Inspection on 23/05/05 for Bradwell Hall Nursing & Residential Home

This inspection was carried out on 23rd May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bradwell Hall Nursing &... 11/06/07

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

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

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

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bradwell Hall Old Hall Drive Bradwell Newcastle Staffordsire ST5 8RQ Lead Inspector Yvonne Allen Announced 23 May 2005 - 26 May 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bradwell Hall Address Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ 01782 636935 01782 719025 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bradwell Hall Nursing Limited Mrs Lynne Garner Older Persons Care Home 156 60 76 20 Category(ies) of DE(E) registration, with number OP of places PD Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1) DE- up to 5 aged 50 years on admission to chatterley unit 2) MD(E) - up to 20 may be admitted to sneyd/Chatterley Unit 3) DE(E) - up to 15 with both nursing and dementia care needs Date of last inspection 25 November 2004 Brief Description of the Service: Bradwell Hall is a purpose built family run home that provides both nursing and personal care for up to 156 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 that provides nursing and personal care for frail elderly people, Chester that 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. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection focussed on talking to staff, residents and visitors. All six units in the home were inspected including all communal areas and a selection of bedrooms, the kitchen and laundry. Documentation was examined. This included looking at care plans, medication charts, complaints books, accident records, staff supervision records, records of activities, staff training records and maintenance records. The inspection took place over 4 days and was carried out by 3 inspectors. Verbal and written feedback was given to the proprietor and registered manager on day 4. Inspectors were made to feel very welcome by all the staff and residents in the home. Most of the standards assessed were fully met, some were exceeded and a few were almost met. Where a scoring of 2 is given a requirement has been made in relation to this standard. At the time of the inspection building work had commenced on the planned extension. This will comprise of a fifteen-bed care unit on the second floor, which would be an extension of Audley Unit and a separate nursery unit on the ground floor. What the service does well: This was a very positive inspection. All the requirements with the exception of one, from the previous inspection report had been addressed. However, plans were in place to address this requirement. All the residents spoken to during the inspection felt well cared for and happy with the services provided by the home. Comments were received that staff were very kind and attentive and this was evident. Visitors spoken to at the time were happy with the care their loved ones were receiving at the home. From observation and discussion with the service users, it was clear that staff had a very good understanding of the service users needs and they worked hard to maintain the dignity and privacy of the service users at all times. Staff Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 6 were observed speaking respectfully to the service users and encouraging independence for those who were more able. Members of staff spoken to all stated that they felt very well supported by the management and that they received regular update training. This was evident in examination of training records. Training support for the staff is very good. Staff stated that they receive supervision on a regular basis. New staff undergo a thorough induction before being counted in on the staffing rota. The standard of care planning was good throughout the home. Care plans had been regularly evaluated and were comprehensive. Individual healthcare needs were being met. Specialist involvement and medical and nursing intervention were evident where needed. The menus were varied and meals served were appetising and nutritious. Management of individual units and general management of the home was very good. What has improved since the last inspection? What they could do better: The staffing arrangements for Keele Unit will need to be kept under review in relation to the provision of a senior care assistant on afternoon and evening duty to support the nurse. Clinical update training and support toward maintaining individual PREP requirements is needed for trained nurses. NVQ training will also need to be stepped up. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 7 Staff must ensure that daily notes as record of care are completed. The provider will need to seek advice from environmental health in relation to the provision of a dishwasher in the main kitchen and a fly screen must be provided. The procedure for handling complaints will need to be reviewed. In relation to when the new unit is up and running the home will need to provide More activities hours. More hours dedicated to staff training. The laundry area will need to be reviewed in relation to storage facilities with the addition of an extra 15 beds. More domestic hours will be needed. More kitchen staff hours will be needed. 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. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Potential service users received an initial assessment to identify their needs before moving into the home and notification that those needs could be met. EVIDENCE: On all the units there was evidence of pre-admission assessments. Residents had undergone an assessment of their needs prior to admission to the home. Either the registered manager of the home or the individual managers of the units had carried these out. Discussions were held with managers who stated that residents always undergo an assessment of needs if transferring from one unit of the home to another and that families are always kept informed. Discussions with visiting relatives confirmed that they are kept informed of any changes. Through examination of care plans and nursing records and through discussions with staff members, it was possible to identify that individual needs of residents were being met on a continual basis at the home. The records showed that the home could meet the needs of the service users for all aspects of health, personal and social care requirements. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 10 Residents entering the home received written confirmation from the providers that their assessed needs would be met. Evidence of this was shown to the inspector. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The care planning processes in the home were clear and consistent and, with the exception of a couple of omissions of documentation, provided good information for staff to meet service user’s needs satisfactorily. Individual residents could be assured that their personal and healthcare needs would be met on a continual basis. Care was delivered in a professional and dignified manner and, with some minor additions; residents could be assured that their privacy would be maintained. EVIDENCE: The above standards were inspected throughout each unit. A selection of care plans was examined. The standard of care planning had improved throughout the home since the last inspection. Individual plans were found to be thorough and comprehensive. The plans had been evaluated on a regular basis and there was some evidence of family involvement in this. Individual risk assessments had been developed and were updated on a regular basis. Some gaps seen were in daily information (day and night shifts) recording personal care provided. This must be improved upon. Individual healthcare needs were assessed and monitored on a regular basis. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 12 The records relating to a totally dependent resident were inspected and provided detailed information concerning all aspects of physical and emotional care. Nutritional screening and waterlow scores were all recorded and reviewed and weight records closely monitored. The resident had a special chair for his use, was hoisted for all purposes and transferred short distances in the hoist as a safety and comfort measure. He had the necessary vitamin and liquefied inputs to sustain him. Relatives were involved in all aspects of care and signed care planning records. This was a good example of a high standard of care provided to a highly dependent resident. Visiting opticians were seen providing eye tests for new residents and further tests to ensure all had at least annual testing. Many residents are unable to speak or intimate whilst being tested but appropriate photographic equipment etc was available for the assessments. New residents are tested within minimum of 3 months. It was also noted that a speech therapist was visiting a resident at the time of the inspection. The overall involvement of healthcare professionals at the home was very good. GP support for the home was good and the GP was seen visiting during the inspection. Several new residents were seen and the relatives of one who were attending for initial review. They spoke highly of the care provided in comparison with previous nursing home placement but had some reservations about the diagnosis and treatment of their mother. This was further discussed during the review and was clear that staff had provided considerable interpretations and support to them to this point. The minutes of the review (later seen) confirmed satisfaction with the care and placement and improved awareness of diagnosis and future care. There was evidence of pressure relieving equipment in use throughout the home and there were only 3 residents with pressure sores throughout the home at the time of inspection. Residents were helped with mobility and assessed for this. A totally dependent lady was hoisted and the hoist used to transport her small distances in the home. This has been cleared with the hoist specialists, appropriate equipment is provided and all staff had received moving and handling training. Relatives also approved the action. A moving and handling assessment had been made and recorded. A resident admitted two weeks prior to the inspection had some demanding behavioural features. These were well documents in a Behavioural Response form, which addressed the issues with clear instructions for managing the behaviours. Excellent multi disciplinary working takes place for the service users within the home. Evidence of this included numerous well-documented records of visits by and to health care professionals e.g. one service user recently attended the Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 13 breast clinic for a mammogram. Other professionals who were accessed were the GP, CPN, chiropodist etc. Service users also confirmed that their health care needs were being met. The medication processes were examined on each unit. Medication was found to be satisfactory, with all records appropriately in place indicating a safe system of medication administration on the units. One concern was that the mediation storage room/office on Audley unit was very warm and the temperature