Inspection on 12/12/05 for Bereweeke Court Nursing Home

This inspection was carried out on 12th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bereweeke Court Nursing Home 27/10/08

Bereweeke Court Nursing Home 25/08/06

Bereweeke Court Nursing Home 03/08/05

Bereweeke Court Nursing Home 25/11/04

Bereweeke Court Nursing Home 12/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bereweeke Court Nursing Home Bereweeke Road Winchester Hampshire SO22 6AN Lead Inspector Isolina Reilly Unannounced Inspection 12th December 2005 09:30 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 Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bereweeke Court Nursing Home Address Bereweeke Road Winchester Hampshire SO22 6AN 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) 01962 878999 01962 863663 hilliertupa.com Care First Care Homes Limited (BUPA Care Services) Mrs Tracey Louise Hillier Care Home 56 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (56), Mental disorder, excluding learning of places disability or dementia (3), Mental Disorder, excluding learning disability or dementia - over 65 years of age (15), Old age, not falling within any other category (56) Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 10 service users in the DE category can be accommodated at any one time. A maximum of 3 service users in the MD category may be accommodated at any one time. All service users must be at least 60 years of age. Date of last inspection 3rd August 2005 Brief Description of the Service: Bereweeke Court is a care home providing nursing care. The home is registered to accommodate 56 service users in the categories of old age, dementia and mental health types care needs from 60 years of age. The home is situated in a pleasant residential area on the outskirts of the city of Winchester and is close to local amenities that residents can access with the support of relatives/staff. The home is owned by a large national organisation. The building was originally part of a private hospital and lends itself to being fragmented. One double and twelve single bedrooms have en-suite facilities. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second unannounced inspection for this service that took place over one day. The opportunity was taken to view records, procedures and talk with residents and staff. The inspector also had the opportunity to observe the lunchtime meal and interaction between residents and staff. The inspector was able to speak with several residents, registered nurses, carers, cleaners and kitchen staff. They all stated they felt the home provides a good service. A full summary of the home’s assessment against the key National Minimum Standards is available by reading this and this year’s previous inspection report of 3rd August 2005. What the service does well: What has improved since the last inspection? The records kept by the home on how to care for the individual resident have improved since the last inspection. The home has looked at ways to reduce the number of falls that residents have. They have increased staff numbers so that there is a carer in each lounge during the day when the residents are there. The home has looked at other causes of falls and made changes. The number of falls is now much lower and the home continues to look at ways of trying to stop falls from happening too often. Since the last inspection, the home has meet the two requirements issued. All new staff recruited have had the necessary checks done before starting work. The home is now keeping a proper record of all the fire safety checks. The staff say the home is more settled and this manager is running the home well. They feel it is a nice place to work. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 6 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. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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 Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The home does not provide ‘Intermediate Care’. EVIDENCE: The deputy manager confirmed that the home does not provide ‘intermediate care’ rehabilitative short-term type care for Social Services. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 The residents are well looked after in respect of their personal, emotional and health care needs. There is an improving care planning system in place providing staff with the easily accessible information they need to meet most of the residents’ needs. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure residents’ medication needs are met. EVIDENCE: The residents spoken with were all complimentary of the care provided by the home. Stating that staff are very helpful, polite, appear to know what they are doing and look after them well. The inspector observed the staff interacting with the residents and found them to be attentive and professional. There were staff around most of the time in the communal areas. The deputy manager explained that part of the home’s strategy for reducing falls was to ensure that a member of staff is always present in each of the communal lounge/diners. The inspector when visiting the communal areas observed this. Refreshments were observed being made available to residents. From the Care Homes Regulations 2001, regulation 37 incident reports it was noted that the home has had a history of excessive number of falls. This number has been reducing over recent months. The manager and staff have Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 10 been assessing records of when, where and why the falls occurred. The deputy confirmed that no obvious trends were identified. However, it was noted that many falls took place during the busy times within the home when staff are providing individual care and are not readily available in the communal areas. The home has subsequently increased staffing levels to ensure there is a staff member present in all lounges during the day. At nighttimes risk assessments were undertaken regarding individual residents with a history of falls and wandering to reduce any potential risks. The home has either provided safety equipment or removed equipment such as bedrails where they increase anxiety levels. The night staff continued their frequent checks throughout the night. The deputy manager and staff spoken with confirmed this and evidence was seen in care plans sampled. The deputy manager stated that an optician regularly checks residents’ eyesight. The optician now marks the glasses with the individuals name so that staff can quickly check