Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Bradley House Nursing Home Bradley House Nursing Home 2 Brooklands Crescent Sale Cheshire M33 3NB The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sylvia Brown
Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home
Name of care home: Address: Bradley House Nursing Home 2 Brooklands Crescent Bradley House Nursing Home Sale Cheshire M33 3NB 01619732580 01619053425 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bange Nursing Homes Ltd T/A Bradley House Nursing Home care home 36 Number of places (if applicable): Under 65 Over 65 36 dementia Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code N 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 Date of last inspection Brief description of the care home Bradley House is a care home providing nursing care and accommodation for 36 service users who have been diagnosed as having dementia or long-standing 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. Care Homes for Older People
Page 4 of 37 Care Homes for Older People Page 5 of 37 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service would experience adequate quality outcomes. The inspection report is based on information and evidence gathered by the Commission for Social Care Inspection (CSCI) since the last key inspection, which was completed on the 12th June 2008. This was a key inspection which included a site visit to the service. The site visit was unannounced, which means the registered manager and staff were not told that we would be visiting. The registered manager Mrs Bange is along with Mr Bange the registered provider. For reporting purposes we will use the term registered manager Care Homes for Older People
Page 6 of 37 when referring to both the registered manager and providers. Residents is also the preferred term to be used when referring to people who live at Bradley House. As part of the inspection process we gathered information from a number of people which included, where possible, talking with and seeking the views of residents during the site visit. We case tracked two people living at the home, this means we looked in depth at their care support which included looking at their records in detail. We spent some time with residents and observed their day to day routines as they received support and assistance from care staff. This helped us get a better view about how people living at Bradley House are looked after and supported. In December 2008 the registered manager completed a self assessment form, which is called an Annual Quality Assessment Audit (AQAA). This document should tell us in detail what the manager has done since the last key inspection to meet and maintain the National Minimum Standards. It should also tell 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. The registered manager had taken time to complete the AQAA well and gave us enough information about how she had managed and developed the service since we last inspected. We also gathered information through general contact with the home through their reporting procedures which are called Notifications and through information we may have received from other people, such as the general public and professional visitors. We have not received any complaints or allegations of abuse about this service within the last six months. Following the last key inspection we met with the registered manager to discuss the outcome of that inspection to assure ourselves that as a new provider they fully understood the changes required to improve the services provided at Bradley House. They were able to tell us of their plans for improvement and confirmed their commitment to improving the services for the benefit of residents. They also provided us with an improvement plan which detailed their plans for improvement. What the care home does well: What has improved since the last inspection? The manner in which medication is stored and administered has improved. When we looked at records, conducted a short audit of medication and observed members of staff as they administered medication to residents, we found that all were done correctly and that residents now received their medication when prescribed, in a sensitive and respectful manner. We saw that when members of staff administered medication to residents who have poor mental health due to dementia related illness they took time to explain that they were being given medication and were encouraged to take it. Residents are now offered a better choice of meals at lunchtime and teatime. The registered manager told us they had consulted with appropriate professionals and made sure that the meals served at those times are nutritious. We looked at the new four week menu and can confirm it has improved. We observed residents receiving and enjoying their lunchtime meal. Staff files have been audited which means the registered manager has looked at all the information in their files to make sure that required recruitment information has been obtained. Where information was missing the registered manager has commenced getting what is needed so she can make sure everyone employed at the home is suitable and safe to work with vulnerable adults. Care Homes for Older People Page 8 of 37 Staff members continue with their training with 55 completing a National Vocation Qualification (NVQ) at level 2 which is above the required standard. Of which 50 are continuing on to level 3. We looked at training records which confirmed staff members attendance at training events and members of staff stated within the surveys that they felt they were given enough opportunities to continue with their learning. Because of this residents receive support from staff who are trained and who know how to support residents correctly and safely. The upgrading of the home has commenced. On the first floor a new lounge has been made from the conversion of a large bedroom, and similarly another lounge was in the process of being developed on the ground floor. The creation of these rooms enables residents to have nicer places to sit which are more