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Inspection on 15/01/08 for Braintree Nursing Home

Also see our care home review for Braintree Nursing Home for more information

This inspection was carried out on 15th January 2008.

CSCI found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The standard of care at Braintree Nursing Home is good and the home promotes a warm and happy environment. Residents, their relatives and health professionals all expressed satisfaction for the care and support provided by the management and staff team. The staff team is stable and turnover is low and staff training is generally good. The manager has an honest and open approach and is keen to address any issues raised. There is a happy and friendly atmosphere in the home, which both residents and staff enjoy. Positive comments were received from residents regarding the food. The meals provided are appetising, well balanced and tailored to resident`s preferences and requirements; alternatives were readily available.

What has improved since the last inspection?

Significant improvements have been made since the last inspection to the organisational structure in the home; record keeping, general care provision and quality assurance and monitoring. These aspects have all helped to improve outcomes for residents.A previous requirement was made for the home to further develop its quality assurance and monitoring systems. The home had progressed with various internal quality audits being undertaken to identify weaknesses as well as strengths in service provision. Newly formed initiatives such as a Residential Forum and a Resident Link for seeking and passing the views of fellow residents to the management, promotes a resident led approach.

What the care home could do better:

Further developments in care planning and more training pertinent to the residents needs would enhance resident care further. Annual evaluation and continued development of quality audits and assurance process will be beneficial to the service by informing future planning and improvements. The information provided in the AQAA should be considered to ensure it provides the most comprehensive details to assist the Commission in understanding how the registered persons understand the service strengths and weaknesses and how it will address these.

CARE HOMES FOR OLDER PEOPLE Braintree Nursing Home 11 Coggeshall Road Braintree Essex CM7 9BD Lead Inspector Gaynor Elvin Unannounced Inspection 15th January 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Braintree Nursing Home DS0000015356.V358051.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. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 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 braintreenursinghome@fsmail.net 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.V358051.R01.S.doc Version 5.2 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 25th January 2007 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. The home is located in the town centre of Braintree, Essex and is within immediate access to all amenities. The site is shared with The White House, a registered care home for people over the age of 65 years, owned by the same company but managed independently. Both units share the very small gardens, which comprise of a patio and grassed area with seating at the front of the building. Car parking facilities are available. The property is a two-storey building with access to the upper floor provided by a passenger lift; a seated stair lift is also provided. A further extension was built in 2001. Personal accommodation in the home is made up of 14 bedrooms of single occupancy with en suite toilet and hand washing facilities and 11 bedrooms providing shared occupancy of no more than two people; these rooms are supplied with personal hand washing facilities only and free standing screens help to provide privacy. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 5 At the time of inspection it was confirmed that the current scale of fees ranged from between £550 - £650 per week. Additional charges are made for chiropody, hairdressing and aromatherapy services. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over eight hours on 15th January 2008. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. Time was spent talking to the Registered Manager, the head cook, the administrator, a registered nurse, care staff and residents. This report has been written using accumulated evidence gathered prior to and during the inspection. Comment cards from 3 residents, 3 relatives of residents, 1 GP, 1 healthcare professional and 1 therapist with an interest in the home were completed and returned to the Commission and views expressed are included within the contents of this report. What the service does well: What has improved since the last inspection? Significant improvements have been made since the last inspection to the organisational structure in the home; record keeping, general care provision and quality assurance and monitoring. These aspects have all helped to improve outcomes for residents. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 7 A previous requirement was made for the home to further develop its quality assurance and monitoring systems. The home had progressed with various internal quality audits being undertaken to identify weaknesses as well as strengths in service provision. Newly formed initiatives such as a Residential Forum and a Resident Link for seeking and passing the views of fellow residents to the management, promotes a resident led approach. 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. The summary of this inspection report can be made available in other formats on request. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Standard 6 is not applicable to this home. Quality in this outcome area is good. People wanting to use the service can be confident that the home can meet their immediate needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has a pre admission assessment system in place. The manager undertakes all the assessments and if unavailable a member of the nursing team would attend. Recent assessments were reviewed and seen to focus on immediate presenting needs. Where areas of need were identified, these could be explored and more detail recorded to inform care planning. The assessment could be developed further to ensure a more person centred approach. The home’s assessments were supported by information provided by nursing needs and social service assessments. