Inspection on 11/06/07 for Bradwell Hall Nursing & Residential Home

This inspection was carried out on 11th June 2007.

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

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

Other inspections for this house

Bradwell Hall Nursing &... 04/01/07

Bradwell Hall Nursing &... 28/11/05

Bradwell Hall Nursing &... 23/05/05

Bradwell Hall Nursing &... 25/11/04

Bradwell Hall Nursing &... 14/06/04

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Maple Lodge

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

CARE HOMES FOR OLDER PEOPLE Bradwell Hall Nursing & Residential Home Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ Lead Inspector Mrs Yvonne Allen KEY Unannounced Inspection 11th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bradwell Hall Nursing & Residential Home DS0000026940.V342696.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. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradwell Hall Nursing & Residential Home Address Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ 01782 636935 01782 719025 Edward-Twigge@hotmail.com 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) Bradwell Hall Nursing Home Limited Mrs Lynn Garner Care Home 171 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (93), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (10), Old age, not falling within any other category (58), Physical disability (20), Physical disability over 65 years of age (58) Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Chatterley Unit may comprise of 30 in total: 30 DE(E); 10 MD(E); 5 DE - minimum age 50 years on admission Sneyd Unit may comprise of 30 in total: 30DE(E); 10 MD(E) Chester Unit may comprise of 33 in total: 33 DE(E) Keele Unit may comprise of 20 in total: 20 PD Audley Unit may comprise of 45 in total: 45 PD(E); 45 OP; 10 PD - Minimum age 60 years on admission Breward Unit may comprise of 13 in total: 13 PD(E); 13 OP; 10 PH - Minimum age 60 years on admission. 04/07/07 Date of last inspection Brief Description of the Service: Bradwell Hall is a purpose built family run home that provides both nursing and personal care for up to 171 people. It is situated within extensive grounds in a pleasant residential area on the outskirts of Newcastle-under-Lyme. The home comprises of six units - Audley Unit has recently been extended by 15 beds. This Unit provides nursing and personal care for frail elderly people, Chester Unit provides nursing and personal care for frail older people and up to fifteen older people with dementia care needs, Keele that provides nursing care for younger physically disabled people, Sneyd, a nursing unit for older people with mental health problems, Chatterley that provides both nursing and personal care to older people with mental frailty and Breward that now provides nursing and personal care and support to older people who may also have a physical disability. The units are all on one floor and can be accessed independently. Each of the units has a lounge, dining room and kitchen area. The majority of the bedrooms are single with en-suite facilities consisting of toilet and wash hand basin and there are assisted bathrooms. The original house is central to the units and houses the reception area, ground floor meeting rooms, administration offices and central kitchen that provide the main meals to all of the units. The laundry is situated to the side of the main house. The fees charged by this home range from £280.00 to £730.00. Extra charges apply for Hairdressing, Toiletries, Newspapers and Transport. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 5 Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was carried out over two days by two inspectors. All the key standards were assessed with samples of evidence taken across all six of the units. The evidence used to assess the standards was as follows – Direct observation of care practices Examination of records and documentation Discussions with service users and staff Discussions with managers and Providers Tour of the units Short Observational Framework Inspection At the end of the inspection the evidence was collated and verbal feedback was given to the Registered Manager and Providers. All the key standards were assessed during this unannounced inspection visit. The Providers had also completed and returned to CSCI an Annual Quality Assurance Self-Assessment which contained information about the home prior to the inspection visit. There were 5 requirements made in total and fourteen recommendations. The majority of minimum standards were fully met with 2 – standards 8 and 9 almost met. The Registered Manager and Providers had worked very hard to address the requirements from the previous report and there had been definite improvements made across many areas since the last inspection. This was a pleasing inspection overall with many positive outcomes for the people who live at the home. Outcomes were assessed as good and adequate. There were no poor outcomes identified. What the service does well: This is a very large nursing home and, as such, it can be difficult to attain and maintain the balance between a clinical setting and a homely environment. The Providers and Registered Manager manage to do this quite well. Each unit is different and caters for differing needs of individuals. Bedrooms are personalised and some of the units have different themed entrances. This now needs taking though the units with the environment being adapted to suit the individual needs of the service users. At the time of the visit there were very few individuals who had developed pressure sores in the home and for a home of this size this could only be Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 