Inspection on 07/04/05 for Bracknell Nursing Home

This inspection was carried out on 7th April 2005.

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

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

Other inspections for this house

Bracknell Nursing Home 27/06/08

Bracknell Nursing Home 04/06/07

Bracknell Nursing Home 27/07/06

Bracknell Nursing Home 02/08/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Bracknell Nursing Home Crowthorne Road Bracknell Berkshire RG12 7D Lead Inspector Julie Willis Unannounced 7 April 2005 @10.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Bracknell Nursing Home Address Crowthorne Road Wildridings Bracknell Berkshire RG12 7D 01344 484584 01344 429343 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of registration, with number of places Four seasons Health Care Bracknell Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The number of persons for whom accommodation is provided at any one time shall not exceed 30. The category of persons to be accommodated shall be, elderly people over the age of 60 years requiring general nursing care and medical care, respite. The category of persons to be accommodated shall be, elderly people over the age of 60 years requiring general nursing care and medical care, respite care, convalescent care. Up to a maximum of five people under the age of 60 years who are physically disabled and requiring medical and nursing care. Date of last inspection 18th July 2004 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. Bracknell Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a weekday morning and afternoon over a period of five hours. A tour of the home was undertaken in which the service users accommodation and communal space were visited. A number of care records, staff files and health and safety documents were examined. The inspector spoke at length to 15 of the 30 service users, spoke to one relative and seven of the staff. The inspector spoke with the Homes Registered Manager at the beginning and end of the inspection when brief feedback about the inspector’s findings was provided. What the service does well: It is clear that the service users living at the home are happy with the care they are receiving. The inspector spent time talking with users who made some very positive comments about the qualities of the current staff team and how well they seem to work together. The home is well managed by a qualified nurse supported by a well-trained, cheerful and enthusiastic staff team. Many of the staff have been working at the home for a long time and have built good relationships with the users. Service users were pleased with the variety and range of foodstuffs provided. Meals were nicely presented, unhurried and offered users a choice. The chef changes the water jugs in the communal areas and bedrooms three times a day and frequently asks the users if they would like extra cups of tea or soft drinks between meals. The home has an enthusiastic activity organiser who provides entertainments and activities in the home. Service users were particularly complimentary about the bingo sessions, quizzes and craftwork that she provides. Bracknell Nursing Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Service users should be provided with more information about the home, prior to admission, to enable users to make an informed decision as to whether or not the home can meet their needs. A copy of their contract or statement of terms and conditions should be kept on file. There is a need to provide staff with more individualised support and increased opportunities to express their opinions in one-to-one sessions with management. This would benefit the users since the teams working relationships would further develop and staff could feel more valued and therefore happier in their work. It is recommended that the home consider allocating each user a key worker who could take a special interest in their health & welfare. This would enable users to be cared for by the same people whenever possible. Staff should ensure that they respond to call bells more quickly so as to maintain the dignity of users. Bracknell Nursing Home Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bracknell Nursing Home Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Bracknell Nursing Home Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 People who may wish to use the service are not provided with enough information to enable them to make a choice about whether or not the home can effectively meet their needs. EVIDENCE: The Statement of Purpose & Service User Guide contain insufficient information to enable a potential user of the service to make a decision as to whether or not the home can effectively meet their need. There is a need to provide all information required by regulation, schedule and standard in a user-friendly format including a list of fees, the number of places provided and for whom the service is intended. The relevant qualifications and experience of the manager, proprietor and staff should be recorded in detail. Examination of the records of the most recently admitted users to the home evidenced that a comprehensive assessment had been carried out by senior Bracknell Nursing Home Version 1.10 Page 10 nurses prior to admission. The information contained in the pre-admission assessment had been gathered from various sources including the service user and their relatives. This information forms the basis on which care is provided in the home. Service users are admitted for a trial period after which a review meeting is held. At this point service users are able to express their choice as to continue to live at the home permanently. The home is wholly accessible to service users with mobility problems and provides a lift and ramps where required. Hoists, aids and other equipment are available to maximise the service users independence. There is a need to ensure that all users of the service are provided with a contract or statement of terms and conditions a copy of which should be kept on the service