Inspection on 12/06/08 for Bradley House Nursing Home

This inspection was carried out on 12th June 2008.

CSCI found this care home to be providing an Adequate service.

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

Bradley House Nursing Home 04/02/09

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Bradley House Nursing Home Bradley House Nursing Home 2 Brooklands Crescent Sale Cheshire M33 3NB Lead Inspector Sylvia Brown Unannounced Inspection 12th June 2008 07:20 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 Bradley House Nursing Home DS0000071671.V367925.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. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradley House Nursing Home Address Bradley House Nursing Home 2 Brooklands Crescent Sale Cheshire M33 3NB 0161 973 2580 0161 905 3425 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) Bange Nursing Homes Ltd T/A Bradley House Nursing Home Mrs Helen Bange Care Home 36 Category(ies) of Dementia (36) registration, with number of places Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia - Code DE The maximum number of people who can be accommodated is: 36 This is the first inspection under new ownership. Date of last inspection Brief Description of the Service: Bradley House is a care home providing nursing care and accommodation for 36 service users who have been diagnosed as having dementia or longstanding mental health needs. The home is a Victorian house with an extension. Bedrooms are on four floors with access by a passenger lift. The home has a conservatory, well kept grounds and a designated parking area. Bradley House is situated near the centre of Sale. The home is close to local amenities such as shops and public houses. Main bus routes and the metrolink station are a short walk away from the home. The current scale of charges at the home range from £547.52 to 625.75 per week. Fees are dependant on a number of factors and are discussed individually for those who are privately funded. Additional costs are incurred for hairdressing and chiropodist. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI). This is the first key inspection of Bradley House under the new ownership. In April 2008 we received information which led us to believe that this service was not maintaining the required standards. As a consequence we decided to bring forward the key inspection process. We completed an unannounced random inspection on 9th May 2008. At that time a pharmacist inspector specifically look at how the registered provider/manager was managing, recording and administered medication. Two inspectors completed another inspection on 12th June 2008, which evaluated how the manager and staff were supporting and meeting the day to day needs and requirements of the service users. Both inspections were unannounced, which means the registered manager and staff were not told that we would be visiting. This key inspection which included a site visit on 12th June commenced at 7.20am and finished at 5pm. Since receiving the concerns about the home, there has been a change of ownership. Bange Nursing Homes Ltd took ownership of Bradley House on 9th May 2008. Mrs Bange is the registered provider/manager and was previously the Matron of the home, although she was not the registered manager. Because of her involvement in the home prior to owing it she is aware of the outcome of the last inspection and the areas where improvements are needed. The registered provider/manager was on the premises throughout both inspections and made herself available to us. We gave extensive feedback to Mr & Mrs Bange at the end of the site visit about our findings. As part of the key inspection process, we gathered information from a number of people, which included talking with and seeking the views of service users. We sent out surveys to service users, relatives and members of staff. This gave them an opportunity to talk with us about their opinions on the services provided at Bradley House. We did not receive any surveys from service users. Comments received from relatives and staff are where appropriate included within the report. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 6 We looked closely at records and the care support of two people living at the home. We also spent time sitting with service users and observing their dayto-day routines as they received support from care staff. This helped us get a better view about how people living at home are looked after and supported. In April 2008 the then registered manager of Bradley House completed a selfassessment form, which is called an Annual Quality Assessment Audit (AQAA). This told us what they had been doing since the last key inspection to meet and maintain the National Minimum Standards. It also told us what they felt they were doing well, how they had improved within the past 12 months and their plans to develop in the next 12 months. Whilst we understand that AQAA does not fully reflect the new owners intentions to develop, the then Matron who is now the registered provider/manager had contributed to the completion of the document. It was agreed with the registered provider/manager that we would make reference to the AQAA, whilst also being aware that the new owners intend make significant changes within the home in regards to general practices and the physical environment. We also gathered information through general contact with the home; through their reporting procedures, which are called ‘Notifications’, and through information we received from other people, such as the general public, including concerns and complaints procedures. We have received one complaint regarding this service. What the service does well: This is the first inspection under new ownership. The new owners have told us they are committed to improving the standards within the home relating to the environment and staff practice. When we consulted with relatives we were told, that they were always keep informed of significant issues regarding their loved one. When asked what the home does well a relative told us a very large percentage of staff are very kind and care well for the patients under very difficult circumstances at times. They treat the patients as family, laughing with them and feeding them if needed, giving them a home.” When asked how they felt the home could improve one person told us “Make sure all staff are kind and care for residents in a friendly way as most do.” They also stated “ under new ownership, I am sure they have plans to improve even more”. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Many of the areas for improvement were identified at the last inspection. The owners told us that they are aware of the improvements they need to make and whilst many of the areas needed for improvement where identified at the last inspection, we do recognise that the owners have not been operating this service for very long. The owners need to make sure that everything we have asked them to do to improve the service they do. Robust systems must be in place, to ensure that service users receive appropriate amounts of nutrition and fluids. Record keeping was in some instances poor regarding these matters and the manager could not always demonstrate that people were being provided with the correct and consistent support. Service users were placed at increased risk due to the wedging open of fire doors. To ensure service users are kept safe, the owners need to consult with the fire service to make sure that the wedging of doors does not compromise fire safety. We identified some cupboards remaining unlocked which contained items which could harm the service users. The manager needs to devise a better system of making sure staff lock cupboards after using them so that service users do not have access to dangerous fluids. To make sure service users receive the care and attention they require in a timely manner staff must be in sufficient numbers and or deployed appropriately at all times. Staff must ensure that they support service users correctly when supporting them to transfer. Systems should be in place to monitor staff practice and ensure that service users are supported safely at all times. Care plans should be developed to ensure they are person centred, that as far as possible service users have been consulted and that their individual care Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 8 preferences are noted. Detailed records should be maintained to demonstrate all care support given including oral health, bathing and personal care. Staff should be trained in treating service users with dignity and respect. Some staff continue to talk to service users in a disrespectful manner, which is demeaning to them. A stimulating and enjoyable activities programme needs to be developed and which ensure that it meets the needs and requirements of off the service users. Consideration needs to be given to group and individual activities to ensure that all service users have the opportunity of social interaction and or stimulation. The registered provider/manager should develop a menu which offers service users choice at each meal time and which includes their favoured food. The menu should be in a format which will encourage and support service users to make choices and decisions for themselves. Meals and mealtimes should be developed to make sure they are enjoyable experiences for service users. They should be given the opportunity of mixing with others and being able to sit at a dining table to enjoy their meal. All staff with the responsibility of preparing meals should be appropriately trained in nutrition and the preparations of meals and specialised diets. We have asked for a full audit of the home, which includes fixtures and fittings including crockery and cutlery. We have asked to be provided with a programme of planned development which will ensure that service users have the aids and adaptations they required and live in comfortable, pleasant surroundings. Odours of incontinence need to be eradicated and stale odours as far as possible reduced. A full audit of staff files should be undertaken and where required information obtained to make sure recruitment information is provided. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 9 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. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 10 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 Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 11 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 is not applicable to this service. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users will continue to have their care needs assessed and are able to visit the home before making any decisions about their future. EVIDENCE: As part of the registration process the registered owners have to provide an updated statement of purpose and service users guide. Because we have been told by the registered provider/manager that the all aspects of the service are under review and will be developed, we advise that both documents should be updated periodically to ensure that prospective and current service users receive up to date information about the home. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 12 There had been no new admissions under the new ownership; therefore we could not assess their practice regarding pre assessment processes. The registered manager is aware that all prospective service users should be visited in their own home or placement and have their needs assessed by someone at the home prior to them making any decision about moving in. The service users files and case records looked at confirmed that previous practice at the home included having the appropriate assessment records in place. Service users are able to visit the home and observed the day to day routines before making any decisions about the future. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were not person-centred and did not demonstrate how the staff were meeting the health and person care needs of service users. Medication practice within the home did not fully support that people were receiving their medication appropriately.. EVIDENCE: We looked at the care plans for two service users. Each care plan sets their needs and gave an overview of how they should be met. The care plans were not person centred and did not fully reflective of the individual for instance, all service users were recorded as having one bath a week. Personal care routines did not detail if or how the service user could be supported to do things for themselves. Details did not include service users personal preferences for how Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 14 care should be provided and we could find nothing to support that the service users had been consulted about their care needs or how they should be met. Personal care records were not appropriately maintained. Bathing records were not completed correctly, one service user records failed to record that the service user had had a bath for two months. Hair washing was not always evident. One person required “bed baths” however there was nothing to indicate the frequency, or how this person should be supported. Health care records were also inappropriately maintained and we have concerns if the needs of one service user are being met sufficiently. The service user required specific support to maintain nutrition and hydration. The care plan stated that fluid must be provided and recorded hourly. We could not find any record of fluids being given on the day of the site visit on the 12th and the two days prior records were poorly maintained and indicated that the service users was not being offered drinks hourly. This service user was assessed as being at high risk of malnutrition. Records were not maintained for nutritional intake, including the provisions of food supplements. We identified another service user who was at risk of weight loss and was required to be weighed weekly. We could not evidence that this had taken place. Some service users required oral health care support and were observed having dry mouths and what appeared to be cracked lips, however health care records did not confirm that they required oral health care support or what practice was undertaken to keep their mouths fresh and lips moist. One service user who was poorly and being cared for in bed, was observed to be in bed on an allocated floor which was not routinely monitored by staff. This service user was observed to be in their room at 10:50 a.m. There was no indication that this service user had received any support with personal care that morning. The service user remained in their nightwear in their bed with curtains closed. There was nothing to indicate that drinks have been provided of breakfast served. This service user was later observed at 11:30 a.m. at which time to staff were in the room. They stated that they had just attended to the service user and was about to provide breakfast. The nurse in charge could not confirm if this service user had been attended to prior to 11 a.m. We could find nothing to support how service users were supported to be independent and make choices for themselves. We observed that many service users remained in the same seat all day even at mealtimes. There were no recorded plans to promote mobility and or ensure that service users had the opportunity of sitting in the various lounges within the home. All the service users are described as having dementia type illness and have been assessed as not being able to manage their own medication. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 15 Inspection of the way the registered provider/manager maintains, records, administers and disposes of medication, identified that some poor practice in administering and recording medicines was still putting residents’ health at unnecessary risk. Some records had been maintained well but others had missing and incomplete entries. Some prescribed medication was not given as prescribed and medication records were signed collectively. In these instances it was not possible to be sure whether people has been given medicines correctly, which is a risk to their health. Observations were that staff practice varied when supporting service users. Some staff took time and consideration when supporting, they spoke directly to the service user and had appropriate and meaningful conversations. Other staff attended service users without speaking or spoke in a disrespectful and demeaning manner. One staff who wanted a service user to say please they was heard to say and what is the magic word another staff was heard to say to service user in response to request give me a minute I have only one pair of hands”. Prior to the site visit we were informed by a member of the public that they had observed staff speaking and acting in a disrespectful manner to service users. We spoke with the registered manager about our findings. She stated that this is not the standard of care and or conducted expected by staff and that she will take action to improve staffs practice. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 16 Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users are not able to make choices about their lifestyle or influence routines in the home. EVIDENCE: There has been no changes to the amount of activities provided for service users. As a consequence service users spend hours sitting in the same seating area watching television or sleeping. Some service users are able to independently move to a dining table and have more interaction with staff, which does provide them with some basic social interaction. Some service users remain in their room and only see or converse with staff when they are having their needs attended to. The registered provider/ manager has not had the opportunity to develop a social programme or provide suitable daily stimulation which is suitable for older people or those who have dementia. She informed us that it is her intention to develop staff practice to include daily social activities. Advice was Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 18 given to consult with service users and relatives when devising activities. Service users should be offered the opportunity to visit outside places of interest and join in group or have individual activities made available to them as they desire and or require. Service users are able to receive visitors throughout the day and evening. Relatives tell us that they are usually kept informed of significant events relating to their relative, and that they are made to feel welcome when visiting the home. Meals and mealtimes