Inspection on 25/01/07 for Braintree Nursing Home

This inspection was carried out on 25th 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 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 12/02/06

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 Key Unannounced Inspection 10:00a 25th January 2007 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.V335595.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.V335595.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 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.V335595.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 12th February 2006 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.V335595.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.V335595.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two visits to the service on 25th January and 20th February, totalling fourteen hours. The person in charge during the first visit did not have access to the staff files and resident contracts and therefore the inspector undertook a second visit when it was known the Registered Manager was available. 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. A tour of the premises was undertaken, interaction between staff and residents was observed and discussions were held with Mr Victor Dixon, the responsible person, Mrs Fiona Kemp, the Registered Manager, registered nurses, care staff, ancillary staff, head cook and cook, residents and visiting relatives. This report has been written using accumulated evidence gathered prior to and during the inspection; including a pre inspection questionnaire completed by the home; and comment cards, distributed by the Commission, completed and returned by residents, relatives and the GP surgery. What the service does well: What has improved since the last inspection? What they could do better: Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 7 Further support with regard to the day to day administrative duties of the home would benefit the manager and enable her to direct her attention to develop and sustain initiatives in good practice and carry out essential elements of management, which will benefit the residents and staff. Care records require improvement to provide a positive and individualised record of the care required and provided to each resident. The in house audits need further development within the quality assurance programme to include an action plan and review to address the outcomes of the audits in order to improve practice and develop the service further. The activities programme also needs to be developed and recorded so the home can evidence what they are doing on a daily basis and review this as part of their quality assurance programme to ensure they are meeting residents assessed needs and wishes. 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.V335595.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.V335595.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents do not benefit from a Service User Guide or Statement of Terms and Conditions that fully inform the individual about specific information relevant to them whilst living in the home. The home undertakes appropriate assessment and works pro actively with health and social services, to clarify people’s needs and to identify appropriate support required to meet those needs. EVIDENCE: The home has produced the Statement of Purpose and Service User Guide as one document. The document does not comply with National Minimum Standards and Regulations, in that they must be in the form of a separate document for each purpose. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 10 The Statement of Purpose is required to provide a broad overview of the aims and objectives of the care home and the services and facilities it provides to inform prospective service users and stakeholders, similarly to a brochure. The Service User Guide, a separate document, should focus on the resident accommodated in the home and provide reference for the individual; including agreed service and facility provision to meet their assessed identified needs. Statement of terms and conditions and contracts were generic and not specific to each person in that it did not identify services and facilities and fees relevant and agreed to each individual’s specific needs. The document did not inform the resident of the breakdown and identification of fees payable in respect of the resident for the provision of accommodation, including food; nursing care and personal care, and by whom, as required by regulation. Comments received from people admitted from hospital to the home to receive short term nursing care were pleased to have received the latter part of their care at Braintree Nursing Home and agreed to be admitted on the strength of their good reputation. 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. Care Management assessments were in place and most, due to admission route and the individuals’ complex needs, were nurse led and mainly focused on nursing needs. The manager or a senior nurse from the home also carried out a pre admission needs assessment for each person, prior to his or her admission to ensure the home was able to meet their needs. The home is not registered to provide intermediate care and therefore outcomes for NMS 6 was not inspected. Braintree Nursing Home DS0000015356.V335595.