user file. Bracknell Nursing Home Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10, for older people and 6, 7, 8, 9, 18, 19 for younger adults People using the service are provided with care that maintains their dignity, privacy and independence. Care plans are tailored to meet individual needs and are comprehensive and holistic in detail. The use of clinical tools to identify and reduce risks to users appeared well developed. EVIDENCE: Bracknell Nursing Home Version 1.10 Page 12 Examination of a sample of 5 care plans indicated that they were generally well written and up to date. The care provided to individual users was underpinned by effective risk assessment and risk management strategies, which safeguarded the health and welfare of users. The plan covered every aspect of the service users life including medication, healthcare, nutrition, continence, personal care needs, assessment of abilities, orientation, cognition, life history and preference for activities. A risk analysis is undertaken of the likelihood of the user developing pressure sores and there is evidence that equipment is provided where a risk has been identified. Service users weight is monitored frequently and regular nutritional assessment identifies users that may be nutritionally compromised and need specialist diets or food supplements. There is a need to involve users and their families more fully in the care plan and review process as the respondents to the latest quality assurance survey carried out by the home clearly indicated a deficit in this area. The inspector had the opportunity to talk at length to 15 of the 30 users of the service and to observe care practices. Service users were generally complimentary about the services provided. In particular service users praised the quality and caring attitude of the staff. Service users expressed their satisfaction with the attentiveness of staff with comments such as “very happy with the care”. “The carers are all kind and lovely people”. “I’m so happy I live here”. One user complained to the inspector about the length of time it sometimes took for staff to answer the call bells. They said “that they felt being kept waiting was undignified, particularly, if they were wishing to use the toilet”. This issue was discussed with the Homes Registered Manager at the end of the inspection, who undertook to investigate and address the issue immediately. Staff appeared cheerful, caring and well motivated during the inspection. Interaction between users and staff was positive, age appropriate, discreet and based on mutual trust and respect. Bracknell Nursing Home Version 1.10 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Older People and 11, 12,13, 14, 15, 16 & 17 for younger adults Service users of all ages are provided with the opportunity to engage in range of leisure activities and frequent entertainments which provide opportunities for mental and physical stimulation. EVIDENCE: At the time of inspection a musical entertainer was performing in the lounge. The majority of service users were joining in the communal singing and there was a lively atmosphere in the home. Those users that participated were clearly enjoying themselves. Several service users told the inspector that they particularly enjoyed the entertainments provided by the activity organiser including the bingo and craftwork sessions. Several users with physical disabilities attend a local day centre where they are provided with the opportunity to engage in trips out, pottery and drama classes. Bracknell Nursing Home Version 1.10 Page 14 Menus on offer at the home appeared varied and nutritious. There is a choice of two main meals available at every lunch and teatime. Fresh fruit and vegetables are on the menu and available daily. On the day of inspection lunch was a choice of Spaghetti Bolognese or sausage & bacon casserole accompanied by fresh cabbage, cauliflower and carrots with creamed potatoes. Dessert was rice pudding or ice cream. Tea was jacket potato with tuna or soup and sandwiches followed by scones and fresh fruit or ice cream. Service users were complimentary about the chef and the food supplied. A number of users commented that “there was plenty to eat”, “ nicely cooked” and “generous portions”. Only one adverse comment was made by one service user who complained that “the mashed potatoes were always lumpy” and “the greens are soggy except the sprouts”. This was discussed with the Chef during the inspection who undertook to investigate the matter. Bracknell Nursing Home Version 1.10 Page 15 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 older people and 22 & 23 Younger adults Complaints are viewed seriously by the homes management and are investigated fully with written outcomes provided to complainants. Service users are protected from abuse by well-trained and competent staff that demonstrate knowledge of the homes abuse of vulnerable adults and whistleblowing policies. EVIDENCE: Examination of the complaint records indicated there have been 6 complaints made by service users, their relatives or social workers about the home in the past 12 months. All are well documented. One complaint is currently under investigation the outcome of which is yet undecided. There have been no complaints received by the CSCI about the home since last June 2004. Since the last inspection all staff have received refresher training in the Abuse of Vulnerable Adults and certificates are on each individuals staff file. The need to use bed rails to prevent individual service users from falling out of bed is well documented in each service user care plan. An appropriate risk assessment and consent form for the use of bed rails is on file for those service users that are assessed as being at risk and in need of them. Bracknell Nursing Home Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26, 27 Older People & 24, 25, 26, 27, 28, 29, 30 Younger Adults The home was clean, hygienic and free from residual odours. All bedrooms were individually personalised to reflect the interests of the occupant. Communal