continue to require development. The menu does not detail that choices are available at each meal nor is it in a service user-friendly format. After observing two mealtimes we found that staff rely heavily on their basic knowledge of service users and make decisions on their behalf regarding food choices. It is unclear how these choices are made, and if service users are in courage to make choices to themselves. The independence of service users is not promoted. A high proportion of service users remain in their lounge chairs to receive their meals, some of whom do not have the opportunity at all of sitting at dining table at mealtimes. They do not have the opportunity of pouring their own drinks and meals are served ready plated. Service users on the first floor do not always have the opportunity of receiving freshly cooked meals. At breakfast toast was observed on an unheated trolley and was served over a period of time, which meant not all service users had hot toast. Furthermore they did not have the opportunity of receiving fresh drinks. Tea and coffee was prepared in flasks and served over several hours. When tasted the tea was strong and there was no opportunity of service users having drinks made to their individual requirements. One service user was observed requesting the second portion of food and was refused being told that all the food had been given out. The service user was not offered an alternative. When spoken with kitchen staff stated that they had not been specifically training in nutrition and the preparation of meals or specialised diets. Crockery and cutlery did not appear to be suitable. Some of cups/beakers were too heavy for service users to hold causing one to spill their drinks. Lighter weight cups were observed to be heavily stained and unsuitable for use. There was no evidence that the home had adapted cutlery or crockery for those people who have difficulty in movement, because of this some service users were observed spilling their food. Service users were not given the opportunity of receiving one-to-one assistance at each meal time when requiring support. One service user who Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 19 required support was provided with food and left alone for some considerable time. A different member of staff on returning was not aware that the service user had given her food away and had eaten nothing at that mealtime. The deployment of staff at mealtimes was inappropriate; with staff having to repeatedly go to the kitchen to collect ready plated meals which meant service users were left alone. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is Good. This judgement has been made using available evidence, including a visit to this service. Written complaints procedures are in place and known by relatives. users are protected by adult safeguarding procedures. Service EVIDENCE: At the time of the site visit no complaints had been received by the registered provider/manager. Written complaints procedures were in place and relatives informed us that they were aware of them and knew how to make a complaint if needed. One relative told us they were “ Generally pleased with the care.” And that “They have sorted out anything I ever asked to be done such as hair teeth etc. As stated within the summery of the report we have received some concerns from a member of the public about the way the staff conducted themselves when they were looking around the home. They felt some staff were disrespectful to service users and that the home had odours. We have brought these issues to the attention of the new providers as the same staff team continue under the new ownership. There are no changes to the adult procedures. The registered provider/manager has reviewed written safeguarding procedures prior to being registered with us. Staff spoken with told us they had received adult Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 21 protection training with the Local Authority and that they were aware of their responsibility to report any suspicions of abuse. We were told by the registered provider/manager that in house training includes adult protection procedures, with staff then progressing onto the Local Authority training course. Staff told us ““ we are encouraged to attend courses in order to keep up-to-date”. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 22 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): 19,20, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users live in a home that is clean, however parts of the home need upgrading to ensure that service users live in comfortable, pleasant surroundings free from odours. In the event of a fire emergency, the practice of wedging doors opens places service users at an unnecessary increased risk. EVIDENCE: During the site visit we looked at all communal areas used by service users and some bedrooms. We found parts of the home had strong smells of incontinence and general stale odours. Whilst we are aware that the previous owners have purchased new carpets within the previous 2 years, they appeared to be stained in various parts of the building. The carpet was also Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 23 lose on one stairway. When informed, the registered provider/manager took immediate attention to prevent any accidents. Parts of the home were shabby and fixtures and fittings required some upgrading. The upper lounge contained a shower chair which was used by a service user at meal times. Other chairs looked worn and in need of upholstering and or replacing, some chairs in the lower ground conservatory smelt of urine. The registered providers should give serious consideration to the lay out of the home particularly the middle and lower ground floor. They should ensure that all service users have the opportunity of joining others in lounges and have the opportunity to sit at a dining table at meal times. It is not best practice for service users to remain seated in the same chair all day. This does not promote their mobility and or encourage positive mental health by mixing with others. As assessment of the seating and dining arrangements needs to be undertaken. We found that when seated at a dining table it was not of