7 attributed to the skills and competencies of the managers, nurses and care staff. Special pressure relieving equipment was provided as and when required and specialist advice was sought when needed. The outdoor space provided for service users is safe and accessible and there was a good example of where a service user had taken ownership of the garden area and was tending and growing plants and vegetables. Daily life and the provision of social activities was good and had improved recently. Individuals are now receiving an improved programme of activities and therapeutic and social needs are catered for. The people who live at this home can be assured that any concerns they have about the home will be listened to and taken seriously. There is a robust recruitment process and individuals can also be assured that, whilst they are in the home they are in safe hands. The home has benefited from consistency of management with the Registered Manager having been in post for several years and having worked at the home for many years. What has improved since the last inspection? What they could do better: The overall management and deployment of staff on Audley unit is in need of improvement. Sometimes periods of waiting for attention were lengthy and Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 8 individual residents were becoming increasingly frustrated. The unit was observed to be quiet on one side and very noisy and somewhat chaotic on the other (new) side. The reasons for this were unclear but there was a lack of staff supervision in this area. Completion of records relating to care – in this instance fluid balance charts, identified that either some individuals on this unit had not been offered drinks from 5pm through to 9am the next morning, or these had been given and not recorded. One resident was overheard to comment, “nothing ever gets done and there’s no organisation”. The medication process needs to be tightened up – to ensure that prescribed medication is signed for at the time of administration – there were a number of gaps noted on Medication Administration Record (MAR) charts. Also photographic identification of each resident is recommended, with consent. The Providers will need to ensure that residents are protected against contracting Legionnaire’s disease and a certificate of compliance is required in respect of the Home’s water system. There have been some recommendations made at the end of this report which the Providers should also take into account and which will help bring about improvements at the home. 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. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 9 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 Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 10 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): Standards 1 and 3 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and their families are supplied with sufficient information about the home in order for them to be able to make an informed decision. The Provider needs to review this information to ensure that it is up to date and made available throughout the units. EVIDENCE: The service does have a Statement of Purpose and Resident Guide that identify the type of service, the care needs it can meet, staffing and management structure, and terms and condition of residency. The providers discussed a Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 11 number of changes that had taken place since the last key inspection in January 2007, it was recommended that a review of both documents was undertaken to ensure that they accurately reflect the current arrangements at the home and fully comply with the changes to the Care Homes Regulations 2001, that took place in July 2006. On Breward Unit, staff are not familiar with either of the documents and did not know where a copy of the Statement of Purpose was. The deputy unit manager did find a copy of the resident guide and was asked to ensure that it was on display in the home. Ideally all residents should have a copy of the guide. It was accepted that Breward staff were relatively new to the service. The service has a number of tools it uses for the pre admission assessment of residents, dependent on the nature of the care required. Senior nursing staff are responsible for all pre admission assessments. There were examples in a sample of care files that these had been properly completed and the information used to inform care plans. Copies of care management/social worker assessments were also available in the paper files for local authority funded residents. On admission to the home each resident and their carers will be involved with the completion of a “getting to know you” assessment, which is used to establish the social history of the individual, likes and dislike, preferred routines, i.e. waking and retiring times and known areas of risk. Information from all these assessment documents are transferred onto the computer records each resident has. From an example of computer records, there was some variation in the quality of the information transferred from the paper assessments. This was discussed with the manager and providers. It is accepted that some units have been using the new computer records for longer than others. But it would be useful if staff are provided with a good practice example for record keeping to ensure some consistency in it. This should also include specific guidance about the location of records, for example some information about GP visits was located in the general progress section on one unit and on another was included in the section for the GP. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 12 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): Standards 7,8, 9 and 10 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall individuals can be assured that their personal, nursing and healthcare needs will be fully met by the staff at the home. There is a need to review and improve this on Audley unit. EVIDENCE: Examples of care records show that care plans are developed based upon the assessed needs of residents. These are also supported by risk assessments where a risk had been identified. Plans are in place to address the physical, psychological/emotional and social care needs of individuals. There is evidence in all cases, of regular reviews of care plans and evidence of multi disciplinary involvement where needed. There is evidence that care plans on Chatterley Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 13 are particularly comprehensive. In the paper care records on Keele unit a number of residents had a consent forms completed with instructions not to resuscitate. All of the forms were signed with the GP, a manager and next of kin, the forms also state that a review of these instructions must be undertaken every 3 months, the records did not show that, in all cases this had happened. During discussion with staff and from information in care records on Breward, it was identified that one resident has had a number of falls. A risk assessment had been undertaken but staff remained concerned about the risk and the frailty of the resident and had been provided with a “Kirton” chair for him, which in effect prevented him from getting up. While this method had reduced the incidents of falls and was clearly undertaken in the best interests of the resident. It could also be considered as a method of restraint, the care manager is asked to arrange a multi disciplinary review of the care of the resident and take action to ensure that, if the “kirton” chair is determined to be ethically appropriate that this is agreed with all relevant parties. These types of resident management must not be used as a substitute for ensuring sufficient staffing levels are provided. On Chatterley unit, the manager identified some concerns she had around the input from social workers that had been difficult to arrange. In respect of one resident, an independent advocate had been sought as the manager did not feel that the residents needs were being met on the unit, and because the social worker had not acted promptly when these concerns had been raised. During this inspection visit, a period of time (2 hours on each unit) was spent observing practice on Keele and Chatterley, this included observing staff and a sample group of residents, interactions, resident engagement and state of well being. Throughout the period of observation, the overall conclusion was that staff were positive in their approaches and interactions to residents, although there were occasions where they could have spent more time to listen to the resident and one occasion where a resident was not acknowledged when calling for staff attention. The observations confirmed that staff were generally familiar with care plans, although there were examples where this was not the case. On one occasion where the care plan had identified that the resident “responds better when staff sit to the left side to feed and interact with her,” this did not happen. Residents were treated with respect by care staff, and there was evidence of good-natured banter between them, this approach was also used on occasions to effectively diffuse situations that could have been potentially difficult to manage. An analysis of the overall outcomes of the observations has been shared with the providers. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 14 The dependency of residents varies from unit to unit. Breward has historically always provided care and accommodation for an older more independent residential client group. As the dependency criteria for residential care has changed, residents now referred tend to be more frail, and over recent years there has been a move on this unit to accommodate some older people who have been assessed as requiring nursing care. At the time of this visit, 6 residents were assessed in this way, with one other who was described as undergoing a review of his care needs. Other residents were assessed as requiring residential care. Keele unit provides care for a predominantly younger resident group where dependency is high. Residents may have complex care and health needs, the majority are wheelchair dependent, requiring the assistance of two care staff to support them with all of their personal care needs. A range of specialist equipment is provided including, pressure relieving mattresses, cushions, hip protectors, hoists and equipment for bathing. Chatterley Unit provides care and accommodation for an older resident group who have health and dementia/mental health problems. Some resident may demonstrate behaviour that challenges the service requiring sensitive intervention. Examination of care plans identified that tissue viability risk was assessed and a care plan put into place. There was specialist pressure relieving equipment provided when needed and the low number of individuals who had developed pressure sores can only be attributed to the skills and expertise of the managers, nurses and care staff delivering care. The details of prescribed medication were recorded in the computer records of residents at the time of admission and there was evidence from some of these records that reviews had taken place. On Breward unit a resident had been recorded as having a small skin break to her bottom, a Tegaderm dressing had been applied. Tegaderm was not included in the list of medication, for this person. One individual on Audley unit currently self medicates their insulin medication. This was an individual who was admitted for respite care. The nurse on the unit was developing an individual risk assessment in relation to this. Selfmedication was discussed with staff and the deputy manager on Breward who felt that a small number of residents might be able to take responsibility for their medication. It was suggested that residents should be supported to be more independent in this respect, following an assessment of risk. The medication process was assessed in detail on Audley unit. The inspector accompanied the nurse in charge on the 11am medication round. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 15 This was carried out as per medication policy. The nurse was observed to be knowledgeable, professional and had a good rapport with the residents on the unit. At one stage she noted that the colour of a tablet had changed in the Nomad system and rang the Pharmacy to check. The colour of the tablet had changed but the description of the tablet scribed on the back of the cassette had not been updated by the Pharmacy and she was right to question this. Examination of the Medication Administration Record (MAR) charts identified that there were some random gaps where the nurse administrating had not signed for prescribed regular medication. This was in relation to different medication on different dates. It was also identified that there were a number of residents on this unit with no identifying photograph in place on the MAR chart. It is good practice and a recommendation that each MAR chart contains a photograph for identity purposes of the resident. The procedure and records relating to the administration of controlled medication was examined on Audley unit and found to be in order. This was in respect of a random sample of Temgesic and Temazepam medication. The inspector was informed by the manager that nurses had undergone refresher training in drug administration earlier on in the year and the nurse on Audley unit confirmed that she and her colleagues had received this. On Chester unit the inspector walked past a bedroom where the door was closed and a care assistant was carrying out personal care for a resident. The inspector noted that the care assistant spoke to the resident with dignity and respect and in a very caring manner. She was obviously helping the resident to get washed and dressed and was a credit to the care team. Staff were observed to be generally very attentive to the needs of residents on this unit. On Sneyd unit staff were observed to be busy meeting the needs of residents – it was pleasing to note how residents move freely around the unit but, at the same time their safety is maintained by the staff. One service user spent much of his time moving systematically around the floor at one end of the lounge/diner. This, albeit at first sight, alarming, was the only way that this resident remained calm and settled. His wife came to feed him daily and was very happy with his care and this did not faze the other residents at all. There was another resident who wandered around the unit constantly, stopping occasionally to look at something in detail – yet her safety was maintained at all times. There were other relatives present on this unit who were observed helping their loved ones to eat lunch. Discussions with two of them identified that they came in to do this because they wanted to (to be involved in their care) and not because they felt obliged to do so. They were both full of praise for the staff who worked on the unit. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 16 Staff moral was good on this unit too. On Audley unit staff were very busy and the unit did not appear to run as smoothly or as well organised as the others. It was observed that there were a number of residents (6 in all) left sitting at the dining table in the new part of the unit for a number of hours – from breakfast through to lunch without being moved. 2 of the residents could move themselves but one of the residents - who was very elderly had been shouting for assistance to go to the toilet for over an hour. In the end – the inspector had to mention this to the manager of the unit and a staff member then came to assist the lady. There was an abundance of fluid balance (intake/output) charts in use on this unit. However, examination of these found that, for several residents, there were no records of drinks having been offered or taken from 5pm and 7pm on one day until 9am the next day. This indicated that either no drinks had been given for 16 hours or the charts were not being completed. Either way this needs addressing. This was discussed with the Registered Manager and Providers during feedback. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are now receiving an improved programme of activities and therapeutic and social needs are catered for. Choices are documented but individual preferences cannot always be guaranteed in relation to meals. EVIDENCE: Standards 12,13,14 and 15 were assessed. Since the last key inspection in January 2007, the service has made a concerted effort to improve the social and recreational opportunities available for residents. The number of dedicated activities co-ordinator has increased from 2 to 4, and each unit had a timetable for planned activities. The sensory room on Keele unit has been fully fitted with equipment and comfortable Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 18 furnishing. On Chatterley the main foyer has been created into two themed areas where residents can sit with staff individually or in couples to reminisce about their lives. One of these areas reflected a beach scene the other represented life during the 1930’s and 