Inspection on 30/01/07 for Birdsgrove Nursing Home

This inspection was carried out on 30th January 2007.

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

Birdsgrove Nursing Home 22/03/10

Birdsgrove Nursing Home 07/12/09

Birdsgrove Nursing Home 21/01/09

Birdsgrove Nursing Home 07/02/06

Birdsgrove Nursing Home 29/09/05

Birdsgrove Nursing Home 13/12/04

Birdsgrove Nursing Home 04/06/04

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 Birdsgrove Nursing Home Warfield Road Bracknell Berkshire RG12 2JA Lead Inspector Mike Murphy Unannounced Inspection 10:00 30 January 2007 th 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 DS0000010975.V325369.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. DS0000010975.V325369.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birdsgrove Nursing Home Address Warfield Road Bracknell Berkshire RG12 2JA 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) 01344 422261 01344 303173 birdsgrove@asterhealthcare.co.uk Southern Counties Care Limited (Aster Healthcare) Ms Mary Jane Katherine Slater Care Home 87 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (67) of places DS0000010975.V325369.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users not to be admitted under 60 years of age for long term care. Service users under 60 years of age to be admitted for respite care only. 7th February 2006 Date of last inspection Brief Description of the Service: Birdsgrove Nursing Home is registered for 67 Old Age (OP) and 20 Dementia (DE) service users above the age of 60 years. Although the home is registered for 87, due to changes in the accommodation it now accommodates 78 residents. On 21 December 2006 ownership of the home transferred to Aster Health Care. The home is situated on the borders of Bracknell in a residential area on the main thoroughfare to the village of Warfield. The home is divided into three wings determined by the development of the establishment over time. The Surrey Wing (23 places) originally a large domestic home which has been converted, the Berkshire Wing (35 places) a purpose built 2 storey extension, and the Kent Wing (20 places), a single storey extension built in the 1990’s for service users with dementia. Fees at the time of this inspection were between £550 and £745 per week. DS0000010975.V325369.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in January 2007. The inspection methodology included discussion with the registered manager, service users, staff and visitors, consideration of information supplied by a relative and resident respondent who completed CSCI survey forms, and information provided by the registered manager, both in advance and on the day of the visit. The visit to the home was conducted by one inspector in one day, between 10:00 and 20:00 hours. It included discussion with staff, residents and visitors, examination of records (including care plans), observation of practice, and a tour of the home. Birdsgrove Nursing Home provides care for up to 78 older people, some of whom are very frail. The home is divided into three wings, one of which provides special care for 20 older people with dementia. Each wing represents a different stage in the development of the home. Surrey Wing is based in the original house. Berkshire Wing is based in a later development. Kent Wing was built in the 1990’s. The home was taken over by a new owner a few weeks before this inspection. There are shortfalls in the environment in Surrey and Berkshire Wings which need to be addressed. These include poor standards of décor, a persistent unpleasant odour which permeates some parts of the building and a lack of communal accommodation in Berkshire Wing. It is understood that the new owner has plans to refurbish, and in some areas rebuild, parts of the home and to improve standards throughout 2007. The majority of residents are referred through local authority care managers in services for older people. About 10 were privately funding. Standards of care are good. The home has a thorough system for assessing the needs of prospective residents. The qualities and skills of staff to meet those needs are acquired through the home’s procedures for staff selection, induction, training, development, supervision and appraisal. In addition to care staff, the home employs a physiotherapist, two activity co-ordinators and a range of ancillary staff. The views of residents and relatives obtained on this inspection are positive. There seems to be a good level of agreement between the views of residents and relatives, of respondents to the home’s own quality assurance survey in 2006, and the impression gained on this inspection, that whatever the deficiencies in the environment the care provided is good. Residents receive care in a home which provides a safe and generally comfortable place to live and which endeavours to meet their needs. What the service does well: DS0000010975.V325369.R01.S.doc Version 5.2 Page 6 The home ensures that staff are trained and supervised to carry out their roles in meeting service users needs. Service users and relatives gave positive reports on the care provided by the staff. The home has good systems for dealing with complaints and the protection of vulnerable adults. What