Inspection on 27/07/06 for Bracknell Nursing Home

This inspection was carried out on 27th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Bracknell Nursing Home 27/06/08

Bracknell Nursing Home 04/06/07

Bracknell Nursing Home 02/08/05

Bracknell Nursing Home 07/04/05

Bracknell Nursing Home 13/07/04

Bracknell Nursing Home 10/06/04

Bracknell Nursing Home 24/04/04

Bracknell Nursing Home 01/04/04

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

CARE HOMES FOR OLDER PEOPLE Bracknell Nursing Home Crowthorne Road Bracknell Berkshire RG12 7DN Lead Inspector Ruth Lough Unannounced Inspection 27th July 2006 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 Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bracknell Nursing Home Address Crowthorne Road Bracknell Berkshire RG12 7DN 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 484584 01344 429343 Tamaris (RAM) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Lydia Dipuo Makuyama Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30), Physical disability of places over 65 years of age (30) Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only people over the age of 60 years to be admitted. Date of last inspection 2nd August 2005 Brief Description of the Service: Bracknell Nursing Home is situated close to the local shopping precinct in Easthampstead. Bracknell Town Centre is approximately one mile away and is accessible via local public transport. The home provides accommodation for up to thirty service users with nursing needs in a variety of single and dual occupancy bedrooms. The service users accommodation is on two levels with passenger lift available between floors. There is a small garden to the rear of the property and parking to the front. The fees for the home range between £529.91 and £622.91, per week. Service users pay additional charges for Chiropody, hairdressing, toiletries, newspapers, trips out and transport. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place over one day on the 27th July 2006. The inspection included a review of information provided by the home and service user surveys returned prior to the visit. 10 of 30 service users responded. Documents and records available on the day were read. Service users, staff and visitors opinions of the service were also obtained during the day visit. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 6 contacting your local CSCI office. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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 Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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 not applicable) Quality in this outcome area is good. Service users have a detailed assessment of need prior to arrival to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are assessed prior to admission to the home. The assessment process includes the health and personal care, personal history and the choices of the individual. Also included is their nutritional, weight, mobility and skin condition that supports the development of their care plan. Information that has been provided by other professionals is used to support the homes own assessment process. A review of 4 service users care files did show that comprehensive information is taken on arrival at the home and this was confirmed when talking to service users or relatives. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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 and 10 Quality in this outcome area is adequate. The detailed care plans give staff good information to be able to carry out the care in accordance to service users wishes. The service users are not fully protected by the medication administration by staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An individual care plan is in place for all service users. The care plans give the necessary information for staff to carry out the care in accordance to the individual’s wishes. The care plans are reviewed regularly and any changes to the planned care, is recorded well. The health of the service users is usually monitored appropriately and the home has implemented action to ensure that specialist medical help is required when needs are identified. A recent complaint to the home regarding care had indicated that there had been a Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 10 deficit in care, medical support and medication administration for one service user. The manager was able to provide information of the actions taken to prevent this occurring again that has included retraining of staff. Two service users expressed that they had difficulties with communication with staff when they were carrying out personal care with them. The home has systems in place for the administration and safekeeping of medicines. They have recently implemented a new pharmacy supplier, who has provided retraining for the staff responsible for medication administration. However, the staff member who was observed undertaking a medicine round during the inspection visit, did not follow the principles of good practice. A service users medication was not administered immediately after being dispensed. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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 and 15 Quality in this outcome area is adequate. Communication between staff and service users needs to be improved. The meals and menu planning meet the nutritional needs of service users but some felt choice was limited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users stated that the liked living in the home, some have made their home there for over 8 years. They also said that the majority of staff understood their needs and that they listened when they wanted to change to the planned care or daily routines. Two service users stated that they had difficulty in getting some staff to understand because on language differences. Personal choice of how they wish to live and their interests are recorded in some service users care files, not all. The home employs a member of staff specifically for activities for 16 hours per week. A programme of games, quizzes, reminiscence therapy, cooking, Tai Chi and craft activities, are provided by the home staff. An entertainer visits the home periodically. The staff gives support to those more able service users to go on shopping trips Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 12 and visits to a garden centre. Two service users did comment that they would like more activities to do and others stated that they preferred their own company and stayed in their rooms. Service users and relatives said that visitors could come and go as they wish in accordance to the preferences of the service users and that they are made welcome by the staff in the home. Service users are able to receive visitors in their own room or in the communal lounge/dining or garden areas. Three service users commented that they were sometimes disappointed with the quality, type and quantity of the meals provided recently. Comments included that the meals “could be hotter”, “fish for 4 days”, “3 triangles of sandwich for the evening meal”, “ ice cream and yogurts only for pudding” and “would like fresh fruit as alternative to puddings”. The manager provided a copy of the planned menu that showed that for some days the recorded choices were limited and that at times fish was provided three days and chicken two days a week. Two service users stated that they were not always consulted on their choices for a meal. The manager had confirmed that this had been noted in a recent service users meeting and that the menu was under review and staff had been reminded to obtain their choices before a meal was provided. The midday meal that was served on the day of the inspection visit was mince, mash potatoes and vegetables. The dinner looked well presented, of suitable sized portions and service users appeared to be enjoying it. The manager stated that the planned fruit crumble was supplemented with ice cream or yogurt, as it was a very hot day. The catering staff record any individuals alternative meal, one service user had a meal of egg and chips instead of the mince. Staff were providing assistance to those who needed it, discretely. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is adequate. The home manages complaints appropriately. Staff has sufficient knowledge to protect service user from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and relatives confirmed that they knew who to speak to if they were unhappy or had any concerns. They would “speak to staff”, “the matron and staff are always available”. One service user stated that she found “ at times a little embarrassing and dislikes making a complaint”. The home has had 9 complaints in the last 12 months of which 3 were substantiated and 1 partially substantiated. The last 4 complaints received were of serious concerns for the home as they were regarding the standard of nursing and personal care, medication administration and equipment available. The Commission has received one complaint (inclusive of the above), investigated by the home, which was partially substantiated. The manager keeps records of all the information obtained about any concerns or complaints but does not have an efficient monitoring tool to identify common trends or record outcomes. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 14 The home has information for staff about protecting service users from abuse and they are also provided with training in the induction and training programme. Staff confirmed that they had an understanding their responsibilities for protecting service users and they knew who to speak to if they have concerns. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. The home is kept clean and fresh. The home has not complied with its legal responsibilities with a requirement made at the last inspection regarding service users access to the communal bathrooms. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was purpose built and is kept in a homely comfortable way. Routine maintenance is carried out on the décor and the facilities in the home. The home appeared to be kept clean, although only 50 of service users commented that this always occurred. The external garden and patio areas are accessible to service users although these were not in use on the day of inspection as the temperature was very Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 16 high. The home does not provide any permanent sheltered areas in the garden for service users to use. The security to the rear of the property could be compromised by the open access to each side of the building from the main road. The manager is proposing to provide more communal space for service users by adding a conservatory to the rear of the lounge area. The home has not complied with a requirement made at the last inspection visit 3/8/2005. This was in regard to making the bathrooms and toilets free from the storage of equipment and accessible at all times to service users. See Standard 38. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. There are sufficient numbers of staff on duty at all times of the day. Service users do not have the confidence that staff will respond swiftly when called. Service users are protected by the recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Just under 50 of the service users living in the home have high dependency needs. There are sufficient numbers of staff on duty at all times according to the rota. The staff team have the 7 Registered nurses and 23 carers. Two carers have obtained NVQ and 3 have been recently enrolled on a course for NVQ 2. This is below the anticipated 50 ratio of care workers who should have achieved a qualification in care. Three service users commented that sometimes staff are slow to respond to call bells especially after lunchtime. Eleven staff members have left the employment over the last 12 months. One staff member had been dismissed for poor performance. The home has used very little agency staff but does access staffing support from another of the company’s home’s, in the local vicinity, when necessary. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 18 Four staff files reviewed, indicate that the home carries out the necessary recruitment checks. Induction and training is provided to ensure that staff have the necessary health and safety knowledge to perform their roles in the home. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. The home has the necessary management structure in place. Service users health and safety is potentially at risk through inadequate storage of equipment in bathrooms and used cooking oils adjacent to the building. Service users and staff safety is a potential risk due to the security to the rear of the property. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 20 The manager and continued to developed her knowledge to support her role. She has been working in her current position for 2 years and came from a previous management position in a nursing home. She has obtained an NVQ 4 Registered Managers Award and attended training such as Pain Control, POVA and Medication Administration over the last year. The service users are consulted about their opinion of the home through questionnaires and service user meetings. A recent meeting has identified some changes that the service users would like and the manager has implemented actions to meet these. The home has a financial administration process that offers safe keeping for service users personal monies should they be unable to manage themselves. All finances are audited by company head office. Service users are provided with secure facilities in their rooms should they wish. Staff are provided with information and training for safe working practices and there are processes in place to ensure that the equipment and facilities are maintained. However, a previous requirement for the home to ensure that all bathrooms and toilets are accessible to users at all times and are free from risks to users safety, has not been met. The bathrooms/toilets continue to be used for storage of hoists, trolleys and personal wheelchairs when not in use. Service users are not able to access the bathrooms unless the equipment is removed. The personal safety of service users is put at risk through poor security to the rear of the building from the main road at the front of the building. The lack of secure gates allows open access to intruders and service users to leave the premises without the knowledge of staff. An additional fire risk is the un-secured storage of used cooking oil, awaiting disposal, at the side of the building. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 1 Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 22 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 OP38 Regulation 13 (4) a Requirement Ensure that all bathrooms and toilets are accessible to users at all times and are free from risks to users safety. Previous requirement made 3/08/05 Ensure that external access to the rear of the property is made secure. That used cooking oils are stored safely. Timescale for action 31/10/06 2 3 OP38 OP38 13 (4) a 23 21/09/06 30/09/06 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 3 Refer to Standard OP14 OP15 OP16 Good Practice Recommendations Ensure that the manager implements strategies to improve communication between service users and staff. That meals and menus meet service users choices and expectations. That the manager implements tools to assist with monitoring concerns and complaints received, effectively. Bracknell Nursing Home DS0000010977.V294810.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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