Care Home: Brownscombe House Nursing And Residential Home

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What the care home does well Written and electronic information regarding the services and facilities provided by the home was up to date to provide prospective residents and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. Residents are generally supported in a way that protects their rights to respect, privacy and dignity. Residents are able to make choices about their daily routines and enjoy and choose from a range of improved activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members and friends. The home has maintained providing a healthy and balanced diet in spacious and pleasant surroundings. Procedures and policies are available in the home to promote the protection of residents from harm. The homes furnishings are of a high standard. The physical layout of the home meets the current residents mobility needs. The control of the spread of infection in the home is robust and the home was clean throughout. Staff in the home were in sufficient numbers on the day of the inspection to support the residents. Residents health and safety is promoted through general health and safety checks. What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective residents needs are consistently identified and documented to ensure staff have the skills and abilities to meet the residents needs. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. The home have improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely. The recruitment practices and management of records have improved to support and promote the protection and safety of residents. The improved day to day management of the home ensures that the safety and well being of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home. What the care home could do better: Where residents have alternative communication styles that profiles are developed and documented in order that staff can identify the residents communication stlye to assist in them in further engaging and interacting with resident in their daily life. The home has an open culture of raising complaints or concerns about the home yet recording of concerns or complaints need to be more consistently documented. Key inspection report Care homes for older people Name: Address: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL     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: Suzanne Magnier     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL 01428643528 01428643616 brownscombe@carehomesofdistinction.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr L K Hasham Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 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 to be accommodated is 36 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Brownscombe House is a care home registered to provide nursing care for up to 36 older people, over 60 years of age. The home is owned and run by Care Homes of Distinction who also run similar establishments in Surrey. Brownscombe House is a large building in Haslemere that provides accommodation Care Homes for Older People Page 4 of 32 Over 65 36 0 0 4 0 2 2 0 0 9 Brief description of the care home over three floors, which can be accessed by a lift. All rooms are single accomodation and are furnished to a high standard. Communal areas include a large lounge and dining area which is situated in the conservatory. A small lounge and reception area are available and the home has extensive well maintained gardens. Laundry and catering facilities are undertaken within the home. There is ample parking available to the front of the house. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The last inspection on this service was completed on the 4th February 2009. This inspection of the care home was an unannounced Key Inspection. Ms S Magnier Regulation Inspector carried out the inspection and arrived at the service at 08.00 and left the service at 15.00. As part of the inspection the commission invited an expert by experience from Help the Aged to be part of the visit in order to speak with residents and people visiting the home about their experience of the home. The expert by experience produced a report and the findings have been included within this document. The service was represented by the appointed day to day manager, referred to in the report as the person in charge, and the homes Quality Manager. The inspection was a Care Homes for Older People Page 6 of 32 thorough look at how well the service was meeting the Key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. For the purpose of the report the individuals using the service are referred to as individuals or residents. The person in charge had completed the Annual Quality Assurance Assessment AQAA which had been received by the commission within the timescales set. The information within the AQAA was well recorded and formed part of the inspection process and references from the AQAA have been included within this report. The information contained in this report was gathered from speaking with a number of residents and care staff, during the inspection. A tour of the premises was undertaken with the person in charge and documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, some residents care plans, daily records, risk assessments, medication procedures, health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the person in charge about the findings of the visit. There home has not been subject to any safeguarding vulnerable adult referrals or have received any formal complaints about the services and facilities provided by the home since the previous inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in February 2009 have been complied with in order to improve the services to the residents receiving care and accomodation at the home. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective residents needs are consistently identified and documented to ensure staff have the skills and abilities to meet the residents needs. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. The home have improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely. The recruitment practices and management of records have improved to support and Care Homes for Older People Page 8 of 32 promote the protection and safety of residents. The improved day to day management of the home ensures that the safety and well being of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written and electronic information regarding the services and facilities provided by the home were up to date to provide prospective residents and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. The admission and assessment procedures have been improved to ensure that prospective residents needs are consistently identified and documented to ensure staff have the skills and abilities to meet the residents needs. Intermediate care is not currently offered. Evidence: The homes Statement of Purpose and Service User Guide were sampled during the inspection. The documents were current and had been improved and developed in large print and a compact disc in order to offer a format suitable to prospective residents needs to inform them and their representatives about what services and facilities the home offers. Care Homes for Older People Page 11 of 32 Evidence: Two residents care plans were sampled during the inspection which provided evidence to support that their needs had been well assessed by the person in charge and a senior nurse with the ability and qualifications to undertake the assessment. There was evidence to support that health needs assessments were obtained for prospective residents and where a prospective resident was admitted from hospital a full assessment had been obtained from the hospital and the person in charge had visited the prospective resident in hospital in order to ensure that the homes staff could meet the persons care and support needs. The person in charge advised that prospective residents and their representatives are encouraged to visit the home prior to admission. The home have developed a new admission questionnaire to strengthen the process of prospective residents views of the home and why they chose the home. The AQAA advises that further improvements to the homes admission process involves developing a compact disc to include details of the information pack and terms and conditions and are considering the way forward in producing a Pictorial Welcome Pack. It was evident that improvements had been made to the pre admission assessment documentation to ensure that a prospective residents needs can be met within the home and to ensure that inappropriate admissions to the home do not occur. The AQAA advises and it was evidenced that the pre admission assessment information gathered and the standard of documentation had significantly improved to ensure the assessments and care plans are person centred, well documented and consistently recorded. The home does not offer intermediate care yet continues to offer respite care for residents. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. Residents are generally supported in a way that protects their rights to respect, privacy and dignity. Evidence: The two care care plans sampled evidenced that each of the resident had had their care plan developed from the pre assessment documentation. The care plans evidenced that the standard of recording, management and documentation of the residents care plans had significantly improved to include the residents health, medical, personal and social care needs. The person in charge explained that an additional improvement has involved the trained nurses in the home overseeing a number of residents as a primary nurse. Their duties include the residents admission, ongoing assessment, monitoring and reviewing of the residents needs and the Care Homes for Older People Page 13 of 32 Evidence: documentation of the residents care plan. The person in charge explained that the new style of management of residents care and support has shown to be of benefit to the residents in ensuring that their needs are met and well monitored and had improved the trained nurses awareness of their roles and responsibilities in the care of residents in the home. The care plans sampled were well documented and included information about the residents maintenance of their daily living skills, their likes and dislikes, their lifestyle choices including daily routines for example what time they like to get up and retire at night, their moving and handling needs, style of communication, involvement of health care professionals, nutritional assessments, continence management, use of bed rails, evidence of deprivation of liberty assessments, history of falls, wound care, weight charts, the residents tissue viability, previous occupation, how the resident likes to be addressed, their spiritual, ethnic and cultural needs and choice regarding gender specific care. Whilst sampling one care plan it was noted that the resident who has recently moved to the home did not use formal speech to communicate and the care plan did not contain any information to describe what tones or sounds the resident may use or what the tones and sounds might mean. It has been recommended that home document a communication profile on behalf of the resident in order that staff can begin to identify the residents communication style to assist in further engaging and interacting with resident in their daily life. The residents daily records were sampled and the person in charge explained that the care staff document the residents daily care which they have received from staff and will report back to the trained nurse on duty if there are any matters of change or concern regarding the residents well being. The person in charge explained that each care plan is reviewed each month to ensure the residents needs are being monitored. A random selection of care plans are monitored by the person in charge each month and the findings documented in an audit to ensure that the standards of robust care planning are maintained. One of the two care plans sampled had been signed by the resident as they were able