has improved since the last inspection? What they could do better: Daily entries in residents’ records should include reference to psychological and social aspects of residents’ lives in the home as well as of the physical care provided. This should reflect the ‘holistic approach’ expressed in the home’s philosophy of care and address the varying needs of individual residents. Arrangements for providing assistance to residents on Berkshire Wing should be reviewed in order to ensure that all residents in need of such support are provided with food served at the correct temperature. The unpleasant odour which permeates some areas of the building should be eliminated by identifying and treating the cause. This will improve the environment for residents, staff and visitors. DS0000010975.V325369.R01.S.doc Version 5.2 Page 7 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. DS0000010975.V325369.R01.S.doc Version 5.2 Page 8 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 DS0000010975.V325369.R01.S.doc Version 5.2 Page 9 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 Standard 6 does not apply to this home. Quality in this outcome area is good. The home’s systems and procedures for assessing the needs of prospective residents prior to admission aim to ensure that it is satisfied it can meet the person’s needs should they decide to move in to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Referrals are accepted from statutory organisations, mainly Social Services authorities, and private individuals. At the time of this inspection around 10 of residents were privately funding. 90 were funded by statutory organisations. The process is usually as follows. Referrals from Social Services organisations are made through care management channels. The referring care manager enquires if the home has a suitable vacancy. In some cases a representative of the prospective resident, usually a member of their family, may make such an enquiry having been given information on the home by a care manager. The representative is invited to visit and view the home. On that visit they have an DS0000010975.V325369.R01.S.doc Version 5.2 Page 10 opportunity to talk to staff, view the accommodation, consider the care programme and discuss the particular needs of the prospective resident. They are given an information pack to take away. The registered manager said that it was rare for the prospective resident to attend such visits because of their frail health. Where an enquiry progresses to an application, the registered manager, deputy manager or training co-ordinator (all of whom are registered nurses) makes an appointment to visit the prospective resident and conduct an assessment of needs. The assessment is structured by a comprehensive assessment form. Additional information may be sought from members of the family, the person’s GP or district nurse. The information acquired is considered by the home and a decision made. In most cases the home accepts the referral but there are some problems – aggression and violence which can be a feature in some stages of some dementias for example – for which it is not equipped to cope. The care manager and family are informed of the decision. The process for private referrals is similar but the home deals directly with the family and does not involve care management channels. The file of one recently admitted resident was examined and provided evidence that the home carries out a thorough assessment before the resident is admitted. Standard 6 does not apply to this home which does not provide intermediate care. DS0000010975.V325369.R01.S.doc Version 5.2 Page 11 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, 10 and 11 Quality in this outcome area is good. Residents care plans are based on a comprehensive assessment of needs, are well written and support the provision of good care to residents. Liaison with healthcare agencies in the community is good. However, weaknesses in recording psychosocial aspects of care could compromise the quality of the overall care provided to some residents. The home’s arrangements for the control, storage and administration of medicines are generally satisfactory and aim to ensure that medicines are correctly administered and minimise risk to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A care plan, based on a comprehensive assessment of needs is in place for each resident. Care plans are well structured. Each of those examined included the following: a recent photograph of the resident, a medical history, a life history (a one page summary of the person’s life written by a relative, usually spouse or child), weight chart, Waterlow pressure sore risk indicator, and an assessment based on activities of daily living. DS0000010975.V325369.R01.S.doc Version 5.2 Page 12 Risk assessments (RA) included the pressure sore RA referred to in the last paragraph, moving and handling RA, falls RA, nutrition RA, and risk assessments specific to individual residents. The last named for example, included increased risk related to disorientation, agitation, and poor eyesight. Care plans also included a ‘Well-Being’ chart (of particular relevance to residents with dementia), continence assessments, a record of the person’s