if the correct pair is being used. Records sampled confirmed this. The staff and deputy manager spoken with stated that the residents clothing and footwear were checked to ensure they fitted correctly. It was found that some of the female residents had tripped over their long flowing skirts when trying to get out of the chair. So the home was able to advise the service users and family that more appropriate clothing is available like trousers or shorter skirts. The deputy manager confirmed that at risk residents had recently had their medication checked to ensure that this was not causing a problem. There is one resident receiving palliative care that is on high dosages of medication said to be contributing to a number of falls. However, in this case the priority is to manage the resident’s pain relief and staff working with other professionals have tried different ways to reduce the risk of falling. The deputy stated that she was not aware of recent guidelines and research regarding the ‘Falls prevention in the elderly’. She is unaware if the manager has this information. This was briefly discussed and the deputy advised where to access the information from. The inspector sampled seven residents’ files. The care plans contained written risk assessments and instructions to staff on how to look after the individual. The records also included names of relatives, friends, health care professionals and social services care managers who are involved in supporting the client. A recent photograph was seen on the files. Five out of the seven care plans sampled had been regularly reviewed. However, two care plans had yet to be reviewed for November 2005 but there was evidence in both files of recent changes to care needs had been included and care instructions to staff up dated. The deputy manager explained that the month of November had been exceptionally busy as a large number of new staff had started working at the home. This meant that the routine reviews had been prioritised to essential changes only for a small number of plans. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 11 The manager, the deputy and some staff have recently undertaken training in ‘Falls prevention in the elderly’ and are in the process of disseminating the training to all staff. The deputy was able to confirm that the home has reduced its falls rate down to an average of 5 per month but continue to look at ways to further reduce this. This trend of reducing falls is evident in the reduced number of Care Homes Regulations 2001, regulation 37 incident reports received by the commission. However, in the month of November 2005 thirteen regulation 37 reports detailing ‘falls’ were received. From speaking to the staff and deputy manager it was evident that at least three of the residents’ presented with behavioural type care needs. However, on sampling the care plans the behavioural type care needs and instructions to staff were yet to be added. This was raised at the previous inspection visit and the deputy agreed it was an important element of caring for residents with dementia/mental health type care needs. The deputy manager gave a verbal undertaking to ensure that all residents’ with a diagnosis of dementia and/or mental health care needs would have a specific care plan including risk assessment, triggers for behaviour and clear instruction for staff on how to provide care for them. One carer spoken with stated that he and some colleagues had recently attended a training course in dementia looking at care strategies and care plans that they are going to disseminate to the rest of the staff group. The deputy manager confirmed this. There were records of doctor, nurse visits and information on outpatient, dental, optician and chiropractic appointments. Some residents stated that the visiting dentist and opticians had recently seen them, although one new resident stated that they had yet to see a dentist and optician. This was discussed with the manager and deputy who stated that the resident has only been resident for less than two weeks and will be offered an assessment with the visiting dentist and opticians. The recent treatment and the corresponding medical notes were present in the file. The commission’s pharmacists have completed a satisfactory pharmacy inspection on the home this year. The staff were observed administering medication appropriately and the good medication administration practices are reflected in the home’s policy and procedures. The home uses the Nomad system from dispensing. The medication is correctly stored in appropriate cupboards on each floor within a locked medical room. The home uses a recognised pharmacists system for recording the receipt and administration of medication. Each resident’s record has a recent photograph. The registered nurses administer the medication. The receipt, administration and disposal records of medication were seen by the inspector and found to be satisfactory. The deputy showed the inspector one of the home’s medical rooms and cupboards were found to be clean clinical areas with medication stored correctly in date and in sufficient quantities including dressings. The registered Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 12 nurses double check prescriptions for quantity and ensure that unnecessary items are not being prescribed. The deputy manager confirmed that she regularly undertakes a full audit of medication rooms and stock levels. The registered nurses and deputy manager confirmed that the nurses also undertake regular updates on medication practices. A copy of the Royal Pharmaceutical Guidelines for residential care was available a long with the most recent ‘BNF’ pharmaceutical reference book. It was noted that the home has samples of staff signatures and initials. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key standards were assessed and met at the previous inspection on the 3rd August 2005. EVIDENCE: Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key standards were assessed and met at the previous inspection on the 3rd August 2005. EVIDENCE: Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The above key standards were assessed and met at the previous inspection on the 3rd August 2005. EVIDENCE: Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 The home is finding it difficult to achieve the percentage of care staff with qualifications in care. Since the last inspection, the recruitment procedures have been improved and are satisfactory ensuring clients are not put at risk. Key standards twenty-seven and thirty were assessed and met at the previous inspection on the 3rd August 2005. EVIDENCE: The residents spoken with described the staff as ‘caring, friendly, helpful and there when they are needed.’ All the residents and staff spoken with said there was sufficient staff around and that the staff know what they are doing. The recently recruited staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to sample five new staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. Since the last inspection, the home has ensured that all new staff only commence working when a minimum of satisfactory Protection of vulnerable adults (POVA) first check and references have been received. This was confirmed by the staff spoken with and records sampled. The requirement raised at the previous visit has been met. The deputy manager explained that the home had put forward several staff to commence National Vocational Qualification (NVQ) level 2 and 3 in care, for January 2006. This would have demonstrated that the home is working towards meeting the minimum fifty percent of carer staff to have a qualification in care. The deputy manager explained there has been a recent corporate decision stating that only carers over 25 years of age are eligible to Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 17 undertake these qualifications. This means that none of the carers names booked to commence the qualification for January are able to do so, as they are all under 25 years of age. The deputy and one member of staff spoken with voiced their concerns regarding this corporate decision and feel ‘let down’ by the organisation. There is also a concern that the home’s programme to increase the quality of care provision through supporting carers to achieve qualifications in care has been set back. The deputy manager confirmed that out of the twenty-eight carers currently employed at the home one has achieved NVQ 2 and one NVQ 3 with another carer in the process of completing. This means the home has achieved ten percent of care staff with a qualification in care. The deputy stated that on the manager’s return from recruiting staff overseas they plan to investigate this corporate decision and the impact it is having on the home with the organisation. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The home is run well by an experienced manager and skilled deputy. The home provides a safe and auditable recording system for managing and monitoring clients’ money. The residents’ health, safety and welfare are appropriately promoted by the home to ensure everyone is protected. Key standard thirty-three was assessed and met at the previous inspection on the 3rd August 2005. EVIDENCE: The manager has many years experience in running a nursing home. This is evident in smooth running of the service and a staff team that was observed works well together. The manager undertakes regular updating training with the staff team and has a National Vocational Qualification Registered Manager’s Award and is a registered general nurse and mental health nurse. She maintains her nursing registration. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 19 The staff spoken with confirmed that there is a clear line of authority within the home. The management is always looking for ways to improve the service and efficiency. All the staff spoken with stated that the home has greatly improved since this manager has been in post with things being more settled and morale was high. They stated it was a nice place to work with good support and training. The deputy confirmed this stating that before the arrival of this manager the home had undergone a period of unsettlement due to several new managers having come and gone. The residents stated that the home help them to look after their money safely. The administrator of the home showed the inspector the electronic recording system for monies in, out receipts and balances for the clients. The inspector was unable to assess an individual’s balance was correct as the home keeps all monies in one account and/or in a separate petty cash tin. The electronic records were clear and each resident had their own account line. The administrator explained that the organisation calculates the interest made on an individual basis and this is clearly shown on each resident’s account summary. Should a resident want some money then this is taken out of the separate petty cash tin and appropriate records are made. Receipts for any transaction are kept and the system is fully auditable regularly by the organisation. The inspector was shown the electronic records and recent receipts kept at the home, which corresponded to the electronic record. However, the residents are only able to access their money when the administrator is on duty as she is the only member of staff with access to the home’s safe were the tin is kept securely. The central storage of all monies even though records are kept separately was discussed with the deputy manager and administrator. The administrator confirmed that an agreement had been set between the organisation and the commission stating that the currently system being used by the organisation nationwide is acceptable. The home’s maintenance person explained the system and shared the maintenance certificates for the home’s electrical and gas systems and appliances. This demonstrated that the home is maintained within good working order. The inspector viewed several areas in the home when speaking to staff and residents. The home appears clean, warm tidy and in good decorative order. The home has a system of testing the fire alarm weekly. The inspector was able to view records that confirmed that the home has tested the fire alarm, undertaken visual checks of fire extinguishers, emergency lighting and smoke alarms. There were also recent maintenance certificates for all fire safety equipment within the home. This was a requirement raised at the previous inspection that the home has met in full. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 20 The inspector was able to see the home’s file and risk assessments for the safe storage and use of chemicals that may be hazardous to health. Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 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. 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 Bereweeke Court Nursing Home DS0000012165.V270763.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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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