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 10 Both the manager and staff spoken with had a good knowledge of the individual needs of the residents. The home’s quality assurance and monitoring system is currently reviewing the admission process with a view to developing a more personalised approach taking residents experiences into account. Introductory visits were not always possible for the prospective resident as most are admitted directly from hospital; but the opportunity is offered by the home. Family or representatives in the main view the home on their behalf and comments received indicated a warm and open reception. Despite assurances given in the improvement plan following the last inspection work had not progressed in ensuring peoples’ written contracts/statement of terms and conditions included detail of their current fee and where applicable a breakdown of fees where an NHS nursing contribution is received; method of payment and identified responsibility for payment. The management need to address this area so that residents or their representatives are appropriately informed. The home does not provide intermediate care; subsequently this standard is not applicable. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. People who use the service can expect to have their basic needs met with dignity and respect and their health care promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst we were at the home, we observed and heard staff interacting well with residents. From observation and discussion with staff it was clear that they generally understood the individuals’ needs and provided a level of care that the residents appreciated. Overall the care planning system in place continues to improve. We looked at three residents’ care files and each consisted of a personal profile; family history, care plan, risk assessments and health care records. Overall we found that these were up to date and more regular reviews had taken place. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 12 The content of care plans were variable and some required further work and increased staff input. There remained scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. This would help the team evidence further that they appreciate the diversity of the residents in their care. There were other aspects of the plans where advice and guidance for staff were too general/brief and would not necessarily ensure a consistent approach in the most supportive manner and did not provide a clear basis upon which to review care practice. For example, ‘needs help to dress and undress’; ‘ensure daily care of hair and nails’, ‘encourage to use commode before getting up’. We noted that more work needs to be completed on the social care plans to ensure that residents’ needs are being met, and this could relate to the, sometimes, limited information on assessment. The care plans viewed did not reflect the emotional care elements of their needs, particularly for those residents who have higher nursing needs. Evidence is needed to show that where possible, residents have been involved in the care planning process or their relative/carer/advocate as appropriate. The manager has recognised these issues as an area for improvement and has stated in the AQAA that documentation requires more input and that some staff have attended training in care planning and already started to be involved in creating care plans with residents to provide a more holistic view of their needs. Risk assessments were seen to be in place covering a wide range of subject matters. Whilst the structure of assessment and risk assessments were in keeping with good practice, the team need to work on linking risk management strategies into the care planning process, so that any action required to reduce or monitor the risk is clear and consistent for staff, and subsequently evaluated. There was no indication, in the care plans examined, how useful or critical information obtained from the assessments informed the plan of care or how it related to the provision of care tailored to individual needs. This was particularly noted in relation to nutritional, mobility, falls and pressure sore risks. The manager and senior nurse, as part of quality monitoring, were currently reviewing the quality of nutritional assessment and care against benchmarking standards to improve recording, consistency and outcome for residents. Feedback from relatives indicated they were happy with the standards of care given at the home. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 13 Each day one of the care staff team remained in the communal areas throughout the day to assist residents in accessing drinks and the toilet. Records show a proactive approach with regard to GP and specialist services being contacted in a proactive manner as and when necessary. Good records are maintained of visits and advice given. The team need to ensure care plans are revised or generated to include this information including any changes or monitoring in the care to be provided, to ensure continuity. Feedback received by the Commission from a GP and other healthcare professionals who attend the home indicated satisfaction with the care practice provided at Braintree Nursing Home. They felt that individual’s health care needs were always met by the service; staff demonstrate a clear understanding of the care needs of the residents and always respect individuals’ privacy and dignity. Records also showed us that residents do see opticians, chiropodists, dieticians and speech and language therapists at the home. Where required the team also access specialist advice from, for example, community psychiatric services, to ensure that they can still meet the needs of residents. The home has sufficient specialist equipment to manage the residents’ mobility needs and pressure-relieving equipment. A good level of secure storage for both general and controlled drugs was provided in the medication room and medication was stored at the correct temperature. Registered nurses administered all medication. The home uses a blister pack and bottle to mouth system. This was reviewed and found in good order. Administration records were completed, dated and signed correctly and omission codes used accordingly. Dates of opening were noted on individual short life medications. The home disposes of unused medication through a clinical waste company in line with guidance determined by the Controlled Waste Regulations. Internal audits continue to be carried out to look at the quality of recording by staff, accountability in the administration of medication and adherence to the homes policy. The management, in their future plans, are considering external auditing by their new provider of prescribed medication to provide an independent and more professional approach in this area. The home aims to provide palliative care in the most dignified and comfortable manner and provides support to the family. The home has arrangements in place, which enable family and friends of the resident to stay and help with care, with the residents’ agreement. The team need to further develop this area in that palliative care and end of life needs of residents are planned for and recorded in the residents care plan, Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 14 so that at the time of their death, dying or serious illness staff are aware of their wishes and how and where they would like their care to be delivered. Braintree Nursing Home DS0000015356.V358051.