Inspection on 12/02/06 for Braintree Nursing Home

This inspection was carried out on 12th February 2006.

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

Braintree Nursing Home 15/01/08

Braintree Nursing Home 25/01/07

Braintree Nursing Home 29/07/05

Braintree Nursing Home 10/03/05

Braintree Nursing Home 29/07/04

Braintree Nursing Home 16/01/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

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

CARE HOMES FOR OLDER PEOPLE Braintree Nursing Home 11 Coggeshall Road Braintree Essex CM7 9BD Lead Inspector Gaynor Elvin Unannounced Inspection 12th February 2006 13:30p 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 Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 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. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Braintree Nursing Home Address 11 Coggeshall Road Braintree Essex CM7 9BD 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) 01376 552391 01376 345966 Avidcrave Limited Mrs Fiona Kemp Care Home 35 Category(ies) of Dementia - over 65 years of age (8), Physical registration, with number disability over 65 years of age (35) of places Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 35 persons) Eight named service users, over the age of 65 years, who require care by reason of dementia, whose names have been made known to the Commission The total number of service users accommodated in the home must not exceed 35 persons The registered person shall ensure that a continuing programme of development is provided for manager and staff in relation to dementia care and good Practice, equivalent to the recommendations of the Alzheimer’s Society The registered person shall keep under review the provision of additional communal living space to meet the assessed needs of the service users The registered person shall ensure that staff provision is regularly reviewed to meet the changing needs of the service users 29th July 2005 5. 6. Date of last inspection Brief Description of the Service: Braintree Nursing Home is registered to provide nursing care for up to 35 people over the age of 65 years, who have a physical disability. The property is a two-storey building with an extension; a passenger lift provides access to the first floor. The home has 14 single rooms with en suite facilities and 11-shared rooms. The home is located in Braintree, within walking distance to the town centre. The site is shared with a care home for people over the age of 65 years. Both units share the small gardens, which comprise of a patio and grassed area with seating at the front of the building. Car parking facilities are available. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place one day in February 2005, over four hours. All of the key standards and the intended outcomes have been assessed in relation to this service during at least two inspections for the current inspection year (April to March). To view the assessment of standards and outcomes not included within this report, please refer to the previous published report dated 29th July 2005. This inspection focused on the key National Minimum Standards and intended outcomes not assessed in the previous inspection, looking at working practices, supporting documentation and records, as well as progress made in addressing the statutory requirements and good practice recommendations made in the previous inspection report. Braintree Nursing Home is a large care home providing nursing care to 35 people with high dependency needs. The home is not registered to admit service users with Dementia, however, since admission, some service users have developed varying levels of mental health needs. Normally, the home would not be permitted to accommodate persons who require care by way of mental frailty. Since the last inspection, a variation to the current condition of registration has been applied for and approved by the CSCI to enable named service users to remain at the home for as long as the home is able to meet their assessed needs. The names of service users to which this applies have been submitted to the CSCI. What the service does well: What has improved since the last inspection? Opportunities for staff training and development continued to be encouraged, developing skills and awareness of staff in areas specific to service users needs. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 6 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. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 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 Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 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 & 5 Prospective service users and representatives have an opportunity to visit the home and were provided with information to enable an informed choice. Not all service users were provided with a written contract/statement of terms and conditions appropriate to assessed needs and services provided, incorporating all the information agreed between the service user/representative and the home. EVIDENCE: One relative spoken with was very happy with the home and said that although they were not given a choice of homes, the first impression during a visit was very positive, ‘the staff had a very friendly and transparent approach and the service users appeared well cared for and the home was clean, which was very reassuring’. The relative found the home met with expectation following the service users’ admission. The service user and relative had received written information regarding the home but was not aware of a Residential Contract and Agreement or Statement of Terms and Conditions appropriate to needs and identified Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 9 services and was not clearly informed in writing of terms, contractual status, fees, reference to clear objective criteria for price variation, fee review terms or notice. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 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 & 11 Staff engaged positively with each individual and demonstrated a good understanding of the service users they were supporting. Service users’ are looked after well in respect of their health and personal care needs. Further attention needs to be given to ensure care plans are consistent and used as an active working document to inform all staff on care delivery and reflect actual care given. The administration of medication was managed appropriately; shortfalls identified were corrected during inspection. EVIDENCE: Whilst the structure of assessment and risk assessments relating to potential healthcare needs were in keeping with good practice, some were incomplete resulting in an absence of relevant information being transferred into care planning arrangements; including one for a service user admitted three months previous to inspection. Care plans sampled were inconsistent in quality and content and did not reflect adequately the support required for the individual to ensure consistent and