an appropriate height, in that the table was to high and made eating difficult and uncomfortable. The completed AQAA identified that the registered owner/manager recognised that the home requires up grading. As part of the registration process, they have agreed to plan for the homes development and upgrading. During the site visit we talked with the registered providers about their intention to improve environmental standards for the benefit of service users. We were told that they have consulted with specialists in dementia care about colour schemes, and that purchases have already been made and plans are in place to commence redecoration. We were also told that over the next twelve months fixtures and fittings will be replaced where required to ensure the comfort and enjoyment for service users. We are requesting that a full audit of the home which includes fixtures, fittings, beds, mattresses, pillows, bedding, curtaining and crockery is completed by the new owners and a detailed report of the outcome be submitted to us. The report should include times scales where it is identified upgrading and replacing of items is to be undertaken. Whilst we found that the home was in the main clean, we found ladders, items of clothing and commode bowls in bathrooms. Doors which were marked “keep locked” were unlocked, with some enabling service users to have direct access to items which could do them harm. Systems should be in place which ensures that service users are kept safe at all times and that parts of the home used by them are appropriately maintained. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 24 We observed that the safety of service users was compromised. Several doors were wedged open either with walking frames, commodes and one kitchen door was wedged open with a fire extinguisher. In the event of fire, service users would be placed at increased risk of smoke inhalation and through the spread of fire. Furthermore we observed that the front door had a bolt in place. This may slow down evacuation procedures in the event of a fire emergency. The registered person should seek advice from the fire safety officer about the locking device and its suitability to be used in a care home setting. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 25 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users may be at risk of not receiving the care they require because of insufficient numbers of staff or poor staff deployment. And because some staff who have not been recruited or trained appropriately. EVIDENCE: We were provided with and evaluated two months rota of hours worked by staff. Because of the homes lay out it was difficult to assess if the deficiencies in staff were due to the lack of numbers of staff or their deployment. We observed one service user wondering around confused and alone on the lower ground floor in the morning, and service users who required support at meal times also left for periods of time without support. We also observed one highly dependent service user who was cared for in bed left unobserved for long periods of time, there was no staff deployed to remain on the floor used by this service user. We found that the service user had not been supported correctly or received the attention they required in a timely manner. Where dependant service users remain in their own rooms, staff Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 26 must be deployed to remain on that floor at all times to monitor service users and be readily available to provide the required support. The AQAA stated that the registered provider/manager will be ensuring that all nursing assistants will complete induction programme and have their own training records in place in the near future. It also stated that staff who have already obtained NVQ level 2 training will be encouraged and supported to complete level 3. All staff spoken with said they had completed moving and handling training. The provider/manager said that one staff has been trained as a trainer and ensures staffs practice. However we observed on a number of occassions staff incorrectly moving service users, the techniques observed placed service users and staff at an increased risk of accidents. There have been no new staff recruited under the new ownership. Inspection of staff files identified that a number failed to have the correct information available to evidence good recruitment procedures and or their further training and personal development. One staff had been re employed, however new recruitment records were not completed. Another staff did not have the appropriate basic training in place for the role they were undertaking, neither did they have records to confirm they has received an induction, supervision, guidance and support to fulfil their role and responsibilities. We are making good practice recommendations to audit all staff files and where possible obtained the required information howbeit retrospectively for some staff. Individual training, development and supervision records should also be evident for all staff Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 27 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, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The health, safety and welfare of service users and staff are not sufficient well promoted and protected. . EVIDENCE: The new registered provider/manager is Mrs Bange, who held the position of Matron of Bradley House; since January 2005. However, she was not the registered manager of the service. Mrs Bange is now the registered provider/ manager and is a Registered General Nurse, and is currently completing the Registered Managers Award. She undertook at a fit person interview with us on 25th February 2008, and became registered with us on the 9th May 2008. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 28 The registered provider/manager was able to demonstrate that she had an understanding of both the National Minimum Standards for Older People and the corresponding regulations. And had an understanding of what her duties and responsibilities were working in a regulatory framework. We have been given assurances that future changes to be made under the new ownership will ensure that Bradley House is run for the benefit of service users and that they will be consulted about the services they receive. The new owner/manager has not had the time to conduct quality assurance procedures, but is aware that one is required annually and that we should receive a copy of the public report about the outcome of that audit. Systems for safeguarding service users finances continue as previously with the registrar provider/manager having minimal responsibility for managing service users finances. Health and safety records were looked at and found to be in good order. A Fire safety inspection was completed in October 2007, and an environmental health inspection was completed in May 2008. Recommendations and requirements made have or are being addressed by the new owners. As stated earlier within the report we found a number of doors wedge open, which is not permissible under fire safety regulations. Appropriate servicing records of electrical and gas appliances were in place as was servicing records for lifts and hoists. Safe and proper moving and handling techniques were not maintained. We observed staff supporting service users in wheelchairs without foot rests, through tilting them backwards whilst in chairs. We also saw staff “drag Lift” service users which in not permissible and places them and staff at an increased risk of harm. We also observed that the laundry area needs some upgrading to ensure that all work and floor surfaces are of the appropriate standard to minimise the risk of spread of infection. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 29 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 13 Requirement Ensure that medication records are completed immediately to be sure that medication has been given accurately and safely. Ensure that medication is given out as prescribed. This will make sure that residents have maximum benefit from their treatment. Ensure that there is a system to keep enough medicines for residents’ needs (to avoid running out) and that medicines that have been stopped or are not fit for use are destroyed straight away so that residents health is protected by the home’s stock control systems. Ensure that medicines are stored at the recommended temperature shown on the pack to be sure medicines are fit to use. The registered provider/ manager and provider must ensure that all service users receive a varied, balanced diet in sufficient quantities as to promote their good health DS0000071671.V367925.R01.S.doc Timescale for action 18/07/08 2. OP9 13 18/07/08 3. OP9 13 18/07/08 4. OP9 13 18/07/08 5. OP15 15 18/07/08 Bradley House Nursing Home Version 5.2 Page 31 6 OP15 16 7 OP19 23 (4) 8 OP27 18 9 OP28 OP30 18(1)(I) Systems must be put into place that makes sure service users are nutritionally assessed and that robust procedures are in place to monitor service users at risk of weight loss. This includes the provision of drinks and food at appropriate and regular required intervals. The fire officer must be consulted on the practice of wedging doors open as this could compromise safety and place service users at risk. Staff should be employed in sufficient numbers to ensure that service users have their needs attended to in a timely and consistent manner. To ensure service users safety, staff must be trained and competent in moving and handling techniques. Systems should be introduced to make sure moving and handling is completed safely at all times. 18/07/08 30/07/08 01/08/08 01/08/08 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 OP7 OP7 Good Practice Recommendations Care plans and service users’ care records must detail all the care needs of the service users and how they are to be met. Service users records should be insufficient detail to demonstrate the personal care provided; this includes recording oral health care support, fluid charts, bathing and personal care Service users must be treated with dignity and respect at all times. Appropriate activities should be provided which meet the DS0000071671.V367925.R01.S.doc Version 5.2 Page 32 3 4 OP10 OP12 Bradley House Nursing Home 6 7 OP15 OP15 8 9 10 OP15 OP15 OP19 OP38 11 OP20 12 OP20 13 14 15 OP26 OP29 OP38 16 OP38 needs of all service users, both as a group and as individuals. A menu needs to be developed which offers choice each meal time and be in a format, which can help people to understand. Systems should be in place to ensure service users are consulted regarding their meal choice. Where decisions are made on behalf of service users, records should clearly demonstrate previous meals in order to ensure repetition is (unless requested) minimised. The home should provide service users with aids and adaptations, which will support their individual needs, including appropriate crockery and adapted cutlery. Staff preparing meals and supporting service users at mealtimes should be appropriately trained. All store cupboard that contain items which may be harmful to service users and which can be reached by those who have dementia, should be kept locked for their protection. To ensure that service users live in a pleasant and comfortable home, a full audit of the homes fixtures and fittings should be undertaken. Once completed a planned programme of the upgrading should be provided to us, which includes the various time scales for completion. Arrangements should be made, which ensures that service users have the opportunity of sitting at a dining table at meal times and that meet with others within the lounge areas. Odours of incontinence should be minimised and where possible eradicated. A full audit of all staff files should be carried out to ensure they contain all the information listed in Schedule 2 of the Care Homes Regulations 2001. The laundry area, should be upgraded to ensure that the risk of spread of infection is as far as possible reduced. Floors and wall surfaces should be permeable and be routinely cleaned. Ensure that a senior member of staff monitors the handling and recording of medicines to protect the residents from bad practice. Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Bradley House Nursing Home DS0000071671.V367925.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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