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Care Home: Northbrooke House

  • Main Road Havenstreet Isle Of Wight PO33 4DR
  • Tel: 01983882236
  • Fax: 01983884414

Northbrook House is a registered Nursing Home providing nursing care and accommodation for up to 40 people over the age of 65 years with nursing care needs. The home is an extended converted period house set within its own extensive grounds with panoramic views out across the countryside. The home is located within the village of Havenstreet and is close to bus stops. The facilities within the village are within walking distance of the home if required. People are accommodated in single bedrooms, all with en-suite facilities, located on two floors accessible to all by two passenger lifts. The home has two large communal lounges, two separate dining rooms and a number of assisted bathrooms. An extension was completed in February 2005 to provide eight intermediate care beds and additional bedrooms for people requiring longer term nursing care accommodation. Early this year the home opened a specialist unit for people with neurological injuries, this four bedded unit providing support to primarily younger adults. The home is owned by Island Healthcare Ltd and managed by Mrs Sally Jolliffe. Fees: weekly fees range from £575.00 to £710.00 (dependant on roomNorthbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 5occupied) not including the nursing care element of £130.00 per week, which may be reclaimed by the person paying for the care from the NHS.

  • Latitude: 50.708000183105
    Longitude: -1.2109999656677
  • Manager: Ms Sally Jolliffe
  • Price p/w: £643
  • UK
  • Total Capacity: 44
  • Type: Care home with nursing
  • Provider: Island Healthcare Ltd
  • Ownership: Private
  • Care Home ID: 11360
Residents Needs:
Dementia, Physical disability, Old age, not falling within any other category

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Northbrooke House.

CARE HOMES FOR OLDER PEOPLE Northbrooke House Main Road Havenstreet Isle Of Wight PO33 4DR Lead Inspector Mark Sims Unannounced Inspection 21st May 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbrooke House Address Main Road Havenstreet Isle Of Wight PO33 4DR 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) 01983 882236 01983 884414 ihl.mail@btconnect.com Island Healthcare Ltd Ms Sally Jolliffe Care Home 44 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Northbrooke House DS0000012563.V363259.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 with nursing - (N) 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 (OP) Dementia (DE) 2. Physical disability (PD). The maximum number of service users who can be accommodated is: 44 22nd May 2007 Date of last inspection Brief Description of the Service: Northbrook House is a registered Nursing Home providing nursing care and accommodation for up to 40 people over the age of 65 years with nursing care needs. The home is an extended converted period house set within its own extensive grounds with panoramic views out across the countryside. The home is located within the village of Havenstreet and is close to bus stops. The facilities within the village are within walking distance of the home if required. People are accommodated in single bedrooms, all with en-suite facilities, located on two floors accessible to all by two passenger lifts. The home has two large communal lounges, two separate dining rooms and a number of assisted bathrooms. An extension was completed in February 2005 to provide eight intermediate care beds and additional bedrooms for people requiring longer term nursing care accommodation. Early this year the home opened a specialist unit for people with neurological injuries, this four bedded unit providing support to primarily younger adults. The home is owned by Island Healthcare Ltd and managed by Mrs Sally Jolliffe. Fees: weekly fees range from £575.00 to £710.00 (dependant on room Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 5 occupied) not including the nursing care element of £130.00 per week, which may be reclaimed by the person paying for the care from the NHS. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over 7.5 hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commissions surveys could not be judged, as at the time of completing the report the replys to the surveys dispatched were not available. What the service does well: The service provides potential residents’, their relatives and/or representatives with access to good levels of information about the home and its facilities and amenities. A ‘service users guide’, ‘statement of purpose’ and specific brochure or leaflet, for people entering the intermediate care wing, which is accessible via the Primary Care Trust (PCT) intermediate care team (ICT), have been produced for prospective residents’. The company has introduced a person-centred approach to care planning, which has been trialled at Northbrooke House sister homes’ and which is being well used by the staff within the new four bedded ‘extra living’ unit. The home employs an activities co-ordinator, who plans, delivers and oversees all entertainments and activities for the service users. Records of the activities undertaken are individually maintained and the company provides access to transport, which is used to facilitate outings and trips. The meals served at the home are all home cooked and the kitchen has received a five star rating from the ‘Environmental Health Department’. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 7 Dining areas are provided within the main building and the smaller unit each dining room is well maintained and equipped. Internally and externally the home is well maintained, with large bright communal lounges, large accessible communal toilets and bathrooms and single occupancy bedrooms, which mainly provide en-suite facilities. The gardens are well kempt and the views across the extensive gardens from the lounges is a significant plus for the home, several people saying how they enjoyed sitting out on the patio watching the wildlife or the roof top patio enjoying the views across the countryside. Staff training and development opportunities are good, with training and development records seen during the fieldwork visit and staff commenting on the courses attended. The management of the home is good, the manager is well organised and has good levels of support from the proprietary company, which includes support with quality assurance and involving the service users in commenting about the service provided at Northbrooke House. What has improved since the last inspection? At the last inspection the service were required to make the following improvements: ‘Care plans and related risk assessments must be reviewed monthly’, ‘the home must have a photograph of all people living at the home or using the intermediate care facility’ and ‘Medication Administration Records (MAR) must be fully recorded at the time of administration’. During the fieldwork visit evidence was gathered which indicates that these requirements have been addressed, the company’s new care planning package being rolled out throughout its homes’, the medication administration process considered appropriate and safe and photographs of each resident affixed to their care planning file. The service states via their AQAA that they have also made the following improvements: ‘improved monitoring methods for care plans and drug routines’. Employed two new deputy managers. Manager has undertaken training in Managing Conflict, Emotional Intelligence, CSCI Star Rating, End of Life Care Pathways and The Mental Capacity Act. Gained further experience of working in multi-disciplinary teams in the development of the new rehabilitation unit for younger adults (Hazel Lodge) at Northbrooke. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 8 Recognised the need for staff to understand more about manual handling of bariatric clients – we purchased digital hoist scales as a result of this training enabling us to ensure regular monitoring of clients weights’. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 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 Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The service tells us, via their AQAA that: ‘Thorough pre-admission assessment are undertaken by the manager or senior staff prior to admission, to ensure we can meet the persons’ needs. This includes a question regarding what the clients perception of the care service will be, followed up six weeks after admission by the Registered Nurse Manager and the Group Liaison Manager by informal discussion’. Opportunities for clients to visit the home before admission and sample the food and tour the building with their families/friends exist. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 11 A meet and greet service by senior managers for all new clients to enable them to settle in. All bedrooms are redecorated between long-stay clients. Liaison with other health and social care professionals including care managers to develop appropriate care plans and risk assessments’. The assessments of five people, admitted to the home, were reviewed during the fieldwork visit, with their care plans found to contain both professional summaries of care and/or an in house assessment completed by the manager. In discussion with a relative the admission, to the home, of her next-of-kin was discussed, the relative stating that the family had visited the home on behalf of the resident and had been impressed by the way the staff conducted themselves throughout and that they had been provided with information about the facilities and amenities of the home. In discussion with the activities co-ordinator she described the ‘meet and greet’ programme that had been introduced, which normally involved the Manager, the Group Liaison Manager or herself visiting a new resident, discussing their immediate needs and wishes and basically being their to answer questions and assist them settle into the home. The intermediate care residents’ are admitted to a specific wing within the home, with the staff able to track who is occupying which room, via a whiteboard in the nursing office that is used to document room allocations and basic client information. Rehabilitation is managed via a ‘multi-disciplinary team’ (MDT) approach, with members of the ‘intermediate care team’ (ICT) visiting the home to coordinate with the homes’ staff the support packages of the ICT patients’ The records maintained for these clients contain pre-admission information, gathered by the ICT staff, which is provided to the home prior to the residents’ admission and ongoing records and care plans updated by the individual professionals involved in delivering, monitoring and planning care/support. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Five care plans were reviewed during the fieldwork visit, three from the nursing home wing, one from the intermediate care wing and one from the four-bedded unit. Generally all of the plans were found to be informative documents, which were well structured and contained an indexing system, which enabled the user to quickly locate the section of the plan they required. The plans used within the nursing home wing, contain a twenty eight point tick box assessment, which the staff are required to complete in order to indicate Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 13 that the person requires and/or has a more in depth care plan further on within the document. The plans referred to above are pre-printed documents, which require some alterations by the staff to make them specific to the resident, although on reading through the three plans it was evident that this personalisation of the plans is not always completed. A good example of this was the constipation/faecal incontinence plans, which require the staff to establish what the persons’ normal bowel pattern/habits are so they have a baseline to monitor for signs of constipation, etc, as this clearly will differ from person to person. It was also noted that where staff are required to differentiate between the sex or gender of the resident, as part of the plan, this is often left unchanged, i.e. where staff should strike through one of he/she to identify the sex of the person this is left so the plan remains unisex and not specific to the person. There were also anomalies noticed between peoples’ own plans, with the urinary incontinence plan stating people should consume between 1.0 & 1.5 litres of fluid a day and their constipation care plan stating 1.5 & 2.0 Litres. These issues were brought to the attention of the nurse in charge and the ‘Responsible Individual’ for the company, who have undertaken to discuss these issues with the manager in order to improve the services records. However, it should be acknowledged that the plans also contained some very good information and instructions for staff about the residents’ needs and wishes. Example of this would include the record for a person who on occasions likes to remain in bed, prefers not to wash and chooses not to change the night attire, as they do not feel like it. The records show that this particular action or request is short lived and that the person is likely the next day to wash, dress and rise. The homes’ approach to the management of accidents is also very good, as evidence by the records of a person whose running record indicated was ‘found by a carer on the floor with their table on top of them and their head resting on the handle of his chest of draws’, the accident book / record was appropriately completed, alongside the running record, the former reviewed on two further dates to monitor for injuries and/or bruising. The persons’ risk assessment documentation was also updated to reflect the increased likelihood of injury caused by falls and consideration was given to how this could be handled. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 14 However, some aspects of the homes’ risk assessments or more specifically their approach to the risk assessment for the use of bedrails should be reviewed, as peoples’ suitability to use or have fitted to their bed a rail is not document. The bedrail assessments do consider the suitability of the rail to be used and the type bed it is to be fitted to, etc but not the specific needs of the person, for example, is the resident mobile, confused or disorientated at times and therefore likely to try and climb over the bedrail, thus increasing the distance to fall. The plans for the people residing within the intermediate care wing are multidisciplinary document, which are maintained equally by all of the professionals involved in the delivery of care and/or support of the residents. As with the care plans used within the nursing wing the plans for the intermediate care residents’ are generally well-structured documents, which contain both National Health Service (NHS) records and documents generated by the home. Whilst reviewing the records of one intermediate care resident, it was noted that they had recently been discharged back to the home from ‘St Mary’s Hospital’, the local NHS facility. On re-entering the home the person was noted to have developed pressure injuries to their heels, one of which required assessing and dressing to manage the wound. However, despite the initial running record, which described the type of dressing used and provided a description of the injury; and subsequent entries, which document that the wound has been redressed, there was no wound care plan in place. This was discussed with members of the ICT team present in the home at the time; who felt the matter was one for the home’s staff to manage, although they did state they could make a referral to the ICT Lead Nurse or the NHS Tissue Viability Nurse if required. This matter was also brought to the attention of the nurse in charge, who accepted that a wound care plans and monitoring system should have been commenced, although she felt photographs of the injuries at least provided a baseline from which to gauge improvements in the areas affected. The nurse also undertook to implement a wound care plan for this person and to reinforce with colleagues the need to ensure that they complete a care plan when identifying a change in a persons’ care needs. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 15 Within the recently opened four-bedded unit the company have introduced a new person centred plan, which is also being trialled with Northbrooke House sister homes’, Tile House and Highfield House. As with the other care planning systems seen during the fieldwork visit the person centred plans are well-structured and set out documents that contain a lot of useful information about the person, their care/support needs and their goals and aspirations. During the fieldwork visit we were lucky enough to be able to read through a residents’ person centred plan in their company, the resident able to confirm their involvement in the initial creation of the plan and its subsequent updating. The plan provides details of the persons’ social networks, their social and educational activities programmes (a duplicate of the programme is also on display in the persons’ bedroom), their involvement with health and social care services and their goals, aspirations and/or support needs. The service tells us via the AQAA that in promoting peoples’ health they: ‘contract with a General Practitioner (GP), who visits routinely once a week or as required. Clients are also encouraged to keep their own GP, if they can continue to support them. Visited by chiropody. Escorted access enabled to opticians and all other health professionals, as required. Such requirements are diarised and transport arranged by the nurse manager. Intermediate care services are provided by Occupational Therapist (OT), Physiotherapist (PT), Care Managers (CM) and Pharmacist who we are also able to consult regarding our resident clients. Appropriate equipment is provided to enable safe manual handling of clients and the prevention of pressure sores. Clients are encouraged to be as self-caring as possible and some clients, particularly those admitted under Intermediate Care, self-medicate within a framework of appropriate risk assessment’. During the review of the residents’ care plans, records were seen, which support the statements regarding their access to GP’s, Opticians and Chiropodist. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 16 Four of the five plans also contained information from the NHS, in the form of correspondence both pre and post the persons’ visits to a clinic appointment or their involvement with a visiting health professional. During the visit the contracted GP was seen in the home visiting residents, as was a Physiotherapist and Nursing Assistant from the ICT, the latter two people discussing how they felt that generally the service provided at the home was satisfactory, although communication could be improved, as at times the homes’ staff fail to pass information on appropriately. An example occurring that day when a St Mary’s Hospital had rung to confirm an appointment for a client, at the request of the ICT but this information was not relayed to the resident by the home staff once they were informed. The service states, via the AQAA that ‘Policies and procedures reflect the company’s commitment to the promotion of dignity in care for all clients. This statement is supported by a declaration made via the ‘dataset’, which forms part of the AQAA documentation and indicates that polices on: ‘Equal opportunities, diversity and anti-oppressive practices’ and ‘Values of privacy, dignity, choice, fulfilment, rights and independence’ are available to staff. During the fieldwork visit the staff were observed knocking on people’s bedroom door (if closed) and on toilet and bathroom doors before entering. The residents’ preferred terms of address were document on their care plans and the interaction between the staff and the residents and the staff and the visitors noted to be appropriate and respectful. The accommodation at the home is single occupancy, which helps promote dignity, respect and privacy during the delivery of care and or support and there was a marked difference between how the rooms were set out or furnished, the younger clients rooms containing computers’, games consoles, large DVD collections, etc, whilst the older clients were decorated more with pictures, paintings and ornaments. The review of the homes’ medication system established that all medications are correctly held and secured. The medication administration records (mar sheets), were generally well maintained and accurate. Medication stocks are kept to a minimum and records indicate that the home’s medication fridge is checked on a daily basis to ensure it operates within safe and acceptable parameters. Staff observed administering medicines did so safely and appropriately, taking the medication to the service user, administering the medicine and then returning to sign the medication record. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 17 The Dataset establishes that policies are available to the staff on the ‘control, storage, disposal, recording and administration of medicines’ and that the management and handling of ‘controlled medications has been appropriate over the last twelve months with no reported concerns or issues. Training records indicate that in October 2007 the Qualified Staff completed updated training on the use of Bulk Prescribed Medications, and presently are using this system to dispense and administer medications to residents’. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities could be improved to better meet individual’s expectations. EVIDENCE: The service employs an activities co-ordinator, who is responsible for planning and delivering activities and entertainments to the residents’. During the fieldwork visit the activities co-ordinator was meet and she explained her role, how she plans the entertainments provided, the records she currently maintains and her plans for developing this system. The activities co-ordinator evidence, via the minutes of the last residents meeting that this is how she plans and monitors the activities she organises, with the minutes providing a record of the groups discussions on both internal and external activities they enjoy and would wish introduced, etc. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 19 A schedule or brochure of the next months’ activities is then produced by the activities co-ordinator and this is then display around the home and/or provided to the residents’ for information. A copy of the May 2008 ‘What’s on at Northbrooke’ document was seen by us during the fieldwork visit and noticed to contain details of external entertainers visiting the home, internal activities like the May Day Parade and games like Snake and Ladders or Quizzes. The activities organiser also delivers and lot of one-to-one support for people, with her records documenting when she visits residents in their bedrooms or when she escorts people on outings or trips. During the visit the co-ordinator was observed taking three people out at different times of the day and involved with residents’ and their relatives in the lounge. In conversation with residents’ the role of the activities organiser was praised heavily and the current co-ordinator described in glowing terms, as someone who is always there to help you, good fun and likeable. The service tells us via their AQAA that they: ‘regularly take people to their own homes for visits with family and friends. Some family members visit daily and have lunch with their loved ones. Regular outside entertainers visit, including hairdressers. Two wheelchair accessible vehicles are provided. Younger adults accommodated at Northbrooke are assisted to enrol at isle of Wight College, become members of local Gyms and visit art therapy groups. Visits to the pub and other leisure activities are also enabled as well as support to maintain family relationships. A quarterly newsletter is sent to all clients and their families.’ The home’s visiting arrangements are detailed within the ‘service user guide’ / ‘statement of purpose’ literature, copies of these documents are available to people within the home’s reception area. Entry to the home can only be achieved via the main entrance, which opens up onto the reception area, which is staffed throughout the busiest periods for the home. During our visit a number of visitors were observed arriving at the home and being welcomed by the reception staff and care staff prior to meeting up with their next-of-kin. In conversation with one relative it was established that they visit daily and spending most of the day with their next-of-kin. This person described that Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 20 staff as caring and considerate and praised the home for the care and attention their loved one received. The relative also confirmed one of the statements made via the AQAA that being, that they enjoy a meal with their next-of-kin whilst at the home. The mix of lounges and dining areas, available to residents and their relatives, ensures that meetings can be conducted in private, although their single occupancy rooms can be used if they prefer. The evidence indicates that the home is good at promoting people’s rights to self-determination and independences. The care planning records discussed earlier in the report reflecting people’s choice over rising and retiring times and their wishes with regards to the delivery of personal care, etc, the example of the person who regularly refuses all support in preference of a days complete rest evidence of this practice. The residents’ meetings providing people with an opportunity to influence the service delivered to them, as established when considering the homes’ activity programme, although their thoughts and preferences with regards to the meals service are also discussed and recorded on the April 2008 minutes. In discussion with one of the residents currently residing in the four bedded unit it was established that they had chosen to stay in the smaller unit, as they are younger and have more in common, they felt, with the other residents’ accommodated in the unit than those in main building. The tour of the premise enable us to visit the kitchen, dining room and food storage facilities, where time was taken to speak to the catering staff. Three catering staff were on duty during the visit and all three confirmed that they had completed food hygiene training courses, whilst the main cook and assistant had also completed National Vocational Qualifications (NVQ) in catering. They also discussed the menus and showed us the records they maintain in respect of the food served and the equipment check undertaken. The food storage facilities were appropriate and provided sufficient dry, cold and frozen food stores and there was a range of catering and/food items available. Observations made during lunchtime, established that mealtimes are social occasions and that sufficient staff are around to support the service users eat their meals. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 21 The catering and care staff also demonstrated an awareness of how meals should be served and presented with soft/liquidised meals looking appealing and well presented. Observations also suggested that the people eating the meals were enjoying what they were served, as people required little or no prompting to eat their food, although the staffs interaction with residents were positive and appropriate throughout. A relative was also noticed to be involved with assisting their next-of-kin with their meal and at least one relative was eating with the residents’. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The service states via the AQAA that: ‘safeguarding adult training is mandatory in house annually. A director sits on the Isle of Wight Safeguarding Board. Manager has undertaken ‘train the trainer’ learning on Safeguarding Adults. Complaints procedure is provided within the ‘statement of purpose’ and ‘service user guides’ and displayed in the reception area of the home. All complaints are dealt with in a timely manner and reported where appropriate to external agencies. Complaints are treated as a valuable learning tool for all involved. Nurse manager has an open door policy for staff to report/discuss any concerns’. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 23 The dataset, which forms part of the AQAA documentation, establishes the existence of the home’s complaints and concerns procedure, although it does not provide details of when this was last reviewed or updated. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 0. No of complaints upheld 0. Percentage of complaints responded to within 28 days: N/A. No of complaints pending an outcome: 0. The evidence indicates that people’s complaints are being appropriately handled, with written responses, where appropriate, being dispatched by the manager, a complaints logging system documents all activities associated with a complaint. Details of the home’s complaints process are made clear to people via the ‘service users guide’ and ‘statement of purpose’, which are, as mentioned in the AQAA and established during the fieldwork visit accessible around the home. During the visit the nurse in charge produced copies of the homes training record, which indicates that all staff have completed ‘safeguarding adults’ training, this corroborated the information contained within the AQAA. The homes tells us, via their AQAA and dataset, that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, although as with the complaints policy information no dates for updating or reviewing the policy has been provided. The dataset also establishes that over the last twelve months no safeguarding referrals have been made to the Local Authority, a statement support by a review of our database, which did establish that one alert had been brought to the Commission’s attention, however, this occurred after the AQAA had been completed and submitted. The evidence indicates that this incident was appropriately handled by the service and has now been satisfactorily resolved. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: A tour of the premise was undertaken in the company of the nurse in charge. The tour established that the home is in a good state of repair, is well decorated throughout and that the fixture, fitting and furnishing are of good quality. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 25 Access to the home has been created to accommodate people using wheelchairs, with a gently slopping ramp leading to the main entrance and two lifts provided for access to the first floor. The communal areas or facilities are also spacious and well set out, with the choice of lounge providing a variety of environment for the residents, whilst the bathrooms and toilets are large, accessible amenities. In discussion with both residents and relatives of residents the external areas of the home were praised, the extensive gardens being well laid out and maintained and the patio areas, one ground floor and one roof top, providing excellent views out across the surrounding countryside. Many of the bedrooms within the home provide en-suite facilities and profiling beds are provided in each room. During the tour of the premise it was established or observed that the rooms visited contained items of an individual nature, pictures, ornaments, pieces of furniture, etc, which had been used by the occupant to personalise their room. It was also evident that a difference existed between the way the younger adults, in the four bedded unit and the people residing in the main house personalised their rooms or were assisted to personalise their rooms, with the young adults possessing more electrically powered items, computers, games consoles, DVD’s, CD Players, etc. The maintenance of the home is over seen by one of the company directors, who the AQAA states is a qualified IOSH trained Health and Safety (H&S) Technician and that in addition to his ‘responsibility for H&S he holds a Portable Appliance Testing qualification and is reviewing the Fire Safety Risk Assessment Policy’.. All maintenance requests are documented by the staff in a logbook, which is accessible within the nurse office, the staff are required to identify the job that requires attention, its location and the perceived urgency. Once the task/job has been addressed the maintenance team sign off the job to confirm completion of the work required. The home employs domestic and laundry staff that were observed during the visit undertaking their duties. The home was noted to be free from odours and very clean and tidy throughout. The service informs us, via the AQAA that staff receive access to training on the management and control of infections and that policies and procedures are available, although again no indication is given as to when this document was last reviewed or updated. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 26 Communal toilets and bathrooms were noted to contain liquid soaps; paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. The laundry, which is located within the main building, is the responsible of the laundry personnel who laundering residents clothing and returning them to the clients room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person, although the laundry operative did say that if people bring in new clothes and forget to label them or inform staff this can lead to delays in returning items. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The service tells us via the AQAA that: ‘robust recruitment procedures including advertisements in the local press. Staff are advised of the job description and role of the job being recruited for before interview. Protection Of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks are always carried out and no new employee is started before their POVA check has arrived. Full ‘Skills For Care’ inductions programmes are carried out for care staff and in-house inductions completed for other designations. A mentor is assigned to all new employees who will work through the training programme and ascertain competence. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 28 Comprehensive training programmes are well established, both internally and externally. Mandatory training is delivered by qualified in house trainers who maintain their own competence by attending regular external training. Staffing levels and skill mix provide a diverse team who can meet the needs of the service users. Dedicated training manager who organises and promotes training – both internally and externally. The training manager timetables relevant training for staff and advises managers’ monthly about the staff who have training needs outstanding and progress of qualifications’. Copies of the home’s duty roster were seen during the fieldwork visit and these indicated that sufficient staff care, domestic and ancillary staff were on duty to meet the needs of the residents’. Details of the home’s staffing arrangements and the skills and experience of the staff are set out within the ‘statement of purpose’ document, which as mentioned is accessible to people within the home. Observations throughout the day confirmed that sufficient staff were employed at the home to ensure the needs of the residents’ were being meet, with nursing staff, care staff, domestic, laundry, catering, administration and the care co-ordinator all seen around the home during the fieldwork visit. In conversation with residents’ and/or their relatives the care provided by the staff was commended and people described as caring, committed and lovely by people. During the fieldwork visit we were provided with sight of the training matrix produced by and maintained by the nurse manager and training manager, these documents have been seen on visits to Northbrooke House sister homes’ and are informative documents, which are also used as part of the homes’ or company’s quality auditing process. Each staff member is also provided with their own training and development portfolio, these folders were seen during the fieldwork visit and provide further evidence of the training completed by staff, include e-learning training programmes. In discussion with staff the training opportunities provided at the home were felt to be good, with the catering staff all confirming the training they had completed and the activities co-ordinator confirming that she had completed the mandatory training events. Whilst chatting to the activities co-ordinator it became apparent that she has found it difficult to locate any specific training around her role, which is Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 29 relatively unique, although it was suggested that she try contacting Age Concern or Help the Aged, as they might be able to assist or provide advice. Information taken from the dataset indicates that currently the home employs forty-eight care staff. Thirty-eight of the forty-eight care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this gives the home a percentage of 79 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that five people are completing their NVQ, which would increase the percentage of staff holding an NVQ level 2 or equivalent to 89 should their be no staff change over in the meantime. Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the management staff when employing new staff. It also indicates that all of the people who worked in the home over the last twelve months had undergone satisfactory pre-employment checks. As the manager was absent from the home on the day of the fieldwork visit it was not possible to check the individual files of the staff most recently employed. However, given the homes’ previous history of compliance with this requirement and based on the information gathered at the inspections of Northbrooke House sister homes’ and the declaration made via the AQAA and Dataset we are satisfied that this outcome area is being meet. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35 and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The service tells us via their AQAA that: ‘the manager is a Registered General Nurse (RGN) with an NVQ level 4 and Certificate in Health and Social Services Management (Portsmouth University). The manager has 21 years experience of working in nursing homes’ and seven years at management level. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 31 The manager works closely with the corporate management team in developing the ethos and general business plan for the home. She has overall, day-to-day, operational responsibility for the running of the home and management of all staff and ancillary services. The manager is also the company’s trainer for safeguarding adults and displays a sound knowledge and understanding of protection and enables issues. She has a special interest in care planning and consequently these documents provide robust evidence of the delivery of care according to clients needs. Quality Assurance (QA) procedures require the manager to review significant performance indicators monthly that identify areas of good practice and also areas where performance could be improved. Action plans are developed as and when necessary to assist in efforts to constantly improve practice. Administration is provided by fulltime support and the backup of head office team in terms of financial and strategic planning. The manager is supported by the organisations training manager in developing comprehensive training support for all staff’. Previous inspection visits have established that the manager is appropriately qualified and experienced, as stated within the AQAA document, whilst the evidence gathered during this visit and produced in this report establish and/or confirm the managers’ competence for the role she performs. With good levels of information made available to the residents’ and their relatives/visitors, reasonably well maintained records, which are well structured and readily accessible, well managed activities programmes that enable people to make choices over what they do and when, robust complaints and safeguarding procedures and practices, a well maintained building and good staffing levels and a well trained and motivated staff group, all evidence of the managers’ effective day-to-day management of the home. In conversation with staff the manager was described as approachable, knowledgeable and good at her job, whilst the only criticism provided by professional visitors was the poor communication that exists at times between the varying parties involved in the delivery of care. As mentioned earlier in the report the manager is supported in her day-to-day role by two deputy managers’ both of whom are reasonably new to the posts but who are available to provide assistance to the manager, as are the corporate team referred to in the AQAA. The company’s approach to quality audit or assessment has been found to be good across all of its services, with a number of surveys and/or questionnaires Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 32 available to the managers and the ‘Group Liaison Manager’, who coordinate’s all evaluation of the service’s performance. Information gathered via the questionnaires is collated and used to inform or support the information used in the company’s performace indicators. Details of the monthly performance indicators, as mentioned within the AQAA and referred to above, are made available in a graphic depiction and displayed on the notice board within the reception area, making the information accessible to residents, visitors and staff. The performance indicators are designed to measure the services performanace againts key National Minimum Standards (NMS) and events such as accidents, incidents, deaths or complaints activity. The ‘Group Liaison Manager’ also undertakes visits to the home in accordance with Regulation 26 of the Care Homes Regulations. The reports produced as a result of these visits are robust and thorough and idenfity areas of good practice and areas where improvements in the service could be made. Residents meetings, as established, are regular occurences with records indicating that these are monthly events, the minutes of the last meeting documenting that people discussed: food, social activities and care practices, the meetings are arrnaged and chaired by the activities co-ordinator. Previous inspections have established and reported that the home does not become involved in the management of people’s monies or finances. Offering instead the opportunity for the person to join an invoicing scheme, whereby the service pays for any item required by the resident and then itemises this on a monthly invoice, which is provided for payment, receipts for items purchased are made available. At this visit it was established that no changes or alterations had taken place to this process and that people continue to be offer the opportunity to join the scheme of manage their own monies if they wish, each bedroom is fitted with a suitable locakable facility, as established during the fieldwork visit. The AQAA and Dataset information establishes that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. The AQAA also indicates that: ‘ A Director is an IOSH qualified Health and Safety (H&S) Technician and keeps up to date with current practice by attending regular external training’, and that in addition to his ‘responsibility for H&S he holds a Portable Appliance Testing qualification and is reviewing the Fire Safety Risk Assessment Policy’. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 33 Health and safety training is being made available to staff, with the training matrix and plan providing evidence of the courses attended and to be attended by staff, including: health and safety, infection control and moving and handling, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed, as highlighted by the service’s decision to improve the ramped access at the front of the home. Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 34 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 X 3 X X 3 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 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 35 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northbrooke House DS0000012563.V363259.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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