Inspection on 23/05/06 for Brandon Park Nursing Home

This inspection was carried out on 23rd May 2006.

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

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

Other inspections for this house

Brandon Park Nursing Home 25/06/08

Brandon Park Nursing Home 26/06/07

Brandon Park Nursing Home 03/01/06

Brandon Park Nursing Home 14/10/05

Brandon Park Nursing Home 25/02/05

Brandon Park Nursing Home 27/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brandon Park Nursing Home Brandon Country Park, Bury Road Brandon Suffolk IP27 0SU Lead Inspector Jill Clarke Unannounced Inspection 23rd May 2006 10:35 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 Brandon Park Nursing Home DS0000024341.V296384.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. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brandon Park Nursing Home Address Brandon Country Park, Bury Road Brandon Suffolk IP27 0SU 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) 01842 812400 01842 813213 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Ms Lisa Elmy Care Home 55 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (55) of places Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2006 Brief Description of the Service: Brandon Park Nursing Home is set within Brandon Country Park amidst Thetford Forest. A short drive from Brandon, which has a Post Office, Library, café, shops, rail and bus links. The care home with nursing, is registered to provide care for 55 older people. The Commission for Social Care Inspection (CSCI) is currently processing the home’s application to provide care for residents, who need nursing care, but also have a diagnosis of dementia. The Grade II listed building has been converted and extended into a 55-bedded nursing home for older people. Bedrooms and lounges are located on both floors, which can be accessed using the passenger lift or stairs. The 2 main dining rooms are located on the ground floor. There are 39 single and 8-shared bedrooms, all of which have en-suite facilities (some also include a bath). There are also bathrooms located close to resident’s bedrooms. The homes own mature gardens leads onto the Country park, and tourist centre. There is ample parking at the front of the home. It should be noted that Brandon park is located close to the military bases of Mildenhall and Lakenheath. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8 hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. The home had 3 vacancies at the time of the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home at the beginning of May. This gave an opportunity for residents, relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (1) joint relative/visitor (9) and staff (4) feedback cards has been included in this report. Two relatives/visitors were also contacted by the inspector, prior and after the inspection, to further discuss what they have written on their comment cards. During the inspection, time was spent talking with relatives and residents sitting in the communal areas, and 5 residents in privacy of their bedrooms, to hear their views on Brandon Park and the level of service provided. Staff (Registered Manager, Nurses, Care Assistants, Housekeepers and Chef) were helpful and co-operative throughout the inspection. A tour of the building, took in all the communal rooms and a sample of 8 bedrooms, 2 bathrooms, sluice, and laundry. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, BUPA Resident Satisfaction Survey, menus, staff rotas and medication records. Previous visits to the home identified that people living at Brandon Park preferred to be known as residents, this report respects their wishes. What the service does well: Being set in Brandon Country Park, residents are able to benefit from the views, the wildlife and being able to access the gardens leading into the park. The friendly staff attitude supports the welcoming atmosphere of the home, which was reflected in residents and relatives comments – ‘the caring staff always make me feel welcome’. The period property with many period features gives the home character, especially the dining rooms, looking out onto the park, with its large glass chandelier, and comfortable furniture. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 6 Staff receive regular training, and supervision to ensure they have the knowledge and skills to undertake their role. Time spent with residents showed that they liked the staff, describing them as “nice people”. One resident said that staff were “ever so kind” to them, and that they got “on well together”. This was also reflected in a discussion with relatives who described staff as “very friendly” and that “some staff are very good and helpful”. Residents are offered balanced, varied, nutritious meals, including homemade cakes and soups. Comments made by residents, when asked about the standard of food included, that they had a “very good kitchen”, and the food was “very good”. A relative had written on their CSCI comment card, that they had found the home and the care given to their relative “excellent in every respect’. What has improved since the last inspection? What they could do better: Care plans contain a good level of information on residents nursing needs, and monitoring resident’s safety. However, more work should be undertaken, around individual residents social needs, and setting goals