space was well used by residents and the home was accessible to users with disabilities. EVIDENCE: A tour of the home evidenced that standards of hygiene and general cleanliness were much improved since the last inspection. New carpet has been fitted in the lounge and an impermeable surface has been provided to the dining area. These improvements have enhanced the overall appearance and ambience for users and aided ease of cleaning. Bracknell Nursing Home Version 1.10 Page 17 New circular dining room tables have made it easier for service users to sit and talk to each other at mealtimes. Each table of four is pleasantly set with bright and cheerful placemats and vases of flowers, which make them, appear more homely. The homes toilets and bathrooms were clean and uncluttered and were easily accessed by users. A number of the users said how much they enjoyed their bath each week. One user said, “that they would like a bath more frequently rather than washing at a sink”. A number of the baths thermostatic mixer valves were being adjusted at the time of inspection to ensure that hot water accessible to users did not exceed a safe 43 degrees centigrade. From examination of the record of the temperature from sinks and baths it is clear that they are monitored frequently to avoid the risk of scalding to users. Bracknell Nursing Home Version 1.10 Page 18 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Older People & 34, 35, 36 & 31, 32, 33, 34, 35, 36 Younger Adults Staff individually and collectively were able to demonstrate that they have the necessary skills and experience to effectively meet the needs of service users in their care. EVIDENCE: Examination of the recruitment files for the most recent employees indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of service users. Staff appeared to have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with service users. Staff are offered opportunities to gain qualifications to further enhance their knowledge and skills such as National Vocational Qualifications at level 2 & 3. All staff are provided with refresher training in core skills such as fire safety awareness, health & safety, first aid, manual handling and infection control to Bracknell Nursing Home Version 1.10 Page 19 ensure service user safety. Nurses are required to undertake regular clinical updating to keep their skills current and based on best practice. The Deputy Manager has recently qualified as a trainer in Manual Handling and has been cascading her knowledge to the staff in order that they may feel confident when carrying out manual handling tasks with service users. There was evidence that new staff are provided with an induction and on-going support but there is a need to formalise this process by ensuring that all care staff are formally supervised at least six times a year. Group supervision may be employed as an adjunct to one-to-one supervision but should be kept to a minimum so as to give staff opportunity to discuss their own personal development issues in a confidential meeting with their line manager. Nurses should be offered clinical supervision at frequent intervals. Service users were very complimentary about the qualities of the staff that they said were “friendly”, “attentive and caring”. Bracknell Nursing Home Version 1.10 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 & 38 Older People and 37, 38, 39, 41 & 42 Younger Adults Service users benefit from living in a well managed home, where there is evidence that their health welfare and safety is of primary importance. EVIDENCE: The Registered Manager is a first level nurse who is experienced and knowledgeable about the service user group in her care. Service users and their relatives say that the Manager is caring and approachable and keen to provide quality care by tackling problems in a pro-active manner. The Homes Manager and Deputy operate an open-door policy where staff can seek advice and support on a daily basis. There is a need to formalise the support process by ensuring that all care staff are formally supervised at least Bracknell Nursing Home Version 1.10 Page 21 six times a year. Group supervision may be employed as an adjunct to one-toone supervision but should be kept to a minimum so as to give staff opportunity to discuss their own personal development issues in a confidential meeting with their line manager. Nurses should be offered clinical supervision at frequent intervals. Examination of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as a safe and risk free environment for users. Quality assurance is constantly monitored by regular auditing of services by the management, discussion and feedback from service users their relatives and advocates and visits from the Responsible Individual who provides monitoring reports to the CSCI on a monthly basis. Bracknell Nursing Home Version 1.10 Page 22 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 1 3 3 4 3 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 3 3 3 3 3 Score Standard No 7 8 9 10 11 Score 3 3 x 3 x Standard No 27 28 29 30 3 2 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 x 35 x 36 2 37 3 38 3 Bracknell Nursing Home Version 1.10 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 36 10 Regulation 18 (2) 12 Requirement Timescale for action By 7.10.05 Ensure that all care staff are formally supervised at regular intervals at least six times a year Ensure that all call bells are Immediate answered in a timely fashion By 7.4.05 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 18 Good Practice Recommendations Consideration should be given to allocating users a keyworker who could take a special interest in their welfare. Bracknell Nursing Home Version 1.10 Page 24 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading 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. Extracts may not be used or reproduced without the express permission of CSCI Bracknell Nursing Home Version 1.10 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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