Care Home: Brookside House care Home

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What the care home does well People have their needs assessed before they move into the home to make sure they can be met. People`s needs and how these are to be met are recorded in a plan of care and they receive care and support in a way which promotes their privacy and dignity. People`s health care needs are attended to and they have opportunities to take part in activities they enjoy. People can raise any concerns or complaints about the home, and staff know how to ensure people are safeguarded. People live in a homely environment. Staff receive regular training and are competent in their work. There is a suitably qualified and experienced manager in post and both the manager and provider work well with the Commission. The required health and safety checks and tests to the building and equipment are carried out. What has improved since the last inspection? Improvements were seen in the care plans and although not fully meeting the requirement set at the last inspection the manager continues to improve them. The provider now ensures he visits regularly to ensure the service is run in the best interests of the people who live there. Staff receive training on how to protect people from abuse. There are systems in place to ensure the quality of the service improves. Risk assessments are carried out on people and are kept up to date to maintain their safety. What the care home could do better: The carpets in the identified corridor and bedroom need to be replaced as their are dirty and odorous. The provider contacted us the day after the inspection to advise that the manager could do this immediately. The secure storage of medication needs to be improved. The manager and provider contacted us the day after the inspection to advise that this had been completed. Information in care plans must be expanded to ensure that staff understand what actions they need to take to provide care to meet a persons health, personal and social care needs. Key inspection report Care homes for older people Name: Address: Brookside House care Home 35 Wagstaff Lane Jacksdale Nottinghamshire NG16 5JL     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: Susan Lewis     Date: 2 9 0 9 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 26 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 26 Information about the care home Name of care home: Address: Brookside House care Home 35 Wagstaff Lane Jacksdale Nottinghamshire NG16 5JL 01773608527 01773541059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Farrington Care Homes Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Situated in Jacksdale village, Brookside House is an established care home, owned by by Farrington Care Homes Ltd and provides personal care for up to twenty-five residents. The home has two lounges and there are twenty-one single and two double rooms all of which have washing facilities and telephone points. The bedrooms are located on both floors of the home, which have access to three bathrooms and four single toilets. The home provides equipment to support residents with mobility and a lift is provided. The home has attractive gardens and patio areas. The home is entered via the car park at the rear of the building. The home provides a comfortable, clean and homely environment with a family atmosphere generated by the staff team and current group of residents. Fees at the time of this inspection were £390 per week. 1 9 1 1 2 0 0 8 0 0 1 Over 65 25 25 0 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of an inspection undertaken by the Care Quality Commission is upon outcomes for people accommodated and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. This was our first visit to the home since 19th November 2008. This inspection involved one inspector, it was unannounced and took place in the daytime, including lunchtime. Prior to the visit an analysis of the home was undertaken from information gathered over the last year. We spent two hours observing the care being given to a small group of people. All observations were followed up by discussions with staff and an examination of the records. Care Homes for Older People Page 5 of 26 The premises were not inspected in detail but various areas of the home were visited as part of the inspection. Care Homes for Older People Page 6 of 26 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 on page 4. Care Homes for Older People Page 7 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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. Evidence: The care plans of four people were looked at as part of the inspection including one for a person who had recently moved to the service. The manager told us that after the last inspection she had been trying to change the style of assessment and plan to ensure that people were assessed properly and their care plans reflected their needs. We saw evidence of this in the plans we looked at. We saw that people had been assessed prior to moving to the home and that a copy of the social workers assessment was also kept with the homes assessment. The assessment covered different aspects of the persons daily needs but did lack Care Homes for Older People Page 10 of 26 Evidence: detail in some areas such as how their needs impacted on their ability to care for themselves. Staff spoken with said that they were aware that the manager went to assess people before they moved to the home and that they had access to the assessments and the needs of people moving to the service were also discussed at hand over meetings at the start of each shift so they knew how to help people. We observed staff providing support and care to people that was meeting their assessed needs and as the person preferred it. This ensures people who use the service are safe and well cared for. In the pre inspection surveys we received from people who use the service they told us that they received enough information about the home to make a decision about moving there. We looked at the Service User Guide and saw that it was kept up to date by the manager and the information reflected the service people could expect if they moved to the home. The home does not provide intermediate care. 