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Inspection on 06/12/05 for Brackley Cottage Hospital

Also see our care home review for Brackley Cottage Hospital for more information

This inspection was carried out on 6th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 kitchen and catering arrangement were noted to be in good order, with all of the required documentation. Service users stated that the food is very nice. The home have not received any complaints since the last inspection. Staff knowledge of abuse and complaints procedures was satisfactory. Staff levels were satisfactory, and recruitment processes were adequate. Staff training was sufficient. Quality assurance monitoring is carried out. Feedback from service users was positive.

What has improved since the last inspection?

One aspect of medication records had improved.

What the care home could do better:

Assessments did not cover all of the required information. Care plans, healthcare assessments, handling assessment and weight record was not held for one service user.Medication administration record sheets contained codes which did not feature on the key found on that chart. More than one type of medication administration record sheets were used, which may cause confusion. Service users spoke of feeling bored due to the lack of activities, and although an activities programme has been written, the inspector was advised that it is not appropriate to the service users, and is not followed. At least one radiator did not have a low surface temperature cover in place. The staff rota did not show the deployment of the staff between the intermediate beds and the service users receiving nursing care. Regulation 26 visit and staff supervision and appraisal are yet to be commenced.

CARE HOMES FOR OLDER PEOPLE Brackley Cottage Hospital Pebble Lane Brackley Northants NN13 7DA Lead Inspector Mrs Sarah Smart Unannounced Inspection 6th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brackley Cottage Hospital DS0000012602.V271376.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. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brackley Cottage Hospital Address Pebble Lane Brackley Northants NN13 7DA 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) 01280 702388 01280 700329 Brackley Hospital Trust Claire Mansfield Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of service users must not exceed 14. The 14 service users will be in the category of OP No-one falling within the category of intermediate care may be admitted to the home when there are 9 persons in this category already accommodated within the home. No-one falling within the category of OP receiving nursing care and not intermediate care may be admitted to the home when there are 5 persons in this category already accommodated within the home. The beds located in the multi bed rooms must only be used for service users receiving intermediate care for rehabilitation, and must not be used for any other category, including palliative care. Service users whose anticipated stay exceeds 8 weeks may not be admitted into the intermediate beds. 31st August 2005 4. 5. 6. Date of last inspection Brief Description of the Service: Brackley Cottage Hospital provides nursing and intermediate care to 14 service users. It is situated close to a park, and close to amenities in the market town of Brackley. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 10am and 1.15pm. Preparation for the inspection included, review of the previous inspection report, requirements and recommendations, and took approximately 2hours. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, quality assurance, staff supervision, complaints records, previous requirements made, and staff and service user interviews. One service user was case tracked. Two staff members, plus the manager, were interviewed at length, and several others briefly, whilst two service users were spoken to in detail. What the service does well: What has improved since the last inspection? What they could do better: Assessments did not cover all of the required information. Care plans, healthcare assessments, handling assessment and weight record was not held for one service user. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 6 Medication administration record sheets contained codes which did not feature on the key found on that chart. More than one type of medication administration record sheets were used, which may cause confusion. Service users spoke of feeling bored due to the lack of activities, and although an activities programme has been written, the inspector was advised that it is not appropriate to the service users, and is not followed. At least one radiator did not have a low surface temperature cover in place. The staff rota did not show the deployment of the staff between the intermediate beds and the service users receiving nursing care. Regulation 26 visit and staff supervision and appraisal are yet to be commenced. 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. Brackley Cottage Hospital DS0000012602.V271376.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 Brackley Cottage Hospital DS0000012602.V271376.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): 3,6 Service users needs are not fully assessed. EVIDENCE: The service users file viewed contained several assessments. One was completed by the care manager prior to admission to the home, and a second by the home at the time of the admission. However, neither of these assessments contained all of the areas outlined in this standard, and between them did not contain all of the information either. This was the subject of a previous recommendation. The home has recently registered eight intermediate care beds. The Responsible Individual demonstrated that local care managers etc had been advised of the conditions of registration placed upon these beds. The statement of purpose is currently being updated to also reflect this, and other information relating to the intermediate care beds. Brackley Cottage Hospital DS0000012602.V271376.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): 7,8,9,10 Service users health and personal care needs are not recorded adequately. EVIDENCE: The content of care plans, and healthcare assessments had been the subject of previous requirements. Compliance with these was discussed with the Responsible Individual at the start of the inspection in the absence of the manager. She advised that all the requirements had been met. Upon carrying out case tracking it was evident that this was not the case. The service user was selected at random. He had been residing at the home for 8 days, and was occupying an intermediate care bed. The care managers assessment stating that he has long standing breathing problems, and daily reports reinforced this. He was also receiving oxygen therapy. The entry under the heading of breathing on the hospitals assessment form was “good”. The service user did not have any care plans written, despite the transfer information indicating that he clearly had specific health needs that must be met. The Waterlow score had not been recorded, despite mention of pressure area breakdown, neither had the nutritional score. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 10 The service user had not been weighed, despite this being the subject of a previous requirement. The moving and handling assessment had not been completed, despite staff being observed to assist the service user to mobilise. The service user had a pressure relieving mattress on his bed, and staff appeared to know the status of his pressure area breakdown. A sample of medication was viewed. The previous requirement in relation to medication had been met. The home use several different record sheets for medication. These sheets have differing keys containing codes for omittance of medication, however staff were using a variety of codes in the records which did not correspond with the keys on that chart. It is strongly recommended that one type of record sheet is used consistently for all service users to ensure that this procedure is safe and clear. All other aspects of medication were satisfactory, including the policy. One service users care plan contained detailed information regarding the administration of certain medication. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 11 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): 12,13,14,15 Service users social needs are not adequately met. Food is provided to a high standard. EVIDENCE: There was no evidence of activities at the time of the inspection. Staff on duty were asked for the activities programme, as this was a requirement from the previous inspection. They were unable to locate it. A copy was found in the office, however service users did not have access to it, and it was not being followed. There were no records of activities taking place, and service users mentioned to the inspector that they sometimes feel bored. They rely upon reading or watching TV. One staff member stated that the service users are unable or unwilling to partake in the activities planned, however the activities should be planned with the service users needs and interests in mind. The inspector was advised that a choir were due to visit the home that night. Service users stated that their relatives are welcomed into the home, and gave positive feedback to the inspector. The kitchen was visited. This area was well managed, clean and tidy. The cook stated that all of the equipment is in working order. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 12 A choice of menu is available, and the cook relies upon knowing what the service users like and dislike. Service users stated that the food is very nice. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 13 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): 16,18 Complaints and protection policies instruct appropriate practice. EVIDENCE: The home have not received any complaint since the last inspection. The home have the Northamptonshire interagency abuse policy. Staff have recently undergone Protection of Vulnerable Adults training, which one carer stated had been most useful. Staff demonstrated a good knowledge of the complaints and abuse procedures. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 14 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): 25 Service users safety must be protected. EVIDENCE: A corridor radiator was noted to be very hot to touch, and did not have a low surface temperature cover in place. A requirement has been made in relation to this. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 15 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): 27,29,30 Staffing levels and recruitment were satisfactory. EVIDENCE: The staff rota indicated one nurse and three carers work a morning shift, and one nurse and one carer at all other times. On the day of the inspection there was only one nurse and two carers on duty, although the home also had some empty beds. It was unclear from the rota exactly which staff were caring for which group of service users. This was a previous requirement. A discussion took place between staff and the inspector about staffing levels. The inspector expressed some concerns about the time spent by staff treating patients in the emergency room. The inspector was advised that records are kept in relation to this should they be required for inspection. It is recommended that this is monitored by the manager. Two staff files were viewed. These contained adequate information. Staff supervision and appraisal is yet to be commenced. Staff spoken to indicated that they are adequately trained. Records were held to reinforce this. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 16 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): 33,35, 38 partially The management of the home is satisfactory, and regulation 26 visits will reinforce this. EVIDENCE: The inspector was advised that the regulation 26 visits were still yet to be commenced. The inspector had been advised that the previous inspection that the trustees are currently being trained, and therefore had expected the visits to have commenced, although this was not the case. The Responsible Individual stated that she would carry out the first visit during the next few days. The inspector was informed that quality monitoring is carried out annually, when service users and relatives are sent satisfaction questionnaires. The home do not currently hold any valuables for service users, but have a policy in place should this occur. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 17 A fire door in the kitchen had a weight holding it open, despite an automatic closure being fitted. The cook stated that this was because the fitting did not hold the door adequately. The wedge was removed at the time of the inspection, and the inspector was satisfied that corrective action will be taken, therefore a requirement has not been made. Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 18 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X 2 x STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x X 3 X 3 X X 3 Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? yes 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 OP33 Regulation 26 Requirement Evidence must be available of Regulation 26 visits by the Registered Provider. This has been an outstanding requirement since 1.8.04, which remains unmet. The staffing rota must indicate the name of each staff member on duty allocated to care for the service users in the care home beds, including the registered nurse. This has been an outstanding requirement since 30.11.04, which remains unmet. The care plans must be accurate in line with service users current needs, and be reviewed timely. This has been an outstanding requirement since 30.9.05, which remains unmet. Healthcare assessments must be totalled, scored accurately, and reviewed timely. This has been an outstanding requirement since 30.9.05, which remains unmet. Service users must be weighed timely. This has been an DS0000012602.V271376.R01.S.doc Timescale for action 15/01/06 2 OP27 17 15/01/06 3 OP15 7 15/01/06 4 OP12 8 15/01/06 5 OP12 8 15/01/06 Brackley Cottage Hospital Version 5.0 Page 20 6 7 OP3 OP9 14 13 8 OP12 16 9 OP25 12 outstanding requirement since 30.9.05, which remains unmet. Service users needs must be fully assessed. This assessment must be recorded. The codes used on medication administration record sheets must relate to the keys given on that sheet. Service users social needs must be met by the provision of regular, planned and meaningful activities. Records must be held of activities offered to or undertaken by service users. A risk assessment must be undertaken in relation to the lack of low surface temperature radiator covers, and identified action taken. A copy of the risk assessment must be forwarded to the Commission for Social Care Inspection. 30/01/06 30/01/06 15/02/06 20/01/06 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 2 Refer to Standard OP2 OP27 Good Practice Recommendations A standard medication administration record sheet should be used for each service user. The manager should monitor the time spent by staff treating emergency patients, and whether this impacts upon the provision of care to the service users in registered beds. Identified action should be taken. Staff supervision and appraisal should commenced at the earliest opportunity. 3 OP36 Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Brackley Cottage Hospital DS0000012602.V271376.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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