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care planning was incomplete and not consistent in the quality of guidance to staff and the actions to be taken by staff to support resident’s needs. Healthcare needs of the residents are monitored and action is taken promptly in response to identified and changing needs. Medication administration practice and records were appropriately managed. EVIDENCE: A sample of six care plans were examined, each varied in content and detail. There were aspects where information and guidance for care staff was too general and would not necessarily ensure a consistent approach. They did not provide a clear basis upon which to review or evaluate care practice. Most remained, as highlighted in previous inspections, task and nurse orientated, and not person centred, in that they did not fully consider all individual and Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 12 diverse needs or provide detailed information to guide staff on the type or level of assistance required and agreed by the individual. One care plan stated ‘ continence and constipation’ as an identified need, the action required of staff to meet this need stated ‘ toilet 2 hourly and on request’, provide green pads at night and blue in the day’, ‘ place drinks in easy reach’, observe skin for redness’, ‘high fibre diet’, ‘encourage fluids’, ‘Senna’, ‘record bowel movements’, ‘privacy and time for eliminating’. These care planning arrangements are prescriptive, brief and task related. Consideration needs to be given to how service users can receive a service tailored to their individual and diverse needs and promote optimal independence. Assessments of risk relating to potential healthcare needs relating to dependency levels, mobility, continence, nutrition and tissue viability were assessed against set criteria and given a score rating. The total score indicated the individual to be at very high, high, moderate or low risk. The score ratings were not fully utilised within care-planning arrangements reflecting relevant and essential risk management strategies to enable care staff to provide appropriate care to prevent, reduce or monitor identified actual and potential risks. For example a falls assessment for one service user indicated the service user was at a high risk of falls due to immobility from arthritis and blindness, the daily records indicated increasing falls; a dependency assessment indicated the service user had a high level of dependency due to blindness and poor cognition, the care plan did not contain detailed management strategies to reduce the risk of falling and promote optimal independence. The moving and handling assessment only identified that the service user required two staff and equipment to assist in moving and did not reflect an individualised approach in supporting the service user in an agreed and helpful manner. This was also found in respect of those residents who had suffered a stroke. Care plans did not provide guidance for care staff to support those service users consistently in respect of moving and handling, positioning, reducing stricture and spasm of effected limbs by passive movement and exercise, pain relief and communication. Some residents, who had sustained weakness or paralysis down one side from a stroke were observed to be sitting awkwardly and unsupported in their armchairs. During the inspection two staff were observed to pull a resident out of a wheelchair, twisting the resident round to sit in an armchair. This did not demonstrate safe working practice or adherence to the homes moving and handling policy and procedure and placed the resident at risk and in discomfort, evidenced by her crying out. Training records indicated that staff had received training in moving and handling, staff competence should be assessed in this area and additional training provided if required. Social, emotional and psychological needs were not reflected appropriately in care plans with agreed and individualised care planning and management arrangements. One plan indicated that the resident displayed erratic behaviour Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 13 and exhibits aggression. The brief action plan stated the resident required ‘constant supervision’ and ‘read care plan and be aware he has thumped a resident’. This sort of comment is not helpful in providing appropriate care and support, the care plan did not provide information relating to reasons or trigger factors identified for the behaviour, associated risk assessments or management strategies. In the main residents are admitted direct from a hospital stay; some requiring basic nursing care and support to promote further recovery before returning home, others in poor physical health whose needs are complex and highly dependant necessitating a move into long term residential care requiring continued nursing care. Comments received from two people who had recently received short-term care in response to a nursing need were very complimentary about the care and support they received. Each said that the staff were attentive, always available and promptly responded to the call bell, medical advice was always sought when required and the cook always endeavoured to meet special requests for alternative food choices. The promotion of health care needs was evident in that throughout the inspection, nurses were observed to liaise with GPs for advice and ensure that new medication prescribed was promptly available for the resident. Comments received from the GP were positive and stated that the home communicates clearly and works in partnership with health care professionals; specialist advice was always followed and incorporated within the residents care, the level of clinical care was good, staff were always very professional and helpful, medication was appropriately managed and there were no concerns. GP visits were recorded in resident’s files. It was noted that the GP was alerted to see one resident who was having vacant episodes and epilepsy was being considered. However this was not reflected within the care plan to guide staff on support and monitoring arrangements and document findings for further GP review. Daily progress reports were maintained but they did not link with the care planning arrangements. They identified aspects of care and change in needs such as ‘trouble standing’, ‘pain in leg’, ‘discomfort loin cream prescribed’ which were not reflected in the care plans. Policies and procedures were in place on the care of the dying and these included practical guidance for staff to follow in these matters. 