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): 12, 13, 14 and 15 Quality in this outcome area is good. Regular activities are provided for people living in the home, however the extent to which the activities meet the needs of the residents varies according to level of need. The home is open and welcomes relatives and friends of residents and the meal provision in the home is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities within the home continue to be developed to provide interest and stimulation for the residents. Four named carers, in turn, organise activities on a daily basis between 11.30 and 4.30pm (before and after dinner). Whilst the provision of activities has steadily improved, more work needs to be done on the completion of social care plans that identify individual needs. This important information would enable appropriate planning and support provision for the frailer resident with more complex support needs. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 16 Family histories are in place and interests recorded for many of the residents and this work should inform social care planning, which overall was weak. Separate records show that whilst residents are taking part in activities, these are not always relating to their noted preferences, a more individualised approach in this aspect of care would bring the activity staffs’ and care teams’ work together to promote a team approach to improving outcomes for people in this area. The manager and staff were observed engaging in positive interactions with residents. Their approach was positive, polite and supportive. Relationships were warm and friendly with good-humoured banter. There were a number of visitors to the home and it was clear that they felt welcome. Meals were offered from a planned menu, and the head cook visited each resident first thing to ascertain their choice of meal for that day, further alternatives from daily choice are offered to meet individual needs and requirements. Specialist diets are accommodated and efforts are made to attempt residents with poor appetites. The head cook enjoys developing the menu and providing residents with new food experiences, which are incorporated into the menu if successful. The food stocks were plentiful; fruit, vegetables and meat are freshly delivered. Overall the residents expressed satisfaction with the quality of the food received. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People who use this service can be assured that satisfactory arrangements are in place to promote their protection from abuse and that any concerns they or their representatives may raise will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from healthcare professionals who regularly visit Braintree Nursing Home stated they had not received any complaints about the home and that they were satisfied with the overall care provided to the residents in the home. Those comments, received by the Commission, from residents and relatives stated that they were aware of the home’s complaints procedure but have not had any cause to complain. They felt comfortable to discuss any concerns with the management and felt they were always listened to. A Resident Forum, held monthly, also open to relatives, had recently been set up and records of minutes indicated participation and good discussion around issues in the home and suggestions were acted upon. The CSCI had not received any complaints with regards to this service during the last twelve months. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 18 In response to the last inspection the manager had established a system for logging and recording complaints or concerns, the action taken and outcome for complainant, including action for future practice and review. Although the manager had not received any formal complaints since the last inspection, she had initially begun to record minor concerns received verbally and any action taken to address them. It was disappointing to note that this system had not been sustained. This important information should continue to be collated to consider the quality and effectiveness of the homes’ response and future actions within the quality assurance process to improve outcomes for residents and stakeholders. An Adult Protection policy and procedure was in place, which ran in conjunction with Local policy and Department of Health ‘No Secrets’ guidelines. Records showed that staff had received training on issues relating to the protection of vulnerable adults. Staff were observed to interact with the residents appropriately and residents appeared relaxed and comfortable with the staff. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 19 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): 19, 20, 22 and 26. Quality in this outcome area is adequate. People who use this service can expect to live in a clean and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the home was undertaken, reviewing all the communal areas and a number of bedrooms, at random. The home was seen to be clean and no odours were noted. The layout of the home is restrictive but the manager has continued to explore various ways of making better use of the space provided until the planned extension to the home is completed. Additional dining areas have been Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 20 incorporated into the smaller communal areas this has provided living areas that are more personal and homely for residents. Overall the dining facilities continue to not meet national minimum standards and desired outcomes for residents in that they are not sufficient to provide the same number of places for which the service is registered. Concerns about the storage of hoists and wheelchairs in the corridors were raised with the manager. Mobile hoists were kept on charge in one corridor and could cause congestion in the event of