wishes in the event of death, a memorandum agreed between the resident or their representative, the home and the resident’s GP on resuscitation, and a record of any food allergies and likes and dislikes. The assessment led to a summary of care needs which was followed by a plan to meet those needs. Other sections included notes of visits by other professionals, a physiotherapy plan, and a ‘diversional therapy’ (activities) plan. Daily notes (‘Statements’) are made on separate pages by nurses and care assistants. However, both were almost exclusively limited to a brief note of the physical care given over the course of the day or night. Notes by the activities organisers were made on a separate record. While the records of each group are important, the practice appears to give the impression of a split between care aimed at meeting physical needs and care aimed at meeting psychological and social needs. Given the extent and nature of the contact which nurses and care assistants have with residents, it is unlikely that they are only involved in physical aspects of care. The presence of a ‘Well-Being’ chart would appear to support this view. There may be a gap in practice to be explored here by the registered manager and the deputy manager. Care plans included evidence of communications with external healthcare professionals. Care plans and risk assessments were reviewed monthly. All residents are registered with a local GP practice. Three nurses have undertaken additional training and act as specialist nurses in tissue viability, continence, and diabetes respectively. A psychiatrist for older people will see residents on referral and is also reported to also drop in informally on occasions. This informal contact is valued. One nurse has undertaken specialist training in dementia and has a lead role in the care of residents with dementia. The nurse is now leading an in-house seven module course using a training pack developed by the Alzheimer’s Society. An optician visits annually or on referral. A local community health dentist visits on referral. Audiology services are obtained through Maidenhead Hospital. Batteries for hearing aids can be obtained from the local health centre. Medicines are prescribed by the resident’s general practitioner and dispensed by Boots Chemists. Most medicines are supplied in the Boots monitored dosage system. Only nurses deal with medicines. Medicines are checked by nurses on receipt. Administration of medicines is recorded in the medicines administration record (“the MAR sheet”). Individual records also include a DS0000010975.V325369.R01.S.doc Version 5.2 Page 13 photograph of the resident and details of any allergies or problem in taking medicine which a resident may have. Storage facilities consist of a portable metal trolley, a medicines fridge, a metal cabinet for storing Controlled Drugs, and other cabinets for storing a range of medicines and dressings. References available for staff include a 2005 British National Formularly (BNF) and a MIMS (Monthly Index of Medical Specialities). Staff competence is periodically assessed by the training manager. Boots do not currently carry out a pharmacy audit of the home’s arrangements. Policy on such audits can vary from area to area but they do provide a good check on a home’s arrangements. The storage and control arrangements in the home were generally considered satisfactory on this inspection. The exception was a handwritten prescription entry for Paracetamol which had not been signed (the medicine had already been prescribed by a GP and the handwritten entry related to a change in time of administration). There is a homely remedies policy which is signed by two GPs and the registered manager. The home has a contract for the disposal of medicines no longer required. Residents’ privacy and dignity appeared to be respected. Personal care and medical examinations are carried out in bedrooms or bathrooms. Residents wear their own clothes. Staff were observed to treat residents with care and courtesy. The screening in the shared room in Kent wing currently consists of a basic portable screen. However, the manager said that the home does not intend to have shared rooms for much longer. The home has a policy to guide staff in the care of a person who is dying and in the event of death. In such circumstances care is provided in liaison with the person’s GP and with specialist services in the community. Around the time of this inspection it was in contact with McMillan Nurses in Maidenhead with regard to the care of a resident. Relatives expressed satisfaction with the care. Two relatives were seen during the course of the inspection and one responded in detail through a CSCI questionnaire. Residents seen appeared well cared for and expressed a positive view of their care of in the home. DS0000010975.V325369.R01.S.doc Version 5.2 Page 14 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 adequate. The home maintains a programme of activities for residents and residents may have visitors at any time. This supports the physical and emotional well-being of residents and maintains contact with family, friends and community. Residents may bring personal possessions into the home which personalises their room, improves well-being and maintains associations with family, friends and life events. The choice and quality of food is satisfactory and helps maintain the health of residents and contribute to their quality of life. However, the home needs to ensure that the arrangements for assisting residents at mealtimes on Berkshire Wing ensure that they receive palatable food served at the appropriate temperature. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents interests are recorded in the ‘life history’, ‘diversional therapy’ and ‘likes’ and ‘dislikes’ sections of care plans. The home employs two activity organisers who organise a range of activities in the lounge on Surrey wing for all residents. The programme for January and February 2007 was available on the information leaflet stand near the reception office. There is one activity in DS0000010975.V325369.R01.S.doc Version 5.2 Page 15 the morning and afternoon, and on Fridays the co-ordinators hold sessions for the residents of Kent wing. Activities on offer include social meetings over tea and coffee, bingo, ‘One-to-Ones with magazines’ and games. The activities organisers holds a quarterly meeting with residents to discuss life in the home and how it might be improved. One resident respondent to the CSCI survey indicated that suitable activities are offered occasionally. Residents on Berkshire Wing do not currently have their own communal living area and thus have fewer opportunities for spontaneous social exchanges with others. It was observed on this inspection that the majority of residents on this wing spent their time in their room. The Bracknell Stroke Club extends an invitation to residents to its twice monthly meetings. Three residents were reported to attend the stroke club and one resident to attend a day centre. A church service is held once a month and a local Roman Catholic Church brings communion to residents who wish to receive it once a week. The autonomy of residents is supported through the home’s ‘Philosophy of Care’ – a copy of which is available to residents, staff and visitors in the information leaflet stand. This includes the statement that the home promotes a ‘person centred’ approach and that it is ‘…committed to ensuring the full participation of clients and relatives in the care planning process’. Residents meetings are occasionally held and it is noted in the notes of the meeting held on 10 January 2007 that the attendance included relatives. Residents may bring personal possessions in to the home and all had done so. Residents may have visitors at any time. The home does not hold money for residents nor does it act in any capacity in relation to their financial affairs. Menus operate on a three weekly cycle and copies are available on the information stand. The chef has been employed by the organisation for over three and a half years and therefore has a great deal of experience in providing meals for older people. The chef says that he likes to walk around the home hearing the views of residents. Alternative dishes will be prepared for a resident who does not want an item on the menu. The chef maintains a notebook of residents likes and dislikes – this is in addition to those noted on the care plan. Breakfast, served around 8:00 am is usually cereal, porridge and beverages although a cooked breakfast is provided on request. Morning coffee and biscuits is served around 10:30 am. Lunch, served around 12:00 noon is the main meal of the day and, with the exception of Friday, is usually meat based and accompanied by vegetables, followed by dessert. Selections offered on the ‘Week 1’ menu included: Sausage Casserole with Creamed Potatoes, Carrots and Peas, followed by Bread and Butter Pudding and Custard (Tue), Roast Beef and Yorkshire Pudding with Roast Potatoes, Creamed Potatoes and Brussels Sprouts, followed by Black Forest Gateaux and Cream (Wed), or Fish (Cod) in Parsley Sauce with Mixed Vegetables and Creamed Potatoes, followed by Egg DS0000010975.V325369.R01.S.doc Version 5.2 Page 16 Custard (Fri). Main course alternatives on those three days were Corned Beef Hash (Tue), Cold Meats (Wed), and Fried Eggs (Fri). Tea and biscuits is served mid afternoon. ‘Tea’ is served around 5:15 pm, is a lighter meal and choices on ‘Week 1’ menu included Corned Beef Hash and a variety of Sandwiches, followed by Blancmange (Tue), Scrambled Eggs, Spaghetti and a variety of Sandwiches, followed by Yoghurt (Wed), and Hot Dogs, Baked Beans and a variety of Sandwiches, followed by Rice Pudding (Fri). Hot drinks and biscuits are served between 8:00 and 9:00 pm. Birthday cakes are provided as required. At the time of this inspection food was supplied in accordance with contracts negotiated by Craegmoor Healthcare. The change in ownership in December 2006 may create opportunities for food to be supplied on a more local basis. The serving of lunch was observed in two of the three care wings. This generally went well. Residents ate at their own pace and were assisted by staff as required. However, it was noted on Berkshire Wing that some quite frail residents who appeared in need of assistance had had their meal served in advance of such assistance being provided. This inevitably leads to some residents being served a cold