was over and above that recommended for the safe storage of some of the liquid mediations. There was no thermometer in this room and it is a requirement that the temperature of this room is monitored and kept within acceptable limits. Staff were observed as treating residents with dignity and respect. Personal care was carried out in individual bedrooms and bathrooms. GP visits and examinations were carried out in residents’ own bedrooms. Many staff members were spoken to and they explained how they promote privacy and dignity for the residents in the home. All staff were helpful and cooperative during the inspection. There was good engagement noted between residents and staff. Several instances of good care and practice were instanced during discussions with residents, visitors, staff and upon the inspection of records. The only relative and next of kin (daughter) for one of the residents accommodated in Chatterley Unit lives in Switzerland she has weekly long conversations with her mother by telephone. Calls are taken on the office telephone and there is no privacy and some inconvenience to the resident and also staff. This instance (there are others) highlights the need and desirability for a portable telephone on units to make and receive calls in bedrooms with complete privacy. The facility would also assist staff in their daily work on the unit. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15 There was a range of social and recreational activities available within the home to meet the expectations of the service users. Visitors were welcomed and encouraged to be involved in care planning processes. Service users were able to exercise their rights to have control over their lives and make their own choices. The dietary needs of the service users were well catered for and a balanced and varied selection of food was available to meet service users individual tastes and needs. EVIDENCE: Since the last inspection there had been an increase of dedicated activity hours at the home by 20 per week. This had improved the standard of this service at the home. Discussions were held with both activity co-ordinators during the inspection and relevant records examined. A male resident spoken to in Chatterley unit expressed his interest in wildlife programmes. There were few TV’s in bedrooms due to lack of capacity but this resident clearly stated he would enjoy the option of a TV installation in his bedroom and use it. It was agreed that relatives would be approached but the Manager stated that a TV in the home would be available if needed. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 15 There was a relaxed atmosphere on Sneyd unit throughout the morning lunch time and afternoon. Activities workers were providing a service to residents, some without poor communication or capacity having hand-massage with interactive input. They responded well with non-verbal communication clearly enjoying the experience. Later care staff spontaneously spent time 1:1 with residents, talking using reminiscence equipment and engaging residents positively. There is an allocation of around 10 hours per week from the Activities Team to the unit. All activities are recorded clearly and indicate reactions of residents. The move towards external visits commenced last year have continued with small group of people attending local pubs for meals and visits to local supermarkets. There are also visits by the local high school and church services. This is a positive development to access community activities. The extra time available for the co-ordinators to spend on keele unit has been beneficial to these residents with complex care needs and one of the coworkers was seen spending time with a resident in the Snoozlan room. She explained that about fifty per cent of residents on this unit benefit from the Snoozlan. The co-ordinators were also observed organising activities on Audley Chester and Breward Units. Relatives commented that they were always made welcome within the home at any time. One service user had recently been on holiday with her daughter and granddaughter and there were many other examples of service users maintaining regular contact with family and friends. Service users were encouraged and supported to exercise choice and control over their lives as much as possible. One lady who had been in the home for a few weeks said that when she arrived at the home, her medication was given to her at different times than she had been used to previously. She informed the inspector that she wanted to stick to the previous arrangements and she was very happy that the care manager rearranged the times for her medication to be administered to comply with that request. The inspector noticed that the same service user was also supported to have a cigarette without impacting on any of the non-smokers within the home. Another service user was very proud for the inspector to view her bedroom, which had recently been redecorated to a very high standard. The service user and her daughter had chosen the wallpaper, border paper and curtains. One service user said that she loved to read quietly and had been at the home for a number of years. She said ‘I am very happy here, I have no complaints at all and the food is lovely too!’ Activity hours will need to be increased when the new extension to the home has been completed and this was discussed with the providers. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 16 The meals served appeared appetising and nutritional. The mealtime (seen) provided a relaxed setting with residents clearly enjoying their food. The food was well presented, nutritious and of a good quality. Menus were examined and found to offer a wide variety of choice. Some service users chose to eat in their own rooms. The inspector was impressed to see that staff used the microwave in the kitchenette/dining room to warm the plates for the service users before they served the lunch. There is now a daily choice of dishes from the menu. Staff were observed to be helping those residents who could not feed themselves. The catering staff provide special diets. Individual nutritional needs are assessed and monitored. Residents are regularly weighed and involvement by the dietician arranged as necessary. Residents with PEG feeds are closely monitored with visits to hospital arranged to change PEGS as and when required. Catering staff hours will need to be increased when the new extension is operational and this was discussed with the providers. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There was an accessible complaints procedure in place at the home. This procedure will need to be amended in order to improve clarity. Residents could be assured that the systems in place at the home would help safeguard them from harm or abuse. EVIDENCE: The complaints procedure is clearly posted in the home. All units now record “domestic type complaints” and the central complaints procedure is still a central point in the home. A complaint about poor quality food had been referred to the unit and recorded but also forwarded in writing to the Proprietors. The outcome at this stage is not clear, but perhaps the process for recording complaints should again be reviewed to avoid duplication or even omissions. Discussion with the manager identified that she would be reviewing this procedure. The manager of the home had dealt with 16 complaints of which 10 had been substantiated. All complaints and outcomes had been recorded. The CSCI had not received any complaints directly since the last inspection. Staff are given training in abuse and when spoken to during the inspection, were able to discuss the procedure for the reporting of abuse. The systems in place at the home help to protect residents from harm or abuse. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The home offered a clean, safe and accessible environment to residents. Redecoration and refurbishment will be ongoing at the home. Residents could adapt their personal living accommodation to suit their needs and preferences. The proprietor will need to attend to the issues raised in relation to environmental health pertaining to the main kitchen. EVIDENCE: Redecoration and refurbishment had taken place since the last inspection. This included a number of bedrooms, corridor areas, lounge areas and kitchenettes. In a home of this size redecoration and refurbishment is ongoing. It was identified that Keele Unit was in need of redecoration especially in bedrooms and ensuites. This was discussed with the providers at the time. Residents were observed using all the communal areas of the home. It was found to be cold in the communal areas and 2 residents said they were cold. The timed heating clock had not been over-ridden as required; this was because the new Manager had not been instructed how to use the system Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 19 effectively. This was quickly remedied when proprietors were contacted. This was a one-off situation but it is important to maintain a constant ambient temperature in all parts of the home. The units were attractively decorated with homely touches and residents were encouraged to bring in personal effects. Bedrooms had been adapted to meet the needs of individual residents and there was evidence of specialist equipment and beds in use throughout the home. In relation to Keele unit some of this equipment was highly specialised. Risk assessments had been developed for the use of this equipment including comprehensive risk assessments for bedrails. There were also daily checks carried out on bedrails by staff with records maintained. The Breward unit was single storey and therefore enabled easy access for all service users including those requiring wheelchairs. Each bedroom was of a good size and accessible for wheelchairs. There were 12 single rooms and 1 double. Each contained a range of personal items belonging to the individual service user and a locked drawer facility. Within each bedroom, there were adequate numbers of sockets and smoke detectors, and a good standard of furnishings and fittings. The unit was well maintained, both internally and externally to a high standard. A patio area with a number of pots and planters, next to the lounge, provided a pleasant space outdoors with seating. Access to this patio and other areas were tidy and safe for service users. The communal areas included a lounge and a dining room, and both were bright and very clean. The lounge was homely and comfortable, and had two birdcages, which contained a cockatiel and a budgie. The home had also been adopted by a cat, which seemed to bring a lot of pleasure to the service users. The dining room included a kitchenette area, which had a microwave, fridge, toaster and drink making facilities. The home was clean and hygienic throughout. There were systems in place to maintain satisfactory standards of hygiene in both the kitchen and laundry areas. Discussions were held regarding cleaning schedules with the housekeeper, domestics and kitchen staff. It was noted that the adhesive flytrap in the kitchen stores contained a number of flies. These were obviously entering the kitchen through the back door as there was no fly screen in place just chains and this was open. The chains must be replaced with a proper fly screen. The environmental health department had carried out a recent inspection of the kitchen but the report was not available. There was no dishwasher in the main kitchen. Crockery and cutlery used at mealtimes were maintained in the kitchenettes on each unit where these were Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 20 put through a dishwasher. The proprietor will need to take advice from the environmental health inspectorate in relation to this. It was identified that, once the new extension is operational, more dedicated domestic/housekeeping hours and more laundry space will need to be provided. This was discussed with the providers. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 21 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staff were carefully selected to work at the home and were given initial training. Staffing numbers and skill mix were appropriate to meet the assessed needs of the residents in the home. Staff training was given a high priority. NVQ training needs developing in order to meet with the standard. EVIDENCE: On the day of the inspection there were 27 residents accommodated on Audley unit, 25 residents on Chester unit, 19 on Keele unit, 11 on Breward, 29 residents on Chatterley and 24 on Sneyd unit. On Sneyd unit staffing remains at the same required level of 8:6:5:3, somewhat hampered during recent staffing shortages (staff leaving). The new arrangements for a dedicated unit manager will sustain the improvement. Sometimes there was 9 staff on duty on the early shift. There was evidence of good working relationships between nursing and care staff and a keenness to continue these well established working practices. On Audley unit there was a staffing level of 8:5:5:3. On Chester unit there was a staffing level of 8:6:5:3. The previous requirement for more RMN hours had been addressed with the introduction of an RMN on duty at night. On Keele unit there was a staffing level of 8:6:5:2. Discussions were held with the manager and provider in relation to reviewing the staffing arrangements on Keele unit. This was with reference to the employment of senior care assistants only from 8am-2pm. There were a high number of residents on this unit Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 22 requiring PEG feeding and with other complex care needs. It was felt that the skills and abilities of senior care assistants with NVQ training would be needed throughout the day, not just until 2pm. This concern was also raised by some of the staff spoken to on the unit. On Breward unit there were 11 residents accommodated requiring personal care. There was a staffing level of 2:2:1. Discussion with the staff evidenced that adequate numbers of staff were on duty to meet the needs of the existing service users. However, two service users required quite significant nursing care and although the unit was supported by an RGN from another unit when required, staffing may have to be reviewed to ensure that the existing residential service users are supported appropriately, if the numbers of service users requiring nursing care increases. The home employed a small number of bank staff, which were used to cover shifts when staffing numbers were inadequate. There was also a number of agency staff employed by the home. Domestic staff were employed on each unit working various hours. A part time housekeeper was employed and a laundry assistant daily. Kitchen staff were employed consisting of a head cook, a second cook and kitchen assistants on daily. Maintenance and administration were also provided by the home. The home employed a part time training manager and 2 activities coordinators. The home had an in-house training co-ordinator and staff spoken to at the home confirmed that the training provided was excellent. They also commented that the management were very supportive towards staff. Discussions were held with staff from all areas and from various job roles and all confirmed the above. Trained nursing staff commented that more clinical update training would be helpful and would assist them to maintain their PREP requirements. At the time of the inspection there was a total of 22 of care staff trained to NVQ level 2 and above. The home will need to work on the NVQ training in order to achieve the 50 required for this year. A number of staff who had recently started at the home were spoken to and confirmed that they had undertaken thorough induction training. All staff spoken to confirmed that new staff are inducted over a 2-3 week period, depending on ability and previous experience. Staff training undertaken since the last inspection included moving and handling, fire safety, food hygiene, first aid and abuse training. Dementia and challenging behaviour were planned for the near future. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 23 Staff had still not had required training in the Management of Violence and Aggression although 2 previous requirements have been made. This is presently being sourced and is required. It is proposed to provide a course for the homes Training Officer who would then be an approved trainer for staff. It may be more appropriate to consider a member of the EMI nursing staff for this purpose. It was discussed with the registered manager and proprietors that extra training officer hours will be required with the addition of the new extension and extra staff. A selection of employee files was examined and these were found to contain all the required information. The required criminal offence checks had been carried out and references had been obtained. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 24 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 38 Staff and residents benefit from the efficiency of the registered manager and management system within the home. The management style is open and inclusive and staff are supervised and supported. The manager and proprietors ensure, so far as is reasonable practicable, the health, safety and welfare of residents and staff at the home. EVIDENCE: The registered manager had the necessary skills and expertise to run this large home. She was supported in her role by the proprietors who were also in dayto-day control of the home. It was now proposed that each unit will have its own manager, and that they, in turn would report to the registered manager. The management structure was in the process of review at the time of the inspection and this would take into account the addition of the new extension. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 25 The registered manager had been managing Keele and Breward units for the last few months prior to the inspection as well as her own role. The manager is to be commended for maintaining the stability of these units under the circumstances. Discussions were held with the proprietors and registered manager who both confirmed that a new manager was about to be appointed for these units, which, in turn, would mean that the registered manager could return fully to her job role. There were previously 2 unit Managers each for Chatterley & Sneyd units. Staff shortages and changes on Sneyd (which affected Chatterley also) had been resolved since the last inspection. Attempts to cover both units with one manager have not been successful and the decision had now been made to again appoint a separate manager for each unit. There was now a manager for Chatterley and other appointment made for Sneyd. At the time of the last inspection there were deficiencies in providing adequate nursing cover for Chatterley - only 42 hours were being provided. This has been rectified with the appointments above and now a total of 102 hours per week nursing is provided to this unit, which, with the increased numbers of nursing residents, is now satisfactory. The manager for Audley unit had been managing both Audley and Chester, but a new manager was to be appointed for Chester and the manager for Audley would stay on this unit a this is the unit which will be made larger with the new extension. All the staff members spoken to supported their direct managers and the registered manager. They stated that the management approach was open and inclusive and that they felt well supported. Staff also complimented the proprietors of the home and stated that the family was approachable. Staff spoken to stated that they received formal supervision on a regular basis and records seen at the time of the report confirmed this. Records were examined in relation to the maintenance of a safe environment and these had all been maintained as required. Regular testing of fire detecting and fire fighting equipment had been carried out including fire alarms and emergency lighting. Environmental risk assessments had been carried out and updated. Equipment had been serviced and examined as required and records maintained. Hot water had been tested and recorded throughout the home. Random tests in relation to the hot water temperatures carried out by the inspector at the time of the inspection were satisfactory. Gas safety checks were carried out annually. Accidents and incidents had been recorded and reported as required. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 26 Staff had received the required mandatory health and safety update training and records had been maintained. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 27 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 4 x x x 3 x 3 Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 28 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 30 Regulation 18(1) Requirement Training must be provided for all staff in the management of violence and aggression. PREVIOUS REQUIREMENT Staff must ensure that daily notes as record of care are completed The provider will need to seek advice from environmental health in relation to the lack of a dishwsher in the main kitchen. The provider will need to install a fly screen which covers the open door in the kitchen The provider will need to provide the CSCI with a copy of the latest inspection report from the inspection of the kitchen undertaken by the environmental health department Clinical update training must be provided for trained nurses. Timescale for action By 1/8/05 2. 3. 7 26 15(2) 16(2)(j) Immediate and on going By 1/8/05 4. 5. 26 26 16(2)(j) 16(2)(j) By 1/8/05 By 1/8/05 6. 30 18(1) By 1/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 29 Bradwell Hall 1. 2. 3. 4. 5. 6. 7. Standard 10 8 28 27 19 16 9 Consideration of a portable telephone for use in bedrooms to provide privacy for residents and also for general staff use would be helpful. Review the practice of beds being stripped and not remade for several hours. NVQ training will need to be stepped up in order to be on target to meet the standard. The staffing arrangements on Keele unit should be monitored closely with a view to providing senior care assistant support throughout the day. Keele unit will need to undergo redecoartion/refurbishment as part of the plan. The procedure for handling complaints will need to be reviwed. The temperature of the medication store room on Audley unit must be monitored and maintained to within acceptable limits for the storage of liquid medication. Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 30 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bradwell Hall E51 E09 S26940 Bradwell Hall V225727 230505 Stage 4.doc Version 1.30 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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