suitable to meet their needs. They are pleasantly decorated and fixtures and fitting have been purchased which are of a good standard. A number of bedrooms have also been redecorated and new furniture provided. This has been welcomed by residents and their families and the outcome of the homes quality assurance identifies that relatives understanding that some parts of the home as not of a good standard and are very appreciative and pleased with the upgrading that has taken place. New dining room furniture has also been provided as has new lighting. Parts of the home have been redecorated. Whilst we are aware that financial constraints prevent the whole home being upgraded quickly we are confident that the registered manager has the best interest of residents as a priority and will continue to make steady improvements to the environment. The registered manager has taken time to consult with specialists in mental health and dementia related conditions about the use of signs around the home to direct residents to specific areas and they have also taken advice of colour schemes. Future plans include the replacement of all bedroom doors. We are told the new ones will be coloured,have letter boxes, door knockers and numbers similar to everyday front doors. The registered manager stated that that this is being done specifically to make residents feel like they have their own front door and personalised and individual living and private areas which they can recognise. New crockery and cutlery is being tried which is designed to support and meet the needs of those with co-ordination difficulties and who have dementia related conditions. They are adapted to support and encourage residents to feed themselves as far as possible and help them to recognise crockery and prompt them to know it is a meal time. A new electronic nighttime recording system has been purchased which means the routines of staff can be accurately monitored as can the support being provided to individual residents. The registered manager told us about and provided us with the detailed information which can be obtained from the system. Because of this we were able to see, which residents were checked though the night, the care support provided and the time it was given. The system is also able to record how long it took to provide the support and who it was provided by. The registered person told us this enables her to make a more accurate assessment about how the needs of residents are being met and if there are enough night staff on duty to meet their needs. Care Homes for Older People Page 9 of 37 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 10 of 37 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 37 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to meet with the registered manager , have their needs assessed , be provided with information and visit the home before making any decisions about moving in. This means they are able to make informed and independent decisions about their future. Evidence: The registered manager has made sure that prospective service users receive the new statement of purpose and service users guide when they make initial enquiries at the home. They are also provided with information about the homes website which although still under development provides up to date information about the services at Bradley House. The registered manager continues with the good practice of meeting with prospective service users in their own home or placement, which gives the service users the
Care Homes for Older People Page 13 of 37 Evidence: opportunity of discussing any concerns they have and ask questions about the service. It also enables the registered manager to assess the prospective service users current needs and discuss with them what support they need and how they would like that to be provided. This helps them both to assess if the the services at Bradley House are suitable to meet their needs. The registered manager has yet to develop formal procedures which lets prospective service users know that after completion of the assessment process, if Bradley House can or cannot meet their needs. Prospective service users are also given the opportunity to visit the home and look around the building, view a room, have a meal and generally look at the day to day routines before making any decisions about their future. Care Homes for Older People Page 14 of 37 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the support to maintain their health and personal care needs, but it is not always provided in a timely manner. This means that some residents have to wait a long time before they get the care they need, particularly in the morning. Evidence: When we arrived at the home at about 7.30am we saw that there were three residents sat in the lounge on the ground floor. One was reading the paper,the other two were in their night clothes. One resident who we were told had stayed in the lounge chair all night was continually calling out and looked distressed. Staff were seen by us to walk past the resident and not pay them any attention. The nurse was later heard to ask a carer how long the service user had been this way but the carer did not know. The resident was given a bowl of cornflakes and a cup of tea but was not supported to eat or drink them. The resident appeared not to be aware that this food and drink was there. Later a drink of milk was given to them without explanation or support to drink it and again the resident was unaware of why it was given, did not drink it and continued to call out. No attempt was made by staff to sit with the resident or attempt
