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Inspection on 29/07/05 for Braintree Nursing Home

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

This inspection was carried out on 29th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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 majority of service users and relatives spoken with stated that the staff were `kind and caring` and one service user in particular stated that ` the staff could not be better, or more helpful`. Relatives and visitors were welcomed into the home and those spoken with felt the home encouraged and supported their visits.

What has improved since the last inspection?

The environment in the home was considered safe and well maintained. Good progress had been achieved in obtaining positive outcomes in a number of areas highlighted in previous inspections. Newly recruited staff and a strong emphasis on staff training provided an established and confident staff group, delivering sensitive and professional care, benefiting the service users. This was observed in the positive relationships formed between service users and staff, and the warm and pleasant atmosphere the home presented on this inspection.

What the care home could do better:

The home provides service users and their representatives with information verbally with regard to the running of the home, services, facilities and the process for making a complaint. This important information needs to be reinforced in written format within the Statement of Purpose, Service User Guide and Statement of Terms and Conditions, provided for and regularly referred to, for the service user and representatives either prior or during admission. In their possession, this would provide easy reference and enables the individual to fill in any gaps that may be forgotten during a stressful and anxious time. Service users care plans and documentation need to reflect all identified needs and could be a lot more informative for staff, to help ensure delivery of structured and consistent care and better reflect the actual standard of care given.