to do so. The staff are reminded that where a resident is unable to sign a care plan this is recorded to evidence that the staff have considered the resident during the formation of their care plan. The care plans sampled contained up to date and well documented risk assessments Care Homes for Older People Page 14 of 32 Evidence: of hazards in residents daily lives which included residents, nutrition, mobility, use of bed rails, moving and handling, medication, eating and drinking and receiving personal care. Concerns had been raised during the previous inspection regarding the number of residents being supported in bed and the commission were advised that the senior management would undertake an audit of residents care who were being supported in bed to ensure that the reasons for them being supported in this way and to ensure risk assessments were completed to ensure that the care represents good practise. It was confirmed with the quality manager that an audit had been undertaken and on the day of inspection only one resident was being supported in bed. The quality manager confirmed that for those residents, who in the past had stayed in bed, they were now enjoying more opportunities within the home yet the residents preferences were still being taken into account. There was well documented evidence to support that appropriate health care appointments including visits every two weeks by the general practitioner had been attended. The AQAA advises that a meeting was held with homes general practitioner and with staff from the health centre and the meeting was very fruitful and beneficial in arranging clear protocols and arrangements for the ongoing management of residents medical and health care needs. It was confirmed and sampled through records that the home continues to work in close liaison with other health care professionals for example physiotherapists, domiciliary dental practise, speech and language therapists, community eye care team, chiropodists, aromatherapists and specialist services such as the tissue viability nurse and nutritionist in order to ensure that residents medical and health care needs continue to be met. The home has a medication policy and procedure in place and continues to use a monitored dosage system. The person in charge confirmed that the medication arrangements in the home had improved and liaison with the dispensing pharmacist regarding the ordering, delivery and disposal of medicines had been maintained. One medication procedure was observed during the morning and the agency staff member administering medicines was methodical and took time to support residents with their prescribed medicines. The medication administration charts sampled were well documented and contained no gaps in signatures. Each resident had a section within the medication folder which contained their up to date photograph, their known allergies and how they liked to take their medicines. It was confirmed that residents have a right to refuse their medication and that the home promotes residents rights to independence, and where possible, following appropriate risk assessments residents would be supported to manage their own medication. Care Homes for Older People Page 15 of 32 Evidence: The person in charge confirmed that all trained nurses, including agency nurses, receive appropriate training to administer medicines in the home in order to ensure the safety and well being of the residents. The person in charge has implemented and undertaken medication audits which are also conducted by an independent pharmacist and any recommendations actioned immediately. During the inspection it was noted that residents and visitors to the home were addressed in a polite and courteous way by staff. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices about their daily routines and enjoy and choose from a range of improved activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members and friends. The home has maintained providing a healthy and balanced diet in spacious and pleasant surroundings. Evidence: The expert by experience from Help the Aged, who was in the home for three hours reported that there is a part time activities coordinator, yet they were not present on the day of the inspection. There were no organised activities going on, apart from a cheery manicurist who arrived after lunch and who visits the home every three weeks. Residents seemed content either listening to music, three different compact discs were used, reading or watching the large television without sound in the two lounges. One resident said she was an avid reader and her daughter brought in books for her. One resident was in their room with their daily newspaper and with their TV on. A large amount of puzzles and quiz books were in the Quiet Lounge and one of the carers said that the residents participated in quizzes. The carer showed the Expert by Care Homes for Older People Page 17 of 32 Evidence: Experience some memory cards and said, the resident loves them and also loves the photos of film stars. There was a notice up in the dining room publicising a Jazz Music Evening at the end of the week for the Christmas party. There was a small Christmas tree not yet decorated in the lounge. One resident said, We always have a party at this time. Several residents said that they enjoyed two visiting pianists and singers who came in weekly. One resident said, They come in twice a week, we have a chat and cup of tea afterwards. Another resident said, Its not my type of thing. Other activities mentioned by residents were carpet bowls and chair exercises followed by skittles once a week. One resident said, The young girl who does the exercises is very good. A resident said they did not want to partake in activities, as they said they were more of a loner. This resident mentioned they liked vintage cars as an interest, and a carer said she would bring in some vintage car books. One of the residents told the expert by experience that quite a few of the residents are deaf, so the expert by experience suggested to the person in charge and quality manager that sub titles