lunch. The number of staff to assist residents appeared to fall short of the numbers required if all residents were expected to eat lunch within a given time frame. The alternative is not to serve lunch to the resident until a member of staff is free to assist. This observation was discussed with the care manager for the wing, with the chef and with the registered manager. DS0000010975.V325369.R01.S.doc Version 5.2 Page 17 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, 17 and 18 Quality in this outcome area is good. The home has a good system for recording and investigating complaints. It has a robust framework of policy, procedure, reporting arrangements and staff training with regard to the protection of vulnerable adults. Together, these aim to protect residents from abuse and to ensure that complaints are properly investigated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. The procedure is straightforward, well written and includes timescales for action. The procedure has been updated to include the contact details of the new owner and the address of the Oxford Hub CSCI office. Records of complaints are retained in the manager’s office. Since the last inspection in February 2006 CSCI have received copies of three complaints to the home. The contents of these were noted and referred to the home for investigation. In addition to the complaints procedure the manager also maintains ‘What do we do well’ and ‘What don’t we do well’ books. These are available in reception for visitors or residents to make entries as they wish. Entries in both books for 2006 were read during the course of this inspection. According to the manager all residents are registered to vote. Some have exercised a postal vote in elections in recent years. Leaflets are available on Age Concern’s Advocacy service in Berkshire. These include the organisation’s address, telephone number, fax number and web address (website being reDS0000010975.V325369.R01.S.doc Version 5.2 Page 18 constructed at the time of inspection). The advocacy service was involved with three residents. The home has a policy covering the subject of the protection of vulnerable adults (POVA). The manager has drawn up a more specific procedure which is at an advanced draft stage. Information on whistleblowing was on display on the wall but needed updating with details of the new owners. The outline training plan for 2007 included one session on POVA. According to training records almost all staff attended ‘Adult Abuse/POVA’ training between October 2005 and September 2006. A notice on whistleblowing was on display. This will need updating in view of the change in ownership of the home. It may also need to include contact details for the Oxford office of CSCI now that the Berkshire office has closed. The training manager uses an in-house package to train staff on dealing with challenging behaviour (primarily aggression and violence). A member of staff on Kent wing was observed to deal skilfully with a potentially difficult situation between two residents. DS0000010975.V325369.R01.S.doc Version 5.2 Page 19 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 adequate. The home provides an accessible environment which aims to offer residents a comfortable and safe place to live. However, these aims are compromised by the quality of some parts of the building and it is expected that a forthcoming refurbishment programme will address weaknesses in this area and lead to an improved environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located a relatively short distance from Bracknell town centre – less than one mile from Bracknell rail station. There are a number of car parking spaces to the front of the building. The home provides care for up to 78 frail older people. Access to the interior is controlled by staff. The home is divided into three care wings – Surrey, Berkshire and Kent. Surrey wing is situated in the older part of the building. Berkshire and Kent DS0000010975.V325369.R01.S.doc Version 5.2 Page 20 wings are situated in a later development. Kent wing is for residents with dementia. There are 76 single bedrooms and one double bedroom. Five bedrooms have en-suite facilities. The one double bedroom is to be converted to a single bedroom with en-suite facilities in the near future. There are 12 WCs and 13 bathrooms. Stairs and a passenger lift connect ground and first floors. There is also a stair lift which the manager said is only used occasionally. There is a garden to the rear of the building. The site is relatively secluded by shrubs and trees. The quality of the environment is extremely variable and there are plans for major refurbishment to some areas in 2007. It is expected that by the end of the year standards will have improved considerably. The plans were not due to be discussed with staff until a few days after this inspection visit, but according to the manager will include removal of trees to permit more daylight to enter, some redesign of the gardens, and changes to the building. Some older parts of the building are to be demolished and replaced with accommodation which meets current standards. The kitchen and staff room are to be relocated from the first to the ground floor. This will provide Berkshire