Care Homes for Older People Page 15 of 37 Evidence: to calm them or offer comfort. Later we did see a carer provide the resident with warmed milk and sat with them and encouraged them to become calm and drink the milk. At 10am we observed one resident in their bedroom who was heard to be calling out for staff, when we spoke with the resident they told us they wanted a drink and that staff would come eventually. Over the next hour and thirty minuets was saw a number of care staff entering and leaving the room without providing drinks to the resident or giving support as it could be seen that the resident had become incontinent and required additional support. It was not until 11am that the resident received support with their personal care and 11:30am when they were provided with a drink. One resident who was accommodated on the ground floor and who was described by care staff has having dementia was in bed at 9.00am which is good if that is what they choose. We understood from the description of the resident given to us by care staff that they were unable to make the choice when to get up due to their mental health. We were also told that the resident needed two staff to support them to transfer out of bed. The nurse on duty told us the resident had been in bed since 7.00pm. This means they had been in bed for about 12 hours. There was no indication that the resident had been given a drink and or had their personal care needs met during this time. On the first floor we observed that residents were being supported to get up and receive their breakfast from approximately 8:30am, however the majority were observed being taken to the lounge/dining room between 10am and 11:45am. All the resident we saw between this time were being supported by at least one care staff with most having two in attendance. When we read some of the residents care plans we could find nothing about the residents preferences to getting up or going to bed, or reasons why they would be receiving support to go for breakfast so late. We observed that when residents received support it was to a good standard and that time and attention had been given to make sure they were dressed nicely. At the time of the inspection all residents had written care plans in place. We had been made aware the registered manager was in the process of putting new and updated care plans in place. When we read some of these plans we found that the amount of information included continued to vary, in some instances there were lots of relevant information whilst in others less so. We are not sure if this was because information could not be obtained or if it was the individual practice of some staff. There did not appear to be any formal monitoring of the new system by the registered manager to ensure staff were recording the expected information. Care Homes for Older People Page 16 of 37 Evidence: The care plans contained details of residents needs, risk assessments and general information on how their day to day health care needs were being met for instance, visits by medical professionals were recorded, hospital appointments and treatments were noted, however the frequency of chiropody services, dental , optical and hearing tests and checks were not sufficiently recorded. Because of this we could not tell if such support was in place to suit the individual needs of the residents. We saw one resident with toe nails that were very long and which were bending over due to their length. This indicates that the needs of residents may not always be met as they require,desire or in a timely manner. The bathing records we looked indicated that some residents did not have regular baths. From the information recorded one of the residents we case tracked did not appear to have had a bath for more than four weeks and for two others, two or three weeks. We also saw that over the Christmas and new year period when it is expected that residents receive additional support to look nice for the festivities, the records identified increased numbers of residents who had not received support to bath. Throughout the visit we saw that the manner in which staff members supported residents had improved and that they were much more respectful when speaking with with them. We observed some good interactions between staff and residents, with staff displaying care and attention to residents. One member of staff was heard to ask a resident what they wanted to drink in a patient and sensitive way suggesting they understood the mental health needs of the particular resident. When personal care support was provided it appeared to be done so to a better standard, with residents receiving the general care they needed. Although we saw some members of staff earlier in the morning ignoring residents, the majority of staff were sensitive when supporting residents and it was clear that they understood the needs of the individual resident and that the residents trusted and felt at ease with them. Training records identified that thirteen members of the care team including the registered manager have attended dementia care training and have been made aware of current best practice. The registered manager stated her surprise at the observations we had made and gave assurances that she would introduce systems which would routinely and formally monitor staff practice to ensure they were maintaining the required standards she wanted which ensures residents receive the best of care which is personal to them. We observed the administration of medication and looked at medication administration records. We found that this aspect of the service had much improved. The medication trolley and storage areas were clean and kept in better order, the medication trolley