were used on the homes televisions especially when the sound was off. One resident said they enjoyed being taken out with their family on a Sunday to their own church. A resident said that she had a 90th birthday in the home recently and was made a cake and had good celebrations. It was good to see one resident frequently walking around the two lounges in a circuit and was allowed to do so. The homes management were advised at the inspection that all gangways should be kept clear, so that the resident would not trip on any tray tables. The person in charge confirmed that the home have maintained regular informal resident and relatives meetings which had proved to be very beneficial to all parties and a suggestion box has been left at the homes reception for visitors to make comments and suggestions about the home. Records of residents and relatives meetings were sampled and reflected that their opinions and views about the home were listened to and considered. It was observed that residents were supported to get up and go to bed when they wanted to. One resident said, I like my bed I get a bit tired after my operation. The visitors book was sampled to evidence that residents family and friends visit the home. A variety of other people including members of the clergy visit the home to ensure residents spiritual needs and residents have the opportunity to take part in a Holy Communion service held at the home if they choose to. One resident confirmed they had a private phone which they used twice a day. Care Homes for Older People Page 18 of 32 Evidence: The previous improvement in the presentation of the conservatory dining room had been maintained where each of the small tables had been set with coloured tablecloths and matching napkins. Condiments and crockery were available and the days menu was on each table in large print which was a talking point for residents. The expert by experience reported that there was a muddling notice board in the main lounge which displayed meals for several days and weeks ahead. After discussion with the homes administrator the issue was rectified immediately and a new wipe board was put up with the days date and menu for the days lunch which the chef wrote up. The dining room was very pleasant and situated in a conservatory with pleasant views of the garden on two sides. One resident said, Meals are served in the beautiful garden when the weather is nice in the summer. Fruit bowls were seen in both lounges with a good variety of fruit. A water cooler was in the dining room and there were jugs of squash with glasses in both lounges. Cloth napkins were on the tables and a choice of lemon or orange squash was handed around by a carer. Tables were laid up with an abundance of cutlery. One set of cutlery was superfluous and the expert by experience was told that is the way the company does it. The chef explained that there had not been a fresh vegetable delivery and there were no salad items. She said that she was making a mushroom soup for supper and there would also be cottage pie on offer. One resident erroneously thought lunch was late, as there were no clocks in the lounge due to redecoration. Lunch was either sweet and sour chicken with rice or spaghetti bolognese with swede and peas, some residents had the peas already mashed for them, followed by spotted dick and custard. The meals looked appetising and colourful. Special diets were available. The meals were served from a heated trolley in an organised way with the chef and several carers in attendance. Some meals were pureed in separate portions. Two carers in the dining room were observant to the needs of the residents. One said, Ill read the menu for you. The same carer asked several residents whether they needed their food cut up and another carer supported a resident with their meal. One resident with dementia wanted to pay for the meal and an agency nurse reassured the resident in a caring and diplomatic way saying, Dont worry, you have already paid. Later on, another carer reassured the resident about the same concerns. Residents who chose to eat in the lounge next to the dining room were kept an eye on regularly throughout lunch. One resident needed the salt and a carer brought it quickly saying, I know you like salt. No residents were rushed, some taking much longer than others. A resident said, I sit next to my friend and were often the last ones nattering away and no one rushes you. A carer told the expert by experience Care Homes for Older People Page 19 of 32 Evidence: that one resident ate without any help, as it was the wish of the residents next of kin. Meals on trays were taken to residents in beds and there was a list with the names of the three carers who were to help support about eight residents. All residents enjoyed their meal. Other comments from residents included Sometimes the vegetables are a bit hard. If I have a bad sweet, I can always have fruit. The food is good. My wife comes for lunch once a week and sits at our table and my friend a fellow resident likes that. The expert by experience noted that two residents, before lunch had stained clothes, but the expert by experience was informed that the residents had decided that they did not want to wear aprons. Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures and policies are available in the home to promote the protection of residents from harm. The home has an open culture of raising complaints or concerns about the home yet recording of concerns or complaints need to be more consistently documented. Evidence: The home has maintained an established complaints procedure which has been developed in large print for residents who prefer this choice. The person in charge confirmed that no complaints had been received by the home. Whilst sampling the resident and relative meeting minutes it was noted that some concerns had been raised which, although not formal complaints, had been raised by residents or their relatives about certain aspects of the home and these concerns had not been included within the homes concerns and complaints log. It has been recommended that any dissatisfaction or concern be documented and the actions taken regarding the response to the concern clearly documented as part of improved good practise in order to ensure that any comments received by the home are addressed and responded to accordingly. Several compliment cards and letters received by the home from residents relatives and friends of residents were sampled to evidence that people associated with the home had taken time to offer their gratitude and praise for the staff in supporting and caring for their loved ones. Care Homes for Older People Page 21 of 32 Evidence: The security of the home has been maintained through the installation of a video intercom system to ensure that residents are safe and secure and staff can see who is visiting the home. The home has a copy of the local authority multi agency procedures for safeguarding vulnerable adults and an up to date whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. The AQAA advises that all staff are instructed to read, understand and sign the homes policies and procedures relating to their duties to promote the safety and well being of residents to protect them from harm or abuse. Two staff training records evidenced that staff had attended safeguarding vulnerable adults training as part of the homes induction programme which complies with the Skills for Care Standards and that Criminal Record Bureaus checks and Protection of Vulnerable Adult checks are carried out on all new staff prior to them working at the home. Care Homes for Older People Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes furnishings are of a high standard. The physical layout of the home meets the current residents mobility needs. The control of the spread of infection in the home is robust and the home was clean throughout. Evidence: The person in charge escorted the inspector of a tour of the premises. Following the previous inspection the home has undergone a complete refurbishment and redecoration. New lighting has been put in place which has been very effective in the residents private bedroom areas and the planned installation for electronic door closures throughout the home has been continued. It was observed that there was minimal signage in the home and the maintenance person advised the expert by experience that the home were going to put up new name plates on doors at a lower level to assist wheelchair users. The home continues to provide pleasant surroundings for the residents with suitable furniture and soft furnishings throughout the home for residents to use. The expert by experience reported that a resident stated that the residents would be silly, if they were not happy and that the beds are good you could not fault it. Care Homes for Older People Page 23 of 32 Evidence: The lack of framed pictures in the home and clinical appearance of the bathrooms was raised with the person in charge who advised they would look into the matters raised in order all of the areas within the home offer residents a homely and atmosphere and environment. The home was clean throughout there was only one malodour detected in one bedroom where the mattress was airing. Significant improvements have been maintained and implemented with the purchase of equipment to improve the arrangements of control of infection and safety to ensure the safety and welfare of all people in the home. The laundry and sluice areas in the home were viewed as clean and orderly. The housekeeping staff were observed to work throughout the day undertaking their tasks in an orderly and safe manner whilst also engaging with residents in a polite and friendly way. The home has an infection control policy in place and staff are trained and aware in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands and using hand gels to prevent the spread of infection in the home. Care Homes for Older People Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home were in sufficient numbers on the day of the inspection to support the residents. The home has improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely. The recruitment practises and management of records has improved to support and promote the protection and safety of residents. Evidence: The home are currently supporting 25 residents. There has been a significant improvement in the management of the home which has included the proactive management of staff by the person in charge. It was confirmed during the inspection that the person in charge ensures that there are sufficient numbers of staff on duty who are supported by a trained nurse and the person in charge is available during the day to support all grades of staff and mentor good practise. The expert by experience observed and spoke with several staff during the inspection and reported that members of staff spoken with said they were happy with the new regime and some new practises and that there is a happy relationship among the staff. A carer said, We all get on very well. Another carer, a trained nurse, said, I have been here eight months and I love my job. It is like being a nurse looking after the residents. The routine is stricter now, but that is good. An agency nurse who had Care Homes for Older People Page 25 of 32 Evidence: been previously employed in the home for some years said, The staff have been very helpful to us agency staff, as we need their support. There was a pleasant and calm atmosphere in the home and staff were seen to be friendly and caring with the residents and showed their knowledge of the residents. A carer told the expert by experience that one of the residents particularly liked the music being played and the expert by experience saw the resident clapping their hands to the music. The chef and a carer were able to tell the expert by experience the names of residents who had thickener in their food. Two carers were seen using the hoist for one resident and both of them talked each process through in a very gentle patient manner such as You are going up now and the resident responded to this well. On two occasions when wheelchairs were used the foot plates were lowered. Several issues