was an appraisal record and the outcomes. All staff do receive daily informal supervision as part of the management role. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that the electrical installation and electrical equipment are also checked. A fire risk assessment and environment risk assessments are in place. All staff receive mandatory health and safety training including, fire safety training, first aid training, moving and handling training, food hygiene training and infection control training. This annual training is provided twice a year to make sure that all staff employed at the home receive this important training. All these checks, along side the training that staff receive, help to protect people living at the home, staff and visitors. Care Homes for Older People Page 28 of 32 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 29 of 32 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 3 14 All prospective residents must receive written confirmation of the outcome of the pre admission assessment. This would confirm to the prospective resident, that their current needs and requirements could be met at the home. 30/06/2009 2 9 13 The storage of controlled 30/09/2009 drugs must be in line with the recently amended Regulation. This would make sure that any controlled drugs maintained at the home are stored as safely as possible. Care Homes for Older People Page 30 of 32 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 It is recommended that terms used in care plans/risk assessments such as a safe position are clearly explained in order to advise and guide staff. All hand written entries in the drug administration record should be signed, dated and countersigned by a second member of staff to confirm accuracy of the recording. The self identified interests of residents obtained through the individual pre admission assessment, should be periodically referred to when devising a social activity programme. This would help to make sure that residents previous interests were catered for along with any new interests. 2 9 3 12 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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