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Inspection on 03/08/05 for Bereweeke Court Nursing Home

Also see our care home review for Bereweeke Court Nursing Home for more information

This inspection was carried out on 3rd August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff seem to be open in their working they have been encouraged to speak out and are being assisted in their confidence to work at the home. The manager and deputy have worked with the trained staff in this and the outcome for the residents is that the staff are more aware of their needs and what they need to do to meet them. The pre admission assessment takes note of all needs of the individuals. Residents spoken with liked the meals and they were seen to be served in a way that suited the individual. The manager says she makes time to speak with relatives and has arranged meetings for them.

What has improved since the last inspection?

The documents used for the care plans have changed since the last inspection the manner in which they reflect the needs of the residents has improved, however there were gaps in the records with not all identified needs having an action to meet them. The storage and administration of medication has improved since the last inspection. Although in the samples seen there were some issues in the recording.

What the care home could do better:

The work on the care plans is to continue and they will be reviewed next time. The activities persons are also being supported to improve what is offered to ensure it is appropriate for the residents. The home needs to improve its fire safety records. The home also needs to ensure that the recruitment checks are thorough to protect the residents.

CARE HOMES FOR OLDER PEOPLE Bereweeke Court Nursing Home Bereweeke Road Winchester Hants SO22 6AN Lead Inspector Val Sevier Unannounced 03/08/05 10.00am 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 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 H54-4 bereweeke.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bereweeke Court Nursing Home Address Bereweeke Road, Winchester, Hants, SO22 6AN Telephone number Fax number Email 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 Care First Care Homes Limited (BUPa Care Services) Tracey Hillier CRH 56 Category(ies) of DE, DE(E), MD, MD(E), OP registration, with number of places Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 10 service users in the DE category can be accommodated at any one time. 2. A maximum of 3 service users in the MD category may be accommodated at any one time. 3. All service users must be at least 60 years of age. Date of last inspection 24/02/05 Brief Description of the Service: Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 4 hours. During this time the inspector was able to speak with several members of staff and residents. The manager assisted throughout and all staff were helpful throughout the visit. What the service does well: What has improved since the last inspection? The documents used for the care plans have changed since the last inspection the manner in which they reflect the needs of the residents has improved, however there were gaps in the records with not all identified needs having an action to meet them. The storage and administration of medication has improved since the last inspection. Although in the samples seen there were some issues in the recording. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 H54-4 bereweeke.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 standard(s) 3 and 4. 6 is not applicable at this service The home has a good understanding of residents needs using the assessment process. The staff seem to have a good knowledge of residents support needs. EVIDENCE: The inspector looked at 5 care plans and each individual had had an assessment prior to moving to the home. The assessments are comprehensive with information about physical and psychological needs of the individuals. It was observed that the information gained through the assessment had been used to complete the care plans. The inspector was able to observe interaction between the staff and residents at the home. The manager had explained that staff had undertaken training in dementia and communication and this was evident in the observed interaction. Staff spoken with had an understanding of the needs of individuals and said they felt able to ask the manager and deputy if they were unsure. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 9 The admissions policy and service users guide state that prospective residents and their relatives or representatives are encouraged to visit the home. Whilst at the home the inspector observed that relatives or representatives are encouraged to view the home and information is sent or given enabling and informed choice to be made. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 There has been a gradual improvement in the care plans and the information in them since the manager joined the home, with involvement of other professionals as needed, although work is still needed. From the last inspection it was seen there has been an improvement in the management of medication, however concerns remain. Staff were seen to behave appropriately with residents identifying their emotional and physical needs. EVIDENCE: The inspector viewed five care plans in conjunction with a sample of medication records and other health monitoring tools used at the home. When looking that the care plans it was seen that other professionals were also involved as necessary. Some individuals required continuing support from psychiatric services for example. The home is supported by the local hospital with community psychiatric nurses calling at the home as needed. The care plans had clear identified needs and action to be taken to assist the residents for some of their needs. In some case there were no plans evident regarding mental health needs. The plans had in some cases the strengths and Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 11 abilities of the individuals, which staff could then help to maintain. There were risk assessments and action to reduce risk. The care plans had not all been reviewed regularly, although there were daily notes, which enabled the inspector to have a picture of the daily life at the home for some. From written evidence of care plans and speaking with staff it would appear that there has been an improvement in the staff’s abilities, knowledge and skills to care for the needs of people at the home. It would also seem speaking with staff and relatives that no one is afraid to ask questions about issues of concern about needs. The manager stated that there were few treatments needed for sores. The one care plan seen where pictures had been taken of injuries and sores of someone admitted to the home recently, there were no plans for staff action regarding these issues. This was discussed with the manager and senior nurse on duty and it was understood that it would be rectified the same day. It was noted that one resident had had their needs reassessed with the result that new equipment was now being used. The staff felt that the quality of life for the individual had improved with the person being more communicative with smiles and words. A pharmacy inspection has been undertaken at the home in May 2005 when there were no requests for action. On this occasion the medication records were only sampled. There were some gaps where nothing had been recoded as to whether medication had been given or not. In one case a prescribed medication had been given ‘as needed’. These were discussed with the manager. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 The social needs of the residents at the home are as varied as they are individuals and with the loss of the second activity person not all needs are met. The home is encouraged to resolve this in order to accommodate as many needs as possible. Dietary needs of residents are catered for with a selection of food that meets resident’s tastes and choices, despite the current circumstances. EVIDENCE: There is currently one activities person working at the home at the moment. The manager has undertaken interviews and hopes to be able to offer activities seven days a week. a senior occupational therapist has been asked to assist at the home with training the staff in activities specifically for older persons with dementia, in order that the activities will be relevant for them. Currently there is a selection of activities such as music and exercise, reminiscence, crafts and external trips such as boat trips, cream tea at Paultons Park and a visit to the aviation museum. It was seen in some care plans that social and recreational interests had been recorded and the activity person completes an observation when an individual participates in an activity. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 13 Visitors sign in at the home and information for them and others is available in the hallway by the signing in book. Environment Health visited in July 2005 and some action was needed, some already planned by the home included the total replacement of the kitchen floor. On the day of the visit there was a temporary kitchen at the home with other arrangements regarding drinks and snacks. Although the menu had been altered to accommodate this temporary change there was still a choice for the residents, and their preference is recorded with copies kept. Fruit was seen to be available and residents can choose where to have their meals. Residents spoken with said they liked the meals. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 standard(s) 16 and 18 It would seem the manager and staff have worked at establishing a sense of openness at the home so that relatives and residents can voice their concerns. The home has training and information available regarding complaints and protection of adults. EVIDENCE: There have been no complaints made since the last inspection to the CSCI, the home has received one complaint from a neighbour and this was seen to have been resolved. The complaints policy was seen to be available in the foyer of the home. There have been two allegations regarding adult protection at the home since the last inspection. One has been resolved although action from it is still taking place at the home with regards to records. The second one has nearly been resolved and the staff member concerned has been dismissed. The manager undertakes training the staff in this area, and staff spoken with were aware of the whistle blowing policy and the training. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 standard(s) 19 and 26. The home is maintained and feels homely and relaxed. EVIDENCE: A tour of the home was undertaken. It was noted that the bathrooms and toilets now have large pictures on them enabling residents to identify them. Staff said that this was a useful indicator for residents and helped them to be independent. Maintenance is taking place at the home. The laundry was seen and the laundress explained that the home had come in the top twenty of BUPA homes in the region for its laundering and care of residents clothing. There was no odour detected in the home in the areas walked around with the exception of the corridor leading to the kitchen this was possible due to the floor having been removed and dampness. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 16 Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The level of staff and training programme would seem to meet the needs of the residents. The recruitment process and checks despite having improved still place residents at risk where they have not been carried out thoroughly. EVIDENCE: The inspector was able to see the rotas for the week of the inspection and older ones. All indicated that the staffing at the home is two/three nurses, with ten care staff in the am and nine in the pm. At night there are two nurses and four care staff. They are supported by activity and housekeeping staff. The staff spoken with felt that there are adequate staff and that holiday and sickness are always covered to ensure residents needs are met. The manager explained that the use of agency staff to cover the nursing hours has decreased and that they have regular agency carers now. She feel that this has helped in the improvements noted a the home The home has a clear and improved recruitment policy that covers all the elements for the protection of residents including criminal records checks and references. Discussion was had regarding when staff could be start work as the home has staff that have undertaken all checks but are awaiting their CRB, these staff are working supervised. Staff files that were sampled evidenced that the BUPA policy was being met. The manager has a training programme for the forthcoming year including mandatory training and areas needed to meet resident’s needs. Dementia Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 18 training has been arranged as well as control of infection, control of hazardous substances, health and safety food hygiene and whistle blowing. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36 and 38 The home regularly reviews aspects of its performance through a good programme of self-review and consultation, which includes seeking the views of residents, relatives and others, with evidence that the views are listened to and acted upon. There was a lack of evidence that health and safety for fire, is attended to protecting the well being of all at the home. EVIDENCE: The manager has worked at enabling trained staff to be confident and competent in their clinical role at the home. She has fortnightly meetings with them for updates, problem solving and clinical leadership. There is an expectation that staff attend at least once a month. Staff spoken with said that they found these useful that they had respect for the manager and the style in Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 20 which they were managed led to openness at the home within which they could discuss issues relating to the care of the residents. Meetings with relatives are held as needed and formally as a group every six months. The manager sends out notes to relatives updating them on issues and action at the home. The manager stated that appraisals have been undertaken on all but 12 staff now, that she offers supervision to the trained staff and heads of areas such as the cook and senior housekeeper. As yet the care staff and others have yet to receive supervision the manager is aware that this is needed and plans to have them in place in the next six months, once work has been undertaken with the trained staff. The Heath and Safety Executive visited the home in March 2005 and there were no issues. A fire inspector visited on 21st July 2005 and recommended that the home replace some existing bedroom doors with improved fire resistance doors. The records for monitoring equipment and fire training were seen. Training is planned and would seem to be meeting the twice a year request. The last date recorded for weekly tests was 13th July 2005; the last monthly test regarding emergency lighting was June 2005. There was a record that the fire equipment had been seen in July 2005. The home keeps a record of accidents/incidents at the home for staff and residents. It was highlighted to the manager that this file was in reception by the front door and contained personal information. Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 3 x x 2 x 2 Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? 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 29 Regulation 19 Schedule 2 Requirement The registered person must ensure that CRB checks have been received before employment has commenced unless alternative arrangements have been agreed. (This is a repeat requirment from November 2004) The registered person must ensure that records are maintained regarding the checks for fire safety. Timescale for action 31/08/05 2. 38 23(4) 31/08/05 3. 4. 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 Good Practice Recommendations Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 23 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton, Hants 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. Extracts may not be used or reproduced without the express permission of CSCI Bereweeke Court Nursing Home H54-4 bereweeke.doc Version 1.40 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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