an emergency. Previous additional storage was noted to be full of wheelchairs and was no longer sufficient to store additional wheelchairs. Proposed new building and refurbishment plans include additional storage space, dining facilities, unitised communal areas and additional bedrooms subsequently reducing the amount of shared rooms. However this muchneeded work is now postponed until the autumn of 2008. The floorboards of the older wing of the building were noted to be uneven and noisy. In one room a wardrobe was noted to lean forward from the wall posing a potential risk. We were advised that work to the floorboards was planned following completion of the new building works, however interim arrangements such as fixing the wardrobe to the wall would reduce potential risks. The home has a maintenance person who undertakes a daily check of the home, and records show that areas identified by staff are attended to promptly. Daily checks include fire safety equipment and water temperatures. The internal audit system needs to be developed further to ensure wider health and safety aspects are considered, monitored and managed, when looking at the premises, to promote the safety of people living in the home. As highlighted in previous inspection reports urgent consideration needs to be given to the provision of sunshade in the conservatory. Residents were not provided with adequate protection from brightness and heat, particularly on a hot sunny day. Feedback from residents was positive about their bedrooms and the facilities at the home. We observed that many of them had personalised their rooms. Since the last inspection the small, patio area at the back of the home, where residents can sit out, has been improved and contains raised flowerbeds for residents to attend to if they wish, a raised fishpond and a shelter for smokers. Infection control arrangements such as waste management and hand washing facilities were seen to be good and training records indicated that staff have received training on this subject. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. The home’s recruitment and selection process, and induction and training programmes ensure an effective staff team to support and protect the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota indicated that there is a minimum of one trained nurse on duty throughout a 24 hour period, generally assisted by six care workers in the morning; four in the evening and two at night. Shift patterns varied to ensure additional cover at times in the day when required most. Four of the staff team, additionally, took the lead in coordinating social care between the hours of 11.30 and 4.30 each day. Ancillary and kitchen staff undertake additional domestic tasks such as breakfast, supper, laundry and bed making. The Commission received positive feedback from healthcare professionals, residents and relatives regarding the staff team. Residents indicated that the staff were caring, friendly and helpful, they always listen and do what is in the residents best interests. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 22 We were informed that staffing levels were calculated according to the resident’s needs. An assessment tool was not used and the calculation was dependent on the managers’ professional judgement. Some comments indicated that at times staffing levels did not always meet residents’ needs effectively such as ‘staff are sometimes pushed hard to cover illness and sickness and this causes staff extra stress when they already work very hard’ and ‘some staff take long periods (up to 30 mins) to answer the call bell eg to be helped off the commode. At staff change over there are no staff available to residents’. The manager acknowledged that although there is a full compliment of staff, sickness and annual leave do have an impact on staffing levels and this needs to be addressed. We reviewed the recruitment procedures at the home and found that they remain robust and that all required staff checks and documentation is in place to help ensure suitable staff are appointed for the job. Feedback from staff indicated general satisfaction in relation to induction, training, support and the provision of information to help them in their work, One commented ‘Staff are given the opportunity for relevant training which keeps us up to date, our manager is very supportive’. All new staff commenced an externally provided three-day structured induction programme that covered core topics. Records showed us that the Skills for Care Induction programme was followed incorporating a competency-based element to the training to ensure new staff fully understand the way in which the service is required to support the residents. The manager or senior registered nurse assessed competency and records to evidence induction outcomes were completed and signed accordingly. The service had achieved more than the minimum recommended proportion of care staff having attained an NVQ qualification in care at level 2, ensuring a competent staff team to support the residents. Staff records viewed contained reference to various short course training undertaken by care staff and nurses. A training matrix showed us that significant numbers of current staff have attended training in core subjects to promote the health, safety and welfare of the residents and subjects pertinent to their individual needs. Training and development plans for staff individually and as a group is an area still to be addressed. Although it was noted that some training had been accessed from the Alzheimer’s Society, one relative commented ‘ some staff are not aware of the needs of people with dementia and seem to think that they are in a bad mood, they are inexperienced in managing their needs, but as a whole, carers are good and support each other in a very demanding job’. Training would be more beneficial to staff and the residents they care for if it was provided within a Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 23 planned programme in response to identified needs of the residents and the staff skills mix. An allocated training budget would enable the manager to determine specific annual training and development plans in relation to staffs individual and team requirements and residents needs. It is also particularly important for registered nurses to be supported to maintain and update their clinical knowledge and skills and professional development to provide care that is evidence based and in line with current guidance. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, and 38. Quality in this outcome area is good. The home is managed in a way that promotes the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Kemp, the Registered Manager, maintains an open and transparent relationship with staff and residents and continues to demonstrate a positive attitude towards the development of the home and care outcomes for the residents. We noted a pro-active approach to the previous inspection report and Mrs Kemp has addressed a wide range of development work in the home. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 25 The additional support with regard to the day to day administrative duties of the home, a domestic supervisor and catering manager have enabled the manager to direct her attention to develop and sustain initiatives in good practice and carry out essential elements of management. The manager and staff were progressing in developing quality assurance and monitoring systems to provide sufficient evidence to demonstrate an open and analytical review of the care and support currently provided at Braintree Nursing Home. A range of internal quality audits were being undertaken to identify weaknesses as well as strengths in service provision in areas such as the admission process, medication management and nutritional care, to inform action plans for improvement in outcomes for residents. These are supplemented by formal questionnaires for residents, relatives and stakeholders and other good practice initiatives that promote a resident led service. These included the commencement of a Resident’s Forum where residents and their representatives are able to discuss views and suggestions and an identified resident link person for those people who do not wish or are unable to participate in the Forum. Recorded minutes from the Resident Forum meeting indicate good resident led discussion on issues around food and meal provision and the development of the activity programme. These are positive initiatives to assess, evaluate and improve current practice and quality outcomes for residents and we look forward to reviewing the progress achieved in the forthcoming inspection process. The manager does not manage the financial affairs of any of the people living there. Where residents are unable to manage their own finances this is managed by nominated persons outside of the home. There was appropriate security and procedures in place for the safe storage for small amounts of personal monies for everyday use – such as toiletries, hairdresser, chiropody, aromatherapy. Receipts are held for expenditure and records confirmed by signature. The procedures were adhered to and amounts held were confirmed as correct. Most records identify negative balance, as residents had not received money on a regular basis to cover costs. Progress has been made with formal individual recorded supervisions, however these need to be more frequent and fully documented to reflect all the elements necessary to support staff in developing and sustaining their working practice. Three staff comment cards indicated that they received one to one support ‘sometimes’. The manager felt there was an improvement in recognising supervision as a valuable process and since the last inspection the manager and senior nurse had received training in the supervision process. Other forms of supervision were discussed which could be incorporated into the process to stimulate interest and enthusiasm, provide additional topics for agenda and promote Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 26 development and competence, all with equal benefit but are required to be recorded. The manager said she would address this. Random inspection of maintenance and safety certificates for equipment and services in the home show that these are maintained and in date. Risk assessments were currently being reviewed. The most recent Environmental Health food hygiene inspection awarded the home with a Silver Award 2007 for its commendable kitchen and catering facilities. The catering staff have all received food handling training and each are doing various modules of NVQ such as food serving/customer service, and the head cook is undertaking a course in food content and food preparation accredited by the Hospitality Awarding Body. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 28 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, 5A, 5B Requirement Timescale for action 01/04/08 2. OP20 23(2) (a)(e)(g) Each resident must be provided with a statement of terms and conditions/contract that gives the resident or their representative a very clear understanding of the fees, breakdown of fees and the circumstances of how the fee is to be funded. This is a repeat requirement not met within given timescale. Residents must be provided with 01/12/08 adequate dining facilities to meet their needs and the homes stated purpose. This is a repeat requirement not met within given timescale. Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations There remains scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. 2. OP12 More work needs to be completed on the social and emotional care elements of care planning, particularly for those with high nursing and dependency needs. Linking activity plans and records to individual social care plans would provide a more individualised approach to this aspect of care and would bring the activity staffs’ and care teams’ work together to promote a team approach to improving outcomes for people in this area. Systems such as the Liverpool Care Pathway for determining the end of life needs of residents would help to assure residents that their needs would be met, including their choice to remain in the home or be admitted to hospital at their time of death. The complaints log should record minor or verbal concerns raised with the home to form part of the quality assurance monitoring and audit system to inform the home of areas identified for improvement. A sun awning or blinds should be considered for the conservatory before the weather becomes warmer to protect the residents from the heat and brightness of the sun. The home would benefit from the implementation of a training and development plan for staff individually and for the team as a whole, to ensure appropriate training is planned for and accessed throughout the year. Additional training for registered nurses in palliative care to inform current practice would benefit residents who require palliative care. 3. OP11 4. OP16 5. OP19 6. OP30 Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 30 Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Braintree Nursing Home DS0000015356.V358051.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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