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 Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 14 enable family and friends of the resident to stay and help with care, with the residents’ agreement. Staff support the family and the home’s other residents during the bereavement process. Compliment cards seen reflected relatives satisfaction with the care provided at the end of life for the individual and the support shown towards the relatives during this time. Care plans viewed did not reflect the wishes of the individual on how they would like to be cared for during the end stages of life. The home provides good levels of secure storage for both general and controlled drugs within the medication room. Registered nurses administered all medication. During the inspection visit the nurse in charge was observed administering medication, the procedure followed was satisfactory and ensured that residents’ safety was maintained. Controlled drugs policy does not inform staff of current guidance on the disposal of unused and unwanted controlled drugs. A quality assurance audit was undertaken, but not dated, to look at the quality of recording by staff and accountability in the administration of medication and adherence to the homes policy. The audit looked at the medication administration record sheets (MARS). Shortfalls were identified relating to a small percentage of the omission of staff signatures and unexplained gaps in the records relating to the use of code F used for ‘other reasons’ when medication is omitted. The audit identified the potential risk to the residents from the shortfalls identified but did not provide an action plan and review to improve practice. The pharmacist mostly supplies prescribed medication in the Monitored Delivery System (MDS) monthly. On inspection it was noted that some systems were commenced on a different day to the first of the month and is potentially confusing to the person administering the medication. The inspector was advised of different reasons for this but it is clearly an area requiring attention to reduce potential error. The home provides the necessary aids and equipment to support both staff and residents in daily living. Some residents were observed to receive therapeutic care in the form of aromatherapy from an outside therapist. Residents enjoyed hand, foot and lower leg massage. Whilst this form of therapy is recognised for promoting peoples well being, the therapy was not reflected within the individuals care planning arrangements identifying the benefits and how they meet the persons assessed needs. The residents received this therapy in the lounge, which is not conducive to the full effects of the purpose of the therapy and the promotion of privacy and dignity. Braintree Nursing Home DS0000015356.V335595.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Visitors are made welcome at the home. Social and recreation provision did not cater for all residents’ needs and abilities. The home supplies sufficient quantity and quality of food, and provided a well balanced diet that was suited to individual needs, requirements and choices. EVIDENCE: Activities within the home continue to be developed to provide interest and stimulation for the residents. Three named carers, in turn, organise activities on a daily basis. One of which took the lead, and having a natural ability, good humour and happy nature was observed on this and previous inspections to always lift the spirit of the residents and the atmosphere in the home. On this occasion, the carer innovatively set up a pretend camp log fire in the middle of the lounge and encouraged the residents to sing along to the accompaniment of the guitar, also played by the carer. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 16 Unfortunately the records inspected do not reflect the activities provided for, planned or participated in nor the outcome and benefit for the resident involved. The care plans examined did not identify the level of ability of the individual or clearly state what action staff should take to help individuals overcome the difficulties they experience due to their physical and cognitive disabilities or other needs. They also did not clearly identify resident’s interests, preferences, likes and dislikes or any previous hobbies or occupation. This important information would enable appropriate planning and support provision for the frailer resident with more complex support needs. Some care files examined contained a small brief personal history about the individual; more detailed information including significant historical information would guide staff in understanding the person, associated behaviours and communication. The provision of social activities was noted not to engage the residents with more complex cognitive disabilities. Staff did not demonstrate the skills and detailed knowledge required to understand the needs and therapeutic approaches to care and support for people with varying levels of cognitive and sensory ability. The manager advised that the lead activity co ordinator was to commence suitable training to address this area of need and cascade training to the staff team. Residents spoken with and feedback from comment cards indicated that they were aware of group activities on offer such as music and sing-along. Some chose not to take part and either stayed in their room or observed. Others confirmed that they enjoyed participating. One resident requiring long term care was being supported to go on a long wished for final holiday by the sea in a chalet/caravan specifically adapted for physical disability. Church services are provided monthly within the home. During the inspection one resident was observed to receive Communion in the conservatory/dining room, which did not fully provide the privacy and quiet required for this occasion. During the second visit of the inspection a vacant room downstairs was being prepared as a second lounge, to provide an additional communal area for residents. This room would be more appropriate for residents who require privacy for occasions such as Communion and receiving visitors. Feedback from relatives comment cards all stated that the home was welcoming and friendly to visitors and that they were able to visit at any time. 