Inspection on 04/01/07 for Bradwell Hall Nursing & Residential Home

This inspection was carried out on 4th January 2007.

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

Other inspections for this house

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

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

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

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

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

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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 Yvonne Allen, Wendy Jones, Wendy Grainger, Jane Capron, Joanna Wooller, Sue Jordan Key Unannounced Inspection 4 January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradwell Hall Nursing & Residential Home Address Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ 01782 636935 01782 719025 Edward-Twigge@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bradwell Hall Nursing Home Limited Mrs Lynn Garner Care Home 171 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (93), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (10), Old age, not falling within any other category (58), Physical disability (20), Physical disability over 65 years of age (58) Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Chatterley Unit may comprise of 30 in total: 30 DE(E); 10 MD(E); 5 DE - minimum age 50 years on admission Sneyd Unit may comprise of 30 in total: 30DE(E); 10 MD(E) Chester Unit may comprise of 33 in total: 33 DE(E) Keele Unit may comprise of 20 in total: 20 PD Audley Unit may comprise of 45 in total: 45 PD(E); 45 OP; 10 PD - Minimum age 60 years on admission Breward Unit may comprise of 13 in total: 13 PD(E); 13 OP; 10 PH - Minimum age 60 years on admission. 28 November 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. The fees charged by this home range from £280.00 to £730.00. Extra charges apply for Hairdressing, Toiletries, Newspapers and Transport. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was carried out over one day by six inspectors. The started at 10 am and finished at 5pm. The Providers were given a short period of notice prior to the inspection visit. All the key standards were assessed with each unit receiving a visit from an inspector. The methods used to gather evidence included – Evaluation of completed comment cards from residents, relatives and visiting professionals. Direct Observation Examination of records and documentation Discussions with staff members Discussions with the Registered Manager and Providers Discussions with residents and visitors Tour of the home The inspectors were made to feel welcome by all concerned. This was a positive inspection visit where it was identified that this home continues to make improvements and provides a comfortable lifestyle for the service users who live there. Although the home is very large each unit is unique and offers its own individual character. There were some areas of weakness highlighted for improvement and requirements and recommendations were discussed with the manager and providers and are included at the end of this report. What the service does well: This is a very large home and, as such, can be difficult to ensure that standards are maintained throughout each unit. However this home manages to do this very well. Each unit has a manager and each manager meets with the Registered Manager regularly. Positive comments were received from relatives and service users about the home – “From the outset Bradwell Hall ticked all our boxes” and “ This nursing home is very well run. The whole set up is very well geared up for the residents and their needs. The staff are wonderful and dedicated. This place should be a role model.” Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 6 The Registered Manager has the necessary skills, qualifications and experience to run the home. She has been in post for several years and this continuity of management is good for the home. The following comments were received about the manager – “The Matron has always dealt with our complaints straight away and, very professionally. We all feel that the matron/manager is a great asset to this nursing home.” The managers deal with concerns and complaints effectively and this was reflected in the views of a relative – “Any complaints regarding issues of care have always been dealt with at the point of concern. The Matron has always dealt with our complaints straight away and very professionally.” There is a good multidisciplinary team working at the home, which ensures that individuals receive good health care, treatment and advice. The professionalism of the nursing team shines through and nurses oversee that individual healthcare needs are met. The training support for staff is good. There is a dedicated staff-training manager who organises and oversees the staff-training programme. The providers are supportive with staff training needs. Maintenance of the home is good. This is a very large home to maintain and keep in good order and the providers manage to do this well. Records relating to maintenance were good and the redecoration/refurbishment programme is ongoing. What has improved since the last inspection? The home now provides records of any nursing provided to the service user, including a record of his condition and any treatment or surgical interventions and daily care notes are completed as required at the last inspection. Residents are checked on a regular and frequent basis when they are residing in their bedrooms and this is recorded. Inspection reports are now available in their entirety at the home. The policy on death and dying is now available on each unit. There was evidence seen of regular evaluations and reassessments of service user needs. The minor maintenance work on Audley unit had been carried out as required. Improvements had been made to the environment as required. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 7 There were indications from comments received and observation at the time of the visit that the standard and quality of the meals served had improved. The new system of plating up of meals had improved this service for many service users but, as highlighted in the next section, this was not working for everyone. The providers had purchased a washer/disinfector for the sluice on Audley wing. This would certainly help to prevent cross infection/contamination. What they could do better: The management and staffing arrangements for Breward Unit require reviewing and improving. This unit is registered as a separate unit under conditions of registration, and, as such, should be run separately. The concept of running Breward and Keele units together is not working effectively and is not working in the best interests of the service users on either unit. Staff on each unit have their own special skills and areas of expertise and should be able to utilise these skills. Whereas, by moving staff across both units staff members felt out of their depth and this was not good for staff moral. Also, those service users with personal care needs felt that the unit was changing and becoming more of a busy nursing unit than a quiet residential centre. There is a requirement to meet the social and therapeutic needs of service users accommodated on Keele unit. This will require the activities coordinator to receive training in this specialist area. Staff moral needs a lift. Staff need to feel valued and the manager and providers need to look at different ways of retaining staff. Those staff members with no direct line manager need to be appropriately supervised and supported. Areas of concern raised at disciplinary meetings need to be more clearly documented with actions taken, i.e. – further training and decisions documented in relation to proficiency of individuals following disciplinary meetings. Where CRB checks have highlighted areas of concern – there needs to be documentation in place to confirm that the manager has discussed the concerns with the individual involved and that, following a risk assessment, the decision has been made to either offer employment or not. Infection control should be taken a step further at the home. It is recommended that an individual nurse be employed as “Infection Control Nurse”. It is also recommended that a washer/disinfector be provided on each unit throughout the home. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 8 The maintenance of personal allowances needs tightening up in order for audit trails to be carried out if required. There is a need to look at the system of delivering meals. This suits some residents but not others – for example – the service users with mental health and dementia needs are unable to make a decision before hand and this new system relies on decisions being made the previous day. A different approach is needed on these units to ensure that all service users are able to choose. Quality auditing needs further development at the home. The providers need to show that the services they offer are regularly assessed and areas of weakness are addressed and appropriate action taken. There were some discrepancies with medication and this area needs tightening up in order to ensure that policies and procedures are adhered to. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 4 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their needs assessed prior to moving into the home and assessed needs will be met. However, on occasions, staff may have difficulties in being able to meet more challenging behavioural needs. EVIDENCE: Keele, Audley and Sneyd units were visited. New service users are admitted to the home following a complete assessment carried out by one of the senior nurses at the home. The Service Users’ individual needs are assessed and agreed prior to admission. All physical, mental and psychological needs are documented and care plans are written to ensure that the needs are met and monitored. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 11 Each Service User had a plan of care for daily living and for longer-term outcomes also. Service Users with specific needs such as ethnic, social, cultural or religious are catered for as required. All specialised services are offered to ensure specific needs of Service Users are correctly addressed through good practice, such as learning disabilities, challenging behaviour and dementia. The home had implemented environmental aids such as pictures on bedroom doors and pictures on toilets and bathrooms to assist service users with dementia care needs to orient themselves to the unit. Relatives and representatives are encouraged to be involved with the care of their relatives, however this was discussed at the visit and ways to readdress this were explored as few visitors became involved in care or reviews of care. It was noted on Audley unit that one of the service users had dementia. Difficulties in maintaining an adequate diet and fluid levels had been identified and as such monitoring was in place. However the unit manager reported that the staff were having difficulties managing this resident’s behaviour. Behavioural management plans had been put in place and any difficult behaviour was being monitored and evaluated. Two staff were observed moving this lady from the lounge area and their actions and attitudes considered inappropriate and insensitive. The wheelchair was banging against the walls and doorframe and was pulled backwards down the corridor. The staff were not interacting with this resident in a sensitive manner and continued with these actions without explanation. Some of the staff on this unit would not appear to have the experience and skill to support residents with dementia care needs. The unit manager did report that a social work referral has been made to discuss this particular resident. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and nursing care are planned and delivered with dignity and respect and healthcare needs are met. Medication procedures need tightening and adopting a more holistic approach for each individual would enhance the outcome. EVIDENCE: Audley, Keele and Sneyd units were visited. The Service Users’ health, personal and social care needs were set out in an individual plan of care. Care records were current and up to date, reviewed monthly and signed by the trained nurses accordingly. However on Sneyd unit some of the plans relating to difficult behaviour need to be more individual and based on an analysis of service user’s behaviour and include distraction and Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 13 diversion practices. There were also several examples where there was no photograph of the resident on file. It was noted that there was not always involvement from the families in the care planning process and a requirement was made to ensure that the home have all care records, including risk assessments signed by the next of kin or a representative. Individual health is promoted and access is available to health care services as required. Risk assessments were in place for the Service Users whose records were inspected. Skin integrity, safe environment, and mobility/ moving and handling were all documented including the use of bedrails. There was evidence that service users were provided with the necessary equipment to promote tissue viability for example mattresses, cushions and hip protectors. On Sneyd unit there were instances where service users were using equipment to prevent falls but which could be used as a method of restraint. There was no evidence that these decisions had been made on a multi disciplinary basis. In one instance a service user was using bedrails but there was no assessment present on file. On Sneyd service users had good footwear as a means of lessening the risk of falls. Physiotherapy was arranged as required, however staff were encouraged to carry out passive limb movements for those Service Users who were immobile Nutritional screening was completed for all Service Users and weights were recorded and assessed. Food supplements were being provided to ensure service users were receiving sufficient nutrition. One individual’s records stated “unable to weigh” and this was to be investigated and a better explanation gained. The majority of Service Users were supported by one local GP and this appeared to work efficiently. Comments from a relative included – “Chiropodist needed more regularly as sometimes it is 6 months before they attend to their needs.” The medication system was found to be in order on Keele Unit, the inspector spoke to the management with regards to trained staff update on medication administration and access to the medication policy and procedure and these were to be arranged. On Sneyd unit medication was being kept securely and external and internal medication was being kept separately. Controlled drugs were being administered appropriately and the necessary records were being kept. However ointments were not being dated when opened and opened insulin was being kept in the fridge against manufacturer’ advice. There was also the occasional gap in the Medication Administration records and there was an instance when one resident was being administered less than the prescribed Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 14 amount. There were no protocols for the administration of PRN medication. The unit was not keeping up to date records of medication returned to the pharmacist. Service Users generally appeared to be treated with respect and dignity, the inspector evidenced staff talking and caring for Service Users on Keele Unit in a quiet, compassionate manner. Service Users were in their own individual clothes and were very clean and tidy, and their bedrooms were personalised. One issue of concern relating to Keele unit was raised with the management with regards to a lack of observation of Service Users in the lounge. These service users have complex nursing needs and, for safety reasons alone, a member of staff must be present in the lounge at all times. Service users on Sneyd unit were observed to be treated with dignity and respect. They were appropriately dressed and were observed to be well groomed having received hair and nail care. Staff were observed feeding residents and this was being undertaken in a sensitive manner. Comments from a relative read – “When approached, the nursing staff have always acted in a professional capacity. Bradwell Hall’s nursing staff are a brilliant team. The unit manager of Audley wing is outstanding.” Another comment from a service user read – “I haven’t had a blood test, blood pressure yearly as at my previous doctors.” And “some carers help but some don’t.” Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life, meals and social activities are an important part of life at the home but providers will need to take into account the skills and time required of staff to meet individual abilities and preferences. EVIDENCE: Bradwell Hall employs two activities co-ordinators who between them work 44 hours per week. They organise a weekly programme for all of the units and as a result each unit has two sessions per week. Generally it was felt that this is insufficient. All of the inspectors commented on the lack of activity on each unit during this visit. The unit manager of Audley, was developing the activities programme. She held a relatives/residents’ meeting in November where it was identified that the residents wanted more tabletop activities. These were now being planned on a once weekly basis and relatives are encouraged to participate. They have Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 16 also developed a monthly newsletter and this is sent to all of the relatives. The unit has its own “comforts fund” and monthly activities are organised. An example of some of the activities were a trip to Llandudno in August 2006, a Fair in September, shopping trips to Trentham Gardens and Christmas parties. A jazz band came to the Christmas party, which was a great success. The unit manager had also introduced a key worker system and the staff were encouraged to be involved in 1:1 social interaction. However the manager reported that these activities were recorded on the daily reports and not on the activities sheets. Each resident had an individual activities sheet, on which personal preferences were recorded. On further perusal it was noted that there was a lot of repetition on the sheets, which