Care Home: Brooklyn House Nursing Home

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What the care home does well The staff are enthusiastic about working with the residents. Residents said that the staff are kind and caring, they said that staff respect their privacy and dignity and that they are always available when they need them. Residents enjoy their meals and said that they are always offered a choice. They said that the chef regularly asks their opinion about the meals provided. Residents who need additional support at mealtimes are provided with this. The organisation employs an activities organiser who arranges activities on a daily basis. Group activities are organised as well as individual sessions for residents who prefer not to join in with larger groups. Residents are encouraged to maintain their interests and hobbies that they had prior to moving into the Home. Staff are provided with effective training and support which enables them to carry out their roles effectively. Staff told us that the staff team work well together and that they all have a clear understanding of their own roles and that of others. The personal and health care needs of the residents are met. Medication is managed safely. What has improved since the last inspection? The recent building work and refurbishment has provided an excellent standard of accommodation in the majority of the Home. The residents said that they really like the improvements. The Home is decorated in an attractive and homely style. Equipment is provided to assist residents with mobility difficulties. The Home is managed by an enthusiastic and skilled Manager. Staff and residents speak very highly of the Manager and said that she knows them all well and spends time with individuals. The Manager runs the Home in a way which puts the needs of the residents first and there are systems in place to continually monitor the quality of the service provided. What the care home could do better: The Manager is aware of the need to increase the staffing levels as more residents are admitted to the Home and has plans in place to ensure that this takes place. The care plans are in the process of being put onto a different format. The new format is much more personalised and is easier for staff to find the guidance about how to meet the residents needs. There is a need for clear guidance about the need for PRN (as required) medication. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brooklyn House Nursing Home Queen`s Road Attleborough Norfolk NR17 2AG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lella Hudson     Date: 2 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Brooklyn House Nursing Home Queen`s Road Attleborough Norfolk NR17 2AG 01953455789 01953457431 brooklyn@caringhomes.org. Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brooklyn House Limited Name of registered manager (if applicable) Ruth Anne Stannard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs fall within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home The home is purpose built, close to the centre of the town of Attleborough and is registered to provide nursing care, including long term and short term respite care. Recent building work and refurbishment has provided additional ensuite bedrooms and additional communal space. The Home also now has its own parking area. In May 2009 the Commission agreed the organisation application to vary their registration so that they could increase the number of residents to 40. There are now Care Homes for Older People Page 4 of 26 care home 40 Over 65 40 0 Brief description of the care home 38 single bedrooms and 2 shared rooms. Only 9 of the bedrooms are not ensuite. Accommodation is arranged over two floors, with communal areas predominantly on the ground floor. There is one first floor sitting area. A shaft passenger lift is provided. Information for service users outlines services available, such as hairdressing, chiropody, and activities organised during the week. The homes current fee levels range from £500 - £700 per week based on needs. Additional charges are set out clearly in the Service User Guide. Prospective residents and their representatives are advised of the fee rate prior to admission to the home both verbally and in writing. The fee rate is also stated within the residents contract. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gathered about the Home since the last Key Inspection (May 2007). It contains information provided within the Annual Quality Assurance Assessment (AQAA) which the Manager completed in detail and returned to us. We received surveys from staff (3) and residents (4) a few months prior to our visit to the Home and responses from these are contained in this report. The report also contains information gathered during an unannounced visit to the Home which we carried out between 9am and 4.45pm on 29th May 2009. During this visit we were shown around the Home, spoke to the Manager, deputy manager and Regional Manager, we also spoke to staff and residents. We looked at a selection of records. Care Homes for Older People Page 6 of 26 The organisation has carried out extensive building work at the Home. This has resulted in additional bedrooms with en suite shower rooms, new patio areas, new lounge areas and a new reception area. Several of the existing rooms have been refurbished also. The Home is now registered for 40 residents. There were 21 residents living at the Home on the day of our visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 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 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides good information about the services provided at the Home. Effective pre admission assessments are carried out. Evidence: The Home has produced a new Statement of Purpose and Service User Guide to reflect the increase in numbers of residents that the Home can admit since the new extension was built. The Home are holding an Open Day the week following our visit to enable people to see the improvements made to the accommodation. We looked at a selection of care records and could see that effective pre admission assessments are carried out prior to a resident being offered a place at the Home. The Manager or the deputy manager carries out the pre admission assessments. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of the residents are met. The privacy and dignity of the residents is respected. Medication is managed in a safe way. The care plans provide information to the staff about how to meet the residents needs. Evidence: We spoke to four of the residents who all told us that they enjoy living at the Home and that the staff are kind and helpful. They said that the staff usually respond to the call bells very quickly and that staff are always available. They said that they choose what times they get up and go to bed and that the staff respect their choices. One of the residents said that the care staff are sensitive when providing assistance with personal care. The surveys that we received from residents confirms the views expressed by the residents who spoke to us. Two residents had written on their surveys I am very happy living here. Care Homes for Older People Page 12 of 26 Evidence: We spent time sitting in the lounge and observing staff supporting residents. All of the staff were kind and attentive to the residents needs. There was a relaxed atmosphere and lots of laughter and conversation between residents and staff. At the time of our visit there were only 21 residents living at the Home. The Manager explained that they had not encouraged admissions whilst the building work was being carried out due to the inconvenience to residents. Staff and residents told us that the current staffing levels are adequate to meet the needs of the residents but comments were made in the staff surveys that there are not always enough staff. The surveys were returned to us a few months before our visit to the Home and there were more residents living at the Home then. The Manager has plans in place for increasing the staffing ratios in response to additional residents moving into the Home. Recruitment for new staff has already taken place in anticipation of new residents moving in now that the variation in registration has been agreed. We looked at a selection of care records and these contain a lot of information about the residents needs and how these should be met. However, some are in need of archiving to ensure that the current care plan is easy for staff to find. There is evidence of reviews taking place and the care plans being updated following these but due to the large amount of records in one file it can be difficult for staff to find things easily. The Home are in the process of changing the care plan format. The organisation has used a corporate template for care plans which is not personalised and is not easy to use. The Manager showed us the care records for one of the residents where the new format has been introduced. This format is much easier to personalise the care plans and to ensure that the residents needs are clearly recorded with guidance for staff about how to meet these needs. The care records show that risks are identified and adequately assessed. The care records clearly show that referrals are made to the GP and other health care professionals as appropriate. The GP visits on a weekly basis to see residents and will visit at other times if requested to do so. In the AQAA the Manager identified that improvements need to be made to ensure that all residents have regular access to dentists, opticians and chiropodists. The Manager explained the steps she has taken to address this and we saw evidence in the care records that this is now taking place. Care Homes for Older People Page 13 of 26 Evidence: We looked at the medication system that is in place. The Home is registered as a Nursing Home and so there are always qualified nurses on duty. Only the nurses administer medication. The deputy manager showed us the system in use. She explained that once more residents move into the Home then more than one nurse will administer medication at a time due to the length of time it takes, particularly in the mornings. Medication is stored securely and records are kept of medication received at the Home and that which is returned. We looked at the records relating to two of the residents and could see that changes to medication could be cross referenced with the care records. The administration records are completed with no gaps. The Manager carries out regular audits of the medication system so that any problems can be picked up quickly. The PCT pharmacists also visits to review medication. There is a need to have clear guidance available about the use of PRN (as required) medication so that all staff are clear about the circumstances in which to administer it. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are encouraged to take part in activities and hobbies that they were involved with prior to moving to the Home. Residents enjoy their meals and are offered choices. Evidence: The Manager said that they have recently appointed a new activities organiser who works approximately four hours per day Monday to Friday. The Manager is aware of the need to review this once the Home has more residents living there to ensure that all residents are able to take part in meaningful activities. We observed the activity organiser organising a session during our visit. Many of the residents joined in and there was a lot of laughing and good humour. Residents told us that they enjoy the activities provided. The Manager and staff try to enable residents to maintain interests that they had prior to moving into the Home. One of the residents has the use of an additional room to use as a workroom. Another resident is enabled to spend lots of time outside and arrangements are in place for them to be able to call staff if needed. Care Homes for Older People Page 15 of 26 Evidence: Residents also told us that they enjoy the meals and that they are always offered a choice. They spoke highly of the chef and said that she always chats to them and asks them what they think about the meals. We saw the chef spending time with residents. We observed a meal and residents were offered support appropriately. Residents are offered a choice about where they have their meals. Some stayed in their rooms, some sat in the lounge with a table in front of them and others went to the dining area. The lounge and dining area have been completely rebuilt and refurbished as part of the recent building work that has been taking place. Both areas are attractively furnished and decorated. There is also a lounge/dining room on the first floor which is not currently used. The care records contain information about residents individual dietary needs and preferences. We spoke to the chef and she has a good understanding of what individual residents like. The chef includes the residents in planning new menus and gathers their feedback about the meals provided. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to speak up if they are not happy about something and action is taken to address issues. Procedures and staff training is in place to provide protection to the residents from abuse. Evidence: The Manager said that she has not received any complaints about the Home and has not had to make any referrals to the Safeguarding team. The Commission have not received any complaints about the Home since the last Inspection. The Home has a complaints procedure which is on display. Residents told us that the Manager regularly asks them if they are unhappy about anything and that they feel confident in saying if there was anything. One of the residents told us that whenever she has mentioned even a minor issue to the Manager it is immediately addressed. The responses in the staff surveys all state that the staff know what to do if someone wants to make a complaint. Staff told us that they have received Safeguarding training and that they feel confident that the Manager would deal effectively with any concerns they may raise. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recent building work has resulted in a very high standard of accommodation in the majority of the Home. Evidence: Extensive building work has taken place at the Home over the last few months. New bedrooms with en suite shower rooms have been built and several of the existing bedrooms have had en suite shower rooms added and been refurbished. A new large reception area has been built along with a small quiet room. The existing lounge and dining room have been completely refurbished and a small lounge has been added to the side. There are enclosed patio areas to the side of the Home with new seating and tables. As the material used to provide the walls is clear the residents are able to watch what is going on in the local community as the Home is located in the town. There is also a more secluded patio area to the other side of the Home. The new buildings and the refurbishment of existing areas has been done to a high standard and has been decorated and furnished in an attractive and homely style. There are lots of ornaments and pictures around the Home. Care Homes for Older People Page 18 of 26 Evidence: Some rooms which have not yet been refurbished are part of the Homes ongoing redecoration and refurbishment programme. They do look rather tired in comparison to the newer areas of the Home. There is equipment around the Home to assist residents with mobility. There is a passenger lift, there are grab rails and toilet frames in the toilet and bathroom areas. The baths have hoists to assist residents to get in and out safely. Residents are encouraged to personalise their rooms and to bring with them any items of furniture or ornaments. Residents told us that they really like their rooms. They also said that there had been quite a lot of noise and disruption during the building work but that it had all been worth it. Some of the residents also said that they had found it to be an interesting process to watch. The Home employs domestic staff on daily basis and has an effective system for managing infection control. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate recruitment procedures are followed. Staff receive training and support to carry out their roles effectively. The staffing provided is adequate to meet the needs of the residents. Evidence: The information in the staff surveys indicates that staffing levels were not adequate to meet the needs of the residents. However, the surveys were received a few months prior to our visit and during our visit staff, and residents, told us that the staffing levels are adequate to meet the needs of residents. As previously mentioned, the number of residents at the Home has reduced over the last few months and the Manager has plans in place for increasing the staffing levels as new residents are admitted. The Manager is also aware of the need to ensure that the staffing levels are adequate to ensure that there are always enough staff on duty including during those times when staff are taking their breaks. The Home is registered as a Nursing Home and so there are always qualified nurses on duty. The nurses are responsible for administering medication and for carrying out nursing tasks. The care staff told us that they have a good relationship with the nurses and feel that all staff work well as a team. Through our discussions with staff it is clear Care Homes for Older People Page 20 of 26 Evidence: that they all have a good understanding of their own role and that of others within the team. Staff told us that staff are kind and that they are available when they need them. Staff were seen to support residents in a kind and calm way. When staff were talking to us they said that they really enjoy working at the Home and that they receive good training. The responses within the staff surveys were positive about the provision of training although there were additional comments about some staff not finding E-learning via the computer as useful as face to face training. The Manager explained that the E-learning is not a substitute for face to face training. She said that the organisation have a training manager who provides a lot of the induction and ongoing mandatory training. E-learning is an additional way of providing further information to staff. The Manager and the deputy manager will be updating their Training the Trainers courses in some subjects, such as moving and handling, so that they are able to provide the training directly to the staff. The Manager confirmed that the induction used complies with the Common Induction Standards. Additional training is provided to staff about issues relevant to residents needs, such as pressure care and diabetes. This training can be provided by nurses working at the Home or by local health care professionals. We looked at a selection of staff files and could see that appropriate checks are carried out prior to staff starting work at the Home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is managed by an enthusiastic Manager who puts the needs of the residents first. The views of the residents are sought on a regular basis and action taken to address any issues. Health and safety is given a high priority. Evidence: The Manager has worked at the Home since the end of 2007 and has recently completed the registration process with the Commission. Ms Stannard has a lot of experience at managing a Care Home for older people. She has undertaken relevant training, including recently attending training about the Mental Capacity Act. In the AQAA the Manager identified that there was a need to recruit a new deputy manager. This took place recently and the nurse who has been appointed took up her post the week prior to our visit. We received very positive feedback from residents and staff about the Manager and Care Homes for Older People Page 22 of 26 Evidence: the way in which she manages the Home. Staff told us that the Manager is very approachable and that she is fair and supportive. They said that she is always available and that she knows the residents and staff well. Residents said that she is a good manager and that she always goes to speak to them. We saw the results of the residents questionnaires that were used as part of the Homes quality assurance process and these were also very positive. The Manager is clear about the need to obtain the views of the residents about the service provided. The organisation has a formal quality assurance process which includes regular audits of aspects of the service with action plans put together which are monitored by the Regional Manager. However, the Manager ensures that she spends time with residents and staff in order to find out what they think about the service and if they have any suggestions for improvements. The Home has an administrator who carries out a lot of the routine administrative work as well as answering telephone calls and greeting visitors. It is planned that the administrator will shortly move to the new reception area. The deputy manager has undertaken to carry out a reivew of the residents care records to ensure that these are all archived as necessary and that they are kept in a format which staff will find easy to use. We looked at selection of health and safety records and can see that regular maintenance and servicing of equipment takes place. The Manager said that great care was taken to maintain the safety of residents and staff during the recent building work. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 It is required that clear guidance is available about the use or PRN medication To ensure that residents receive medication at appropriate times. 31/07/2009 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 the care plans provided clearer, more personalised, guidance to staff about how to meet the residents needs Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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