Wing with space to establish a much needed living room for residents. The plans include the replacement of carpets in many areas of the building. The accommodation on Surrey wing is on the ground and first floor and includes a large living room with dining area, bedrooms, bathrooms and WCs. The accommodation on Berkshire wing is also on two floors but residents there do not have access to their own communal living room because of the siting of the kitchen and staff room on the first floor. This seems to be a significant deficiency and it was noted on this visit that the residents on Berkshire spent most of their time alone in their rooms. These residents had fewer opportunities for spontaneous social interaction with others than residents on Surrey and Kent wings. Kent wing is on the ground floor and includes bedrooms (including the one bedroom which is shared), bathrooms, WCs and two living/dining areas. There is a shared activity room on the ground floor. The kitchen on the first floor was generally in good order, tidy and clean. Arrangements for the storage of food was satisfactory. Refrigerators and freezers were in order. Cookers were clean. The insectocutor was clean although it fell off the wall while the collection tray was being replaced (a maintenance man replaced it within ten minutes). The kitchen had been inspected by an environmental health officer on 8 August 2006. The report of that inspection was made available for this visit. All points were actioned within two days according to the home’s response dated 10 August 2006. A Bronze Certificate was awarded to the kitchen by the Environmental Health Department. The chef was looking forward to moving to a new, hopefully ‘state of the art’ kitchen during the course of 2007. DS0000010975.V325369.R01.S.doc Version 5.2 Page 21 The laundry is located in the basement. Entry is by a coded lock. Personal laundry is done in the home. Bed linen is laundered by a commercial laundry which collects and delivers weekly. The laundry is equipped with two washing machines and two tumble dryers. The washing machines can cope with high temperature washes, including laundry washed in alginate bags (which dissolves in hot water). It had facilities for hand ironing personal clothing. The laundry area is quite spacious and has sufficient space for separating dirty and clean laundry. The floor is concrete. The area was fairly tidy but had a very uncared for feel to it and would benefit from a thorough clean and ideally some refurbishment. The sink in particular required cleaning. The home was generally tidy and clean but a distinct rather unpleasant odour permeated some areas. It was noted that some relatives had also commented on this. The manager though it might be connected with some older areas of carpet and the underlying flooring. It was noted that these are soon to be replaced. It was agreed that it might be worth considering alternative flooring in some areas. The home has a control of infection policy and the deputy manager has a lead responsibility for staff training in this subject. A training pack is available in the manager’s office. The hot water was tested for Legionella in January 2007 and the results negative. DS0000010975.V325369.R01.S.doc Version 5.2 Page 22 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. Staffing levels appear satisfactory and the home has a positive approach to training at all levels and across a broad range of subjects. This helps to ensure that there are sufficient numbers of appropriately trained and supported staff to meet residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information on the number of staff employed and of the training undertaken by staff was supplied by the registered manager in advance of the inspection. At the time of this visit the home employed 19 registered nurses, 36 care assistants and 24 ancillary staff. The numbers of nurses and care assistants employed on each shift is as follows: Surrey – AM: 5 (1 or 2 RGN care staff Berkshire – AM: 7 (1 or 2 RGN care staff) Kent: AM - AM: 4 (1 RMN care staff) PM: 4 (1 or 2 RGN care staff) PM: 5 (2 RGN care staff) PM: 4 (1 RMN care staff) At night each wing is staffed by an RGN (RMN on Kent) plus 2 care staff. Staffing is increased where necessary. The home reports that 50 of its care assistants have acquired NVQ2 or above. A wish to have at least one more member of staff on duty, particularly at peak times, was expressed in one care wing. DS0000010975.V325369.R01.S.doc Version 5.2 Page 23 In addition to registered nurses and care workers, the home employs a physiotherapist, two activity co-ordinators, domestic, catering, laundry, maintenance and administrative staff. Up to December 18 2006 the home was supported by the human resources department of Craegmoor Healthcare. New staff had not yet been appointed by the new owners of the home, therefore its systems were not open to inspection. All applicants for jobs are required to complete an application form, to provide two references (including their most recent employer where employed), to complete a medical questionnaire, and attend an interview. Interview notes are taken. Staff are not appointed until an enhanced Criminal Records Bureau (CRB) certificate (which includes