CARE HOMES FOR OLDER PEOPLE Braintree Nursing Home 11 Coggeshall Road Braintree Essex CM7 9BD Lead Inspector Gaynor Elvin Unannounced 29th July 2005 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 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 I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Braintree Nursing Home Address 11 Coggeshall Road Braintree Essex CM7 9BD 01376-345866 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Avidcrave Limited Mrs. Fiona Kemp Care Home (CRH) 35 Category(ies) of Physical disability over 65 years of age registration, with number (PD(E)), 35 of places Physical disability (PD), 3 Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 35 persons). 2. Persons of either sex, aged 49 years and over, who require care by reason of a physical disability (not to exceed 3 persons). 3. The total number of service users accommodated in the home must not exceed 35 persons. Date of last inspection 10 March 2005 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 and up to 3 identified adults over the age of 49 years. 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 I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place one day in July 2005, over 5 hours. The inspection process included discussions with Mr Dixon, the Responsible individual, Mrs Dixon, the administrator, two Registered Nurses, five service users, five relatives, an informal interview with three carers, observation of care practice and examination of service users care files. Braintree nursing home is a large care home providing nursing care to 35 people. It was evident on this inspection that careful consideration had been taken with regard to the homes capacity to meet service users needs and the ability to sustain the Statement of Purpose for current service users before accepting future admissions with high dependency needs. In responsibly managing this fine balance, together with the successful recruitment and robust training of additional staff, Braintree Nursing Home had made significant progress in meeting good care outcomes and National Minimal Standards. What the service does well: What has improved since the last inspection? The environment in the home was considered safe and well maintained. Good progress had been achieved in obtaining positive outcomes in a number of areas highlighted in previous inspections. Newly recruited staff and a strong emphasis on staff training provided an established and confident staff group, delivering sensitive and professional care, benefiting the service users. This was observed in the positive relationships formed between service users and staff, and the warm and pleasant atmosphere the home presented on this inspection. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 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 I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 4, 5. The home was able to demonstrate that the service it provided met the needs of the service users and the homes stated purpose. The home needs to ensure that new service users are given clear and accessible written information and guidance with regard to the home. EVIDENCE: From documentation and discussions with new service users, it was clear that the majority of new service user’s needs were complex and highly dependant. New service users spoken with were admitted direct from a hospital stay, in poor physical health, necessitating a move into residential accommodation providing nursing care and support. Introductory visits were not always possible but the opportunity is offered by the home. Service users indicated that relative’s choice, location or availability were strong indicators for their choice of home. New service users spoken with expressed satisfaction with the way their admission was managed and with the way the home was meeting their needs. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 9 They did not recall receiving written information with regard to the home but impressed that verbal information was given at the point of admission. Management assessments and reviews were in place and noted to be nurse led, mainly looking at nursing needs. A full holistic needs assessment was carried out by the home prior to admission. The home is not registered to provide intermediate care and therefore outcomes for NMS 6 was not inspected. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 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 standard(s) 7, 8,10 & 11 The service users were looked after well in respect of their healthcare and personal needs. Staff engaged positively with each individual and treated him or her with dignity and respect. EVIDENCE: Respectful and helpful interaction was observed between the staff and the service users. New assessment forms had been introduced, a comprehensive tool enabling staff to identify all aspects of care needs and risks, the recording of personal history, self care and cognitive ability, lifestyle choices and preferences including an assessment overview, providing all the essential information for care staff to know and understand the individual. The forms were not in place for all service users as they had only recently been introduced. However, it was disappointing to note that an assessment form had only been partially completed and did not give a full and accurate picture and reflect all the needs, Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 11 particularly important for this individual recently admitted, who had breathing, eating and mobility needs due to her condition and was very frail and weak. Care plans examined were well-structured utilising risk assessments associated with moving and handling, continence and skin viability and other identified health care needs, providing information for staff of the action required to meet the needs. The care planning process was carried out by the Registered Nurses and tended to focus heavily on physical needs. The care plans required a more holistic approach and reflect all needs assessed. Care staff indicated that the manager was looking to involving care staff in the care planning process as it was recognised they had an important part to play in assessing and meeting the social, emotional and psychological needs of the service users. Individual night care plans were in place informing night staff of likes, dislikes and preferences required to promote a good night sleep. None of the service users spoken with could recall participating in the planning of their care. One individual said she does tell the staff how they would like things to be done and the staff will do it willingly. Another service user said they chose to sleep in own reclining chair, despite advice given by the staff with regard to the risks to health and welfare and alternative options offered. Service users and relatives spoken with were positive about the way personal care and health needs were met, and felt that staff treated them in an appropriate way, respecting privacy and dignity. Records showed good monitoring of health needs, and appropriate referrals and follow up care with healthcare professionals. Relatives of a service user just returned from a hospital admission expressed how the care at the home was so much better than the care received in hospital. Appropriate pressure relief equipment was in use, and care plans reflected preventative care. Policies and procedures on dying and death were not inspected, but from conversations with relatives there was evidence that staff responded appropriately to the changing needs of the service users, and provided all the care and support they were able. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12,13 & 15 Staff interacted well with individuals and were aware of their personal interests. Independence and choice was promoted. Visiting arrangements were open and relaxed and staff welcomed relatives to the home. Food was good and appetising although greater attention needs to be given to the dietary needs of individuals with specific needs. EVIDENCE: From discussions with service users and staff it was clear that service users choices were accommodated. One member of staff said the service users are treated in the same way you would treat your own family, involving them in daily activities and promoting decisions and choice. One service user said she had been taken shopping and for the first time, in a long time, was able to buy new clothes. Regular one to one casual interaction was observed, promoting stimulating conversation and ensuring individuals were comfortable. Staff indicated they were able to spend more time with the service users now there was more staff. Old time music was playing before dinner and one member of staff was observed dancing a slow waltz with a service user who was visually impaired, Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 13 the carer arranged a regular dance and music session each Thursday evening for the service users. All relatives spoken with said they were able to visit at any time and reported the staff were very accommodating and supportive. All service users spoken with were positive about the food. Many experienced eating difficulties or had diminished appetites and staff indicated that they were able to access and provide snacks any time throughout the day. The home needs to ensure that all persons preparing the food are aware of all dietary needs and appropriate balanced, nutritious food is available. One service user was observed to choke during lunch, staff immediately went to her aid and a registered nurse successfully removed the offending piece of food by a Heimlich manoeuvre. Later this person said they had difficulties swallowing following a stroke and required food prepared to an appropriate consistency, however the food was not suitable today as it was a different chef, and so she had a banana and this got stuck. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16. Complaints procedures are in place but there is a low awareness amongst service users and relatives of how to access information and they do not have related guidance in their possession. EVIDENCE: Service users, relatives and staff comments showed that they all felt comfortable discussing any concerns with the manager. One member of staff said that the home dealt with all issues raised, promptly and efficiently ensuring the service users needs are met, they do not procrastinate. One service user said there was a concern with regard to the room accommodated on admission but this was dealt with promptly and amicably. Not all service users and relatives spoken with were aware of the formal procedure with regard to complaints but were comfortable to raise any issues informally. They were also not aware of the CSCI or their role in Regulation, Inspection or complaints. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19, 20 & 26 Braintree Nursing Home presented a clean, safe and well maintained environment. The lounge and dining room facilities are not adequate to support service users dignity or promote independence, mobility or general wellbeing. EVIDENCE: A programme of refurbishment continued to be carried out. Suitable storage facilities had recently been built to provide storage space for wheelchairs and equipment, enabling a safe and tidy environment to be maintained throughout the home. A new washing machine with appropriate temperature controls to control the risk of infection had recently been installed. One service user commented the laundry service was excellent and the home was always spotless and the domestic staff were always cleaning. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 16 No further thoughts had been explored with regard to the lounge and dining facilities, which in their present state, do not provide a positive environment for service users. The practice of service users remaining in their armchairs and having meals served at adjustable bedside tables continued and was not felt to support service users dignity, promotion of independence and mobility or general wellbeing. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30. After a period of previous considerable instability in staffing, there is now a good team of staff offering consistency of care within the home. Staff morale was high resulting in an enthusiastic workforce that worked positively with service users. EVIDENCE: Successful recruitment of additional staff had greatly reduced the number of agency staff used and enabled consistency in care. Eight carers and two registered nurses were on duty. Staff felt part of a good working team and morale was high, having a positive impact on the service user’s, this was evident by the warm happy atmosphere within the home. Staff indicated that training and development had improved and progressed significantly, enabling them to gain confidence in their roles and a better understanding of service users needs and how to meet them appropriately. A newer member of staff had received a thorough induction process and received all mandatory training within the first three months of employment. Recruitment files were not inspected. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 Effective investment has been placed into areas requiring improvement with good results. EVIDENCE: Action has progressed within the agreed timescales to implement requirements identified in the last two CSCI inspection reports with regard to recruitment, retaining, training and development of an efficient knowledgeable staff team. Staff indicated communication has improved with more regular meetings informing staff of home developments and good handovers to inform staff of issues arising throughout the day enabling them to deal with them promptly. Relatives and service users spoken with commented positively on the open and transparent management of the home. Policies and procedures, quality assurance and monitoring systems and health and safety risk assessments and records were not examined on this inspection Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 19 and therefore any requirements previously made with regard to these areas will be carried over. Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 3 x x x x x x Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 21 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4, 5, Schedule 1 Requirement Timescale for action 1st October 2005 2. 7 15 The Registered Manager must ensure that all service users are provided with written information with regard to arrangements, services and facilities provided within the home, for reference. This was a previous good practice recommendation. The Registered Manager is 1st October required to ensure that needs 2005. assessments and care plans are always developed as soon as possible after admission. 3. 15 4. 33 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. 16(2)(i), The Registered Manager must 13(4)(b)(c ensure wholesome, nutritious ), 16(4) diet suited to individual assessed and recorded requirements and specialist needs, are provided at all times. 24 The Registered Person must ensure quality assurance and monitoring systems are in place to measure success in meeting the aims, objectives and statement of purpose of the I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc 1st October 2005. 1st October 2005 Braintree Nursing Home Version 1.40 Page 22 home.This is a second repeat requirement. (Carried over from previous inspection) 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 15 & 20 Good Practice Recommendations The Responsible Individual should 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. This is a third repeat recommendation. The Registered Person should ensure all service users and their representatives are provided with written information and guidance for making a complaint or referring a complaint to the CSCI, at any stage for reference. 2. 16 Braintree Nursing Home I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection First 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 I56-I05 S15356 Braintree Nursing Home V237205 290705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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