to increase quality of life. This is especially important for very frail, vulnerable residents who may not be able to make their wishes known. The home has introduced weekly ‘Resident Personal Care’ sheets, after concerns raised by a resident’s family that the resident was not always being supported with their personal care. To enable the system to work properly, the personal care sheets need to be monitored, to ensure staff are completing them fully. Where residents refuse personal care, staff need to be more flexible in their approach. For example letting the resident take the lead, identifying when they will allow staff to give support, and liaising with the resident’s family, to try and resolve the situation. The staffing levels need to be reviewed over a 24-hour day, to ensure the home can evidence that all resident’s mental, physical and social health needs can be met, at the time they need it. Medication records must be fully completed, to ensure accurate records are kept, and evidence that medication has been given out as prescribed. Staff need to review any practices (which are not in the best interest of the residents) that may have developed over time, such as removing used towels Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 7 and flannels in the morning, and not replacing until later in the day. This also included infection control procedures; although staff has received training, clean linen was being placed on toilet seats. With the shortage of storage space, staff must ensure that any equipment left in corridors or bathrooms, although not ideal and seen as only a temporary move by the CSCI, must not hinder residents’ access to those areas. 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. Brandon Park Nursing Home DS0000024341.V296384.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 Brandon Park Nursing Home DS0000024341.V296384.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, 4, and 5. (home does not offer intermediate care) People wishing to move into the home, will be given information on the level of care provided, and can expect their needs to be fully assessed. This supports the prospective resident in identifying if the home is suitable, and ensures the home only admits residents whose care needs they can meet. EVIDENCE: Located in the entrance hall was a copy of the home’s Statement of Purpose, previous CSCI inspection reports, and BUPA newsletters. The manager confirmed that they had made no changes to the Statement of Purpose since the last inspection. A copy of the home’s information file (service users guide) for residents was located on the back of bedroom doors. Although not looked at this time, during a previous inspection (14 October 2005) the file gave a good level of information on the home, which included, terms and conditions of residency, meal times and details of local organisations. The Manager said that they would be updating the information to reflect current staff changes, as they had recently taken on a new Chef/Manager. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 10 Residents had also been given information on their lead Nurse and Carer, who have overall responsibility for ensuring the residents care needs are met, and are responsible for advocating on the residents behalf. Time was spent talking (in private) with a resident who had recently moved in. They felt comfortable at the home and said they had “no complaints – nothing wrong with place”. Although waiting to move to a home closer to where they lived, they felt they had “settled in”, and staff were able to meet their care needs. Pre-admission assessments (undertaken by the manager), where seen on their, and another resident’s file who had just been admitted. Discussions with the manager confirmed that it was normal practice to undertake their own pre-assessment to ensure that they can manage the prospective residents needs, both physically and environmentally. This was especially important due to the location of the home, where a resident with confusion, could walk into the extensive park, and lose their way, putting them potentially at risk. A sample of 2 resident’s records (1 social care funded and 1 privately funded) were checked to see if they had been given information on fees, and what was covered in the fees. The resident paying privately, had signed a ‘Terms of Residency Contract’, which give full information on costs. There was no copies of contacts held in the resident’s file, who was funded by Social Care, to be able to evidence if they had been made aware of the fees payable. The manager said that this often happened with their contracted beds. They confirmed they would be sent a copy, but the length of time varied. To ensure all residents were aware of what they were paying for, a sample copy of the homes ‘Terms of Residency’ was contained in the residents information file. Although the manager was aware of the set costs of a social funded bed, they would be unable to give any information to the resident, as it varied depending on their financial position. The resident spoken with, said that they did not visit the home beforehand, but a member of their family had. Previous discussions with residents and relatives, confirmed that they were always offered a look around the home, to meet the other residents and staff. This supported the resident and/or their family to ask questions and take a view on the level of service provided. Brandon Park Nursing Home DS0000024341.V296384.