indicated that the activities co-ordinators may not have the knowledge required to develop specific individual programmes. For example there seems to be a conception that all service users with dementia care needs require sessions on reminiscence. Records are made of the activities actually participated in. One of the residents spoken to said that she enjoyed the weekly bingo session. A church group visited the unit monthly and a Catholic priest visited some of the residents independently. Evidence gathered at this inspection, including discussions with staff and residents indicated that where possible people were encouraged to get up and go to bed when they choose. The home has a ‘natural wakening’ policy. One of the residents spoken to had risen at 10:30 am that day. Restrictions to personal choice were discussed with the resident and appropriate professionals and recorded within the care records. It is recommended that restrictions or limitations to personal choice be recorded in the form of a risk assessment and therefore more available to staff. Visitors are made to feel welcome and can visit at any time. One visitor spoken to confirmed this & expressed her satisfaction with the care provided to her parents. She said that the staff were very caring and that there always seemed to be plenty around. Some of the residents had a personal telephone, which was provided by their families. There was a pay phone available for the remaining residents, in a private area. Incoming calls could be received in the lounge area. None of the service users in this unit managed their own finances. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 17 There were fifteen residents living in Breward unit, five of which were in receipt of personal care and ten of which required nursing care. Originally this unit was intended to offer residential and personal care support only. The activities sheets were only completed by the activities co-ordinators and as a result there was little evidence of regular activities. For example, during this visit a staff member was noticed taking the Christmas decorations down with one of the service users. This 1:1 interaction could be recorded as an activity. A residents/relatives meeting was held in November 2006. This was for both Keele and Breward. The needs of the residents living in the two separate units are very different and as a result it was questioned why they are being managed as one unit. One of the residents in Breward said that she enjoyed the activities and that these included dominoes, jigsaws and craft. However she said that the unit had changed and that the staff were busy caring for the poorly residents. She intimated that there was a lack of stimulation because of the amount of residents now requiring nursing care. She also said that there were not enough staff available in the mornings. Two staff had to provide personal care and prepare breakfast for 15 residents. In Keele unit there were 20 younger people with a physical disability living within this unit. During this inspection most of the residents were seen to be sitting around the lounge area in their wheelchairs and the TV was on in the corner of the room. During the afternoon, one of the activities co-ordinators was playing Connect 4 with one of the residents. There is a Snoozelan facility within this unit and it was reported that the activities co-ordinators take some of the residents into this room on a weekly basis. It was noted however that this room was also being used to store a number of items and had visual stimuli only. The activities co-ordinator did indicate an awareness of this and reported that she was intending to improve this facility with more tactile equipment. A recommendation is made that the snoozelan facility be further developed as soon as possible. The social needs of these residents are presently not being met. The activities records in this unit are also being completed by staff. However some of entries are not of actual activities. For example, “ M relaxed in the lounge with other residents today”, “M rested in a comfy chair in the lounge area, she slept most of the time”. A choice of 2 main meals & 2 deserts was provided at lunchtime and a choice of hot & cold at teatime. The residents were able to choose the size of their meal. A menu was sent to each unit so that the residents could choose their Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 18 meals for the following day. In most cases this worked well, however concerns were raised about the ability of some people to choose. For example those residents with dementia care needs. The home had recently changed its mealtime system. The kitchen staff were ‘plating up’ the meals for some of the units. Whilst this system may work for some residents, it does not provide a ‘visual’ choice, which can be helpful particularly for those residents with dementia care needs. Previously the staff were dishing up the meals in front of the residents but it was felt by the manager that this had led to a lot of wastage and a lack of choice in some cases. The manager was asked to explore this whole issue further. The majority of the meals were provided from a large central kitchen. However each unit had its own satellite kitchen, in which breakfast, snacks, drinks and supper were prepared. The kitchen personnel and the care staff were all appropriately trained. Care staff were provided with basic food and hygiene training in their induction. High quality ingredients were purchased and the cook reported that she could order whatever was required. The majority of the meals were homemade. Fresh fruit and vegetables were delivered daily and fresh full fat milk provided. The Environmental Health Department inspected the kitchen in November 2006 and all of the requirements had been addressed. A random selection of the kitchen practices were checked during this visit and found to be satisfactory. A recommendation is made that the frozen goods be dated on opening. Special dietary needs were catered for and advice sought from the relevant professionals if applicable, for example dieticians, speech and language therapists. All of the residents