Care Homes for Older People Page 17 of 37 Evidence: was correctly prepared with drinking water, glasses and medicine pots readily available. We saw that medication was given in a kind and caring manner with one member of staff spending a considerable amount of time when supporting residents with dementia to take their medication. Records were maintained correctly, however we are recommending that when medication is given more than an hour later than prescribed or nearer the next administration time, records should have the time details to enable the correct spacing out of medication when administered. Care Homes for Older People Page 18 of 37 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some residents who are able to make their own decisions about how they live are supported to do so, where action is taken on behalf of residents who cannot make informed decisions and choices, records need to be more detailed to demonstrate how they are supported to live meaningful lives. This means residents who have decisions made for them have their individual needs recognised , recorded and met. Evidence: The registered manager stated within the AQAA that service users are encouraged to to invite visitors to the home at any time and that meals and snacks are readily available to encourage visitis and make them more pleasurable. Since the last inspection the registered manager has attempted to improve the social activities for the residents. We are told that a clothes party was held to support residents to purchase their own clothing and that Christmas festivities included a party which was well attended by residents, friends and families. Relatives are provided with a newsletter to keep them informed of planned events within the home and are able to join in all of them if they wish. The registered manager has purchased specially adapted games and jigsaws which are more suitable to meet the needs of those who
Care Homes for Older People Page 19 of 37 Evidence: have mobility difficulties and dementia related illness. New hairdressing services have commenced at the home which now ensures that hairdressing is provided to the specific requirements of the individual residents rather than one style. The registered manager has yet to develop a routine activities programme which ensures the social needs of all residents are met, however the initial plans in place indicate that she is taking seriously her responsibilities to promote social interaction and provide meaningful actives for residents which promote positive mental health and a sense of wellbeing. Because a number of residents have dementia related illnesses, some are not able to make informed choices about their own routines, particular their preferred times for getting up and going to bed,how they would like to spend their day or what they would like to eat. We saw that those residents who prefer to be awake at night are not restricted and have the opportunity of staying up. We think that whilst nighttime care plans should be in place for all residents, those who prefer to be up at night should have more detailed plans. Those plans should record the support to be provide including food, drink and occupation. Where sleeping arrangements are flexible and where residents are able to sleep in lounge chairs if they require, records should be specific regarding why this is acceptable and how support should be provided for this. When we arrived earlier in the morning we saw some residents sat in the main lounge who had been up early or all night. There seemed little attention given by members of staff to make them comfortable to sleep in chairs other than providing them with a cover and a pillow. We saw one person who was quite agitated and calling out who was ignored for quite a while particularly by night staff. When we spoke to members of the night staff team about residents they told us some residents had been up all night or some have been wandering. They also told us about their nighttime routines and what they did. Night staff members seemed unaware of how they could develop routines to ensure standards of care and support provided at night in way the registered manager wanted and expected of day staff. Where residents receive support to make choices and decisions or where they are made for them, record keeping should be of the highest level in order to demonstrate how or why decisions are made and to ensure that residents have varied and enjoyable routines which support them to live meaningful lives as far as possible. After improving her knowledge on diet and nutrition, the registered manager has put
Care Homes for Older People Page 20 of 37 Evidence: into place a new four weekly menu which provides residents with a better choice and variety of food. The menu continues to need development to ensure it includes all meals such as breakfast, supper and snacks available throughout the day. We saw better and improved practice by members of staff at meal times. One to one support was given to residents where needed and soft diets were nicely presented enabling the residents to taste the individual foods served rather than one combined mixture. New hot food trays enabled hot food items to be served at correct temperatures. Whilst we observed improved mealtime routines at lunch time, the service of breakfasts was inconsistent. For residents on the ground floor they were offered and served a large variety of breakfast items which included eggs and bacon, fresh tea and coffee. Unfortunately on the first floor things were not the same. Two types of cereals, toast and flasks of tea and coffee were sent to that floor at approximate 8:30am. Residents were not offered hot food items other than porridge. We saw four residents arriving for breakfast between 10am and 11:45am , they did not receive fresh toast or fresh tea and coffee. We have identified this kind of practice on a number of previous inspections and have spoken at length with the registered manager on the need to improve this service to make sure residents receive freshly prepared food items and drinks. When we asked a person with kitchen and cooking responsibilities why residents on the first floor did not receive the same standard of service at meals times she stated she did not know and that arrangements could be made to improve the service. When asked, staff could not tell us which residents had received morning drinks and when. We observed that at least three residents did not receive a hot drink from at least 8:30am to 11:50am. Care records did not detail when drinks were provided therefore we do not have confidence that all residents are receiving enough fluids to keep them hydrated and which supports them to maintain good general and mental health. Care Homes for Older People Page 21 of 37 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written complaints and safeguarding procedures continue to be in place. Residents, relatives