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 and 10. People using the service can expect to have their nursing needs monitored and appropriate action taken by trained staff. Not all resident’s personal hygiene is being monitored closely, to ensure they maintain a good level of personal hygiene. The home has safe systems in place for the storage and administration of medications. However, not all staff are completing Medication Administration Records correctly, which could potentially place residents at risk. EVIDENCE: Since the last inspection (3/1/06) concerns have been raised during a vulnerable adults meeting (22/02/06) and by a relative (2/02/06) via an outside agency, that staff were not always monitoring resident’s personal hygiene, especially mouth care. To address the situation, and to be able to evidence and monitor the level of personal care being given, and by which member of staff, a ‘Personal Care Sheet’ was introduced in March. Staff are asked to complete the form daily for each resident, confirming what personal care has been given. Personal care covered, included bathing, shaving, assisted washes, hair, teeth and nail care, as well as ensuring reading glasses were kept clean and residents were wearing their hearing aid, if appropriate. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 12 Due to concerns raised on 1 relatives/visitors feedback card, the inspector contacted them prior to the inspection, to gain further information. This led to discussions that staff were not always monitoring a resident’s personal hygiene, an example given was supporting them to keep their nails clean and manicured. The use of personal care sheets, to monitor interaction by staff was seen as a positive move forward, as physically and mentally frail residents are reliant on staff to support them with their personal care needs. However, the form does not look at a resident’s personal care on 24-hour basis. For example, there is no evidence that residents are being supported to clean their teeth more than once a day. It was noted that on 1 resident’s care sheet who has dementia, that they had ‘refused’ ‘tooth care’ on a few occasions. There was no further information to evidence what action staff had taken to support the resident with their mouth care. One resident looked unshaven, their personal care sheet was checked, which confirmed that they had not been assisted to have a shave. During the inspection, whilst talking to a resident in their room, it was noted that their fingernails, although short, were dirty. The resident’s daily care sheet showed that the nails had not been cleaned. Their care plan identified reasons why their nails could be dirty, which should have instigated extra monitoring by staff. Other residents, who shook hands with the inspector where found to have clean, manicured nails. The 4 care plans looked at, gave a good level of information on residents nursing care needs. Areas of the body that could develop pressure areas were being risk assessed, and specialist mattress and chair pads used to reduce pressure on the skin. Where pressure sore/leg ulcers had developed, these were being monitored by nursing staff, which included good practice of taking photographs (with the residents permission). This supported staff in monitoring the size of the ulcer, and take appropriate treatment to promote healing. Care plans showed that each resident’s individual physical, and nursing needs were being monitored, and advice sought from external health professionals when needed. Care plans held a form signed by the resident (if unable, a relative or advocate) to confirm that the care plan gave information on how they wish to be cared for. Time spent talking to 1 resident identified their care plan reflected the level of care they wanted/needed. Information held on care plans was being updated at least once a month. A letter in 1 care plan, showed where the lead nurse had contacted a relative, and invited them to a meeting, as part of their 6-monthly joint review of the resident’s care. Completed risk assessments held in the care plans, covered restraint, nutrition, and falls. One resident visited was sitting in a specialist armchair, with table attached. They appeared comfortable, although the chair restricted the resident from being able to freely get up. There was no restraint form held on file, although there was one for the use of bedsides. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 13 Another resident’s care plan, showed that they had lost a great deal of weight, and concerns had been raised by their friend in December, although a nutritionist had not been contacted until April, and visit arranged for May. This was fed back to the Manager, who described the support given by staff to assist the resident with their food in-take. They said all referrals to a nutritionist had to go through the resident’s Doctor, which could cause delays at times. Under the communication section of the care plan for a resident who was unable to speak, staff had related to the resident having communication difficulties, stating that the resident was ‘able to make their wishes known’. There was no information on how they made their wishes known, or aids available to support them. Staff were seen to interact well with residents, and show respect. Screening was provided in double bedrooms, to ensure