were weighed at least monthly, although those with particular dietary problems may be weighed more regularly. The home also supported those residents requiring peg feeds and prescribed food supplements. Most of the residents spoken to said that the food was good. One said that she would like more variety and another was disappointed that a particular meal had been taken off the menu. There was evidence however that the residents are offered alternatives to the menu, if required. Many of the residents required assistance to eat their meals and pureed food, if required was made to look as appetizing as possible. Generally the staff were observed assisting people in a sensitive manner. However one member of staff was observed to be kneeling on the floor by the side of a resident in a lounge chair and feeding the resident without speaking to her. Another took a meal away without any real effort to encourage the resident to eat. The Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 19 manager must ensure that all staff are aware of the importance of nutritional needs and the right of every resident to be treated with dignity and respect. Comments received from a relative in respect of the food served included – “ The quality and variation offered on a daily and weekly basis, including dietary needs are to be complemented. A new management/kitchen team now listen to residents and family and have flexibility to residents’ requests.” Another read – “Meals have gone down bank in the last 6 months up until then the meals were excellent.” Another comment read – “Staff are not always available to assist residents at mealtimes. Some of them have the use of only one hand and cannot always ask for help to cut up meat etc into bite size portions.” Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives can be assured that any concerns they might have will be listened to and acted upon and that the systems in place at the home help keep them safe. EVIDENCE: There was a complaints procedure displayed in the home, which was clear and accessible. Each unit manager dealt with concerns as they arose but complaints were sent to the Registered Manager of the home to address. The log of these was examined at the time of the visit. This contained investigations, outcomes and actions taken if needed. There were copies of letters in place from the Manager to the complainant outlining what action would be taken and the timescale. There were also copies of the letters of the complaint findings, which had been sent out to the complainants. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 21 The CSCI had not received any complaints directly about the home since the last inspection. The Manager of the home had dealt with 25 complaints in total over the last 12 months, 21 of which have been substantiated, 3 partially substantiated and 1 pending an outcome. 100 of complaints had been responded to within 28 days. The comments included in a comment card from a relative read – “Any concerns or meetings have been dealt with and satisfaction from a medical requirement met and given. Issues of care have, in the past, been raised, sometimes vigorously. At each point, the care matters raised have always been dealt with amicably.” Staff are carefully selected to work at the home, undergo police criminal records checks and are assessed as to their suitability to work with vulnerable adults prior to being offered employment at the home. Staff stated they had received training in the protection of vulnerable adults and recognising and reporting abuse. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24, 25 and 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were provided with a warm comfortable home, which was generally clean and well presented. Attention must be given to ensuring that infection control procedures are adhered to. EVIDENCE: Each of the units including the laundry were visited and areas were sampled during the tour of the home. The housekeeping staff provided a wellmaintained environment. From the sample of the bedrooms visited it was obvious that residents were encouraged to personalise their personal rooms. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 23 The units were warm and spacious. Some of the decoration in bedrooms and corridors were tired and needed to be included in the next phase of redecoration. The majority of the bathrooms were used for some form of storage purpose; these are registered facilities and need to be a hazard free environment for the less able residents. Identified in bathrooms and toilets were numerous unprotected extra toilet rolls left on the cistern or hung on the grab rail. Toilet rolls should be contained or covered to prevent cross infection contamination. Identified in some of the bathrooms were the lack of tops to the taps to identify the hot & cold water, this could be a potential hazard to residents. On each of the units however bathroom hot water outlet temperatures were taken and found to be satisfactory. Identified on Chatterley and Breward units were personal toiletries and creams, which had been left in a bathroom, and socks were being soaked in a wash hand basin. This practice is unacceptable and a potential hazard for residents. House keeping staff need to ensure that they do not leave their trolley unattended when entering bedrooms but to take them with them, this will ensure the safety of the residents. External to one of the fire doors on Chatterley there was a need to ensure that the external area was made safe, in the event of it being used in an emergency, if less able residents were being evacuated from this point. On Brewood there were uncovered bowls containing breakfast cereals, the inspector was told that the night staff had filled the bowels before they finished their shift. This is unacceptable and an alternative practice should be in place. When speaking to the staff responsible for the laundry, it was felt that further/ or refreshment training for COSHH (the control of substances hazardous to health) was needed. The combination of linen and personal items being washed together gave the inspector some concern. It was pleasing to note that, since the last Random Inspection, the providers had purchased a washer/disinfector for Audley unit. It is recommended that one such machine be provided on each unit throughout the home to help with the control of infection. It is also recommended that, for a home of this size, a suitably trained nurse is appointed in the capacity of “Infection Control Nurse”. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 24 Comments were received from 2 concerned relatives in relation to smoking within the home both indicated the same – “Where smoking is allowed could it be prohibited in dining areas particularly in the half hour before meals are served when residents have already been seated at the tables? All the residents are elderly and some have breathing problems and most are receiving some sort of medication.” There is a requirement that a separate smoking room be provided for residents who wish to smoke away from the public/communal areas. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by the recruitment procedure adopted by the home and are in safe hands. A review of the staffing arrangements for Breward unit is needed. EVIDENCE: Keele, Breward and Chester unit were visited to assess staffing levels and interview staff. Recruitment records, general: A sample of recruitment records was examined. Training: Training information was inspected and the training co-ordinator was interviewed. Chester: Has 33 beds; at the time of the visit the occupancy was 29 residents. Staffing levels for a two-week period were examined against the staffing levels on the day of the visit. They indicated that the average staffing Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 26 levels were 8 including the nursing staff from 8am-2pm, 7 from 2pm-5pm, and 5 from 5pm-8pm. At night there was one qualified nurse and 2 care workers. During this visit there was one qualified nurse throughout the morning shift, supported by a senior care staff from 8am-5pm. Keele and Breward: Keele is a unit that provides care and accommodation for up to 20 residents, within the registration category of YPD, young physically disabled. Breward provides for up to 13 people over the age of 65 years who also may have a physical disability. Staffing levels during the day of the visit, included the unit manager, 7.55am5pm and a registered nurse 8am-8.05pm, 2 senior care staff, 8am-2pm, 1 from 2pm-8pm and a care team that included 1 x 8-2, 2 x 8-5, 3 x 8-8, 1 x210, 1 x 5-10. Night staffing arrangements included 1 registered nurse, 8pm8am, and 2 care staff. The current arrangements for this area have been established so the Breward unit is managed as part of Keele unit, this has been discussed at previous visits and concerns have been raised. These issues remain of concern; following discussion with staff it was clear that there were some concerns about the management arrangements and staff skills and understanding of the needs of such a diverse group of residents. Staff said that there had been some concerns expressed by residents in relation to staff turnover and understanding, this was confirmed from the minutes of residents meetings, and there was also concern about the deployment of staff into areas they had not been properly inducted into for example – Breward Unit. These matters were discussed with the care manager and the provider at feedback. It is required that the management arrangements for Breward are revised, to ensure that residents are receiving a good quality service that is meeting their expressed needs. The staff allocated to Breward must have received training in that area and have an understanding of the very different needs of residents. The unit manager stated that staff meetings were usually planned approximately every 3 months, but were more frequent if the need arose. A recent meeting had been arranged to address some areas of conflict and concern. While accepting that this is responsible to address acute concerns, there needs to be a more proactive approach to address these types of matters that should include regular staff supervision. Staff stated that there was a high turnover of staff and underlying conflicts were not being resolved resulting in more staff leaving the service and poor staff morale. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 27 Staff stated that there had been some staff shortages due to the high turnover of staff; the unit manager had been included in the numbers to address the balance. Comments from a relative included in a comment card read – “Currently there is low staff moral and carers are looking for employment at other homes. This is causing concern as residents need continuity and occasionally their needs are not always met.” While this is understood as a short term solution, the manager must have some management time to address some areas of deficit that were identified, for example, poor levels of staff supervision. The service has recruited staff from overseas for some time, most recent recruitment includes, 12 staff from India, all are nurses who have to complete a period of adaptation, during which they are employed as care workers. The service has contracted with a training provider to verify and accredit this training. Staff Training: The home has a training co-ordinator employed for 30 hours per week. The home employs approximately 114 care staff and 28 nursing staff. It was identified that there were currently 120 hours vacancies and that approximately 86 staff had left the service in the previous 16 months. It was of concern that the high level of staff turnover and the impact and potential effect on care and care delivery, some of which had been identified through discussion with residents and staff. The home employs two activities co-ordinators for 44 hours per week, they provide a range of recreational and social opportunities for residents. They allocate their time in 10 sessions per week which means that each unit has between 1 and 2 sessions per week. Activities can be group or one-to one. The activity hours should be increased to provide residents with more opportunities to engage in sessions. Also the co-ordinators should be provided with training