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 Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 17 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. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has systems in place to help ensure that concerns and complaints will be listened to and acted upon. The home has systems in place, which help to ensure the protection of vulnerable people from abuse. EVIDENCE: The policies for complaints and protection were unchanged from previous inspections and met the standard expectations. Complaints were acted upon and responded to in writing within required time scales. The home did not have an established system for logging and recording complaints or concerns, the action taken and outcome for complainant, including action for future practice and review. Without this information an audit cannot be undertaken to consider the quality and effectiveness of the homes complaints system, or if the action taken is appropriate to improve outcomes for residents and stakeholders. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 19 Staff had received regularly updated training in safeguarding vulnerable adults’ as part of their annual training plan. Although the homes whistle blowing procedure needs to be more supportive towards the reader in encouraging staff to report bad practice, staff have alerted the manager when unsatisfactory practice was witnessed to which the manager acted upon promptly and appropriately ensuring the safety and wellbeing of residents. The home undertook its own investigation with a satisfactory outcome and it is disappointing to note that support was not forthcoming in a timely and efficient manner from the local Social Service team in taking the lead in a strategy investigation in this instance. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is clean and well maintained. The dining room does not provide adequate accommodation for all residents. EVIDENCE: A tour of the premises identified that the home was well maintained. Rooms were clean and there was no evidence of unpleasant odours in the home. The dining area has been relocated to the small conservatory and continues to not meet National Minimum Standards in that the dining area was not sufficiently spacious to accommodate all residents should they all wish to attend for meal times. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 21 The conservatory does not provide any more additional space than that provided by the small original dining room and it was observed that many residents still remained seated in the lounge to take their meals. The inspector was advised that the current residents preferred not to take their meals in a dining area, however it was unclear as to how this decision was reached, and whether it was a case that there simply was not enough room and residents were aware of this. Proposed plans for an extension to the building was discussed by the responsible person with the inspector, who pointed out that the plans still did not include adequate dining facilities. Urgent consideration should be given to the provision of sun shade in the conservatory as the half length net curtains did not give residents adequate protection from brightness and heat, particularly on a hot sunny day. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Records relating to staff recruitment were satisfactory to help ensure residents protection. The numbers and skill mix of staff generally meets residents needs. Residents are generally in safe hands but an increase in staff knowledge could improve this further. The home has a staff group training programme in place, individual training profiles would help to ensure that staff are competent to do their jobs and identify areas of weakness and strengths. EVIDENCE: Staff rotas were clear and identified the roles of staff. Additional ancillary and kitchen staff had been employed since the last inspection, to undertake domestic tasks such as breakfast, supper, laundry and bed making. The manager indicated that this has released care staff considerably to spend more time on the caring aspects of their role. Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 23 A sample of records for three care staff were inspected, all of which contained appropriate levels of documentation required in respect of adequate recruitment. These support the homes intention to fully understand prospective employees background and experience and help safeguard the residents from possible abuse. The records also contained reference to various short course training undertaken by care staff and nurses. Records demonstrate 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. Staff files included an Annual Appraisal, which briefly reviewed the individuals’ performance and identified their weaknesses and strengths and basic training and development needs. There was no available training profile generated from the appraisal to determine specific annual training and development plans in relation to the individual’s needs and requirements. It is 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. This inspection highlights a training need for all staff to develop their skills and understanding in care planning and person centred care to enable them to effectively meet all individualised needs and deliver planned agreed and consistent care and not just deliver ‘ task orientated’ care. Braintree Nursing Home DS0000015356.V335595.