a POVA list check) is received. The Personal Identification Numbers (PIN) of registered nurses are checked with the Nursing and Midwifery Council (NMC) and were included in the personnel list supplied for this inspection. The files of the two most recently appointed care staff were examined. Both were in good order and found to contain the information required under Schedule 2. Staff are provided with a copy of the GSCC codes of practice on induction and all staff are provided with terms and conditions. One experienced registered nurse has a lead responsibility for staff training. Craegmoor Healthcare is an Investors in People (IIP) organisation and the home was visited by IIP in 2006. The staff induction programme was reviewed and improved in 2006. The Craegmoor Healthcare Foundation Programme is considered to meet current Skills for Care standards for new staff. The training manager has begun to use a ‘Caring Times’ publication ‘How to be a Great Carer’, which together with induction and foundation training, is considered to provide an excellent basis for new staff to the home. The home encourages care staff to pursue NVQ2 and for some, NVQ3. Details of the qualifications held and training undertaken by registered nurses, of the training plan for 2007, and of training attended to August 2006 were supplied for this inspection. These confirm that the home has a positive approach to staff training and development. The home believes that investment in staff training leads to an increase in staff confidence, an increase in quality of care and a reduction in staff turnover. The information supplied included details of mandatory training (such as moving & handling, fire safety and food hygiene), professional development (such as Dementia, Tissue Viability, Nutrition, Continence Care, and Wound Care), management training (Supervision, First Line Management, and Registered Managers Award) and NVQ 2 and 3 training attended by staff. Information on dementia training was provided. 13 staff had attended a range of training under the heading ‘Dementia Care Training’, 7 attended training under the heading ‘Alzheimer’s Society Training’ and 4 had attended both. DS0000010975.V325369.R01.S.doc Version 5.2 Page 24 Staff spoken to acknowledged the training and professional development opportunities which the home provided. The future of staff training was reported to be unclear in the light of the recent change in ownership. The training co-ordinator was looking at alternative training arrangements including new funding streams and training providers. DS0000010975.V325369.R01.S.doc Version 5.2 Page 25 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 is a well managed home and feedback from residents and relatives indicate that it is generally providing good care outcomes for residents. In the context of a home which requires substantial investment in its environment and which has recently changed ownership, the present arrangements for health and safety appear satisfactory and aim to ensure the safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In December 2006, without forewarning, the manager and staff were informed that Craegmoor Healthcare had sold the home to Aster Health Care. A number of staff at all levels expressed concern that they did not know the future of the home in light of the sudden and unexpected change in ownership. Meetings with staff, residents and relatives were planned for January 2007. DS0000010975.V325369.R01.S.doc Version 5.2 Page 26 The registered manager is a registered nurse and obtained the Registered Managers award (RMA) in 2003. The manager is well qualified and experienced for the position. Over the course of 2005 and 2006 the manager attended training in Performance Management, Performance Appraisal, Medication Competency, Fire Safety, Moving & Handling, Infection Control, Basic Food Hygiene and in health and safety training as an accredited trainer with The Institute of Occupational Safety and Health (IOSH). The manager is supported by a deputy manager who is also a registered nurse and obtained the RMA in 2006. The deputy manager is appropriately experienced for the position and over the course of 2005 and 2006 attended training in Medication Competency, Moving & Handling, Fire safety, POVA, and Infection Control. Lines of accountability within the home are outlined in an organisation chart. At the time of this inspection the manager was relating directly to the new owner. Over the course of 2006 the home carried out five audits in line with the policies of its former owners, Craegmoor Healthcare. These covered medication, health and safety, kitchen, infection control, and care facilities. In late autumn 2006 the home carried out a survey of residents, relatives and professionals. The results, dated November 2006, were made available for this inspection. The environment, laundry and odours were the subject of negative comment. The quality of care received positive comment. These results concur with the views of a relative respondent who completed a questionnaire for this inspection. In reply to the question ‘Is the home fresh and clean?’ the respondent stated ‘Bed linen, wash basin, table in room, always clean, but there is a distinct smell of urine pervading the corridor leading off rooms – very off-putting for visitors’. The respondent went on to write ‘Filling in this questionnaire, as well as the one from Birdsgrove has made me realise that, despite lots of assurances and info. re. making complaints, I feel the main problem is a lack of communication, both between staff and between staff and me. I am however very pleased (respondents emphasis) with the care X has. X has improved physically and mentally since going there…. All staff are friendly – this is much more important than surroundings’. Another respondent was positive about most aspects of the service. The three exceptions were whether suitable activities were arranged by the home in which the respondent ticked ‘sometimes’, whether the home smells fresh and clean in which ‘Usually’ was ticked, and the comment added ‘The furniture and carpets are very old and the walls are dull’. Residents meetings are held every two months and a meeting with residents and relatives was scheduled for two days after this inspection. The new owner was due to attend. DS0000010975.V325369.R01.S.doc Version 5.2 Page 27 The home does not have any involvement with residents’ monies. Residents and families are required to make their own arrangements for dealing with this matter. Staff supervision is established in the home – ‘Personal Performance Agreement’. A policy, procedure and structure is in place. Care staff receive supervision every two months, ancillary staff every three months. Sessions are planned and notes are taken. All care staff have an annual appraisal. Staff confirmed that supervision is established in the home. Arrangements for maintaining safe working practices appear satisfactory. The registered manager has undertaken training with IOSH and has renewed her accreditation until 2009. Staff training takes place at induction, foundation and NVQ levels. Mandatory subjects include Moving & Handling, Infection Control, Fire Safety, Food Hygiene, First Aid (nurses and care staff), Health & Safety (including COSHH), POVA, Medicines Administration (nurses only) and Management of Violence and Aggression. Staff training has been well organised to date. A Health and Safety Executive (HSE) poster is on display in the office and staff room. Systems are in place for carrying out risk assessments. The registered manager reported on a range of health and safety matters in the pre-inspection questionnaire. The home was last visited by the fire authority in 2003. Fire equipment was checked in June 2006. Fire lectures are featured on the staff training programme. Fire alarms are tested weekly. An environmental health officer inspected the kitchen in August 2006 – all work required was promptly carried out. Gas systems were checked in November 2006. Electrical equipment (portable appliances) were checked in December 2005. This is now due again. The fixed electrical wiring was reported to have been checked in December 2005. Baths (8 Parker) and hoists (9) were checked by contractors in August 2006. Wheelchairs are checked and cleaned monthly by maintenance staff. The emergency call system, which is now quite old, was checked in November 2006. The home has a contract with Biffa for the removal of domestic waste and with SGMS for the removal of clinical waste, sharps, drugs and dressings. The home has a health and safety policy but this may need to be reviewed in light of the recent change of ownership. Systems are in place for recording accidents and incidents. DS0000010975.V325369.R01.S.doc Version 5.2 Page 28 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 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000010975.V325369.R01.S.doc Version 5.2 Page 29 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. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that the registered manager review the content of daily entries in care plans by nurses and care assistants, with a view towards ensuring that such records reflect a more comprehensive view of a residents day. It is recommended that the registered manager ensure that all handwritten entries on medicines administration records are signed and dated by authorised staff. It is recommended that the registered manager review the present arrangements on Berkshire Wing for providing assistance to residents at mealtimes to ensure that food is of the correct temperature when eaten. This should include consideration of staff numbers and organisation. It is recommended that the registered manager review and update contact details for the new owners and for CSCI in the home’s guidance on whistle blowing. It is recommended that the registered manage takes measures to identify and eliminate the persistent and DS0000010975.V325369.R01.S.doc Version 5.2 Page 30 2 3 OP9 OP15 4 5 OP18 OP26 6 OP26 unpleasant odour in some older parts of the building. It is recommended that the registered manager take measures to improve the standard of the environment in the laundry, in particular standards of cleanliness around the sink. DS0000010975.V325369.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000010975.V325369.R01.S.doc Version 5.2 Page 32 - 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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