opportunities, particularly in areas that require some expertise such as sensory stimulatory activities. The house keeping position has been vacant for 3 months, it was understood that some interim arrangements were being proposed, which included the training co-ordinator taking some responsibility for supervision and management of staff. It is recommended that the proposed arrangements be kept under review to ensure that there are sufficient hours to adequately manage staff until the vacancy can be filled and that the training co-ordinator receives training in management and supervision. The levels of mandatory staff training were reported to be good, records seen confirmed that they were satisfactory, although some difficulties were noted in arranging updates, this was due to a number of factors including staff Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 28 commitment and resources. An area identified as of particular concern, was night staff training, although it is understood that the night manager takes some responsibility for this. There were some gaps in the training records of some of the night staff. National Vocational Qualification (NVQ) levels have improved 32 staff have level 2 or above, 16 are undertaking the training and 8 others have been enrolled, the training co-ordinator stated that the high turnover of staff had an impact on the numbers of staff trained to the minimum level of NVQ level 2. At this point in time the service does not meet the minimum standard of 50 of the care team trained to NVQ level 2. It should be noted that 4 of the ancillary staff have achieved NVQ level 2 in their area of expertise. In total 27 domestic and laundry staff are employed, 9 kitchen/catering and 3 maintenance staff. The training co-ordinator also provided evidence of additional training including Dementia care, Dysphasia, Continence and Nutrition. Staff have also received training in none violent crisis intervention, the training co-ordinator has attended a training the trainers course, and identified some areas of concern about some of the content of the training which were considered unsuitable for the resident group at Bradwell Hall. The training programme is currently being delivered in its entirety, as the training co-ordinator is assessed on the delivery of the whole of the course content. It was suggested that other more suitable training for the management of challenging or difficult behaviour is resourced. Other training evidenced included first aid; fire training health and safety and infection control. Staff stated they had received training in the protection of vulnerable adults and recognising and reporting abuse. Recruitment: A sample of 14 recruitment records were analysed during this visit, there was evidence of good practice in this area, with evidence of written references, assessment of previous work history, staff contracts and terms and conditions and appropriate interview techniques. Work permits were in place, in one example it was not clear from the information available if the current work permit was valid this was discussed during feedback. Other records required by regulation were in place with the exception of evidence of CRB and POVA checks, which were in a separate file. It was recommended that a record is kept on the individual file of the date the POVA and CRB check has been received and if there are any issues identified. There were records of staff disciplinary also on file; it was also recommended that the service provide evidence that any areas of concerns have been properly addressed. In one example there was allegation of inappropriate manual handling techniques identified that were alleged to be wide spread, but no evidence of how this matter had been addressed. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33, 35 and 38 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed but some procedures require improving in order to ensure that the home is run in the best interests of the service users who live there. EVIDENCE: The inspectors met with the Registered Manager who has held this position for a number of years at the home. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 30 The consistency of manager has had a positive impact on the standards of service delivered to service users at the home. The manager possesses the necessary skills and experience to run this large home and the inspector was shown evidence of training which the manager had undertaken to keep her updated. This training comprised of – completion of the Registered Manager’s Award in line with CSCI requirements. Staff and service users were complimentary about the management of the home – “The management are striving to meet residents’ needs” and “The Matron has always dealt with our complaints straight away and, very professionally. We all feel that the matron/manager is a great asset to this nursing home.” Discussions held with staff members indicated a need for the Registered Manager to attend the staff meetings held on the various units in order for her to be aware of issues arising from these. Also, by making her presence felt throughout the units, the manager would go a long way to help improving staff moral. Evidence of quality auditing was limited to infection control audits done on 27/4/06, 25/5/06, 31/8/06 and 24/12/06 and various service user questionnaires completed throughout the year. Although these audits in themselves were comprehensive and detailed, there was no evidence of action, if any, being taken where areas of weakness were identified. The results of quality audits must be displayed within the home together with the action taken. Also, auditing needs to be further developed to include all of the services provided by the home. The questionnaires completed by service users also need to be dates – there was no evidence of this. The maintenance of personal allowances was examined on the home’s computer system. Each service user had a separate running balance, the statements of which were sent out to the service user or representative on a monthly basis. Receipts were not given routinely for items bought from the home’s shop and it is recommended that these be provided. Also, for one service user, the statement documented that she had been given £5.00 out of her account but no receipt could be found to confirm that the lady had received this and an audit trail could not be done. The procedure requires tightening up and it is recommended that 2 signatures be provided for monies going out of accounts. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 31 The maintenance and servicing of equipment used in the nursing home was on going and records had been maintained. The required testing and checks on hot water, emergency lighting, fire alarms and fire fighting equipment had been carried out as required. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 2 3 3 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 x x 3 Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 18 (1) Requirement It is required that the management arrangements for Breward are revised, to ensure that residents are receiving a good quality service that is meeting their expressed needs. The staff allocated to Breward must have received training in that area and have an understanding of the very different needs of residents. The registered person must investigate and implement methods for retaining staff. Those staff working in isolation, with no direct line manager must be more appropriately supported and managed. The registered person must ensure that there is evidence that overseas staff have a valid work permit and this must be available for inspection. The records must show what action has been taken to address areas of concern identified in disciplinary records. The recruitment records must show the date POVA and CRB DS0000026940.V320883.R01.S.doc Timescale for action 20/02/07 2 OP4 18 (1)(c) 20/02/07 3 4 OP27 18(1)(b) 18(2)(a) 20/02/07 20/02/07 OP27 5 OP29 19(1) 20/02/07 6 OP27 19(1)(a) 20/02/07 7 OP29 19(4) 20/02/07 Bradwell Hall Nursing & Residential Home Version 5.2 Page 34 8 OP26 9 OP7 10 OP7 11 OP22 12 OP9 13 OP9 14 15 16 17 OP9 OP9 OP12 OP15 checks are received and identify if there are areas of concern. 13(3)(4)a The registered person must make suitable arrangements to prevent infection and the spread of infection in the care home and that all parts of the home accessed by residents are so far as possible free from potential hazards. 15(c) The registered manager must ensure that the care plan is agreed and signed by the Service User or a representative and regularly reviewed. 15(1) The home must ensure that all elements of the care plan for people with dementia are individual and in respect of difficult behaviour are based on an analysis of the service user. 12(1)(b) Decisions to use equipment to prevent falls but that could be used as a method of restraint must be made on a multi disciplinary basis. 13(2) Medication must be stored appropriately and short life medication must be dated on opening. 13(2) The appropriate quantities of medication must always prescribed and all medication administered must be recorded. 13(2) Protocols must be put in place for the administration of PRN medication. 13(2) Accurate records must be kept of medication returned to the pharmacy. 16(2)(m,n The social needs of the residents ) on Keele Unit must be fully assessed and met. 12(4)(a) The manager must ensure that all staff are aware of the importance of nutritional needs and the right of every resident to be treated with dignity and DS0000026940.V320883.R01.S.doc 20/02/07 20/02/07 20/02/07 20/02/07 31/01/07 31/01/07 20/02/07 31/01/07 20/02/07 31/01/07 Bradwell Hall Nursing & Residential Home Version 5.2 Page 35 18 OP19 13(4)(c) 19 OP33 24(1,2,3) 20 OP35 20(1,2,3) respect There is a requirement that a separate smoking room be provided for residents who wish to smoke away from the public/communal areas. The results of quality audits must be displayed within the home together with the action taken. Also, auditing needs to be further developed to include all of the services provided by the home. The questionnaires completed by service users also need to be dates – there was no evidence of this. The maintenance of personal allowances requires reviewing and tightening up with receipts given and signatures recorded. 20/02/07 20/02/07 31/01/07 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 Refer to Standard OP12 Good Practice Recommendations The activity hours should be increased to provide residents with more opportunities to engage in sessions. Also the co-ordinators should be provided with training opportunities, particularly in areas that require some expertise such as sensory stimulatory activities. It is recommended that other more suitable training for the management of challenging or difficult behaviour is resourced. It is recommended that the proposed interim arrangements are kept under review to ensure that there are sufficient hours to adequately manage staff until the vacancy of housekeeper can be filled and that the training co-ordinator receives training in management and supervision. Consideration should be given to the provision of a deputy manager. DS0000026940.V320883.R01.S.doc Version 5.2 Page 36 2 3 OP30 OP30 5 OP31 Bradwell Hall Nursing & Residential Home 6 7 8 9 10 11 12 13 14 OP28 OP30 OP8 OP22 OP15 OP26 OP25 OP26 OP26 Levels of NVQ training should be improved. Other more appropriate crisis management training should be sought. That Service Users are observed at all times when seated in communal areas. The snoozelan facility housed on Keele Unit should be fully and further developed as soon as possible. The manager should explore the issue of the “plating up” of meals to ensure that all residents receive a choice at mealtimes. Frozen goods should be dated on opening. The room temperature in the training co-ordinators office was excessive and action should be taken to resolve this. It is a recommendation to introduce a washer/disinfector on each unit throughout the home. It is a recommendation, for a home of this size to have a nurse responsible for infection control. Bradwell Hall Nursing & Residential Home DS0000026940.V320883.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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