40’s. Records on both units showed that residents’ social histories have been established and information about hobbies and interests previously enjoyed provided. There was evidence in the records that residents had been involved in some activities in the home and occasional outings had taken place or were planned. On Chatterley, one resident had been supported to continue with his love of gardening and clearly was benefiting from this. During the visit a number of residents were involved in a craft session, which they evidently enjoyed. The service has an open policy in relation to visitors; there was evidence of this throughout the visit and from the visitor’s book located at the main entrance to the home. Menu’s have been created with a choice of main meal at each mealtime and on Chatterley the meal choice was displayed in the unit. Residents are asked to choose a meal from the menu, the day before it is to be served. A mealtime was observed on both Keele and Chatterley. Residents on Keele were fully dependent on the care staff for their meals, a significant number are not able to receive an oral diet due to their healthcare needs. Staff closely monitor their nutritional needs and fluid intake, with advice from dieticians this was evidence from the records available. Other residents on Keele require “soft diets,” this can mean that the meal choice for the day is liquidised. It is usually accepted good practice that when liquidising meals, each item is liquidised separately, so that the food is attractive to look at and also the resident can taste the flavours of each of the ingredients. The meal choice on Keele was “lobby,” a type of usually un-thickened stew that is local to the North Staffordshire area. This cannot be liquidised separately as it is normally served as one dish with all ingredients together. Staff supported residents on both units appropriately during mealtimes, and from observation the experience for residents was relaxed, calm and unhurried. The practice of the home is to serve the pre-selected meals on plates. This approach has its benefits but could also limit the amount of real choice for residents. The care manager and a unit manager stated that this was not the case; if a resident indicated that they wanted an alternative to the meal they had chosen, one could be provided. The pre-plated meals can present other difficulties, for example on Chatterley one resident was heard to say “ they’ve put too much on my plate, it over faces you and puts you off when there is too much None of the residents on Chatterley were told what the meal was when it was served, or were asked if they wanted to have gravy or sauce on their Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 19 meals, it is accepted that staff know what each residents usual preference is, but again it should be normal practice to offer choice on each occasion. A short inspection of the kitchen was conducted. This was found to be clean and tidy at the time. There were two cooks and 2 kitchen assistants on duty. The kitchen has its own cleaner who comes on each evening. The cook explained how individual choices are upheld and plates were coded as to large, medium and smaller sizes. All the kitchen staff had their food safety training certificates on display on the wall. It was identified that one of the cooks, who works on the bank, had an out of date certificate and this training will need to be updated. The main dish served at lunchtime was braised steak with mashed potatoes and vegetables - the inspector tasted this and found the meat to be very tender and the meal itself delicious. A small kitchenette is available on each of the units that contain a fridge or fridge/freezer, microwave, a boiler and storage units. Care staff make drinks, breakfast and snacks in these areas. Daily fridge temperatures are recorded and were on display on both Keele and Breward unit, but not checked on Chatterley. The evidence of the records showed that there were problems in both areas, on Breward the temperatures had been recorded as consistently high since April 07 on the 10/05/07 a note had been made in the communication book that the “fridge was not working right” and again on the 14/05/07 “ the fridge not working as it should.” The temperatures were recorded as above 9c for that period; although more recently the records showed that the matter had been resolved. On Keele, high temperatures had been recorded since 22/04/0,7 on the 01/06/07 a note had been made that management had been made aware of the problem. Since that time some improvement had been noted but at the time of the inspection the records showed again that temperatures were high at 10c, when it had been checked at 5am. The temperature was checked during this visit and found to be within the acceptable range. All of these matters were discussed with the providers and care manager for their attention. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at this home can be assured that any concerns they have about the home will be listened to and taken seriously. They can also be assured that, whilst they are in the home they are in safe hands. EVIDENCE: The CSCI have received and investigated one complaint since the last inspection. The complaint was that there were not enough staff on duty during the night shift on Audley unit. An unannounced night visit was made to the home on 22/3/07 at 10pm by two inspectors where it was found that there was one nurse and three care staff to care for 40 residents requiring nursing care. One resident was complaining about having to be put into bed early because “there are not enough staff on duty” and it was observed that staff were struggling somewhat to cope and the nurse was having to keep breaking off from the 10pm medication round in order to help the care staff put residents to bed. This was discussed with the Registered Manager following the inspection and it was agreed that an extra care staff member would be rostered to work on this unit until 10pm every evening and from 7 am every morning. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 21 There was a clear complaints procedure displayed at the home on which the details of CSCI were included. The number of complaints received by the manager during the last 12 months was 26. 24 of these complaints were upheld and 2 were waiting for an outcome. The managers spoken to on the units stated that they would address any concerns as and when they arose but that the Registered Manager dealt with any major complaints. The people who were spoken to at the time of the inspection visit commented that they would know who to go to if they had any concerns and that the manager always came and listened to them. There was recorded evidence that staff are given instructions in Protection Of Vulnerable Adults (POVA) and the Vulnerable Adults policy. This is usually given during induction. There was written evidence that staff receive further training session updates in Abuse. Staff members spoken to during the visit confirmed that they were aware of the policies and procedure and would report any suspected abuse to their line manager. During the last 12 months there had been 1 safeguarding referral made and a corresponding investigation carried out. Staff are very carefully selected to work at this home and undergo a number of stringent checks to ensure that they are suitable to work with vulnerable adults before being offered a job at the home. Examination of a random sample of staff files confirmed this. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents live in a safe well-maintained environment, which has been adapted to meet physical needs this could be improved by further adaptation to meet the specific needs of those individuals suffering with confusion, disorientation and dementia. Also more provision of equipment to help maintain infection control standards is recommended. EVIDENCE: Standards 19 and 26 were assessed. A tour of the units was conducted where it was identified that the Providers had made a concerted effort to improve the environment. There was an on Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 23 going redecoration/refurbishment programme and many of the bedrooms had been updated with matching duvets and curtains. New carpets had been provided in the lounge on Keel unit. All areas of the home were clean and well presented and there were no mal odours noted. Bedrooms had been personalised and adapted to meet individual needs. There were items in place to help maintain infection control measures such as separate hand wash gel and disposable paper towels for the nurses and care staff, alcohol gel was provided on each unit for visitors to use. There were separate sluice rooms – one for each unit – although for Audley unit one sluice room was considered insufficient for such a large unit. Nursing and care staff sometimes had to carry used commode and bedpans, urinals and vomit bowls – a large distance along the corridor, which is not ideal when considering the spread of infection. There was one sluicing/disinfector provided for the whole home. It is a recommendation that the arrangements for infection control at the home be reviewed. The external entrances to the units were very pleasantly decorated each having different themes – This could now be extended through the units, where further adaptation of the environment would benefit the people who live there and would help meet some of the needs of residents with dementia such as help with orientation and stimulation. From each unit residents had access to a safe enclosed garden. On Chatterly unit the inspector spoke at length to a resident in the garden area. He was very keen to show the inspector the plants including tomato plants, which he had grown and was tending very carefully. The garden was very attractively laid out with plants in pots, shrubs, garden furniture and ornaments – all set out over a large patio area. This resident obviously had a very keen interest in gardening and this had been facilitated and encouraged by the Providers. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The improvement in staff recruitment and retention generally has had a positive impact in staff moral and, in turn, on the delivery of care to residents. The provision and deployment of staff on Audley unit is in need of review and improvement in order to ensure that individual needs of residents are met. EVIDENCE: At the time of the inspection visit there were 155 residents accommodated in the home over 6 different units. Breward: Staffing levels have been increased since the last key inspection, this improvement is considered necessary given the increasing dependency of some of the resident group. Staffing arrangements provide for 3 staff during the morning shift, and 2 throughout the afternoon and evening, with 1 carer at night supported by night staff on Keele. One unit manager, who has a deputy manager responsible for the day-to-day care provided in Breward, manages both units. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 25 Numbers of NVQ trained staff were low on this unit, with 1 person undertaking the level 2 training and the deputy manager at level 3, it was also noted that the majority of staff were fairly new and were following the induction programme for the home. A number of these staff stated that they hoped to undertake NVQ training on completion of their induction period. All staff spoken to confirmed that they had received induction training when they started at the home and that newcomers receive the same. A selection of staff training records were examined where it was identified that there was a training plan in place at the home with training sessions geared around meeting the needs of individuals. It was also noted that there were a number of gaps where staff had not received update sessions in mandatory training such as moving and handling and other areas. This was pointed out to the training manager at the time where she commented that it had been difficult, over the past months, to organise training sessions due to staff having to cover shifts on the units. Also she did not have a hoist available in the training room. This was discussed with the manager and Provider during feedback where it was confirmed that the staffing situation had now improved with staff being available for training and a hoist would be provided in the training room. Keele: Staffing arrangements were usually 7 during the morning, 6 during the afternoon and 5 in the evening of whom a minimum of 1 is a qualified nurse, the unit manager stated that she tried to have at least 1 shift a week where she is supernumerary to the staffing numbers. Night staffing levels included 1 qualified nurse and 2 care staff. An activities co-ordinator is allocated between Keele and Breward for 5 day’s per week between 10am-3pm. Chatterley: Staffing arrangements were usually 8 during the morning, 6-7 during the afternoon and after 6pm 5, of these numbers a minimum of 1 is a qualified nurse. Of the care workers 2 have NVQ level 2, 3 were doing the training and 1 was training at level 3. An activities worker is allocated to this unit from 10am-3pm over a 5-day period, these hours are shared with another of the units. Managers stated that they arranged supervision for their staff and held staff meetings periodically. On Chester unit there were 2 trained nurses, 1 manager and 5 care staff on the morning shift. There was a good staff moral noted on this unit and two members of staff spoken to confirmed that staff moral had improved as there was a new manager in place and staffing had started to settle down. The Providers had recruited a Housekeeper since the last inspection. Discussions with her identified that she had obtained the City and Guilds 717 award in Housekeeping. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 26 She was responsible for a team of 27 domestic staff and also liaised with the maintenance team – 3 maintenance persons and two people carrying out carpet cleaning. She held supervision meetings and ensured that staff had training in fire safety, moving and handling (equipment), H&S, Infection control and COSHH. She appeared very organised and efficient. The Providers had also recruited a Deputy Manager and this appointment is discussed under the next outcome (Management). As outlined earlier in the report, Audley unit was somewhat chaotic and poorly managed there appeared to be insufficient staff around to attend to the needs of individuals with residents complaining about having to wait for long periods of time for attention. This was discussed with the manager and Provider during feedback and will need to be addressed. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recent recruitment of unit managers, a deputy manager and a housekeeper has had a positive impact and the home is managed in the best interests of the people who live there. There is a need to review and improve the management of Audley unit. EVIDENCE: The providers had made improvements in the management support for the home since the last inspection. Each unit now had its own manager in place. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 28 Discussions were held with the manager on Audley wing, who was a Registered Mental Nurse. This unit accommodated people with general elderly nursing needs and it is a recommendation that this manager receive training in general nursing (Registered Nurse training). It is also recommended that the manager have the support of Registered General Nurses on each shift. Discussions with the Registered Manager and examination of the duty rota, confirmed that there is always a General Registered Nurse on duty on this unit. Management of this unit at the time of the visit was in need of improvement. The Manager of Chester wing was not a trained nurse but had a great deal of experience in care of the elderly with dementia needs. As this was a unit catering for nursing needs discussions were held with the Registered Manager in relation to ensuring that there was good trained nurse support on this unit. It was identified that there was a trained nurse on duty constantly on the unit. The manager of Sneyd unit was spoken to at length as was the managers of keele/Breward and Chatterly units. The managers all appeared competent and possessed the necessary skills and expertise to manage their units. Discussions identified some very positive thinking and some good ideas for development and improvement of the units. The home had also recruited a Deputy Manager since the last inspection. She was not a qualified nurse but had many years experience as a care manager. Discussions with her identified that she was responsible for – staff recruitment and retention, staff induction training, auditing on each unit, pre-admission assessments, together with the managers of units, staff meetings, staff supervision and monitoring of staff sickness. She stated that she meets with the Registered Manager of the home on a daily basis. The Registered Manager had been in post for several years at the home and had worked hard to recruit new managers for the units. The introduction of the managers had generally had a positive impact on staff – who commented that they felt more settled and that staff moral had improved as a result. There was a Quality Assurance programme in place at the home which included seeking the views of the people who use the services. These included – Service User questionnaires Regular relatives and residents meetings Care plan reviews The following changes had been made as a result of the above – Changes made to menus Further provision of evening staff Increase in the number of outings Increased the number of activity hours Refurbishment plan across all the units Introduction of incentives for staff retention, including employee of the month Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 29 The Providers are in day-to-day control of the home and therefore are not required to send in a Regulation 26 report to the CSCI. Examination of records relating to Quality Assurance identified that an audit of maintenance throughout the home had been completed in March 2007. There were areas identified for improvement and the date the work was completed. On Sneyd unit controlled drugs had been audited on 25/05/07, personal care had been audited on 09/05/07, infection control in April 2007 and the relatives’ questionnaire in April 2007. Records relating to the maintenance of personal allowances were examined. Wherever possible families were encouraged to deal with the finances of individuals. There were also some who had advocates. Personal allowances were found to be in order and there was a clear audit trail of monies received and spent. Receipts and invoices were kept and signatures recorded. It was identified with the Provider that any individuals who had large sums of money – were helped to invest this in a savings account, which accrued individual interest for them. The provider was in the process of facilitating this for 6 individuals in the home at the time of the inspection visit. The Health and Safety (H&S) of the staff who work in the home and of the people who live in the home is taken seriously by the Providers and Registered Manager. There is a H&S statement in place at the home and many policies and procedures in place relating to this. Individual risk assessments are carried out and recorded in care plans. Records relating to the servicing of equipment were checked and found to be in order. There is a requirement for the Providers to obtain a certificate of Legionella compliance in order for individuals to be protected from contracting Legionnaires Disease. Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 30 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13(1)(3) Requirement There is a requirement for the Providers to obtain a certificate of Legionella compliance in order for individuals to be protected from contracting Legionnaires Disease. Individuals must be offered regular drinks and where intake and output charts are used for individuals – these must be fully completed in order to give a true picture of nutritional intake. This was in respect of Audley unit. Staff must supervise the communal areas where residents are sitting so that attention can be given and individual needs can be met. This was in respect of Audley unit. Medication must be signed for on the MAR Chart by the nurse at the time of administration. Timescale for action 27/08/07 2 OP8 12(1)(a) 27/07/07 3 OP8 12(1)(a) 27/07/07 4 OP9 13(2) 27/07/07 Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 32 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 OP1 OP1 Good Practice Recommendations Undertake a review of the Statement of Purpose to ensure that the relevant changes that have taken place since the last inspection are included. Undertake a review of the Resident Guide, to ensure that the fees are included, and residents can easily see how the fees are broken down, this includes both nursing and residential residents. Ensure that copies of the Statement of Purpose and the resident guide are available in the home and that staff are familiar with both documents. Where necessary and appropriate standardise the criteria for recording information on the computer to ensure consistency of care plans. The agreement for “do not resuscitate” must be reviewed every 3 months. The service should demonstrate how residents are involved in care plan reviews and evaluations. Accident records should be maintained as required by data protection regulations Personal details should not be included in a communal communication book. The service should promote resident independence as much as possible, in this instance this relates to selfadministration of medication. Provide residents with more meaningful choices at meal times. Ensure that any problems with the equipment is promptly reported and acted upon this relates to the fridge, which was recorded as being at temperatures above those recommended. It is a recommendation that the arrangements for infection control at the home are reviewed. The cook who works in the kitchen on the bank will need his food safety training updating and a certificate in place. All staff should receive regular update training sessions in mandatory training and this should be recorded. It is a recommendation that each MAR chart contains a photograph for identity purposes of the resident. DS0000026940.V342696.R01.S.doc Version 5.2 Page 33 3 4 5 6 7 8 9 10 11 OP1 OP7 OP8 OP7 OP7 OP7 OP9 OP15 OP38 12 13 14 15 OP26 OP15 OP30 OP9 Bradwell Hall Nursing & Residential Home Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-56 Stephenson Street Birmingham West Midlands B2 4UZ 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 Bradwell Hall Nursing & Residential Home DS0000026940.V342696.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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