Care Home: The Brooklands

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What the care home does well The Brooklands provides a safe, comfortable and relaxed environment for the people who live there, and they are encouraged to personalise their rooms with their own possessions and furniture and treat it like a `home from home`. They are encouraged to join in with the regular activities arranged by staff, and the importance of maintaining links with family, friends and the community is also recognised and supported. Although the home was originally founded with strong Christian principles, and communion is still arranged through the local church, a commitment to this is no longer a requirement for coming to live there. The residents are admitted to the home following a full assessment of their individual needs, and care and support is provided by a staff team that has been recruited and trained properly. Everybody spoken to at the home felt that residents are treated with respect and this was especially important as several of the residents are very frail and have poor mental health. Links with professionals from the local social and health care networks are particularly good and the home receives their support to enable the full range of resident needs to be met. Residents were positive about the meals provided at the home, and they stated that they were provided with choice and variety. Similarly they were positive about the standards of cleanliness and hygiene around the home, and that everybody was working hard to make them as comfortable and happy as possible. What has improved since the last inspection? Care records and documentation have continued to be improved so that staff work more safely and consistently, and this is linked to the information provided by outside professionals who may be involved with people before they come to live at the home. The physical environment of the home has continued to be improved and a number of problems identified at the last inspection have been dealt with. CARE HOMES FOR OLDER PEOPLE The Brooklands Coombs Road Bakewell Derbyshire DE45 1AQ Lead Inspector Brian Marks Unannounced Inspection 9th April 2008 09:00 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 The Brooklands DS0000019949.V362074.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. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Brooklands Address Coombs Road Bakewell Derbyshire DE45 1AQ 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) 01629 812023 01629 814105 Christian Homes for the Elderly Mrs Diane Margaret Ashbrook Care Home 19 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (9) of places The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2007 Brief Description of the Service: The Brooklands is a care home that has been operated by Christian Homes for the Elderly, a non-profit making organisation, for over 50 years. Although it has retained its spiritual focus this is no longer a criteria for coming to live at the home. It is in an old building, which has been adapted to residential home use, and is situated in its own grounds on the outskirts of Bakewell. It is registered to provide services for 19 older people, including for 10 who have been diagnosed with suffering from with dementia. The ground floor communal area allows for a choice of lounge and dining room and activities and family meetings can take place in these areas or in the bedrooms situated over tree floors. Access to the upper floors is mad via a passenger lift. The current scale of charges is £435.00 to £450.00 per week. Additional charges are made for hairdressing, toiletries podiatry and newspapers. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a Key unannounced inspection that took place at the home over one day. Additionally, time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us and the written annual quality assurance assessment document (AQAA), which was returned before the inspection. This allowed for the preparation of a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent with the manager of the home, who was in charge during the visit, members of the Committee who operate the home and talking with all five of the staff working on the day shift. The care records of four people who live at the home were examined in detail and one of these was interviewed along with two others who were living there on the day of the inspection. Because of the capability of the majority of residents of the home they were unable to contribute directly to the inspection, but during the tour of the building and in the afternoon we were able to observe life at the home and the activities of staff caring for the residents. A family visitor and a care manager, who were at the home during the inspection, were also spoken to. No other inspection visits have been made to the home since the last Key unannounced inspection 2 April 2007. What the service does well: The Brooklands provides a safe, comfortable and relaxed environment for the people who live there, and they are encouraged to personalise their rooms with their own possessions and furniture and treat it like a ‘home from home’. They are encouraged to join in with the regular activities arranged by staff, and the importance of maintaining links with family, friends and the community is also recognised and supported. Although the home was originally founded with strong Christian principles, and communion is still arranged through the local church, a commitment to this is no longer a requirement for coming to live there. The residents are admitted to the home following a full assessment of their individual needs, and care and support is provided by a staff team that has been recruited and trained properly. Everybody spoken to at the home felt that residents are treated with respect and this was especially important as The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 6 several of the residents are very frail and have poor mental health. Links with professionals from the local social and health care networks are particularly good and the home receives their support to enable the full range of resident needs to be met. Residents were positive about the meals provided at the home, and they stated that they were provided with choice and variety. Similarly they were positive about the standards of cleanliness and hygiene around the home, and that everybody was working hard to make them as comfortable and happy as possible. What has improved since the last inspection? 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. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 7 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 The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 8 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): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being fully identified. EVIDENCE: Four resident care files were looked in detail at this inspection and all had information about the person and an assessment of their needs, taken at the time of admission and either provided by outside professionals such as local hospital staff, or obtained by a senior member of staff from the home. For people coming to the home from hospital, detailed information was given about specific healthcare issues and additional information was sought about difficult areas such as poor mobility, falls, and mental health needs. Three of the care records looked at also contained a detailed life history of the person and contained information about their strengths and achievements. All of the people spoken to, including residents, said that their needs were being met; this was also confirmed by the observations of a social worker from the local Mental Health Team who has had considerable professional contact with the home and its staff. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 9 The home does not offer an intermediate care service so Standard 6 does not apply. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care arrangements to meet the health, personal and social care needs of people living at the home are planned and delivered safely and consistently, and in ways that respect their individuality and dignity. EVIDENCE: All residents have their own file containing their care records and four of these were looked at in detail during this inspection. The care plans in place focus on a broad range of areas where each individual needs help, and are completed as a series of evaluations of progress being made rather than action steps that need to be taken. Areas of healthcare activity are described in detail and taken together with other care records give an overall picture of how the resident’s needs are being met by the activities of the staff. The regularity of these activities being reviewed varies within the different elements of each care plan and for different individuals, and none met the required standard of monthly evaluation with one not having had an overall review in the past year. The care activities are further supported by assessments of risk areas and ways these are managed, and these cover such topics as wandering, falls, The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 11 aggressive behaviour, personal handling needs where there are mobility problems, and an assessment of the bedroom areas for possible hazards. These are being periodically reviewed. Contact visits made by a wide range of health professionals are well recorded including regular contact from district nursing services, and the use of specialist equipment such as stand aid, hoists and safety equipment in the bedroom, such as pressure mattresses, bedrails and ‘cocoons’, are properly managed and recorded. Observations of care practice by staff in the communal areas indicated that they take care to relate to all residents in a sensitive and friendly way, and the style of communication is appropriate to the needs of people with dementia. Whilst the practical activities of staff are ‘person centred’ and individualised the style of care plan documents, referred to above, does not fully support this sort of approach. People spoken to were all very positive about the standards of care at the home and one resident spoken to, who spends much of her time in her room, described how staff respected her wishes and how they are ‘respectful and good at caring’. Another described how ‘this is a well organised home; I am well looked after and quite satisfied with my life here’. The social worker spoken to was particularly positive about standards of café at the home and how effective it was in supporting people with moderate degrees of mental ill health and in helping them improve their emotional, behavioural and physical problems: ‘They get things done here – its one of the best. The relaxed atmosphere helps people settle and the positive attitude of the management and staff are important reasons for its success’. Staff look after the medicines of all residents and the medication administration record (MAR) charts for four residents were specifically examined; systems for storage, recording and administration of medicines on their behalf were generally satisfactory at the time of this visit. However, three of the handwritten sheets on the MAR had not been signed and dated and, although there weren’t any controlled drugs prescribed for residents at the time of the inspection, the arrangements for storage do not comply with the latest legislation, introduced in 2007. The home also had its own policy on dealing with medication. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for people living at the home to take part in leisure and social activities are organised, and generally they enjoy a life that suits them. EVIDENCE: Social activities are organised at the home to meet the broad needs of the resident group and two members of staff have benefited from active involvement with the charity ‘First Taste’. This organisation provides activities at the home for a day every two weeks and these recently there has been pottery, music and chair-based exercise. Other activities described by staff and residents include outings, shopping walks, organist and vocalist, games T.V. and clothing sales. A hairdresser attends regularly and a representative from the local church comes to the home every 2 weeks to give communion. The residents and friends spoken to described daily routines that are flexible, with residents getting up when they want to and some spend much of their time in their room, their preferred option. Care records indicated regular visits from family and friends and the residents spoken to described how they sometimes go out with families or friends. Currently there are no restrictions on when visitors arrive and the home has an open door policy. The residents are all encouraged to personalise their rooms The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 13 as they wish and bring in their own possessions. Evidence of this was seen during the tour of the home. People spoken to during the visit were happy with the meals provided: ‘The food is very good and they don’t keep me hungry’. The dining room is attractively set out with residents being given a choice of where they sit and lunch was observed to be relaxed affair and it was clear that all residents enjoyed their meal. A visit to the kitchen showed that the purchase, storage and stock control of food are satisfactory and that daily preferences from the four-week menu, which has two choices available for the lunchtime main meal, are catered for. Breakfast and teatime meals can include a hot option if required. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 14 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: The home has its complaints procedure on display, and this contains information about how to contact the Commission for Social Care Inspection at any time if they wish to do so. The complaints record was examined and showed that five complaints had been received at the home over the previous year, all of which were responded to within a twenty-eight day period. The people spoken to said that they would contact the manager if they had any concerns and were confident of being listened to. There had been no formal complaints received at the Commission during the past year. The homes policy on safeguarding adults has been updated, as required at the last inspection and, although it describes the responsibilities of the home’s management in relation to the local statutory authorities, the need to refer to Council Social Services Department at the first instance of any suspicions being apparent was not emphasised. All staff have received training in their responsibilities for recognising and reporting the possible abuse of vulnerable people, and the manager described her intention to refer all staff to the more comprehensive training provided by the Social Services Department, which she and the deputy manager had attended previously. There has been no reported incident of the sue of the statutory procedures since the last inspection. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 15 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, maintained environment and standards of cleanliness and hygiene are satisfactory. EVIDENCE: The home is set in extensive grounds with a view from most bedrooms and living areas down across the Wye valley. It is homely, light and comfortable in appearance with some older furniture in corridors and communal areas, in keeping with the age of the building. Refurbishment activities have taken place as required at the last inspection and the manger reported that: • Armchairs and new beds have been purchased and redecoration has taken place in bedrooms where needed. • Carpets have been replaced in the stairs and hallway. • Cleanliness has been improved with changes to infection control and cleaning practices. Whilst the standard of outside painting of a number of windows remains poor, this does not affect resident safety, but the lack of proper locking The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 16 arrangements on bedroom doors does affect individual security and privacy, and resident preferences have not been recorded in care records. The home has an infection control policy and procedure, and records indicate that staff have continued to receive update training in this subject. The laundry was tidy and the washing machines have a sluice wash facility. On the day of the inspection the home was clean, tidy and free from odours and the residents spoken to had no complaints about the laundry service; all residents observed in the home wore clean and well-presented clothing. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 17 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): 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. People living at the home benefit from being looked after by staff who are on duty in satisfactory numbers and who have been properly recruited and trained. EVIDENCE: Staffing provision at the home has continued at the same level as at the last inspection and, whilst some of the people spoken to said that sometimes staff were very busy, they did not view the numbers of staff on duty to be lower than was required to meet the needs of the people living at the home. Whilst the home operates one long day shift for staff to work through, nobody commented unfavourably about this arrangement. All of the staff spoken to said that there was good commitment to training and development of skills at the home and records and notices in the staff office support this. During the past year there has been update training in the key subjects of safeguarding vulnerable people, safe moving and handling, managing infection and fire safety. Some staff have had training in relation to caring for people with dementia and another session is planned for those that missed this. The senior staff responsible for administering medicines have also been appropriately trained. Good achievements have been made in helping staff gain a care qualification and seven out of eleven have the National Vocational Qualification level 2 with four having achieved the higher level 3, in excess of the required national target, which is to be commended. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 18 The recruitment files of the two most recently appointed care staff were looked at and a systematic approach to selection was in evidence, indicating that all the checks required by law had been made before they started work at the home. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a well-managed and safe environment in which to live and work, and everybody involved with it is given the opportunity to give their views on how it is being run. EVIDENCE: The current manager of the home was appointed in early 2007, having previously worked at another home within the Christian Homes Group. She is registered with the Commission for Social Care Inspection, has achieved the Registered Manager’s Award, and has several years experience and skills in running residential homes. People at the home spoke positively about the impact she has made and how a relaxed approach to caring has been allowed to develop. Staff said that they were well supported if they have problems and ‘hands on’ contact is the usual way the home is run. This does not extend to The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 20 formally arranged individual meetings for staff and records indicated that most had met infrequently on a one-to-one basis with the manager in the past year. Members of the Christian Homes Committee are regularly at the home, including the chairman who visits weekly, and all have recently completed summary reports on the running of the home that indicates their visiting pattern and observations about the running of the home. They also share responsibility in completing the formal monthly visit that is required by law. The manager completed a survey of resident/relative satisfaction during 2007 and the results of this are posted on the wall of the lounge area; high levels of satisfaction with the home and its staff are indicated by this exercise. The systems for the safe keeping of residents’ personal spending money have been in place for some time and these remain unchanged from the last inspection. Information on the home’s health and safety procedures and maintenance activity was provided in the previously returned AQAA and this confirmed that all the relevant checks had been undertaken. An examination of a sample of records and observations around the building further supported this. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 2 X 3 The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2) Requirement Individual care plans and risk assessments must be reviewed at regular intervals and evaluated for their effectiveness, so that care staff are supporting people who live at the home in consistent and safe ways. The storage arrangements for medicines defined under the schedules of the Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 – controlled drugs – must be updated to comply with the law and to ensure greater safety of resident property. Timescale for action 31/07/08 2. OP9 13(2) 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP36 Good Practice Recommendations Staff supervision should take place every two months and DS0000019949.V362074.R01.S.doc Version 5.2 Page 23 The Brooklands include career development needs, and philosophy of care in the home. The Brooklands DS0000019949.V362074.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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