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. People receive their care in a way that suits their needs. People receive the medical attention they need and their privacy and dignity is respected, however medication is not always stored in a safe manner. Evidence: We looked at the care plans for people and checked the information to see if it reflected the care they received. The manager has been trying to update the plans since the last inspection to improve the information contained in them. We saw evidence in the plans that the manager has used different formats to try to get them right. Each plan contained a narrative of the persons needs which the carer used to ensure the person received the care in a way they preferred. However it did lack some detail in particular how to support people people with their dementia. We spoke with staff and they all had a good understanding of the needs of the people they worked with and how to meet them. They knew what they needed to do if Care Homes for Older People Page 12 of 26 Evidence: someone became ill or if someone had diabetes and what they needed to watch for to ensure they remained stable. People told us in the pre inspection surveys that they receive the care and support they need and that they either always or usually get the medical care they need. We looked at records that showed that people saw the doctor or other health care professionals when they needed to. Medication records were looked at to ensure that people received the medication that was prescribed to them and it was stored safely. We saw that records were well maintained and that only trained people gave medication out. Staff told us that medication was handled safely to ensure people received their medication at the correct times. Medication was stored in a locked trolley and was safe and secure, however the extra medication was stored in large plastic storage cupboard and although this was locked and chained to the wall the chain was of a flimsy nature. The controlled drugs were stored in this cupboard inside another locked box this does not meet current regulations for the storage of controlled medication. The day after the inspection the manager contacted us to confirm that arrangements had been made to change the storage of the controlled drugs to a suitable cupboard. We observed people during the morning for a period of two hours to see how staff treated and cared for people. We saw that staff were respectful and caring and understood how to support people with a dementia. We spoke to staff who told us that they had been trained regarding privacy and dignity during their induction period to ensure they always treated people with respect. However, we did see a staff member using curl tonges on a persons hair in the dining room and this activity should take place in the persons bedroom to respect their dignity. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to take part in activities both in the home. There are opportunities for people to exercise choice in their lives and they are provided with a wholesome diet. Evidence: During the period of observation staff were seen to spend time with people who live in the home. Staff were seen talking and enjoying a light banter with people. Various activities took place during the day including picture bingo and eye spy. People spent time in a positive state and were encouraged to be involved according to their abilities. Care plans detail peoples interests but staff do not make the most of this information in devising appropriate activities. Training records show that a number of staff have attended specialist training for developing activities for people with dementia. Information was also available regarding peoples spiritual needs, their preferences regarding how they spent their day from what time they got up and to where they ate their meals. Care Homes for Older People Page 14 of 26 Evidence: Although on the day of the inspection only one set of visitors came to the home the Service User Guide says that people are able to visit at any time and this was confirmed by the manager. Information was seen in the care plan regarding the persons mental capacity this assists staff in supporting people to make choices. Peoples bedrooms were seen and they were supported to personalise them to make the space their own. The midday meal was observed and it appeared appetising and nutritious. Staff were seen to assist people who needed support in a discreet manner and the meal time was taken in a unhurried calm manner. Staff were also observed supporting people who due to their dementia were unsure where they wanted to eat. This means the experience of people at mealtimes is calm and relaxed. Records showed that suitable meals are provided to meet peoples individual dietary needs such as diabetes. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for people to raise any concerns and staff know how to safeguard people. Evidence: From information received before the inspection People told us that they were aware of who they needed to speak to if they were unhappy or needed to complain. Staff told us that they were aware of the complaints procedures and knew where to find the information if they needed to. The manager told us about one complaint they received since the last inspection that was still being dealt with and we received one complaint since the last inspection regarding the cleanliness of the home. This will be addressed in that outcome group. Copies of the complaints policy were available around the home and in the Service User Guide supporting people to make a complaint if they needed to. There have been no safeguarding concerns since the last inspection and training records showed that all staff have either been on refresher training or due to attend. Staff spoken with confirmed this. Staff said they knew how to raise any issues if they were concerned with