privacy. Concerns were raised by a relative/visitor (CSCI survey) that staff had a communal container of socks, tights and ‘pop socks’. They said these items quite often went missing, resulting in residents “having to pay out” to replace the items again. A Housekeeper confirmed that they did keep a communal bag of socks etc, which was used for emergencies only, “rather than leave a resident without”. Further discussions with the Housekeepers identified that there had been problems with unnamed items go missing. To help resolve the problem, the home had recently introduced a new system of using individual named laundry bags, to keep the items together whilst being washed, reducing any losses. These were seen to be placed into the resident’s individual laundry holders, which were be used to take the clean laundry around the building. A trained Nurse was giving out medication during the inspection with the assistance of student nurse. When the staff were administering medication in a resident’s bedroom, the trolley was left outside, securely locked. Resident’s prescribed medication is dispensed to the home from the Pharmacist in ‘blister’ packs. The home’s Medication Administration Records (MAR) charts, showed that the medication received in blister packs had been booked in by staff. However, a resident’s course of medication, which was not dispensed in a blister pack, had not been recorded on the MAR chart. The home had a safe system in place for recording medication disposed of. The MAR charts for the 2 downstairs units looked at, identified that staff had not always been signing for medication, to confirm that it had been given. A check of 2 of the resident’s medication, not held in the ‘blister’ pack, against the homes records, showed that the medication had been given, but not signed for. Good practice was seen with the use of residents photographs on MAR charts to confirm their identify, and a sample of staff’s signature, initials to identify who had given mediation out at that time. As an organisation, BUPA have produced comprehensive medication policies, a copy of which was attached to medicine trolley, to enable staff easy access. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 14 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 and 15. People can expect a choice of nutritious, varied meals, and be consulted on their likes and dislikes. Activities arranged by the home meet some, but not all the residents needs. This could potentially lead to some residents not having access to social/mental stimulation. Families and friends are made to feel welcome, and can visit in private. The practice of not replacing clean flannels and towels until later in the day is not flexible to the residents needs. EVIDENCE: A resident was asked if they had to get up and go to bed at a set time replied, “no staff don’t wake you up”, they went on to say that staff knew what time they normally woke up, and would come in and check – but “if they see you asleep would leave you longer”. The resident said they were normally served breakfast in their bedroom, which they had in bed, or sitting out in their armchair. The resident confirmed that staff showed the same flexibility at bedtime, which depended if they were “watching something on television”. They went on to say “ that everyone has got their own time they like to go to bed”, and sometimes they “went to bed earlier if they felt tired”. All 9 relatives/visitors who had completed CSCI surveys confirmed that they were made to feel welcome when they visited, and were able to visit residents in private. Relatives spoken with, said that they made full use of the gardens in the good weather, which had seating areas. Visitors were seen to freely come Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 15 and go during the inspection. Seven out of the 9 relatives/visitors completing surveys, felt that staff kept them informed of important matters affecting their relative or friend. Two felt that ‘consultation and information is not a good as it was’, and another voiced concerns that they had to actively advocate on behalf of the person they visited. They felt there was ‘a lack of communication between the Nurses and Carers’, when there are changes in a resident’s condition. Care plans held copies of communications sheets, which gave details of two-way conversations with the resident’s representative and the outcome of the conversation. On 1 of the resident’s file, it did show where the resident’s representative had raised the concerns with staff first, which was then followed by what action the staff had taken to address them. The activities programme for the week was displayed around the home. During the afternoon 12 residents were observed joining in with a sing-a-long in the lounge, which they were enjoying. The Home’s own survey asked residents to give a rating to ‘The extent to which you find the activities and events interesting? Out of the 26 residents who had replied, 6 said ‘poor’, 28 , ‘neither good nor poor’, 56 ‘good’ and 11 said ‘excellent’. Although the majority of residents gave a score of good or excellent, the survey clearly identified that not all residents’ social needs and interests were being met. This was reflected during feedback from residents spoken with in private, which was mixed about the range of activities on offer. One resident did not like Bingo, which featured regularly, whilst 2 other residents were