Inspection on 28/11/05 for Bradwell Hall Nursing & Residential Home

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 &... 23/05/05

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

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

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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 Y Allen. Other inspectors– Mr P Dawson, Mrs W And Mrs L Gammon Unannounced Inspection 28th November 2005 09:30 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.V272958.R01.S.doc Version 5.0 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.V272958.R01.S.doc Version 5.0 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 bradwell@btconnect.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.V272958.R01.S.doc Version 5.0 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. 23rd May 2005 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. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by four inspectors and took from 09.30am – 4.30pm. The inspectors visited all the units throughout the Home and focussed mainly on talking to residents and visitors about what life in the Home was like for them. Tracking of care was also undertaken and relevant documentation was examined. Discussions with staff members were held where their views and opinions regarding the running of the Home were sought. Discussions with the providers and Registered Manager were also held with all the inspectors. Verbal feedback was given at the completion of the inspection. Those standards not assessed at the previous announced inspection were assessed together with other standards, which had not been fully met last time. Requirements and recommendations have been made as a result of this inspection and have been included at the end of this inspection report. What the service does well: The Home is managed very well and for a Home of this size to maintain high standards of care throughout all the Units is commendable. All the comments received from residents and visiting relatives were complimentary with overall satisfaction with the services received. Staff also felt supported in the main, especially in relation to the training received. Staff training is very well organised by the training manager. With the exception of one Unit, staff morale was good. Staff were seen to have a good interaction with residents and a good understanding of their needs. The Health care needs of residents were very well met with plenty of evidence of multi-disciplinary working and involvement of healthcare specialists. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: 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 Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 7 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.V272958.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 1,2,4,5 Prospective residents and their families are provided with information about the Home. The providers will need to ensure that this information is complete. Following the assessment of individual needs the providers will need to ensure that the information contained within care plans is a true reflection of the assessment. EVIDENCE: The Statement of Purpose and Service User Guide were examined. The Statement of Purpose had been amended to include the addition of the 15bedded extension to Audley wing. Both documents were informative and available to prospective residents and their families. All permanent residents were accommodated in the Home under Terms and Conditions. A copy of the contract for self-funding residents was seen. This did not outline the “trial period” of six weeks as indicated in the Statement of Purpose and as contained in the Terms and Conditions for residents funded by Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 9 Social Services. This was discussed at feedback and will need to be included in the contract. It was noted that, on Keele Unit, the last inspection report on display was missing the requirements. Commission for Social Care Inspection, inspection reports should be provided for service users, relatives and staff in their entirety. Records of recently admitted residents were inspected on Chatterley and Chester Units. It was clear that pre-admission assessments had been carried out by the home prior to admission in the current setting of prospective residents. Care Management assessments were available and comprehensive. It is difficult always to arrange pre-admission visits for prospective residents to EMI units, but this had happened in two instances. One lady had visited the unit prior to admission and ultimately been admitted. A man had visited from hospital for a half-day and ultimately decided the home was not suitable for his needs. The preferred option is for prospective residents to visit but this is not always possible. Relatives are always invited to the home and there are extensive discussions prior to admission. Care plans were inspected in relation to recent admissions to the home. One resident was admitted three days prior to the inspection had “superficial” pressure areas which were seen to be clearly recorded on a body map following admission and a clear account given in daily notes of identified areas with measurement and grading of the sores. However, further tracking of the person revealed some inadequacies and concerns: The man had spent three nights on the unit following admission and there were recorded notes only for one night. There were also missing entries for care provided throughout the day. The recording of information pre and post-admission on Sneyd Unit was questionable. In one instance, behaviour was described as “aggressive,” in another “violent”. There was no record of physical threats or actions. Staff are reminded of the crucial importance of correct accurate and quantifiable information being recorded in care plans to avoid incorrect labelling of behaviours and people. Other plans sampled showed good pre-admission assessments and Care Management assessments had been carried out prior to admission. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7,8,9,10.11 The health needs of residents are generally well met with evidence of good multi disciplinary working taking place on a regular basis and the overall standard of care planning was high. The providers will need to ensure, however, that individual needs are reassessed as and when required, in order to ensure that needs are met on a continuous basis. The medication administration process requires tightening up in some areas. Residents are treated with dignity and respect. The providers will need to ensure that staff have the information at hand in relation to care of the dying in order to ensure that dignity is afforded to the end of life and beyond. EVIDENCE: On Audley Unit four individual service user’s care plans were examined and were very well written, detailed and comprehensive and reflected the current needs of the service users. The documentation seen and a discussion with both service users and staff confirmed that health and personal care needs were being well met. In particular, excellent recording was noted regarding turn charts, pressure area assessment, Waterlow, dependency levels, nutritional assessments etc, and provided evidence of excellent nursing care. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 11 All aspects of daily living were contained within the care plans and reviewed monthly. Risk assessments were also completed and reviewed each month, including bed rail assessments, which were, each supported by a consent form signed by a relative. Records also evidenced visits to the home by health professionals when required, such as a community psychiatric nurse, a chiropodist etc, and of hospital appointments made and attended by service users with support from staff. Service users also had access to their own GP. Observation of staff and their interaction with the service users confirmed that there was a respectful regard for service users. Service users stated that the staff were very friendly and supportive and treated them with dignity and respected their need for privacy when required. Care plan records evidenced the wishes of service users regarding death and dying in some cases and in one particular case, the end of life plan was extremely well documented. A discussion took place with the Unit Manager regarding the appropriate time to develop an end of life plan and it was agreed that it had to be undertaken at the time to suit the service user and/or family as appropriate. However, the inspector was satisfied that every attempt would be made by staff to ensure that the death of any service user would be handled with dignity and respect. The inspector noted on one care plan that the GP had written ‘TLC’ and the Unit Manager confirmed that this meant ‘no resuscitation’. It is a recommendation of this report that a resuscitation policy is developed to ensure that all staff, including agency staff, are clear about when and whom to resuscitate at all times. On Chester Unit the policy relating to death and dying could not be accessed. It is required that the policy on death and care of the dying, included what to do in the event of a sudden death, are readily available on each unit. On Chatterley Unit Several residents were spoken to, those able to express a view seemed happy with care. One resident said “they are very good to me” A visitor who visits her husband four times each week was spoken to and said she had been satisfied with the care provided to her highly dependent husband during the six months of his stay. She said he was closely monitored by staff. He had several falls; she was happy with the responses from staff and said that her husband was monitored at half-hourly intervals throughout the night following his falls. There had been severe weight loss (later checked in care plan) she said he was weighed regularly and she was involved and informed about all aspects of care. She had access to the care plan which she regularly checked. She had no complaints. Care plans sampled were based upon good assessments provided by the home and Care Management personnel prior to admission. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 12 Care plans are kept in residents bedrooms and readily available for relatives to see. There were monthly reviews of plans. This takes place on a particular date each month. Relatives know the date and check care plan following review. Visitors spoken to confirmed this. Care plans contained adequate and comprehensive information concerning all aspects of health, personal, social and emotion care needs. Daily notes had been completed in all instances sampled and the standard of recording was good. There were no pressure area management issues in the home at the time of the inspection. The unit has a good record of early identification of tissue viability risk with appropriate equipment and procedures in place. There were Waterlow/nutritional risk assessments in place in all records sampled and regular weighing. The majority of residents have diagnosed conditions of dementia, some with other mental health needs. Dependency levels are generally high, although there has been a slight reduction in the overall physical dependency levels following six deaths in the home since the last inspection. There is a high incidence of continence management and this is handled well in both personal care routines and domestic support arrangements. The atmosphere was relaxed on this unit, staff were quite busy at the early morning time of peak need, but there was a calm response to urgent situations. A male resident thinking the lounge was the toilet area and about to take appropriate action was dealt with swiftly but sensitively and calmly. Staff on this unit are quite experienced and many long-serving. The staff group work well as a team. The incident given above is an example of the awareness of staff to the needs of residents and the resultant professional responses. There have been six deaths since the last inspection, including two in hospital. Several instances were discussed, but the principles of dying and death required in the standard were clearly part of the philosophy and required procedures of the home. Relatives are given equal support where death is imminent or following death. Many relatives of this resident group do find difficulty in dealing with the final deterioration in the condition of their relatives and need tremendous support in the final situation. A regular visitor had informed the Manager that it was difficult to know if/when people had died on the unit and asked if there could be a way of informing visitors. In response, the unit now place in the reception area an appropriate announcement “In Memory…” with photograph of the person, cards, flowers etc – a most appropriate and sensitive way of dealing with the request from visitors. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 13 On Sneyd Unit the gentleman spoken about under the previous section had bed guards fitted which had been the case in hospital, but the contact with the relative had not been possible, a consent therefore not obtained, although this had been discussed over the telephone. The person had three falls following the admission, which were recorded in the accident book. The last being the previous night when he was found on the floor with bed guard in situ. It was presumed he had exited from the bottom of the bed. He had sustained a cut to the arm but no record of action to address this. The man was examined and found to have a dressing on the arm, which was not recorded or identified to staff for observation/follow-up. A small set of drawers was situated at the bottom of the bed, which may be the reason for the injury. It is important that a risk assessment is carried out following falls/injuries and the drawers immediately relocated. Sleep profile charts had been completed for the three nights he had been resident but were very questionable; he had slept five, three and two hours respectively over the period. He has nighttime sedation and although only two hours recorded sleep was recorded on the previous night he was awake throughout the day. Care monitoring forms in the bedroom showed he had been checked at two hourly intervals. The system of care and recording at nighttime on this unit needs to be reviewed and improved procedures and recording of events put into place. None of the issues highlighted above had risen at staff hand-over and that process should be reviewed also. On Sneyd Unit review of the gentleman’s care plan highlighted inadequacies in the monitoring processes. A resident had secured a skin rash caused by scratching - cream prescribed and administered but there was no record in the care plan relating to this treatment and the progress or otherwise of the interventions. It was mentioned only in daily notes. - Health care matters must be recorded individually (not in daily notes) and be part of the care plan health monitoring system. The focus on Sneyd Unit was upon tracking in relation to recent admissions and matters highlighted above and under the previous section took up a disproportionate amount of time. There were good interactions observed between staff and residents. On Keele Unit all service users had an allocated named nurse and key worker (senior care). Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 14 Each service user had care plans in their bedrooms accessible to them and staff, there was evidence of monthly reviews of care plans and assessments in the sample seen. One Activities of Daily living assessment had not been fully completed and was lacking information relating to personal history, communication other essential information. Each file had a record of the date of admission, the date of birth and next of kin of the service user. There was evidence in a sample of care records that relatives had been involved in the care planning process and had signed them on behalf of their relative. Two sets of relatives spoken to were satisfied with the level of involvement they had in the care of their relative. On Chester Unit six care plans were examined and were found to be of a high standard. Individual risk assessments had been developed and the plans had been regularly evaluated. There was one exception to this, where a recent admission highlighted that a diabetic care plan had not been developed for a lady who had been assessed as diabetic. There was evidence of visits by healthcare professionals and attendance at clinics and hospitals where required as outpatients. Residents had received Influenza and Pneumonia vaccinations from the practice nurse. There was one resident on this unit, whose needs did not readily fit in with the services offered at the Home. This elderly gentleman had learning disability needs, although to a lesser degree. He had become gradually more depressed and withdrawn over the last few months. The needs of this gentleman were discussed at length with the manager of the unit – who stated that he had been referred for an assessment by the Learning Disability team. His social worker was also involved with the assessment and he had a lot of support from a close family member. The family member wanted the gentleman to stay at the Home as he had been here for five years. It is required that this gentleman undergoes a full assessment of his needs and that, if it is felt that the Home can no longer meet these needs, on any of its units, then an alternative placement is found. A record of controlled medication was inspected on Keele Unit; there was a running total of the quantity of medication following each occasion of administration. Two staff signed each record. In one example the medication was recorded for twice per day, the manager indicated that the GP instruction was for up to four times per day. A requirement that the administration instruction on the Medication administration sheets must accurately reflect the GP’s instructions was made. Each of the care records seen on Keele Unit included consent to resuscitate form, which clearly identified the instructions of the family agreed with the G.P, in respect of any treatment if the condition of the service user declined. The Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 15 letters had been signed by the family on behalf of the relative; the GP and the Registered care manager. In some records there was evidence that there had been some discussion regarding the preferred arrangements in respect of the death of a service user. Guidance for staff in the care of service user who may be dying or dead was available in the Staff handbook. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 12,13, 14 and 15 The meals in this Home are good offering both choice and variety and catering for special dietary needs. The routines of daily living are made flexible and varied to suit resident’s expectations, preferences and capacities. EVIDENCE: Activities Co-ordinators provide a service within the home, specifically they allocate time to Chatterley Unit Wednesday a.m. and Thursday pm. The usual range of indoor activities appropriate to this resident group is provided. It was pleasing to see that the external visits commenced last year for this group have continued there have been parties, barbeques, shopping trips during the summer months. There is a safe external patio area. Six residents went in a hired mini-bus to Blackpool for the day; those remaining had Fish & Chip supper. Regular entertainment is provided on the unit and some will go to other units where there may be entertainment, providing a needed changed venue. Activities are good and seen to develop further on each inspection. Care staff are involved with activities workers in these scenarios. This is a very positive development for this client group and much needed. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 17 Visitors were seen arriving throughout the morning of the inspection. Several spoken to and all expressed high levels of satisfaction with care provision. Most were regular including daily visitors and noted were relaxed and friendly exchanges between visitors, staff and residents. The emotional support required for this resident group is high due to the restricted memory recall and reduced concentration spans of the group. Those residents able to express a view to the inspector said they were happy with life on Chatterley Unit. One man said, “It is good to be here and I am happy”. An activity co-ordinator visited Keele unit for 12 hours per week, divided into four, three-hour sessions. A record of all activities undertaken was maintained; many of the activities were on a one to one basis. There was evidence of a range of opportunities including relaxation and sensory stimulatory therapies, hand and foot massage, reading daily papers and discussing current affairs. A relative and two staff commented favourably on the input of the activities coordinator, and the benefits for service users. The units had kitchen areas where food was served and drinks and snacks could be made. The majority of residents on Keele Unit received their nutrition via artificial means, four service users had an ordinary diet. Three required some assistance and support when at meal times. One relative stated that the standards and quality of food was good. Menus were provided weekly, staff stated that the meal choices were ordered for the following week. It had been understood that the service had changed the food ordering system to choosing the meals for the next day only. Clearly there appeared to be some confusion in practice, this was discussed at the feedback session. Records of dietary and fluid intake should be more accurately maintained to provide a record that could be assessed by a dietician if necessary. Records of fridge freezer temperatures should be recorded daily, as some gaps were noted. There was a busy but relaxed atmosphere on Chatterley unit. Lunch was being served at the start of the inspection. Several people need to be fed due to high dependency levels in the unit. Most residents sit at tables in the dining area, others are fed/assisted with meals in the lounge area to provide sensitive support and privacy. One member of staff was standing feeding a resident in the main lounge area – this was pointed out to the Manager who said it was not normal practice. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 18 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 the following standard(s): 16 and 17 The Home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Residents have their legal rights protected and are enabled to exercise their legal rights directly and participate in the civil process should they wish. EVIDENCE: There was a clear and simple complaints policy in place on display in the Home. This included the details of the local CSCI office. The CSCI had not received any complaints directly regarding the Home since the last inspection. The Unit Manager on Chester Unit explained how she dealt with concerns and minor complaints and that more serious complaints are referred to the Registered Manager of the Home. The Registered Manager commented that she also monitors the complaints received on each Unit on a regular basis. All complaints are documented along with outcomes of investigations and any actions taken as a result. Residents spoken to on Breward Unit stated that they would now who to go to if they had any concerns or complaints and that concerns they had had in the past had been dealt with effectively. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 19 On Audley Unit the Unit Manager confirmed that service users were asked if they wished to have a postal vote or required a lift to the electoral polling station when national and local elections were in progress. She also confirmed that each year, information regarding those living in the home was updated and sent to the local authority in order for the service users to be added to the electoral register and therefore, eligible to vote. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 20 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The overall standard of environment provided at this Home is good. This will be further enhanced by the continuous implementation of the redecoration/refurbishment programme. EVIDENCE: On Audley Unit A new extension to the Unit had been completed recently and was very bright and clean. One service user stated ‘It’s like being in a hotel – I can’t believe it really’. A tour of the new extension highlighted a number of areas for attention such as: a new bath was missing a back panel, no signs were in place on toilet/bathroom doors and only one nurse call bell was situated in the bathroom by the toilet – none by the bath. It is a requirement of this report that these areas are addressed and rectified. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 21 The new extension exaggerated the ‘tired’ areas of the older part of the unit, but it was still a comfortable and clean environment for the service users. However, one room in particular, Room 43 had quite bad stains on the carpet and it is a requirement of this report that this is cleaned. There were adequate lavatories and washing facilities in the Unit for the service users. The bedrooms were clean and homely with satisfactory fittings and furnishings. Service users had many of their own possessions in their rooms and comments from service users were very positive about their home. On Chatterley Unit There is a good standard environment, which meets the National Minimum Standards. There is an ongoing repair and replacement programme. Some areas would benefit from replacement particularly the carpets in the lounge area and some bedrooms where there is considerable wear and which suffer from repeated deep cleaning routines. The possibility of refurbishment of some areas next year is being considered. All areas of the unit were clean and there were no mal-odours. This is to the credit of domestic staff in this unit where continence management is prevalent. The unit has a range of specialist mattresses/overlays /cushions/beds etc in place and reported an ample supply of equipment available as required. It was noted in the lounge area that a resident was transported in a wheelchair fitted with footrests – but the footrests were not used. This is a dangerous practice and must cease. A recommendation of the last report to provide a portable phone for residents use and to provide privacy has been addressed. A portable payphone has been made temporarily available and a cordless telephone provided in the office area, which will greatly assist calls to residents and also flexibility for staff. On Sneyd Unit, the environment is good and well maintained and odour control to a high standard. The standards of hygiene throughout Keele unit was high, infection control policies appeared to be effective. Protective aprons were provided white for care and blue for meal times and disposable latex free gloves. Red alginate bags were available for any infected linen and yellow bags for clinical of infected waste. Any sharps were collected weekly for disposal. Above each of the wash hand basins in communal areas there were antibacterial soap dispensers available. It was suggested that these should also be made available in the en-suites of service users for staff to use. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 22 In one service users en suite there were three disposable razors that had been used and not discarded, no toothbrush, an opened tube of gel without lid and a roll on deodorant without lid. These matters were discussed with the unit manager and reported in feedback. Keele unit provides single occupancy bedrooms all with en-suites. Communal areas are open plan, and provide comfortable and pleasant surroundings. On Keele Unit a carpet leading into the activity room was frayed. A storeroom door opposite the sluice room was not closing too properly. It was recommended that room temperatures should be monitored to ensure an ambient temperature at all times. The risk assessment for the specialist bed should include daily checks of the restrainers used. Two relatives spoken to were satisfied with the standards of the unit. The laundry was inspected and it was found that over on the storage area/clean side, the carpet was in need of urgent replacement. The procedures in place for the control of infection were adequate, although it was noted that contaminated bed linen had been misplaced into a general skip at the time of the inspection, this was not usual procedure. The staff in the laundry are struggling to accommodate all the clean linen and clothes as storage is restricted, especially in light of the recent addition of 15 beds. This was discussed with the provider during feedback where he was asked to consider the possibility of expanding this area. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Staffing numbers and skill mix are appropriate to the assessed needs of the residents in the Home. There is a need to review the staffing arrangements on Breward Unit in order to ensure that the needs of the residents on this Unit are fully met at all times. EVIDENCE: On Audley Unit staffing rotas were examined and the numbers and skills of staff were appropriate to meet the needs of the service users. The inspector interviewed two members of staff, one who had worked at the home for only three weeks and the other, had been employed at the home for over six years. Both staff members were complimentary about the support and training provided to them. The newest member of staff confirmed that she had received in-depth induction training and outlined areas covered within that training, including health and safety, fire safety, manual handling, values and principles of care and abuse awareness. The inspector was shown a copy of the induction booklet for staff and was impressed by the content, which covered a variety of topics regarding care for the elderly. The new member of staff also confirmed that she was supervised at all times initially and had since been ‘shadowing’ a senior carer for key tasks of learning such as checking cot sides each week etc. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 24 The other member of staff had recently been promoted and was in the process of completing her NVQ Level 2. She was also able to confirm recent completion of mandatory training and the support that was provided to her and all staff from senior managers. On Sneyd Unit At the time of this inspection there were 28 people in residence on this unit. There were two vacancies. On Chatterley Unit there were 30 people in residence at the time of this inspection. There were no vacancies on this unit. Staffing levels remain at the required level. 8:6:5:3 – sometimes there are nine staff on the morning shift. The numbers are adequate for the dependency levels of the current resident group. There is a very static staff group on this unit, many worked there for several years. One carer has left since the last inspection and replacement being sought; meanwhile existing and bank staff covers the hours adequately. The staff on this unit provide a good standard of continuity of care. Most staff have received training in the Management of Violence & Aggression, following previous requirements being made. It consists of one or two full days training. One person is the approved trainer in this area and all staff will receive this training in the near future. The number of nursing hours allocated to the unit is 100 per week. At nighttimes nursing cover is from the nurse on duty on Sneyd Unit. A Night Manager for the home has recently been appointed and has based himself on Chatterley Unit, thereby providing night nurse cover direct to the unit. Keele Unit provides care and accommodation for younger adults. Occupancy at the time of the inspection was 19. On Keele dependency of residents was high, with 15 requiring peg feeds, 17 residents were totally dependent on two staff to meet all of their needs, one resident retained mobility independence with the use of an electric wheelchair, one resident was ambulant with the assistance of two staff and two residents had tracheotomies in situ. Staffing for this Unit consisted of 1x Nurse/manager 7.45am-8.15pm 1x senior care 8am-2pm, 1x 2pm-8pm. 3x care workers 3x 8am-2pm, 2x 8am-5pm, 1x 8am-8pm, 2x 5pm-10pm. 1 nurse and 1 care worker 8pm-8am. Two staff were interviewed during the visit to Keele Unit, regarding the induction and training they had received. Both gave a satisfactory account, of Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 25 induction and support they had received. All mandatory training appeared to be up to date, or had refreshers planned. On Breward Unit care staff were provided as the following - 1x 8am-8pm, 1x 8am-5pm, 1x 5pm-10pm, 1x 10pm-8am. NVQ 3, 2 senior cares, NVQ 2, 1 senior care. The trained nurse went over from Keele Unit to give nursing care the 7 residents receiving this on the unit at the time of the inspection. Staff spoken to on Breward Unit were not happy with the staffing arrangements and stated that, on more than one occasion, they have had to work short. They have sometimes only had one care assistant on duty from 5pm-8pm and, on occasions, there has been just one care assistant on duty from 8am-5pm. Arrangements are in place to provide a care assistant from Keele Unit when Breward is short-staffed but the care staff commented that, in reality, this rarely happens. Staff also stated that the morning shift on this Unit is difficult to manage with two staff members. Seven of these residents require nursing care with varying degrees of dependency. It takes two staff members 45 minutes to bath one of the residents, leaving no one to supervise and monitor the other 12 residents on the Unit. The staffing arrangements for this Unit need to be reviewed urgently and measures put in to help with morning shifts and better cover arrangements for when staff are off sick. On Chester Unit there were 26 residents accommodated 14 of who were receiving nursing care for mental health needs and 12 were receiving general nursing care. The registration of this Unit will now develop to accommodate residents with mental healthcare needs only. The Manager was on duty together with seven care staff until 5pm, and then from 5pm-8pm there was one trained nurse on duty with four care staff. On night duty from 8pm-8am there was one nurse and two care staff. There were two domestic staff on duty until lunchtime on this unit. Staff commented that they felt supported with their training needs. The Home had an adequate supply of ancillary staff, maintenance support, administrative staff, a training manager and two activities co-ordinators. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 The Home is well managed and the manager is well supported by her senior staff in providing clear leadership throughout the Home with all staff demonstrating an awareness of their roles and responsibilities. Attention is required in relation to the management of Breward Unit in order to ensure that communication is maintained and that all staff feel supported and included. EVIDENCE: The Registered Manager was present throughout the inspection and during feedback and discussions were held with her and the provider representatives. Staff comments received about the Manager were very positive with staff feeling supported. Residents spoken to on Breward Unit stated that they knew who the Manager was and that she chatted to them when she came round, was “pleasant and approachable.” Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 27 On Keele Unit, the unit manager had been recruited since the last inspection, had 30 years nursing experience, four years in intensive care, at the start of her nursing career and more recently in orthopaedic care. This Manager is also responsible for the management of Breward Unit. Staff spoken to on Breward Unit felt that there was a lack of communication between the two Units and they sometimes felt isolated. It is recommended that the arrangements for management of Breward Unit are reviewed and that management becomes more open and inclusive. A new Unit Manager was appointed to Sneyd Unit six months ago. Previously one person managed Sneyd and Chatterley Units – each now has a Unit Manager. A new manager had been recruited to Chester Unit since the last inspection. The Manager is a Registered Mental Nurse with many years experience in different care settings. Staff spoken to on this unit were complementary about the Manager. Regular staff meetings had been held on the Unit, the minutes of which were seen by the inspector. The Manager herself commented that she would like to see more Managers’ meetings organised. The financial viability of the Home was not assessed during this inspection, as there were no indicators to suggest that the Home was not financially viable at the time. The providers had recently invested capital expenditure into the Home with the construction of a new extension. There was up to date insurance cover in place. The maintenance of residents’ personal finances was assessed. The required receipts and documentation relating to individual income and expenditure had been maintained and these were examined. There was also a running balance recorded for each resident. Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 28 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 1 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 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 3 18 x 2 3 2 2 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x 3 3 x x x Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 2 Regulation 5 Requirement The trial period outlined in the Service User Guide will need to be included in the Contract for self-funding residents Residents must be checked at hourly intervals throughout the night and appropriate records kept The home must provide “a record of any nursing provided to the service user, including a record of his condition and any treatment or surgical interventions” Staff must ensure that daily notes as a record of care are completed (Requirement of the last report). Footrests must be used on wheelchairs for transport at all times unless disclaimer is obtained. The staffing arrangements for Breward Unit need to be reviewed urgently and measures put in to help with morning shifts and better cover arrangements for when staff are off sick. Timescale for action 20/01/06 2. 7and 8 12(1) 20/12/05 3. 8 17(1) Schedule 3 20/12/05 4. 7 17(1) schedule 3 13(4) 20/12/05 5. 22 20/12/05 6. 27 18(1)(a) 20/12/05 Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 30 7 9 13(2) The administration instruction on the Medication administration sheets must accurately reflect the GP’s instructions Commission for Social Care Inspection, inspection reports should be provided for service users, relatives and staff in their entirety. 20/12/05 8 1 5 20/12/05 9 11 12(4)(a) 10 8 14(2) 11 21and 22 13(4) It is required that the policy on 20/12/05 death and care of the dying, included what to do in the event of a sudden death, are readily available on each unit. It is required that the individual 20/01/06 needs of residents are reassessed as and when required so that needs can be continually met by the Home. On the new unit on Audley wing 20/01/06 a new bath was missing a back panel, no signs were in place on toilet/bathroom doors and only one nurse call bell was situated in the bathroom by the toilet – none by the bath. It is a requirement of this report that these areas are addressed and rectified. Bedroom 43 on Audley Unit had 20/12/05 quite bad stains on the carpet and it is a requirement of this report that this is cleaned/replaced. On Keele Unit a carpet leading 20/12/05 into the activity room was frayed. This must be repaired or replaced and made safe. A storeroom door opposite the sluice room on Keele Unit was not closing too properly. This must be addressed. The carpet in the laundry area (clean side) must be replaced DS0000026940.V272958.R01.S.doc 12 19 23(2)(d) 13 19 23(2)(b) 14 19 23(2)(b) 20/12/05 15 19 23(2)(b) 20/01/06 Page 31 Bradwell Hall Nursing & Residential Home Version 5.0 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 3 4 Refer to Standard 15 32 11 15 Good Practice Recommendations The principles of care demand that where people need feeding this is done individually, sensitively and by staff in a sitting position only. It is recommended that the arrangements for management of Breward Unit are reviewed and that management becomes more open and inclusive That a resuscitation policy is developed to ensure that all staff, including agency staff, are clear about when and whom to resuscitate at all times. Records of dietary and fluid intake should be more accurately maintained to provide a record that could be assessed by a dietician if necessary. Records of fridge freezer temperatures should be recorded daily, as some gaps were noted. Records of fridge freezer temperatures should be recorded daily, as some gaps were noted. On Keele Unit above each of the wash hand basins in communal areas there were antibacterial soap dispensers available. It is recommended that these should also be made available in the en-suites of service users for staff to use. It was recommended that room temperatures should be monitored to ensure an ambient temperature at all times. The risk assessment for the specialist bed on Keele Unit should include daily checks of the restrainers used. The possibility of expanding the laundry area should be considered. 5 6 15 26 7 8 25 22 9 19 and 26 Bradwell Hall Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Stafford Office 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 Nursing & Residential Home DS0000026940.V272958.R01.S.doc Version 5.0 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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