Care Home: Brymore House

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What the care home does well This service provides comfortable well maintained accommodation which includes a facility for eleven people who need intermediate care. These people are admitted for up to eight weeks and supported to improve their mobility and work toward being able to return to their own homes. Those people who are not able to return to independent living often elect to stay in Brymore. All of the people who we spoke with praised the staff in the home. They told us "I couldn`t imagine living anywhere else" "staff are always very kind and helpful" and I feel very lucky to be able to live here". There is a wide range of activities arranged for them to take part in if they want to and examples of arts and crafts are displayed throughout the home. Their visitors are always made welcome, we saw that some visitors bring dogs in with them as well and there is also a resident cat. The homes manager promotes a very caring ethos in the home. Staff are encouraged to consider caring as a career rather than just a job and trained nurses uphold the values of traditional bedside nursing techniques. Staff training is given high priority and the home also offers placements to student nurses from Greenwich University. Mealtimes appear to be a pleasurable experience for those people who live in the home. They say that they enjoy the food that is served to them and there are always choices available them. What has improved since the last inspection? All of the requirements issued at previous inspection have now been complied with. There are now systems in place to offer residents and their families the opportunity to comment on the service that they receive and influence how they like th home to be run. All staff now receive supervision to allow then the opportunity to talk with the manager and identify any future training needs that they might have. All equipment is appropriately maintained and staff attend regular fire drills so that they know what they should do in the event of a fire. There is an ongoing redecoration and refurbishment programme in place which will continue over the next year. The home is now working toward participating in the Gold Standards Framework. This is an initiative which will be developed in conjunction with the local hospice to ensure excellence in the care of those people who are nearing the end of their lives. What the care home could do better: We issued two requirements regarding the safe handling of medication in the home. We found that there were occasions where medication that was being given was not being recorded accurately.We are confident that careful auditing will ensure that these are easily met. Although the residents in the home enjoy the food that is served to them they have tomake their choices a week in advance. Given their frailty and failing memories we recommended that consideration should be given to reducing this to at most the day before. We also made some recommendations about residents care plans. Improving the information that is collected about their life history and achievements help the care staff understand more about the people that they are caring for. Also residents or their relatives should be encouraged to participate in compiling the care plans so that staff are sure that the care and support is being given according to their preferences. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brymore House Brymore House Residential And Nursing Home 243 Baring Road Lee London SE12 0BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Ford     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Brymore House 243 Baring Road Brymore House Residential And Nursing Home Lee London SE12 0BE 02088514592 02088514207 brymorehouse@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Mary Marjoram,Mr Michael Marjoram Name of registered manager (if applicable) Mrs Sharon Feleppa Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: 14 of the beds registered as `nursing` can be used for either patients or residents maximum of 46 patients and residents combined 20 residents 30 patients One (1) place for a service user aged 54, requiring intermediate care, can be accommodated. Up to 11 patients, aged 60 or above if female or 65 and above if male, for intermediate care using bedrooms 2, 3, 4, 5, 7, 27, 28, 29, 30 and 31. Care Homes for Older People Page 4 of 27 care home 46 Over 65 0 46 0 0 46 0 46 46 elderly, frail persons aged 60 years and above (female) and 65 years and above (male) persons aged 55 years and above, and persons suffering from dementia to include one person with palliative care needs Date of last inspection Brief description of the care home Brymore House is located on a main residential road and is about 5 minutes walk from Grove Park railway station and the local shops. The house is a large detached property with its own drive. There is an attractive enclosed garden and patio at the rear of the house. The accommodation is on three floors; the rooms in the home vary in shape, as part of the house was originally a private residence which has been extended, however the room sizes meet regulations, rooms are accessed by stairs and a shaft lift provides level access to all parts of the home. The registration is for a maximum of 46 service users, up to 30 of who may require nursing care. There are also eleven places for intermediate care. The manager is a Registered General Nurse, and has attained the Registered Managers Award she also has considerable years of experience in nursing and management. The last key inspection of this home was on 27/02/2007 Care Homes for Older People Page 5 of 27 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: We undertook a key inspection of this service which was comprised of two visits. The first was unannounced and the majority of the field work was completed with help from the trained nurses and the homes administrator. However the manager was not available on this day so we returned a week later to discuss other issues with her. When compiling the report we have also taken into account comments made by some of the 44 residents living in the home and their relatives and information received throughout the year such as notifications. In addition the homes manager sent us a completed Annual Quality Assurance Assessment document( AQAA). This document tells us how well they believe the service is operating and about their plans for the future. In this instance the AQAA was comprehensive and gave us lots of useful Care Homes for Older People Page 6 of 27 information about the service that we were able to check out when we visited. What the care home does well: What has improved since the last inspection? What they could do better: We issued two requirements regarding the safe handling of medication in the home. We found that there were occasions where medication that was being given was not being recorded accurately.We are confident that careful auditing will ensure that these are easily met. Although the residents in the home enjoy the food that is served to them they have to Care Homes for Older People Page 8 of 27 make their choices a week in advance. Given their frailty and failing memories we recommended that consideration should be given to reducing this to at most the day before. We also made some recommendations about residents care plans. Improving the information that is collected about their life history and achievements help the care staff understand more about the people that they are caring for. Also residents or their relatives should be encouraged to participate in compiling the care plans so that staff are sure that the care and support is being given according to their preferences. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not admitted into the home unless a full assessment has been undertaken to ensure that their health care needs can be met. Those who are admitted for intermediate care are cared for by a specialist staff team and have access to appropriate equipment to help rehabilitate them. Evidence: Potential residents are only admitted into the home after a full assessment has been undertaken to make sure that their needs can be met. If it is possible people would be invited to visit the home to see if it will suit them although they are often too frail to be able to do this. Families and relatives would always be encouraged to participate in the admission process. We saw that there was information from residents care managers outlining the support that they would need and that these were reviewed and updated regularly. The manager told us that the information coming from the care managers is not so comprehensive of late and she is developing a more detailed Care Homes for Older People Page 11 of 27 Evidence: document which will be used when the home undertakes its own assessment. The home has a facility to accommodate eleven residents requiring intermediate care. They are in a specialist unit which is funded by the local authority. It is staffed by a multidisciplinary team which includes physiotherapists and occupational therapists. After the rehabilitaion process has been completed if people are not able to return home they often ask to stay at Brymore. One gentleman told us I came in after a fall and decided to stay while a lady told us I feel I am very lucky to be able to stay here. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of the people who live in this home are being met in a way which suits them and they are treated with dignity and respect. Care must be taken to ensure that medication is always handled according to current guidelines. Evidence: People who live in this home tell us that their health care needs are being met in a way which suits them. They all looked clean and well cared for and those who were being nursed in bed looked comfortable. The home has a strong ethos of traditional nursing care, and the maturity of many of the trained nurses and their attention to basic skills is appreciated by the residents. During the visit we could see that staff took extra care to make sure that residents were comfortable and that they had a good empathy with them. People told us that staff are always kind and we all feel very well looked after here. All of the residents have an individual care plan which identifies areas where they need Care Homes for Older People Page 13 of 27 Evidence: support and the interventions that are needed. We looked at six of them during the visit and were able to see that they are reviewed regularly to make sure that any changes are identified. There are risk assessment in place and factors which might lead to the development of pressure sores are monitored regularly. We could see that the homes doctor visits regularly and that other members of the multidisciplinary health care team are also involved. There are visits from dentists opticians and chiropodists. In some of the plans we noted that information about residents past lives and achievements was not always very detailed. This information provides a useful insight in to residents behaviour and knowing more about them helps staff to understand and build a relationship with them. There was also limited evidence to show that residents or their relatives are given the opportunity to contribute to the care planning process. Discussion with them when care plans are reviewed will help to ensure that care is being delivered in a way which suits people. The Registered Manager has agreed to address theses issues. We looked at the way that medication is managed in the home. We noted that there were some omissions in recording when medication had been given. Also that where topical preparations were being applied it was not always clear where this should be and they had not always been signed for. In order to provide evidence that residents are receiving their medication as it has been prescribed by the Doctor, all items must be signed for appropriately. We have asked the Registered Manager to improve the audit process in place in the home so that regular checks are made to ensure that all medication is being given as it should be. The home must also buy a new thermometer for the clinical room so that we can be sure that medicines are all being stored at the correct temperature. The home is currently participating in a training programme to enable them to deliver care for those people who are nearing the end of their lives in line with The Gold Standards Framework. This is being done in conjunction with the local hospice, St Christophers. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life in the home suits those who live there. There are activities arranged for them to join in with if they want to and they enjoy the meals that are served there. Evidence: The routines of daily living are made as flexible as possible with residents being encouraged to choose how they spend their days. A wide variety of activities are arranged for them to join in with if they wish to. A full time activities coordinator organises trips out, entertainers, craft groups, bingo, quizzes etc. During the visit, people spoke very highly of her commitment and we saw several examples of residents work displayed around the home. Care plans reflect any individual activity that residents wish to pursue and the organiser visits anyone in their rooms who does not wish to join people in the lounge. Music therapy has recently been introduced in to the home and this is going to be expanded on along with the possibility of aromatherapy. Spiritual needs are addressed with visits from various church representatives and the home recognises holy days and feast days of various religions. People told us that they enjoy the meals that are served in the home and there is always a choice. The menus that we saw looked varied and interesting and particular Care Homes for Older People Page 15 of 27 Evidence: diets could always be catered for. The chef has worked in the home for some time and he explained that he likes to use fresh rather that frozen food whenever possible. Residents choose their menus the week before and we did suggest that this might be too long for elderly people. The Registered Manager has agreed to look at changing this. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints procedure which ensures that any concerns will be taken seriously and addressed in a timely way. Evidence: There is a complaints procedure displayed in the home and it is also in the Service User Guide. It is easy to understand with clear timescales by which any issues will be addressed. Those people we spoke with didnt think that they would need to complain, but said if they didnt like something, then they would tell the staff and they are sure that it would be sorted out for them. Neither the home or The Commission have received any complaints about the service during the last year. Staff have all undertaken training to help them recognise possible signs of abuse and those that we spoke with had a good understanding of what they should do if they were unhappy about anything that they saw. No new members of staff are employed without all of the relevant clearance which ensures that residents are protected from those who have been judged as being unsuitable to work with vulnerable adults. Care Homes for Older People Page 17 of 27 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 home is warm clean and suitable for the residents who live there. It is well maintained. in line with current guidelines. Evidence: The home is situated on a main road near to both bus stops and the station. There is very limited off street parking available. We walked around the home during the course of the inspection. Although some of the decor is looking a little tired the home was welcoming, warm and clean and there is an ongoing redecoration and refurbishment programme in place. People that we spoke with commented on how clean the home was kept and said that there were never any unpleasant smells. They told us that their bedrooms were comfortable and that they had been able to bring things in from home to make it feel cosy. There are aids and adaptations throughout the home to help residents use bathroom and toilet facilities, there is a shaft lift and a stair lift to one of the staircases. There is an attractive secluded garden to the rear of the property, with seating and some of the flowerbeds are raised so that residents can potter around and grow things in the warmer weather. Measures are in place to comply with reccomendations regarding infection control issues. This includes protective aprons, hand gels and anti-bacterial handwash. The home has close links with the local hospital to make sure that their practices remain Care Homes for Older People Page 18 of 27 Evidence: up to date. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are always enough suitably trained staff in the home to meet the needs of the people who live there. Evidence: The people that we spoke with said that there were always staff around to help them and they were all very kind and helpful. One lady told us I couldnt imagine living anywhere else. We looked at the staff rotas and could see that there are always enough staff, both nurses and carers. Shifts have been arranged so that there are more staff at times of peak activity such as when residents want to get up. The home also provides placements for student nurses from Greenwich University. The manager tries to promote an ethos of caring being a career rather than just a job and she is supported in this by her trained staff many of whom have been there for some time and uphold a very traditional approach to nursing. More than 50 of care staff have achieved an NVQ level 2 and others have progressed to level 3 or an access to nursing course. Training is purchased through the local authority and is given a high priority in the home. Staff have attended sessions including moving and handling, food safety, and health and safety since the last inspection. Yearly visits from the fire safety officer and regular fire drills help to ensure that staff know what to do should there be a fire. Care Homes for Older People Page 20 of 27 Evidence: The Registered Manager is in the process of developing a training matrix which will make it easier for us to see exactly what training has taken place. Robust recruitment procedures ensure that people are protected from those who have been judges as being unsuitable to be working with vulnerable people. We looked at four staff files and saw that all the necessary checks had been completed before they had started work in the home. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by a person who is competent and fit to be in charge, in the best interests of those people who live there. Evidence: This home is the only one that is owned by these providers and as such has a small management structure. The Registered Manager has been in post for over eight years, holds an NVQ level 4, and is supported by a deputy and an administrator. They displayed a good understanding both of the problems experienced by the residents and the need to value the staff working in the home who told us that they were very fair, and good to work for. They hold regular staff meetings and ensure that everyone gets the minutes even if they were not able to be there. The homes owners visit the home regularly to make sure that it is running as they want it to in line with regulation 26. We did suggest that reports of their visits would be more useful if they contained more detail. There are regular meetings for residents and their relatives and minutes are sent out to those who were not able to attend. Questionnaires are also distributed Care Homes for Older People Page 22 of 27 Evidence: periodically regarding various issues such as food, entertainments and activities. The service has some money kept on behalf of residents and accounts are kept of this however, most people have a relative or representative to manage their affairs for them. Staff all receive regular supervision. Trained nurses observe their practical skills and they also get the opportunity to sit with the manager and discuss their performance and training needs. Documentation we received tells us that equipment and services are maintained appropriately and the last EHO visit awarded the kitchen a score of 4 stars. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All items of medication must 28/02/2009 be signed for when administered. In order to provide evidence that residents are receiving their medication as it has been prescribed for them by the doctor. A thermometer must be in the room where medication is stored. In order to provide evidence that medication is being stored at the correct temperatures. 28/02/2009 2 9 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that there should be more information gathered about residents past lives, interests and achievements, so that staff can develop more understanding of their needs and preferences. Page 25 of 27 Care Homes for Older People 2 7 It is recommended that care plans should be drawn up with the involvement residents and their relatives to ensure that their care is being delivered according to their preferences. It is recommended that consideration should be given to adjusting the timescales that are in place for residents to choose their meals. 3 15 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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