Care Home: Brownlow House

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• Chirnside House
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• Parkside
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What the care home does well People’s needs are assessed before they move into the home enabling individuals’ and staff to decide if the home would be able to provide the care and support required.Brownlow HouseDS0000062022.V377779.R01.S.docVersion 5.2Staff develop relationships with people living in the home and people are treated with dignity and respect. People receive the right amount of support, particularly in relation to making timely referrals to healthcare services when concerns are identified. Staff are attentive and support people in an enabling and natural manner and, in the main, people are treated as individuals. Visitors are welcomed into the home and no restrictions are placed on the times when people can visit. People living in the home said they enjoyed the meals and daily activities provided and that staff treated them well. Comments included: ‘Things aren’t bad and people can come when they want to visit.’ Policies and procedures for managing complaints and protecting people from harm provided reassurance and security to the people accommodated. Quality assurance monitoring is taken seriously and peoples opinions are actively sought. Staff have been made aware of the issues concerning the running of the home and the role they play in improving the outcomes for the residents. We were told: ‘I am a new starter at Brownlow House and I have received all the training and support needed. The management are working very hard to improve the rating and an effort is been made by all staff which helped me to settle in quickly and have the reassurance of working with a professional team.’ What has improved since the last inspection? Since the previous inspection the manager and owner have attended training and briefing meetings about the implementation of the Mental Capacity Act and the Deprivation of Liberty Safeguards, this is to ensure that the home operates within the law. The manager has also made links with an Independent Mental Capacity Advocate (IMCA) so that questions can be answered quickly in relation to assessing a person’s ability to make decisions relating to freedoms and choice. Since the previous inspection recruitment practices have improved and become more robust and therefore protect against employing unsuitable people. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Since the previous inspection the management of personal finances has improved in that the monies checked were fully accounted for and accurate. Staff moving and handling practice has improved because all wheelchairs that staff used to transfer people had foot plates that people were encouraged to use. Since the previous inspection staff have received training in dementia care. What the care home could do better: The registered person should make sure that the information in daily records demonstrates that staff are following the instructions in peoples care plans. This will make it possible to assess and monitor the progress made in these areas. People should be provided with a more varied menu so that they do not become bored with the choice and also to ensure that nutrients are gained from a variety of sources. The manager needs to ensure that steps are taken to promote the inclusion of everyone living at the home in relation to social activities, access to the communal areas and participating in social activities. This will prevent social isolation and promote a sense of wellbeing and value for all. This is especially important for people who do not speak English or whose culture differs from the majority of the people living at Brownlow House. The registered person should ensure that two people counter check medication when a member of staff has to write the instructions of a prescription onto the medication record sheet, this will reduce the risk of errors going unnoticed. The registered person should ensure that all parts of the home are clean, well maintained and furnished in a homely manner, this will help to demonstrate respect for the residents and so provide comfortable surroundings that are pleasant to use. The registered person must ensure that all health and safety training, including adult protection, infection control and moving and handling is up to date. This will ensure that staff are trained in current safe health and safety practice and so able to afford protection to the welfare of people using this service. It is unfortunate that this not been achieved because a recommendation concerning health and safety training was made at the previous key inspection.Brownlow HouseDS0000062022.V377779.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Brownlow House Brownlow House 142 North Road Clayton Manchester M11 4LE Lead Inspector Michelle Haller Key Unannounced Inspection 26th October 2009 09:45 DS0000062022.V377779.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 2 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 Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownlow House Address Brownlow House 142 North Road Clayton Manchester M11 4LE 0161 231 7456 0161 231 0032 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Bradley Scott Jones Mr Russell Scott Jones Mr Bradley Scott Jones Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 31. Date of last inspection 22nd October 2008 Brief Description of the Service: Brownlow House is a registered care home providing personal care only for up to 31 older people over the age of 65 years. The home is a detached building set within its own grounds, with a garden to the rear of the property and a parking area to the front of the building. The property has access both at the front of the building and the rear by steps and ramps. The home has three floors of accommodation accessed by stairs and a passenger lift. The basement of the property accommodates the laundry and the boiler for the heating system. The accommodation comprises of 3-shared bedrooms each accommodating a maximum of two people and 25 single bedrooms. Two of the single rooms have en-suite facilities and all other bedrooms have a hand basin. There is a large lounge to the rear of the property leading onto the dining room. At the front of the property there is a lounge, there is also a small television lounge for use by residents who prefer to watch television rather than being involved in group activities. Fees are £382.92. Extra charges are made for hairdressing. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We conducted this inspection without informing the manager before hand and looked at all of the most important or key Care Homes for Older People, National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This information included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the previous key inspection which we conducted in 2008. We received two completed Care Quality Commission (CQC) surveys from people working in the service, and two surveys from people living at Brownlow House. We visited the home and checked through written information including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to people and their relatives about their experience of living at Brownlow House. We interviewed members of staff and the manager of the service. The manager returned to us the Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks when applicable. This information also influenced the outcome of the inspection. What the service does well: People’s needs are assessed before they move into the home enabling individuals’ and staff to decide if the home would be able to provide the care and support required. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 6 Staff develop relationships with people living in the home and people are treated with dignity and respect. People receive the right amount of support, particularly in relation to making timely referrals to healthcare services when concerns are identified. Staff are attentive and support people in an enabling and natural manner and, in the main, people are treated as individuals. Visitors are welcomed into the home and no restrictions are placed on the times when people can visit. People living in the home said they enjoyed the meals and daily activities provided and that staff treated them well. Comments included: ‘Things aren’t bad and people can come when they want to visit.’ Policies and procedures for managing complaints and protecting people from harm provided reassurance and security to the people accommodated. Quality assurance monitoring is taken seriously and peoples opinions are actively sought. Staff have been made aware of the issues concerning the running of the home and the role they play in improving the outcomes for the residents. We were told: ‘I am a new starter at Brownlow House and I have received all the training and support needed. The management are working very hard to improve the rating and an effort is been made by all staff which helped me to settle in quickly and have the reassurance of working with a professional team.’ What has improved since the last inspection? Since the previous inspection the manager and owner have attended training and briefing meetings about the implementation of the Mental Capacity Act and the Deprivation of Liberty Safeguards, this is to ensure that the home operates within the law. The manager has also made links with an Independent Mental Capacity Advocate (IMCA) so that questions can be answered quickly in relation to assessing a person’s ability to make decisions relating to freedoms and choice. Since the previous inspection recruitment practices have improved and become more robust and therefore protect against employing unsuitable people. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 7 Since the previous inspection the management of personal finances has improved in that the monies checked were fully accounted for and accurate. Staff moving and handling practice has improved because all wheelchairs that staff used to transfer people had foot plates that people were encouraged to use. Since the previous inspection staff have received training in dementia care. What they could do better: The registered person should make sure that the information in daily records demonstrates that staff are following the instructions in peoples care plans. This will make it possible to assess and monitor the progress made in these areas. People should be provided with a more varied menu so that they do not become bored with the choice and also to ensure that nutrients are gained from a variety of sources. The manager needs to ensure that steps are taken to promote the inclusion of everyone living at the home in relation to social activities, access to the communal areas and participating in social activities. This will prevent social isolation and promote a sense of wellbeing and value for all. This is especially important for people who do not speak English or whose culture differs from the majority of the people living at Brownlow House. The registered person should ensure that two people counter check medication when a member of staff has to write the instructions of a prescription onto the medication record sheet, this will reduce the risk of errors going unnoticed. The registered person should ensure that all parts of the home are clean, well maintained and furnished in a homely manner, this will help to demonstrate respect for the residents and so provide comfortable surroundings that are pleasant to use. The registered person must ensure that all health and safety training, including adult protection, infection control and moving and handling is up to date. This will ensure that staff are trained in current safe health and safety practice and so able to afford protection to the welfare of people using this service. It is unfortunate that this not been achieved because a recommendation concerning health and safety training was made at the previous key inspection. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.2 Page 8 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. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable) People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager ensures that the peoples needs can be met at Brownlow House through completing needs led assessments before they are admitted. EVIDENCE: We looked at the care records for four people admitted to the home including the two most recent admissions. We noted that assessments had been completed by the manager who visited people in hospital. The manager said that the information she used to decide whether peoples needs could be met was provided by the hospital nurses and social workers. We also noted that some files contained in depth social service assessments and some of this information was reflected into the initial assessment. We saw that some information concerning peoples religion is made available, however more information is needed in respect of cultural preferences and forms of address, for example whether people want to be called by their first Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 11 names. It is important because this information helps to develop personalised care plans which inform staff in how to provide individualised support in a dignified and respectful manner. We were told by the staff who returned CQC questionnaires that they ‘always’ received enough information about how to meet peoples needs. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at Brownlow House benefit from been treated with dignity and respect and have access to the full range of community health and social care services. EVIDENCE: We looked at four care plans and these had been developed from information recorded in the assessment and additional information gained through getting to know the person, conversations with them and their representatives and staff actually assessing and seeing what people could do and would like. Risk assessment concerning people moving and handling needs, risk of falls, risk of developing pressure sores and potential to develop malnutrition had also been completed. The care plans in response to recognized needs were detailed and Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 13 did inform staff about the actions and observations needed to promote well being and positive outcomes for people in each area. We found that letters, notes and other records provided evidence that health concerns had been quickly referred to the relevant healthcare professional for advice or further investigation. We also saw that staff followed instructions and that peoples health improved from the support at Brownlow House. We found that people living at the home continued to see their original general practitioners and that the manager dealt with a number of different GP surgeries. This is good because it means that people continue to be treated by people who know them well and who have a historical interest in their progress and wellbeing. Records also confirmed that people were seen by district nurses, dieticians, dentists and chiropodist. We also noted that the manager ensures that staff support people to attend out patient appointments, this means that people are able to company and someone to explain what is going on when they are in an unfamiliar situation. It also means that staff can listen and report back what has been said and the plans for care that has been decided by the specialist. We looked at the daily records and found that although written respectfully the information did not always fully reflect all the actions taken by staff or that care plans were being followed. We found that, in the main, the daily reports concentrated on the diet taken by people. We accept that this is important information; however it is also essential that staff record all aspects of what happens for people on a daily basis so that all the information about how people are and what they have done is readily available for all concerned with providing support and care. We noted that men and women living at Brownlow House were supported to achieve a reasonable standard of personal hygiene. A hairdresser was working in the home on the day of inspection, and the hair styles were very individual and suited each person. For the most part people looked neat. We examined the care files to find out about baths and showers. We could not tell from the information available whether people were having sufficient numbers of full immersion baths or showers to meet their needs. We could not tell if people had been offered baths. We would therefore like more information to be recorded about this matter, and evidence that people receive or are offered a bath or shower at least once a week. We found that people received a lot of support and input from social care professionals such as social workers, care managers and specialist support workers. We noted that these workers visited people on a regular basis in order to, conduct reviews of care, and spend time in one to one sessions or to go out to local events with their client. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 14 We observed moving and handling practice at Brownlow House. We saw that all wheelchairs that staff propelled had footrests and that these were put in place while people were being transferred. We checked medication records belonging to the majority of the people living at the home on the day inspection. We saw that photographs had been attached to record sheets for identification purposes. We noted that there were some gaps in staff recording the amount of medication received into the home. We noted that there were some gaps in the signing off regarding medication being administered. We noted that medication was entered onto the medication record sheet by one person; it would be safer if this were checked by two people so that there is less chance of human error in relation to transferring the information onto the medication record. It was however noted that in the majority of cases medication had been correctly signed into the home and administration had been fully documented. The shortcomings discovered were brought to the attention of the manager. We also found that medication was stored securely and records of administration for controlled medication appeared to be accurate and up to date. We also noted from what was written that the staff monitor the effect of medication and take steps to ensure that any problems are dealt with quickly. We observed interactions between care staff and people living in the home. Staff had developed good relationships with the people they supported and conversed respectfully. Personal care was provided in private and staff were observed to knock on bedroom and bathroom doors before entering. People we talked to concerning health and personal care stated that: ‘We get well looked after’ And ‘The home copes with people who have some challenging behaviour- staff will persevere with strategies- give people time to settle in and for relationships to develop.’ Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People using the 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 living at Brownlow would benefit if steps were taken to provide more choice in respect of diet and activities for people who there. EVIDENCE: We talked to people about what it was like to live at Brownlow House and observed how people related to each other. People told us that they were satisfied with the activities, they also told us that people got on and that people with similar interests and abilities related well. The residents said that they had parties, played games such as bingo and had also been on a trip to see the lights at Blackpool. On the day of the inspection the activities co-ordinator was not on duty. Unfortunately we were not able to confirm the activities in which people had participated because this information is not consistently included in their daily records. However we were able to see that one person enjoyed listening to Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 16 tapes in their room. We saw that people were supported to complete a profile about their likes and dislikes, interests, family and work life. On the day of inspection activities centered around watching films on television which people really seemed to enjoy. Residents also held conversations with each other. People also sat and listened to music. Staff entered the lounge areas on numerous occasions, sitting and talking with people, offering drinks, sweets and snacks. We noted that a large Connect Four game was available although we did not observe this being played during the inspection. We looked at the photographs and general information about activities and we saw pictures of people currently at Brownlow House enjoying arts and crafts, sitting in the garden during summer and playing games. We noted that staff took time to sit and talk with people and relations were natural and relaxed. The owner and the manager knew the residents well and people approached them with confidence. All staff were seen to listen to what people were saying and took time to deal with requests as they arose. Although people at Brownlow House appeared very animated, alert and interested in what was happening around them without being provided with specific activities, it is important that all staff recognise their responsibility in relation providing structured activities. This is so that activities that people enjoy continue when the activities co-coordinator is off duty. It is also important that staff record the activities that people do in their files so that information about what people have enjoyed and participated is readily available. We were told that visitors were made welcome in the home and that restrictions were not placed on visiting times. Since the previous inspection an Independent Mental Capacity Advocate (IMCA) has visited the home to talk to staff and the residents. We discussed the implementation of the Mental Capacity Act and deprivation of Liberty safeguards. The owner and manager are making themselves familiar with these matters and are applying for training and additional information. It was evident from information left by the IMCA that they were working towards a clear understanding of when mental capacity issues needed to be fully assessed and applicable legislation implemented. We looked at the menu and talked to the cook during the inspection. We noted that although all the food is home cooked the choices are limited because a roast is on the menu every day. There is also a second choice that includes fish-fingers, quiche, mince pie, stewed steak or other dishes. We assess that offering a roast meal every day does not facilitate a broad enough choice, even if the choice of meat is rotated. We looked at the food record kept by the cook and found that some people did choose an alternative but in the main people had a roast meal daily. We saw that the lunchtime meal was well cooked and Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 17 people we spoke to told us that they enjoyed the food provided. There was also a good selection of desserts all of which had been home made. We noted that people were also offered a choice of hot and cold drinks, sweets, fruit and other snacks throughout the day. We looked in the larder and noted that it was well stocked with a variety of fresh fruit, vegetables, meats and other ingredients for making dishes. We talked to the cook who stated that they were in the progress of changing the menu in consultation with the residents at Brownlow House. The cook stated that she had completed National Vocational Qualification level 2 in Catering and also food hygiene courses. We saw certificates to confirm this. The cook stated that the environmental management of the kitchen was under the Safer Food Better Business initiative regulated through the local council. We were shown the folder and all checks appeared to be carried out daily or in accordance with the system in use. People we talked to about the lifestyle at Brownlow House were complimentary and appeared satisfied. They told us: ‘The food is alright you can have what you want.’ ‘I get on well with the people who live here- people who can talk to one another sit together and do things.’; ‘About 12 of us went to Blackpool Lights the other week- it was great.’ And: ‘They make me welcome’ Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures are in place to listen and deal with the concerns of people using the service and to keep them safe from harm. EVIDENCE: We looked at the record of complaints and found that the information detailed the nature of the concerns and the action that had been taken to investigate and resolve the complaint. The record is kept in a hardback book and the manager needs to make sure that only one complaint is recorded on each page so that they comply with the requirements of data protection law. This is so that confidential information is always be recorded in a manner that is accessible to authorised persons, such as people using the service and courts of law, without breaching the rights of others to have their personal information disclosed. This was requested at the previous inspection however it appears that the instructions were not fully understood. This matter was discussed again, and the manager and owner then demonstrated that they understood how complaints and other confidential information should be recorded. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 19 We saw that relevant policies, procedures and systems were in place that enabled concerns to be raised in safeguarding people using this service from harm. We discussed the matter of safeguarding adults with two care staff. Both were able to describe different scenarios that could be seen as abuse. Both felt confident that if they reported concerns these would be taken seriously and steps taken to protect people. We asked the manager and owner about the home policies and procedures regarding incidents between residents should they occur. From what they said we remained uncertain whether all staff understood that incidents between residents must be recorded as an incident and looked at as a potential safeguarding issue. We asked the manager and the owner to ensure that staff understood the safeguarding policy in relation to this. We also requested that a means of recording incidents in the home should be introduced and the policy and procedure made clear. This is because it is essential that potential safeguarding incidents between residents are dealt with openly, fully monitored and steps taken to protect people from harm from every source. We requested the training matrix so that we could confirm that staff had received protection of vulnerable training, either as a separate course or through completing the unit as a part of the National Vocational Qualification level 2 training. We saw that this training had been provided more than a year ago. We discussed this with the manger who agreed to provide updated training to staff as soon as possible and confirm when this had been accomplished. We have not been made aware of any adult safeguarding investigations in the home since the previous key inspection. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with a safe environment however more steps need to be taken to ensure that all areas are clean, wellmaintained and updated. EVIDENCE: We visited the home. The outside and garden facilities are well maintained and accessible to the residents. We had a look round the home to assess cleanliness, hygiene and maintenance of the building and facilities provided. Since the last inspection several bedrooms had been redecorated and some furniture and carpets had been replaced. We noted that all of the rooms are single rooms and some had been Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 21 made into bed sits with separate sitting and sleeping areas. We noted that rooms had been personalised to meet individual preferences. We saw that the carpets in a number of the hallways were dirty and grubby looking, the flooring in a number of areas needed to be replaced. We also saw that the flooring in some bedrooms looked very institutional. We understand that this flooring has been laid in the interest of hygiene, however, we assess that more domestic and homely looking products are now available and request that these are provided when refurbishment takes place. We saw that in the main the communal spaces and bedrooms were clean; we also noted that one toilet in particular was very dirty and unhygienic. We also saw that some of the occasional furniture was grubby looking, dirty and covered in smears. We also noted that at times there were offensive odours in different parts of the home but it was difficult to accurately identify where the odour came from. We discussed these matters with the owner and the manager. The manager stated that she had introduced a cleaning roster and she will audit that it is being adhered more frequently. We noted that staff were provided with good hand washing facilities as each bathroom and toilet area held liquid soap dispensers and hand towels. Staff also used personal protection equipment such as aprons when carrying out personal care or dealing with food. We saw that people were able to mobilise around the home and use the equipment independently and in safety. We looked at the maintenance records, these confirmed that regular health and safety audits had been undertaken to ensure that a safe environment was being maintained. People who returned CQC surveys felt that the home was ‘usually’ fresh and clean. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are employed in sufficient number and using robust selection and recruitment procedures but training needs to improve to ensure that staff are up to date with new ways of working in respect of health and safety issues. EVIDENCE: We found that on the day of inspection there were 21 people living at Brownlow House and the staffing included the manager, the manager, three care assistants, the cook and a domestic for part of the day. We saw that staff were always available to support the residents in a patient and enabling way. Staff and residents who returned surveys confirmed that there was ‘always; sufficient staff on duty to do the work required. We looked at the personnel files belonging to five members of staff including two new recruits to determine if suitable pre-recruitment checks had been undertaken. All files contained copies of the required information. This included proof of identity such as passports, drivers licence or birth certificate, proof of address, Criminal Record Bureau (CRB) certificates and Protection of Vulnerable Adults (POVA First) confirmation. There were also two suitable references and evidence that people had undertaken an induction programme. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 23 The home’s manager forwarded the home’s training matrix to us following our visit. This document detailed the dates of training courses attended by staff working in the home. This matrix identified that fire safety and moving and handling training had not been fully updated since the previous inspection even though this was a recommendation. We noted that health and safety training had been provided, however infection control training has not been updated. We were told at the previous inspection that all training would be updated but the owners have not been able to confirm that this has been fully implemented. We noted however that staff have received the following training since the previous inspection in 2008: introduction to dementia, protection of vulnerable adults, health and safety, induction, community dignity, sensory deprivation and professional boundaries. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 and 38 People using the 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 management and conduct of the manager demonstrates that the home is run in the best interest of the service users. EVIDENCE: We found that a new manager called Patricia Dunne had started to work at Brownlow House at the end of July 2009. She said that her qualifications and training included the Registered managers Award and NNEBs Management training. Ms Dunne confirmed that she has begun the process of becoming the registered manager for the home in that she started the CRB application. Ms Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 25 Dunne said that she was tracking the progress of this application on line. Ms Dunne is in day-to-day charge of the home and one of the owners, Mr Russell Jones, appears supportive and informed about the day to day running of the home. We noted that that people were given satisfaction surveys, staff and service user meetings had taken place and the manager had interviewed everyone living at Brownlow House in privacy and individually to find out their opinion. The manager stated that this information, although not officially collated had been used to begin the process of changing the menus, and also introducing more trips out of the home. Since the last inspection the home has also achieved the Investors in People Award. This is an industry and business award achieved through demonstrating to an independent body that staff are supervised, trained and supported to achieve their best in customer services. We looked at the personal accounts belonging to people who were receiving support to manage their finances. The majority of people living in the home had their personal finances managed by the local authority or their relatives. We looked at the records held in the home concerning peoples money and found a clear audit trail of expenditure and balances. Receipts were in place and numbered and the amounts written in the records tallied with the amounts held. We examined a number of health and safety records and found these to be up to date. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30 Regulation 18 (1) (c) Requirement The registered person must provide staff with relevant up-todate training in accordance with their role, including infection control, moving and handling and medication. Timescale for action 01/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The registered person should make sure that the information in daily records demonstrates that staff are following the instructions about how to meet people’s needs; this is so that it is possible to assess the success of the support offered and monitor how people are progressing these areas. People should be provided with a more varied menu so that they do not become bored with the choice and also to ensure that nutrients are gained from a variety of sources. 2. OP15 Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 28 3. OP9 4. OP14 5. OP26 The registered person should ensure that two people counter check medication when a member of staff has to write the instructions of a prescription onto the medication record sheet, this will reduce the risk of errors going unnoticed. The registered person should promote better communication between staff and people who do not speak English through use of communication aids such as pictures, symbols or translated sentences that may be useful to that person. This will promote independence in the person concerned, reduce dependency on family in relation to having to be involved in communicating all needs, improve communication with staff, and encourage the development of a positive relationship with staff. The registered person should ensure that the home has an effective cleaning roster and that the maintenance programme is progressed quickly, so that people live in a clean and well maintained home as soon as possible. Brownlow House DS0000062022.V377779.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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