any unsafe practice within the home including feeling confident to report it to outside agencies if necessary. Care Homes for Older People Page 16 of 26 Evidence: At the last inspection the manager had not provided us with enough information before the inspection on how she intended to keep people who use the service safe. During this inspection the manager completed the pre inspection information fully and showed us how she intends to keep improving this area. There are policies and procedures in place to protect peoples finances from potential financial abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained environment. Evidence: We carried out a partial tour of the home to look at communal areas and some bedrooms to see how they were maintained and if they were clean and fresh. We saw that some areas are currently being redecorated and some areas have already been redecorated. However there was an area of the home we identified with the manager as having a strong smell and the carpet was dirty. This was discussed both with the manager and one of the directors for the company. This was followed up by email confirmation the following day that they would be replaced. We received a complaint about the cleanliness of the home and so we looked at some bedrooms to see if this was the situation. On the day of the inspection we saw the cleaner going around the home cleaning bedrooms and vacuuming. On this occasion we did not feel the home was dirty. Staff told us that they thought the home was well maintained and was kept clean. People told us in the pre inspection surveys that they felt the home always or usually clean and fresh. Care Homes for Older People Page 18 of 26 Evidence: The laundry is suitable for the needs of the home and there are policies and procedures in place for infection control. Staff spoken with understood the importance of good hygiene and training records showed that staff were up to date with their infection control training. 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. There are sufficient and suitably trained staff on duty. Evidence: There were four care staff on duty at the start of the inspection. In addition there was the manager, cook, domestic and handy person. Staff said that staffing levels were satisfactory and they were able to spend time with people living in the home. Although some staff told us that due to the design and layout of the home it could be difficult if a person needed to be supported by two staff and other people in the home needed assistance at the same time. They told us that on some occasions the lounge had been left unattended. The manager told us that care hours had been increased recently and that staffing was constantly monitored in line with peoples needs. We spent time in the lounge observing how staff interacted with people who lived there and saw that staff, although busy were able to spend time with people talking to them and doing a variety of activities with them. It was clear from the way people responded to staff that they enjoyed this time with them. Currently there over 50 of staff who have completed their National Vocational Care Homes for Older People Page 20 of 26 Evidence: Qualification level 2, showing that they are trained to a minimum competent level in care. Staff records were looked at to ensure that all checks were being made before people were employed within the home. A recently appointed member of staff confirmed that she had completed and application form, provided the names of two referees and did not start work until her Criminal Records Bureau (CRB) had been received by the manager. The manager said regular training is provided and she ensures that staffs training is kept up to date. Training records showed that staff receive regular training, there were copies of training certificates in staff files to confirm this. The manager also told us that she and her deputy had recently attended Mental Capacity training and had found this very useful with working with people with dementia. 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. There are suitable management arrangements in the home to ensure the home is run in the best interests of people living there. Evidence: The manager undertakes regular training and has completed the Registered Managers Award. The manager showed real willing to work with us to improve services within the home and responded promptly to any issues raised on the day. Staff said the manager is very supportive. People told, I think the home is managed very well. They provide a safe and happy environment. Staff, particularly Lyn (manager) and the deputy are very supportive to my relative, who has severe dementia. The manager told us that they carry out quality surveys and in discussion with staff they confirmed that questionnaires are sent out about twice a year. Care Homes for Older People Page 22 of 26 Evidence: We looked at the visit reports that the registered provider must carry out monthly. As not all of them had been left at the home we asked the director of the company to send copies of these to us. This was done the next day. The manager said that most people have assistance in managing their finances from relatives, but there is a system in place to help people manage their personal allowances. Records for these showed each transaction is witnessed and receipts are kept of expenditures. The manager said that all safety checks and tests are carried out at the required frequency. We looked at maintenance records and confirmed this. 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 7 15 The care plan must set out in detail what care a person is to receive from care staff and how. This ensures that all aspects of a persons personal, health and social care needs are met. 30/12/2009 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 9 The chain on the medication storage cupboard should be stronger to ensure it is suitable for its purpose. Care Homes for Older People Page 25 of 26 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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