continued care, appropriate monitoring and review. A care plan for an Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 11 individual with epilepsy was very brief and only informed staff to ‘maintain a safe environment’ and not how to achieve this. The care plan also lacked information to guide staff on how to recognise a fit, what to do during a fit and how to care for the individual following a fit. Care plans continued to focus only on the main presenting needs rather than adopting a person centred approach. It also focused on emotional needs and maintaining strengths. Although care staff demonstrated a good understanding of service users’ personal care and social needs, they were still not participating in the care planning process. Although it is recognised that consultation around this area has been taking place and the Manager is also keen to introduce a key working system; the infrastructure is not yet finalised for implementation and it is disappointing further progress had not been made since the last inspection in July. Staff spoken with were able to demonstrate an understanding of the principles of care planning and positive elements of good practice. They identified episodes of aggression displayed by one service user as an expression of frustration and anxiety due to sudden enormous changes in lifestyle in relation to loss of eyesight, contributing to loss of independence. Whilst the care plan objective for this individual covered basic personal and healthcare needs, it did not reflect the underlying emotional and psychological needs discussed. The plan lacked clear, essential information informing care staff of agreed, planned and consistent support to promote well-being and optimal independence, particularly in providing support to familiarise and mobilise around the home. Staff wanted to fully support this individual but felt they would benefit from some specialist guidance. They also felt the service user should be supported to take responsible risks. A risk assessment and management strategy would support this approach. Care staff stressed that they do not always understand nursing or medical terminology used and would like to see plain English and more detail reflected within a care plan. For example care staff were told a service users Hb was low and were not informed of potential related needs such as tiredness, weakness or dietary requirements. A plan of care identifying these needs and appropriate management would inform staff on care delivery and benefit the service user, and in effect relate to a more holistic person centred approach. A weight list, bath list and fluid charts on the wall in the office did not give the impression of a needs led service, preserving dignity and confidentiality and deflected care staff from a care planning, key working process. Care plans examined identified medication prescribed, however, information relating to the side effects and adverse reactions of medicines being taken by individuals was not readily available. Records of six monthly medication review and outcome, undertaken for those service users on four or more medications, in line with the National Service Framework for Older Persons and Medication, was not evident. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 12 Registered Nurses administered medication. The home’s Administration of Medicines policy contained the relevant information for staff to follow for the receipt, recording, storage, handling and administration of medication but required review and update to include new guidelines and the homes arrangements for the disposal of medication. The policy and procedure for the supply and delivery of oxygen was out of date and did not reflect new local arrangements. A sample of Medication Administration Records (MARs) was examined. One MARs referred to the pet name for the individual and did not include details of full name, which could pose a potential risk of mistaken identity; this was corrected during the inspection. The records were accurately completed, signed and dated. Medication was received from the pharmacy in Monitored Dosage Systems and individually named containers and was appropriately stored in locked facilities. Controlled Drugs were stored in a locked cupboard within a locked metal cabinet. Records of administered controlled medication were accurate and correct. Controlled Medication prescribed in June 2005 and no longer required had not been disposed of appropriately. From conversations with care staff it was evident that they responded appropriately to the changing needs of the service users during the end stages of life and delivered all care and support, with dignity and respect, how the service user would wish. Staff indicated that great care and attention was also given to the other service users in their grief. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 13 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): 15 The home offered suitable meals and choice, and the cook worked closely with health professionals to provide diets to meet specialist needs and had taken positive steps to improve presentation of food for service users with swallowing difficulties. EVIDENCE: Discussion with the home’s cook indicated new approaches to improving meals for those with swallowing difficulties were being introduced. Individual foodstuff prepared to a suitable consistency by prescribed thickening agents is placed in moulds provided by the manufacturer, reshaping it to its original form, providing appetising and appealing meals, promoting dignity and selfesteem. The cook consults with nutritionists and speech therapists. One relative spoken with expressed satisfaction with the way diet had been managed, including joint consultation with the cook and the speech therapist regarding the swallowing difficulties experienced by the service user and the support received to manage and enjoy a soft diet. A four-week rolling menu is planned providing a choice for each meal; service users are consulted each morning of their choice for the day. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 14 Arrangements for ordering and purchasing food supplies was considered with the cook and this would appear to be well managed and budgeted for appropriately. Ample stocks were seen in the kitchen. All meals were prepared daily with fresh produce. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 15 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 & 18 The home needs to adopt a more open approach to complaints and concerns and consult with service users and/or their representatives. Staff treated the service users well and were aware of issues related to protecting vulnerable adults but a more robust adult protection policy could enhance the service users protection. EVIDENCE: Two separate concerns had been raised anonymously with the CSCI regarding the untimely breakdown of the passenger lift facilities during the Christmas period and the implications for their relatives accommodated. The concerns were referred back to the home and, in response, temporary arrangements were provided for those service users unable to access the ground floor during the interim period until the lift was repaired. A relative spoken with during the inspection felt comfortable to raise any concerns with the home if the need arose. However, it is concerning that each of the complainants felt unable to raise their concerns with the home directly in the absence of the Manager, and although prompt action was taken in response to the concerns, contingency plans were not informed, with regard to service users unable to use the chair lift, or implemented initially at the time of break down of the lift. Staff had attended awareness training with regard to protecting vulnerable adults, provided by Essex Vulnerable Adult Protection Committee and staff demonstrated understanding of this issue. However the homes protection of Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 16 vulnerable adults policy and procedure requires review and clarification to include local guidelines within it, with regard to the appropriate lines to take in making a referral or raising of suspicion, the alert forms and appropriate department and telephone number. The inclusion of both the old and the new Essex guideline booklets in the policy file may cause staff confusion. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 17 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): The Standards and intended outcomes relating to the environment were not assessed on this occasion. Please refer to previous inspection report dated 29th July 2005. EVIDENCE: Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 18 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): 30 A good level of staff training helped to promote good care practice and enable staff to develop the skills required meeting the assessed needs of the service users accommodated. EVIDENCE: In the absence of the manager, staff recruitment records were not available for inspection and therefore Standard 29 and intended outcome was not assessed on this or previous inspection. There has not been any cause for concern in this area brought to the attention of the Commission. The previous and current annual training and development plan included mandatory health and safety subjects and specialist topics such as Stroke care, eating, swallowing and communication, nutrition and diet and care of people with dementia. Care Planning and Death, dying and bereavement is planned for later in the year. However, further development is required in the Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 19 programme to ensure that the basic level of training is complemented by further initiatives in areas such as a person centred approach to care, the emotional and psychological impact of the disease process on individuals, sensory impairment and specific areas such as epilepsy. See Standard 7 & 8. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 20 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): 33, 37, 38. The home had not progressed in addressing quality assurance and quality monitoring systems and continuous self-monitoring to look at service provision, care practice and outcomes to inform future service development. Records, policies and procedures and risk assessments relating to safe working practice require review and up date to help ensure and promote service user’s safety and welfare. EVIDENCE: Regular staff meetings provided opportunity for a formal style of information sharing. Although the views of service users and their representatives were sought through questionnaires, the manager had not progressed in developing systems of quality monitoring to inform future practice, since the last inspection. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 21 Comments are made within the report relating to the need to review and update policies and procedures to include new and current guidelines, to inform staff of safe working practice. One of the concerns raised with the CSCI by two anonymous people related to the evacuation procedures in the event of a fire with regard to those service users who were immobile. The home must review its fire policy and procedures and ensure they are accessible to service users and their relatives; giving clear information on evacuation procedures particularly with regard to the rationale for not using the passenger lift in the event of a fire. Risk assessments and risk management strategies were not completed for appropriate areas within the home and in the workplace including passenger lift malfunction. As previously mentioned within the report, contingency arrangements should be planned for and documented to inform staff, enabling immediate implementation in the eventuality of lift breakdown, particularly as parts for the lift are produced abroad and repair can be delayed. An outbreak of diarrhoea and vomiting amongst seven service users was appropriately managed and steps were taken to prevent spread of infection, the service users all recovered. Results later confirmed the outbreak was due to a winter virus. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 23 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 OP2 Regulation 5 Requirement The Responsible Person must ensure all individuals admitted to the home are provided with a Statement of Terms and Conditions or Residential Contract, to which they are entitled and which the care home is required to provide in accordance with NMS. The Registered Manager is required to ensure that needs assessments and care plans are always developed as soon as possible after admission. The Registered Manager must ensure a service user plan of care reflects all aspects of the health, psychological and social needs of the service user. This is a repeat requirement not met within previous timescale of 1st October 2005. The Registered Person must ensure quality assurance and monitoring systems are in place to measure success in meeting the aims, objectives and DS0000015356.V283177.R01.S.doc Timescale for action 01/06/06 2. OP7 15 01/05/06 3. OP33 24 01/06/06 Braintree Nursing Home Version 5.1 Page 24 4. OP33 10, 12. statement of purpose of the home.This is a second repeat requirement not met within previous timescale of October 2005. The Registered Manager must ensure policies, procedures and practices are regularly reviewed in light of changing legislation and of good practice advice. 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP38 Good Practice Recommendations 1. 2. OP38 The Registered Manager should ensure that risk assessments are carried out for all safe working practice topics and that significant findings of the assessments are documented and appropriate and relevant contingency arrangements in place where required. The Registered Manager should ensure the understanding and implementation of appropriate fire procedures. Braintree Nursing Home DS0000015356.V283177.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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