looking forward to “the musical session” in the afternoon. Contact with relatives and visitors since the last inspection, raised their concerns that some residents, especially residents who dementia, are left for long periods in their bedrooms, without staff or social interaction. Care plans read, gave information on residents visitors, and when they went out. The Activity Co-ordinator keeps records of who has attended activity sessions, and if they took part. However, there was no evidence of time staff spent (or able to spend) with residents on a 1 to 1 basis, as part of a resident’s care plan. Care plans held a very good information page ‘Life Map’ and residents had been asked to give information on their interests, and what activities they would like to join in with. This had not been developed further to evidence what action had been taken to meet these requirements. One relative discussed a resident’s love of gardening, and felt it was a shame, that this could not be pursued further. The manager confirmed as part of ‘their best practice’, which is constantly looking at ways to improve service, they would use the information gained, to review and work on developing their activities. Whilst visiting residents in their bedroom, only 1 of the en-suite toilets seen, held a linen towel and flannel. There were paper towels available for use by staff as, part of the home’s infection control procedures. Staff asked why there was no towels or flannels in the room visisted, said that they were Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 16 removed in the morning after use, and not replaced till later in the day. Doing it this way, carers felt it would ensure all used towels and linen were replaced, and not forgotten. After lunch a resident was observed to get quite distressed, as they tried to get staff to understand what they wanted. Although staff were understanding and patient, it took a while for the resident to get over the message what they wanted. When they had, it was because the resident wanted a towel in their room. Comments from residents throughout the inspection on the standard of food were good. Their comments included “very good” “can’t fault it” and “very good kitchen”. This reflected the home’s own survey, where the 26 residents who had replied, had given overall (taste, variety, choice) of the meals supplied, 12 had said ‘excellent, 85 ‘Good’ and 4 had felt the ‘food was neither good nor bad’. No one had scored the food as poor or unacceptable. A resident who had completed the CSCI survey, felt that ‘more variety is needed, we need a good pastry cook and better soup at supper time’. There was also a comment that ‘puddings here – to be seen to be believed’. As the survey was anonymous, the inspector was unable to follow up, if this comment was meant to be positive or negative. The comments made were fed back to the new Chef/Manager. They said that they had recently sent a survey out to all the residents, to gain feedback from them on what they would like included in the menu. The information gained would then be used to put together the new menus. The home now aimed where possible, to produce more home made soups, which hopefully will address the resident’s concerns. Although time was not spent observing lunch time routines during this visit, the inspector did take the opportunity to walk round and introduce them self to the residents, as they sat at the tables waiting to be served. The main dining room was comfortable and inviting, with tables set with coordinating table linen and napkins. The large French windows enabled residents to look out to the gardens and Country Park. The second smaller dining room has higher staffing levels to be able support residents with their meals. The size of the room limits where residents, seated in specialist armchairs, who need assistance, can be seated, which results in some residents sitting in a line, facing the member of staff assisting them. The choice for lunch was Chicken & Ham Pie, or Fish Burger in a bun, served with Cauliflower, Swede, cream and Croquette potatoes. Followed by Rhubarb & Custard or Jelly. For supper Lentil soup, followed by a choice of Smoked Haddock, Bread & Butter or a variety of sandwiches, and cake. A resident who had eaten in their bedroom, said that they had enjoyed their meal. Residents spoken with in private confirmed that they were offered enough refreshments during the day; many had a jug of water and glass close by. One visitor who had completed a CSCI survey, raised concerns that staff did not always ensure that residents in their bedrooms had their drinks within Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 17 reach. Two residents spoken with were found to have their drink out of reach. When discussed with the first resident, they said the cup was where they wanted, and demonstrated how they used a “grabber”, which was an aid they used to pick up items, such as their drink. The care plan of the second resident, whose drink was out of reach, identified a risk of them choking if they drank unsupervised. This led to discussions with the manager, taking into account the resident’s continence needs, that there should be some form of monitoring that staff had offered regular sips/drinks, when the resident is in their bedroom. Brandon Park Nursing Home DS0000024341.V296384.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 and 18. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: A resident asked if they were ever unhappy, did they know who to talk to? gave the name of a couple of staff they were “very fond of” who were always around, and would be happy to share any concerns. They went on to say “on the whole all very nice to me – ring the bell they come in”. Another resident asked (CSCI survey) if staff act and listen on what they said?, wrote ‘usually they do, given the time’. Another resident asked if staff were nice to them? Replied “Yes – lovely”. Seven out of the 9 relative/visitors who had completed the CSCI survey, said they were aware of the home’s complaint procedure, out of these – 4 said that they had made a complaint, although 1 stated it was more of a ‘dissatisfaction’. A copy of the home’s complaint procedure is contained in each of the resident’s information files, kept in their bedrooms, and in the home’s Statement of Purpose. The home’s complaints policy gave set time scales for action. All complaints were entered on a ‘Complaints Investigation Form’, which gave details of the complaint/concern made, and showed what action had been taken to investigate and resolve the situation. Records showed that there had been 4 complaints made since the last inspection (3/01/06), which had all been fully documented and actioned within an acceptable timescale (28 days). Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 19 Staff (4) who had completed CSCI surveys confirmed that they had received training in the home’s abuse policy. Training records looked at confirmed that all staff had been booked on a refresher-training day between April and July 2006. Brandon Park Nursing Home DS0000024341.V296384.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, 21, 22, 23, 24, 25 and 26. People living in the home can expect a clean, comfortable, homely environment, which meets their needs. The on-going maintenance programme will address any areas of the home, which show signs of wear and tear. To ensure a safe environment, staff must review their current storage arrangements, to ensure bathrooms are easily accessible, and clean linen is not stored in the bathrooms. EVIDENCE: A resident asked if their bedroom was kept clean for them replied “cleaner comes in every day – very good” and that the toilet was “always kept spic and span”. Another resident asked, confirmed that their bedroom was “always” kept clean. The homes own survey (as referred to in Management and Administration section of this report) had asked residents if the home, and their bedroom were kept clean and odour free, had given a rating of ‘excellent’ or ‘good’. Residents also gave an ‘excellent’ or ‘good’ when asked about the upkeep of the home and grounds. Bedrooms looked at, were found to be clean with only an odour located in 1 room, which had later disappeared. One Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 21 resident’s armchair had a stain, where they might have spilt their drink, which was fed back to the manager. A walk around the home showed that some areas were showing wear and tear, especially from marks made by wheelchairs and trolleys. Carpets although clean, were also marked. The manager said that they had recently carried out an environmental audit with the maintenance person, to help them prioritize re-decoration work to be undertaken. They had been given a budget to replace some of the carpets. During the inspection, an estates representative was seen assessing external redecoration work with the manager, which is to be undertaken in the future. Resident’s bedrooms were personalised, and varied in size. Time spent with 2 residents who shared a bedroom, identified that they got on well, and were happy sharing. During the last inspection concerns were raised that the home had insufficient storage areas for hoists, which were stored in the corridors. Due to the corridors being wide, there was still enough room for wheelchair users to be able to pass by. The manager said that they were in discussions with their estates department to review their storage problems. The upstairs bathrooms were cramped, due to clean linen trolleys, and linen skips being stored there. Although all bedrooms have their own toilets, at least 1 resident, due to their mobility needs, preferred to use the toilet in the bathroom. The use of bathrooms as storage areas restricted resident’s choice, and caused a health and safety hazard. Staff had placed clean towels on top of the toilet seat in 1 bathroom, which raised concerns over staff following safe infection control procedures. Once brought to the manager’s attention, they immediately took action to remove the linen from the toilet seat (putting them in the wash), and clearing a path to the toilet. This led to discussions with the manager that this was a temporary solution, and the home must review their current practices of storing equipment. The home’s laundry was busy, with staff processing the resident’s and home’s laundry. Staff were following safe systems for handling clothing and linen soiled by body fluids, to reduce the risk of infections spreading, which included using specialist wash bags. Although it was not a hot day, the laundry room was very warm, even with the use of a portable fan, due to only having a dorma window. The Manager confirmed that action was being taken to give better ventilation. Residents and visitors were seen to make use of the different communal rooms and lounges, which they felt, with all the period features and views of the garden, supported a homely atmosphere. Brandon Park Nursing Home DS0000024341.V296384.