and visitors are aware of how to make complaints and raise any concerns they have. This means the registered manager has ensured members of staff have received up to date training on their responsibilities to protect and safeguard residents and provide residents and visitors with information about advocacy services. Evidence: We have not received any complaints or allegations of abuse since the last inspection. Previously we have identified good practices for safeguarding service users from harm. The registered manager continues to ensure us that staff receive updated training in adult protection and operate both their own and the Local Authoritys safeguarding procedures. Staff surveys confirmed that staff members are aware of their responsibility for reporting any suspicions or allegations of abuse. The registered manager is developing ways in which she can improve communicating with residents and relatives. There is a suggestion box in the entrance at the home which enables comments to be made confidentially on the service. Care Homes for Older People Page 22 of 37 Care Homes for Older People Page 23 of 37 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is being upgraded, this means some parts of the home are of a better standard than others in respect of the comfort and safety. Evidence: The registered manager has commenced upgrading parts of the home, however because of financial restraints the planned upgrading will take time. At the time of the site visit a new lounge had been developed on the first floor. It was pleasantly decorated, with new fixtures and fittings. This means residents have a much better place to sit and meet together during the day. Specialised chairs were provided for service users who required additional support and new lighting meant that residents could see easily when walking and reading. The main hallway has been redecorated and new lighting has improved the overall feel of this area on the ground floor. The conversion of bedrooms into a large new lounge means that when completed, residents will have additional seating space during the day. Consideration has been given to the decoration, colour and the fixtures and fittings are of a good standard. Once completed this lounge will be a pleasant place for residents to spend their time. Whilst other parts of the home have been painted and some repairs made, therr is still
Care Homes for Older People Page 24 of 37 Evidence: many areas which are not of an appropriate standard. The carpet in the main lounge on the ground floor was dirty and the room appeared shabby and showing signs of wear. Whilst we know that upgrading is underway, some action is required to make sure that standards are improved whilst waiting for total upgrading. All areas used by residents should be safe, comfortable, clean and fresh. We saw some residents sat on lounge chairs which did not have base seat cushions. We were told by members of staff that they had been cleaned overnight but had not been brought back. Arrangements should have been in place to make sure they had been put back on the chairs before they were used by residents. We saw that some new dining chairs had been purchased which were nice and clean and staff said they were easier to move to support service users to sit at the table. A toilet on the lower ground floor didnt have a lock on the door so residents are not afforded the privacy of locking the door when using the toilet. The cistern top was missing and a piece of wood painted white was placed where the cistern lid should be. One residents room had clear glass in the door and we could see the resident in bed which means her privacy and dignity was not respected. The registered manager continues to use a number of gates around the home to restrict residents access to certain areas or prevent them from falling down stairs. After discussion with the registered manager we became aware that the home has not been assessed by an independent professional who has the knowledge to assess how to make an environment safe for residents with dementia without resticting their freedon to move around the home to much. Care Homes for Older People Page 25 of 37 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support from staff who have worked at the home for considerable amount of Time, who are trained and who have the appropriate skills and experience for the work they are employed. This means residents are more likely to receive care from staff who they know and trust to support them correctly. To make sure all levels of staff have their practice disscussed and receive information and support, they should recevie formal supervision at the required frequency and as they require. Evidence: We looked at two staff files one of which we had looked at on a previous inspection and found information was absent. Both the files we looked at contained enough information to demonstrate that appropriate recruitment procedures had been carried however one had been completed retrospectively. The registered manager has audited staff files and where required recruitment information was missing. She has put systems in place to gather up to date required information. One member of staff told us they had not received any training in over a year and had
