Care Home: Brooklyn

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What the care home does well Brooklyn is a well established service in the Clacton area that has continuously developed the quality of its provision over successive years. Mrs Morley is both proprietor and manager and demonstrates a clear sense of leadership and purpose in developing a service to meet the complex needs of people using the service with dementia. The manager is supported by a qualified, knowledgeable, competent team, who were observed throughout the inspection to offer high standards of care, dignity and respect to all. The service shows a commitment to improving standards and service`s for people and is currently working on further improving the care provision through the use of an enriched dementia care planning document being introduced. People using the service benefit from the consistent provision of a core staff group who are committed to the service. One person using the service stated, "the staff are great". In addition to this one person stated, "I like it here". The service offers a sound assessment process and aims to involve the individual, their family and or representatives as much as possible. People are offered a range of activities suitable to meet their needs. At the time of the inspection, the service was undertaking internal redecoration and refurbishment in further improve the environment for the people using the service. This will eventually include an additional multi media room for people to use on the first floor. What has improved since the last inspection? A number of improvements have continued to be made to the service since that last key inspection and include becoming an active member of the consortium, maintaining a low turn over of staff and ensuring that 63% of the staff hold NVQ II in care. In addition to this a number of carpets have been replaced, the office has been relocated to the ground floor and internal redecoration is and has occurred in many of the communal areas. The AQAA told us that a new larger television has been purchased as well as the commencement of a music group and digital recording of activities people are involved in to support and aid with memory. All staff had received training in safeguarding of vulnerable adults and the service has installed a loop hearing system. The manager has also attended additional training provided by the Alzheimer`s Society - Dementia Matters Enabling and Observational Tool. What the care home could do better: The service must ensure that all risk assessments and those for the control of substances hazardous to health (CoSHH) are up to date and that data sheets are reviewed. Further exploration and evidence could be gathered during the assessment and care planning stages, of a person`s cultural and diversity issues. The Statement of Purpose and Service Users Guide should be reviewed to ensure people have accurate and up to date information at all times. Key inspection report Care homes for older people Name: Address: Brooklyn 22-24 Nelson Road Clacton on Sea Essex CO15 1LU     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: Louise Bushell     Date: 1 6 0 3 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Brooklyn 22-24 Nelson Road Clacton on Sea Essex CO15 1LU 01255430324 01255688370 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Eileen Theresa Morley care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum numbers of service users who can be accommodated is: 16 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 Dementia - Code DE Date of last inspection Brief description of the care home Brooklyn is a converted premises, which is in walking distance of Clacton seafront, and local amenities. Mrs Morley is the registered owner and Manager of the home. The home provides accommodation for 16 residents on two levels. Communal space is made up of two lounges and a dining room. Twelve of the fourteen bedrooms are single and all but one room have en suite facilities. Residents have access to a passenger lift. The home is well maintained throughout and there is a small Care Homes for Older People Page 4 of 29 Over 65 0 16 16 0 Brief description of the care home garden area to the back of the premises. Parking can be found to the front of the home. Care Homes for Older People Page 5 of 29 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 focus of the inspections undertaken by the Care Quality Commission, is based upon outcomes for the people who use the service and their views of the services provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received, through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 16th October 2007. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Assessment (AQAA) and reviewed what the service has improved in the last twelve Care Homes for Older People Page 6 of 29 months and its plans for the next twelve months. The AQAA is a legal document which the service has to complete on an annual basis and provides us with information and data about the service. This is then used as part of the evidence throughout the report. During the visit information was gathered directly from the staff, people who use the service and the manager. Additional information was gathered from people using surveys. We received a number of surveys from staff, people using the service and a range of health and social care professionals. All comments have been considered as part of this inspection and have been used throughout the report. The visit took place between 10:40am and 16:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted. We spoke with people who use the service, staff and the manager. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The service must ensure that all risk assessments and those for the control of substances hazardous to health (CoSHH) are up to date and that data sheets are Care Homes for Older People Page 8 of 29 reviewed. Further exploration and evidence could be gathered during the assessment and care planning stages, of a persons cultural and diversity issues. The Statement of Purpose and Service Users Guide should be reviewed to ensure people have accurate and up to date information at all times. 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 29 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 29 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 using the service can be assured that their needs will be assessed and that staff have the right information in order to ensure that they receive care tailored for them. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care the service offers. The guide details what the prospective individuals can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. It was observed, however that the information regarding how to make a complaint was out of date in the current Statement of Purpose. The manager confirmed that the Statement of Purpose and the Service Users Guide are available for all people and were on display. When requested the service can provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of the Care Homes for Older People Page 11 of 29 Evidence: resident. The AQAA tells us that all new residents and their family sign a Contract of Care which is updated yearly. The manager conducts all initial assessment and obtains relevant information from relatives and health and social care providers. COM 5 forms are obtained from Social Services from their referrals. A review of the information gathered and discussion with all involved will determine our ability to meet the needs of the individual concerned. Prospective residents are offered a trial visit and assessed in the home but if this is not possible the Manager conducts the initial assessment in the persons home or in the hospital. Admissions are not made to the service until a full needs assessment has been undertaken. Two peoples assessments were case tracked. One of the individuals had only recently moved into the service. It showed that an initial assessment had been completed by the manager and that this information was used to transfer to a working care plan for the staff to follow. Some preferences of the person had been considered. For example their preferred name and there are sections available to record information regarding a persons religion, faith, life history and social interests. On the person who had recently moved into the service this information was not completed. The assessment format did not fully explore the diverse needs of the person using the service. A skilled and trained person always completes the assessment prior to admission to the service. The assessment format is basic in style, however seeks to establish the primary care needs of the individual prior to admission. The assessment explores a number of areas of physical health care needs, including personal care tasks. Each defined area is then further explored . Each area of the assessment is assessed using a risk assessment which directly links to the over all level of care to be provided. Examples of assessments completed include a falls risk assessment, mental health risk assessment, personal risk , behaviour and nutritional screening. During the inspection, time was spent talking to the people using the service. On person using the service stated, they talked to me about moving here and gave me lots of information. Staff supporting people were seen to interact with total respect and dignity for the individual at all times. It was established that staff have knowledge of a persons personal choices and preferences, current and accurate to the needs, wishes of the individual. Privately funded people who use the service are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. People who are funded receive a social service contract. Contracts are reviewed when Care Homes for Older People Page 12 of 29 Evidence: there is a change in the needs of the person using the service. Care Homes for Older People Page 13 of 29 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. People using the service can be assured that their social and health care needs are met at all times. Evidence: A total of two care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health, social needs and dietary requirements are recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes a number of detailed and fully reviewed risk assessments, for example for the management of falls, bed rails, manual handling and self medication. The care planning format explores and outlines the individual needs and preferences of a person. It was observed that personal support is responsive and tailored to meet the individual Care Homes for Older People Page 14 of 29 Evidence: choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. The atmosphere and approach of the service is very friendly and home from home. One person using the service stated, I like it here and I like corned beef. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs as appropriate. The AQAA tells us that further improvements have been made and states that the manager attended training by Alzheimers Society, Dementia Matters- Enabling- an observational tool in December 2009, and that consortium funding has been obtained to provide ongoing training. A staff member commented we always give person centred care, we know our residents individuals needs and personalities, we really care. Residents have access to healthcare and remedial services. The health care needs of residents unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the District Nursing team and General Practitioners. Surveys received from a total of five health care professionals commented highly on the level of care and supported provided. One person stated Brooklyn is a residential home that is friendly and welcomes support from us. Residents are looked after very well and the staff seek advise from us if they are concerned. In addition to this a GP stated, the home always appears clean and tidy. Staff are friendly, efficient and caring....... I have no concerns regarding their patient care. A number of comments were received directly from people that use the service. One person commented that, the staff give me my medication all of the time, so I dont have to worry about it. Some one even comes every six weeks to cut my toe nails. The AQAA tells us that care plans are person centred and identify strengths and weaknesses. These provide a foundation for staff to work from hence providing a consistent level of care and support. Care plans, reviews and staff handover ensure the residents needs are frequently monitored. Input from GPs, Dietitians, District Nurses, Community Psychiatric Nurses and Physiotherapists is sought where a need is indicated. During the inspection it was directly observed that care plans were reviewed on a regular basis. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. The AQAA tells us that The people using Care Homes for Older People Page 15 of 29 Evidence: the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. Risk assessments are in place for the self administration of medicines. Residents are asked if they would like to self administer their medication on admission. A lockable space is available for this if resident wishes. Their response is noted in their care plans. Staff are trained to administer medication in a safe manner. Yearly training is provided for senior staff. Four staff will be attending a course in March 2010. Staff are aware of adverse side effects and report to manager accordingly. GPs review medication at least yearly. Observation of medication being administered occurred and practices were of a good standard. On the day of the inspection it was directly observed that people who use the service were being supported and provided with specialist treatment in their own rooms and in private. Care Homes for Older People Page 16 of 29 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 using the service are offered the time and opportunity to participate in meaningful activities of their choice. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from people using the service determined that they are able to receive visit from friends and family at any reasonable hour. A number of people that use the service have stated that the staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. One person stated, its very nice, the staff they are very good, they have their work cut out looking after us lot. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. Staff were directly observed asking people how they were, chatting to them in a respectful but causal manner and offering choices, for example would like to wear and apron at lunch time or not. The staff team help with communication skills, both within the service and in the Care Homes for Older People Page 17 of 29 Evidence: community, to enable residents to fully participate in daily living activities. One person using the service commented Its very nice. A further person stated, they listen to us and help me all the time the best they can. Individuals are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They are involved in the planning of their lifestyle and quality of life. The AQAA tells us that residents are given as much freedom as possible to pursue their own activities of daily living in a safe environment. A variety of individual and group activities are planned with the aim of stimulating memory and promoting wellbeing. Visitors are encouraged to come to the home at any time. We facilitate contact with relatives / friends by face to face contact, telephone, mail and e-mail. One person using the service stated my visitors come all the time. In addition to this one person stated we have people who sing to us too. The AQAA also tells us of the improvements made to the service in the last twelve months, this includes the purchase of a larger television, a music Group and more group activities / parties have been organised, installed a Loop Hearing System and digital recording of activities to play back to people using the service. The menu is varied with a number of choices including a healthy option. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. People using the service commented that they have choices of the meals they are provided with and are supported to draw the menu up. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of supporting at the pace of the individual, making them feel comfortable and unhurried. The AQAA states there are regular meal times but if residents wish to eat outside of these times it is readily accommodated. The food store is fully stocked so a variety of fare is always available. A selection of hot and cold drinks are always available. Staff are on hand to give assistance when necessary. There is a pictorial menu available and residents are asked for their choices on a daily basis. This was directly observed during and throughout the inspection. There is a large menu board on display so people are aware at all times of the meals being offered throughout the day. Care Homes for Older People Page 18 of 29 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. People can be confident that they will be listened to and that their concerns will be actioned. People using the service can be assured that they are protected from abuse by the staffs understanding of safeguarding adults. Evidence: The service has an open culture that allows residents to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided; feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of formats. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There have not been any complaints to the service within the last twelve months. It was observed that the complaints procedure was out of date and required amending. The AQAA tell us that there is a simple, clear and concise complaints procedure which assures people in what time frame their complaints will be responded to. It shows that complaints will be dealt with promptly and effectively. Residents and family are given details of the North Essex Advocacy Team if they wish to access this type of support. Postal votes are offered to any resident that so wishes to exercise this right. We also provide transport for residents who wish to visit the polling station to vote. All staff Care Homes for Older People Page 19 of 29 Evidence: have received an update this year, 2010, on how to recognise abuse. Robust procedures are in place to ensure the safety and protection of residents. All staff receive a CRB and POVA check before starting work. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. From a number of surveys received from staff it is determined that the induction process covered everything they needed in order to complete their role and that they knew what action to take if someone had concerns regarding the service. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Training of staff in safeguarding is regularly arranged by the Service. Three staff files were reviewed and all contained the correct information and current checks to ensure that people using the service are protected and safe. Care Homes for Older People Page 20 of 29 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. People using the service benefit from an environment that meets their needs and provides a homely and welcoming place to live. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs. The service is a pleasant, safe place to live the bedrooms and communal rooms providing a personal homely feel. The layout of the building enables people to move freely with several different seating areas throughout to encourage socialising or enabling the person to have privacy. The AQAA completed by the service determines that the internal and external improvements have been made to improve a homelier feel. The people who use the service appear like the changes made. The AQAA states that over the last twelve months they have replaced carpets in several rooms with non-slip laminate flooring, moved office to ground floor, decorated hallways, decorated and refurbished bedrooms when vacant and improved access to the front of the building. The people who use the service are encouraged to personalise their bedrooms. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. The AQAA states all bedrooms offer comfortable accommodation that meets the specified space requirements. All bedrooms have low profiling beds. Care Homes for Older People Page 21 of 29 Evidence: Residents can bring items of their own furniture if they wish. The building is designed to support the needs of people who are ageing. Thoughtful and appropriate additions to the environment have been made in particular the large open plan communal space with the new extension. The garden area has been improved recently and during the inspection a number of people were observed using this space. The dining room is laid out to encourage communal dinning with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. In general, the people who use the service say that they like the decoration and that there is a nice garden to relax in. One person using the service stated the garden is new, its very nice. The manager of the service has identified works throughout the forthcoming twelve months that will be completed; this includes to create a multimedia room on first floor, add en-suite to bedroom 4, replace carpet in room 9, ongoing refurbishment of bedrooms when vacant. The service is clean, well lit and smells fresh. There was an infection control policy in place and in discussion with the staff and observation of care practice demonstrated that the infection control practices were being followed. There was restricted access to high-risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Care Homes for Older People Page 22 of 29 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. People using the service can expect to be cared for by a group of staff who are supported and trained to meet their needs. Evidence: The people spoken with and from information gathered from a number of surveys determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people suing the service. Specific attention was given to the busier periods of the day. The manager was on shift daily and supernumerary to the staffing numbers. This enable the service to ensure that numbers were maintained for the safety of all and that record keeping was completed and monitored as required. Staff members undertake qualifications required to meet the needs of the people using the service. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. One person using the service stated the staff are lovely. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the Care Homes for Older People Page 23 of 29 Evidence: protection of individuals. A total of three staff files were audited and were seen to contain all the required documentation. The AQAA tells us that people are employed according to their abilities regardless of age (but must be over 18 years), sex, culture, race or religion. Two written references are obtained prior to employment and employment gaps discussed. A POVA and CRB check are carried out prior to employment being offered. A Code of conduct is given to new members of staff and a contract is issued in writing after completion of their probationary period. We provide the necessary statutory training to all staff and other courses relevant to their position. We have concentrated in the past year on courses specific to dementia care. We are part of a consortium organised through Essex County Council which funds much of our training. Training records reviewed, reflected that all mandatory training was up to date and well managed by the service. The AQAA tells us that of the 16 care staff employed at Brooklyn, 10 have completed their NVQ 2 or equivalent and a further 3 should complete their NVQ 2 by September 2010, 3 members of staff have many years of experience in this home. One staff member has foreign qualifications and is studying at level 4 NVQ. 3 staff have completed their NVQ 3 and three staff hope to commence their NVQ 3 this year. 11 staff have completed their NCFE Level Two in Dementia Awareness. The Manager and three senior staff have completed a Dementia Care Mapping course. In addition there is mandatory training for all new staff, including Manual Handling, Food Hygiene, Dementia Care, Health & Hygiene and Fire Safety. All staff surveyed commented on the strong team. Staff recruited confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. People using the service could not praise the efforts of the staff enough. One person using the service commented, the staff are simply great. Staff reported that they felt supported in their roles and that they were to discuss issues with a member of the senior team if required. One staff member stated Brooklyn creates a homely and warm atmosphere, both to work in and for our service users. staff communicate well and recognise the needs of our service users and fulfil;l them to the best of our ability. Our manager is the heart of Brooklyn and knows exactly how to get the best out of her workers to achieve our ultimate goal of delivering a quality service. In addition to this staff commented I feel supported by the whole workforce and structure.....We have a really good team and fantastic leaders. Care Homes for Older People Page 24 of 29 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 using the service can be assured that the service is run by a competent manager who listens to their views and makes sure that they are safe. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. There is a focus on person centred thinking, with the people who use the service becoming increasingly more involved. The AQAA tells us that the manager runs the home in a manner that is inclusive and transparent. Suggestions for improvements from residents, relatives and staff are always taken on board and implemented if feasibly possible. Leadership and direction are ongoing as the manager is on the premises 24 hours a day Monday to Friday and on-call at the weekends. Staff are closely supervised and any shortfalls in service provision on their part are quickly addressed. There is an Annual Quality Survey seeking the views of the residents and their relatives. The results are analysed Care Homes for Older People Page 25 of 29 Evidence: and a report produced that results in an action / business plan for the following year. All documentation relating to quality assurance, surveys and inspections is made available to interested parties. An advocate from Age Concern was involved this year in helping residents to complete the AQAA questionnaire. The manager was directly observed throughout the inspection to lead by example and manage the service efficiently. The Registered Manager leads and supports a stable staff team who have been recruited and trained to satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The AQAA tells us that the Manager is responsible for supervision and appraisals and has worked hard in the past year to improve the processes that ensure staff receive supervision as follows: 4 1:1 sessions, 1 Observational Session and 1 Group Session per staff member per year. Records are kept up to date and provide accurate evidence of the care provided at Brooklyn. Policies and Procedures are reviewed annually or more frequently if required. Personal information is held in accordance with the Data Protection Act and Brooklyn is registered with the Information Commissioners Office. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. All maintenance and health and safety records and checks were up to date as required. It was observed however that the COSHH data sheets required reviewing and additional risk assessments to be implemented. The service works to a clear health and safety policy. Health and safety is well organised and managed throughout. Records are very well ordered and maintained. Safeguarding is given high priority and the service provides a range of policies and guidance to underpin good practice. One staff member stated the manager is always available to discuss any fears or worries that we might have and this makes for a good working environment. A further staff member commented In my opinion the home does an excellent job in meeting all the needs of the service users......I feel that the home does all it can to make it a happy and comfortable place to live. Care Homes for Older People Page 26 of 29 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 27 of 29 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 38 13 Risk assessments must be in 31/05/2010 place for the control of substances hazardous to health and be reviewed on a regular basis. To ensure that people are protected from harm and that chemicals are stored as required. 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 3 1 2 16 The Statement of purpose should be reviewed. The assessment should further explore and record a persons preference and diversity. The complaints procedure should be reviewed. Care Homes for Older People Page 28 of 29 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. 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