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager is supported well by senior staff in providing clear leadership throughout the home with all staff demonstrating a good understanding of their roles and responsibilities. Staff do not benefit from satisfactory supervisory arrangements. Service users do not fully benefit from the homes record keeping and policies and procedures. There is no system in full operation to improve quality of the service provision. EVIDENCE: Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 25 Positive responses had been received on the home, care and staff. The manager operated an open door policy and was well known to residents and most relatives, although some relatives have stressed to the Commission that they have found opportunities to speak with the manager personally, limited. This may need to be addressed and arrangements put in place and brought to the attention of visitors and relatives of the availability of the manager or a deputy in her absence. Safe working practice risk assessments were in place but these required more detail to guide staff appropriately in reducing risks identified. Policies and procedures, although reviewed and dated, some were too brief and others were untidy with written amendments and crossing out over a fiveyear period. It was recommended that further attention be given to the documents to ensure they are clear, up to date and in line with current legislation and professional guidance to appropriately inform staff in their working practice. For example the Infection Control policy in place was produced in 1996, further guidance has since been released by the Department of Health, 2006, Infection Control Guidance for Care Homes. The certificates relating to equipment and services to the home were in place and updated as required. Staff supervision was considered as part of this inspection. The three files sampled indicated that limited progress has been made with formal individual recorded supervisions. The sample of staff files examined did not contain a record of regular supervisions and those records available of formal one to one meetings indicated a need for discussions to have a stronger link to care practice issues and meeting the needs and objectives of the individual service users. This was discussed with the manager, who advised that observation and informal supervision takes place but is not recorded. The manager agreed this was an area to be developed and indicated that the time element required for a large workforce - 37 care staff and 14 nurses, was an issue to be addressed. It is important that the person in day to day charge of the home has sufficient time to carry out the essential elements of management including supporting the staff within a formal supervisory process and provide staff with the opportunity to discuss care practice; assess competence and training needs and share information about developments in practice and policy. The process also enables problems and concerns to be openly discussed. Quality assurance and monitoring systems were still not fully in place to meet NMS. Although it was acknowledged the home had begun to address quality issues, there was insufficient evidence available to demonstrate an open and analytical review of the service currently provided, and identify the actions Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 26 required that would impact on outcomes for residents and ensure continuing improvement in the areas identified. Braintree Nursing Home DS0000015356.V335595.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 2 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 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 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 2 3 Braintree Nursing Home DS0000015356.V335595.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 OP1 Regulation 5 Requirement Timescale for action 01/06/07 2. OP2 5, 5A, 5B. 3. OP7 15 The registered person must produce a service user guide as a separate document containing written information with regard to arrangements, services and facilities provided within the home; relevant to the individual for reference. This is a repeat requirement not met within given timescale 01/06/06. 01/06/07 The registered person must ensure residents or their representatives are supplied with a copy of their Statement of terms and Conditions/Contract, that gives a clear understanding of what to expect from the home that is relevant to the individual relating to agreed service provision and the corresponding fees payable and by whom for 1. accommodation and food, 2. nursing care; and 3. personal care. The registered person must 01/06/07 develop service users plans to ensure they contain all aspects of the individuals health, personal and social care needs DS0000015356.V335595.R01.S.doc Version 5.2 Braintree Nursing Home Page 29 4. OP20 23(2) (a)(e)(g) and adequate directions to inform staff how identified needs in respect of health and welfare will be met to ensure consistent and appropriate care delivery. The Responsible Individual must consider how to meet Standard 15 and 20 of the National Minimum Standards in respect to providing dining room facilities for all the service users accommodated in the home within its annual business plan. The registered person must develop quality assurance and monitoring systems for reviewing the quality of care available at the home and ensure that the home is run in the best interests of the service users. The registered person must ensure that persons working at the home are appropriately supervised. Supervisions need to be more frequent and fully documented to reflect all the element’s necessary to support staff in developing and sustaining their working practice. The registered person must ensure that records required by regulation are adequately maintained. The registered manager must ensure the competence of staff working in the care home to ensure the health and welfare of service users, particularly in safe working practices and moving and handling of residents. 01/06/07 5. OP33 24 01/06/07 6. OP36 18(2) 01/06/07 7. OP37 17(1)(a) (3)(a) 18 (1)(a) 01/06/07 8. OP30 01/06/07 Braintree Nursing Home DS0000015356.V335595.R01.S.doc Version 5.2 Page 30 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 registered person should link the activities plans and records to the social care plan for individual residents. Braintree Nursing Home DS0000015356.V335595.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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Braintree Nursing Home DS0000015356.V335595.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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