Care Homes for Older People Page 26 of 37 Evidence: not completed up to date fire training. When we asked the staff member what they had done to continue with their own learning, they were vague in their response. From looking at staff records and talking with the registered manager we could tell that she has met with some registered nurses working at the home to discuss ways on how to improve the recording of information and raise the standards of the staff teams general practices, but there was not enough information to demonstrate that the registered nurses at Bradley House receive formal supervision, which looks specifically at their clinical practice, training and development. We were given copies of the working staff rota and again found that it failed to identify staffing positions, their full names and the start and end times of each duty. This means we could not tell how staff time is allocated including ancillary staff members. Staff were generally complimentary about the way they were managed and told us that things were improving and that training is planned for. We could not find out about any routine meetings for the staff team and when we spoke with staff there were mixed views about the amount of information they received and from whom. Some staff felt they were kept well informed whilst others said and or indicated that they never saw the manager were not kept up to date with new ways of working and did not feel included in what was happening at the home . Staff also said that communication between the nursing staff and themselves is poor . During the site visit we spoke with staff about lots of aspects of their work and though they generally seemed to care for the residents and were committed to providing a care support service, they felt that they were not always treated as they should have been. They stated they are given cooking duties to do without notice and feel this is not right and that they should be consulted about this. We feel that if this service is to continue with developing standards, the registered manager should take a proactive part in meeting with all staff, providing them with regular formal supervision, hold team meetings for both same level staff and mixed teams and complete a quality audit within which members of staff could confidentially comment about the services at Bradley House. Staff continue with their training, we know from looking at training records that staff have received training in dementia care,nutrition , health and safety and the safeguarding vulnerable adults. Furthermore 55 of staff have completed NVQ training at level 2 of which 50 are currently training at level 3. Care Homes for Older People Page 27 of 37 Evidence: Care Homes for Older People Page 28 of 37 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bradley House continues to develop and improve, however there are still a number of areas which need further development , this will ensure that residents receive support from staff who are supervised and trained in all safety aspects of the service and make sure it is a safe place to live at all times. Evidence: The registered manager continues at the home and is making steady progress towards improving the services provided to residents. We are satisfied that she is working to the best of her ability and continues with her own learning and development . We can confirm from looking at records that she has attended training herself. We are aware of the amount of work involved in developing a care service and we are pleased with some of the progress made so far, however we advise the registered manager to consider increasing her direct management of staff until standards are consistently maintained. It may be beneficial for the registered manager to personally observe practice herself rather than delegating this responsibility to others. The manner in
Care Homes for Older People Page 29 of 37 Evidence: which records are being developed, and the way staff members work together would benefit from assessment and development by the registered manager. The registered manager should review all the records and paper systems at the home to ensure consistency of recording is maintained and that it correctly reflects the needs and requirements of residents. We also saw that at times some information refers to residents as patients which is a term used in medical practices and not expected within a care home setting. Even though members of staff have received training in moving and handling , we saw on a number of occasions staff members transferring residents incorrectly when using a wheelchair. Footrests were not always attached to wheelchairs and when they were they were not always used. Some staff members continue to walk backwards holding residents hands in an attempt to encourage them to walk. Both these practices are incorrect and increases the risk of accidents for residents. Staffing records and information provided by the registered manager confirmed that staff members were trained in infection control, however we saw on a number of occasions that they put on plastic gloves used for personal care in corridors and lounges and continued to wear gloves and aprons after supporting residents. Plastic aprons and gloves were openly displayed within bathrooms and in corridors, medication creams were observed within toilets all of which places residents at an increased risk of the spread of infection. We also observed that white plastic aprons used for personal care were placed on residents at meal times. We were also made aware that night staff are routinely asked to cook the next days meat. On arrival we saw a number of cooked chickens cooling in the kitchen and night staff confirmed they had cooked these. When we asked the cook why they were not cooked fresh on the day she stated that she did not have sufficient time. When we checked food temperature records they were not recorded for the cooking of the chickens, neither was the cook aware of when the cooking time was complete. We also noted that there were no training records to confirm that the person in charge at night and who took responsibility for the cooking of the chickens had not been trained in food hygiene or informed of the procedures for the recording of the cooking and cooling temperatures of cooked food. We do not have confidence that all staff have received practical fire drill training particularly night staff. When we spoke with them one stated they had never had it, one was vague in their response but another stated they had completed training. We are also aware that the homes workplace risk assessment needs updating due to the changes within the building. Care Homes for Older People Page 30 of 37 Evidence: Residents monies are mainly managed by themselves or by a family representative, small balances held at the home are recorded and audited. From information we have received from staff members we are aware that whilst some have received formal supervision, others have not. It is important that staff have the opportunity of meeting formally and privately with the registered manager and have the opportunity of discussing their work practices, training and development, particularly as all aspects of the service are under development. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 30 18(1)(I) To ensure service users 01/08/2008 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. Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 15 16 The registered person must make sure all residents receive frequent drinks throughout the day and have opportunities to have freshly made hot drinks at all times. This should encourage residents to drink and make certain they are correctly hydrated. 24/04/2009 2 30 28 The registered person must 24/04/2009 have systems are in place to make sure and monitor care staff support is provided to residents in a timely manner. This should enable residents to receive the care and support from staff as they desire and require. 3 36 18 The registered manager must make sure all levels of staff receive the required formal supervision at the required frequency and 24/04/2009 Care Homes for Older People Page 33 of 37 which is suitable to their employment positions ,roles and responsibilities. This will ensure that residents are supported by members of staff who are supervised and kept informed of best practice by the registered manager. 4 38 23 The registered provider must ensure that all levels of staff receive practical fire drill training. This includes night staff members. This will ensure that in the event of a fire emergency day , evening and night staff members will know what to do to keep residents and themselves safe 24/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 4 After the registered manager has meet with and assessed prospective service users, they should provide them with formal confirmation about whether their needs can or cannot be met by the service. Systems should be in place to make sure all residents care plans contain all the required information about their personal needs and how they should be individually met. Information should include preferred rising and retiring times. To make sure residents receive the care and attention to maintain good health, systems should be in place to make sure chiropody treatments, optical ,dental and hearing checks are provided and recorded as the individual residents require. 2 7 3 8 Care Homes for Older People Page 34 of 37 4 8 Residents personal care records should be individually maintained, this includes bathing records. Those records should record the preferences of residents regarding how often they would like a bath and when they receive support. Systems should be in place for the formal monitoring of records in order to identify if support is being provided and recorded as required. Detailed times of when medication is given should be recorded when it is administered later or earlier than prescribed. This will enable staff to know when the last medication was administered and if required adjust the time when the next dosage should be given To make sure that activities are planned and that residents personal interests have been considered, an activities programme should be put into place which enables staff to prepare for activities and support residents to take part. The registered manager should make sure that service users always have freshley prepared food and drinks available and served to them at all times and that meal time service is conssitant throughout the home and not dependant on which dining room residents are using. Nightime care plans should be put into place, particulaly for those residents who perfer to remain awake at night. Staff should be trained to support the needs of individual residents at night and provide them with the support which will promote and maintain their general and mental good health. A menu should be put into place which lets all residents know what food is available at each mealtime including breakfasts, supper and snacks. The menu should be in a suitable format to support them to make their own choices as far as possible. After a full assessment of the building the registered provider must provide us with a full and detailed plan of upgrading to take place within the next twelve months. This plan must include timescales for each part of the upgrading. A a full assessment of the building should be conducted and professional advice sought regarding the best way to safeguard residents from entering unrestricted areas within the home to keep them safe. The staffing rota should contain all the required details to enable accurate monitoring of staff hours. This should include the full names of staff , employment position, and times of working and where they have alternative delegated split staffing duties such as caring and cooking 5 9 6 12 7 15 8 15 9 15 10 19 11 19 12 27 Care Homes for Older People Page 35 of 37 ,the hours of working should be clearly defined. 13 30 The registered manager should make sure tall levels of staff incliding registered nurses receive formal supervision and have their practices assessed and monitored. Appropriate support and opportunities should be provided to make sure they continue with their learning. Records relating to residents which they have access to should be developed, to refer to them in one manner such as residents. The term patients is not relevant to people being supported within a care home setting. Systems should be introduced which makes sure all memebers of staff are monitored in their day to day practice and receive timely support and advice when their practice require improving in order to make sure residents are supported safely. Action should be taken to make sure that all staff with responsibility for cooking food receive the appropriate training and are completing the required records when preparing food. 14 32 15 36 16 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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