were brought to the person in charge and the quality managers attention during the inspection which included observations from the expert by experience that included on one occasion a member of staff used their arm under the residents arm to support the latter up. One member of staff who had been in the home for four months said they had not received any dementia training. One resident said, I am thirsty, I want a drink, and there was no drink in front of them, so the expert by experience poured some squash from the jug in the room. One resident said, The staff dont always put the call button in my reach. Sometimes the handling can be a bit rough by one member of staff and they shout, although I am told, that member of staff means well. Once my skin was broken by being pulled up. This same carer referred to a napkin as a bib in front of the resident. The inspector and expert by experience discussed the findings with the person in charge and the quality manager and were assured that the observations and comments received from residents would be addressed with staff following the inspection. Other comments from residents included, The girls are very helpful, they are very good girls. Sometimes you might have to wait, but they always come back and do it. They are very kind and everything is comfortable and one member of staff in particular is everyones friend. The person in charge confirmed that the home are actively recruiting three more staff and staff stated that they felt supported by the management of the home and the pace of the home was relaxed. The two staff files sampled evidenced that the person in charge had improved and implemented a programme for staff supervision and supervision records were evidenced during the inspection. Care Homes for Older People Page 26 of 32 Evidence: The staff files contained well documented evidence to support the improved management of records related to the recruitment and safe vetting practises of staff. There was evidence to support that the home continues to be committed to the ongoing training and development of staff and the staff files detailed that they had received a thorough induction programme and had, or would undertake appropriate mandatory training in accordance with the organisations training programme in order to ensure that staff have the skills and are suitably trained and competent in their duties. The AQAA advises that fifty percent of the staff have achieved their National Vocational Qualification in Level 2 and 3. Care Homes for Older People Page 27 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improved day to day management of the home ensures that the safety and well being of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home and residents health and safety is promoted through general health and safety checks. Evidence: There has been a significant improvement in the day to day management of the home and the two requirements made by the commission during the previous inspection have been met in order to promote the safety and welfare of all people in the home. Following the previous inspection the home have continued to undertake a review of the service and the day to day management of the home has changed. A new person in charge has been appointed, who has been in post for five months and who represented the service during the inspection. The person in charge has advised the commission that they will be seeking to register with the commission as the registered Care Homes for Older People Page 28 of 32 Evidence: manager of the home. The improvements in the management of health and safety in the home have been sustained. It was observed that all hazardous substances were stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and welfare of residents and staff in the home. The homes documents confirmed that the homes chef had undertaken a long distance learning course regarding supporting residents nutrition and diet and the home continues to comply with current good practise regarding the food hygiene standards. Records confirmed that the homes fire procedures and equipment checks were undertaken to promote residents safety. Regulation 26 records of unannounced visits by the homes quality manager were sampled and it was noted that the records were thorough in assessing the quality of the service. The person in charge confirmed that no residents monies are kept by the home on behalf of the resident and residents are encouraged to keep their own money. The procedures for invoicing residents for the services of the hairdresser and aromatherapist have been maintained. The current certificate of registration and insurance liability were sampled. The home have continued to inform the commission regarding any event which affects the well being and welfare of residents. As recorded throughout the report there has been a significant improvement in the overall delivery of care and support for residents, improved standards of documentation and management and support of staff has had a positive affect in improving the quality of residents daily lives and the care and support they receive. It has been acknowledged by the commission that the review of the service has been a difficult time for the residents and the staff and that the significant improvements made reflect the hard work of the staff at all levels to improve the standard of care and support for the residents at Brownscombe House. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 has been recommended that home document a communication profile on behalf of the resident in order that staff can begin to identify the residents communication style to assist in further engaging and interacting with resident in their daily life. It has been recommended that any dissatisfaction or concern be documented and the actions taken regarding the response to the concern clearly documented as part of improved good practise in order to ensure that any comments received by the home are addressed and responded to accordingly. 2 16 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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