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 and 30. People using the service should expect to be looked after by trained staff, who have undergone full employment checks, prior to them starting work at the home. The current staffing levels do not enable staff to be able to meet all resident’s physical, mental and social care needs. EVIDENCE: A resident commented that “staff need more time to talk to residents”, another resident raised concerns that “staff were very busy”. When asked if staff came quickly when they rang their call bell, they said “fairly” quickly, although sometimes staff would “pop their heads in” explain that they were busy and would be there in “10 minutes”. The resident felt this was acceptable, as they knew other residents required a lot more care than they did. Relatives/visitors asked (CSCI survey) if they felt there was always sufficient staff on duty?, 6 had replied ‘yes’, and 3 ‘no’. Discussions with family and visitors identified that during afternoon handover time, less staff were available – which resulted in a resident having to wait at times, if they wanted to be taken back to their bedroom for a rest. Another visitor also felt that there was not enough staff, to enable them to spend enough one to one time with residents. They said especially residents, who did not want to join in organised activities, but would enjoy being taken for a walk in the gardens. Another relative felt that over the years, the time which staff could spend with residents had reduced, which they felt was a backward move. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 23 At the time of the inspection there were 52 residents, and 9 care staff on duty, which gave a ratio of 1 carer to every 5 or 6 residents. Due to last minute sickness, there was 1 instead or 2 Nurses on duty (excluding the manager). During the afternoon, the staffing level was 6 carers; this gave a ratio of 1 carer to every 8 to 9 residents. The home is not purpose built and has bedrooms spread over 2 floors. Staff were busy throughout the inspection, providing nursing and dementia care, which also needs to be taken into account when calculating staffing levels. The home’s own survey, asked residents about staffing levels, out of the 26 residents who had completed the survey, 19 had replied ‘excellent’, 50 ‘good’ and 31 felt that the staffing levels were ‘neither good or poor’. No concerns over staffing levels had been raised by the 4 staff who had completed the CSCI survey. A copy of the staffing rota showed that staff either worked a early or late shift. Some staff worked continually through the day covering both the early and late shift. On the day of the inspection, 3 staff were roistered to work the long day, which would further encroach on residents care time, to cover the staff’s lunch breaks. The rotas did not give flexibility for extra staff to be around at peak times, such as lunchtimes, where staff cover 2 dining rooms, and serving meals to residents eating in their bedrooms. All 4 staff completing the CSCI comment cards felt that they were given sufficient training to undertake their role. They also felt the home had a good training and development programme to support staff. Overseas trained Nurses, now undertake their adaptation training at another BUPA. Once they have received their registration number with the Midwifery and Nursing Council, they can then be transferred to a smaller BUPA home, which was the case of 1 Nurse spoken with. They felt the home was friendly and they were getting to know the residents. Training information held on the computer included a ‘matrix’ of core training to be undertaken by staff. This included Food Hygiene, Manual handling, Fire awareness, Infection control, Abuse awareness, Health and Safety. Each member of staff also had their own individual training record, which covered relevant training days undertaken such as dementia care, to keep their individual skills and professional (Nurses) knowledge updated. Although not looked at during this inspection, previous inspections showed training days undertaken by the Nurses to update their skills in wound care, diabetes and medication procedures. The Manager confirmed that new care staff undertake an induction and foundation training course, and are supported through the programme by a dedicated member of staff. The Manager is aware that any changes in staff, can affect the home being able to maintain having 50 of their staff holding a National Vocational Qualification (NVQ) level 2 (or equivalent qualification). At the current moment 42 of the care staff hold a NVQ qualification. However, the home has been proactive by accessing, and currently having 5 members of Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 24 staff on the NVQ level 2 training course. Once they have completed the course, the home will have 56 of their staff qualified to NVQ level 2 or above. Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36, 37 and 38. People using the service can expect to be cared for by approachable staff, and the home run by an experience manager. Quality assurance work is undertaken to gain feedback from residents on the level of service provided. However, the home needs to ensure a more suitable format is used, to be able to gain feedback from residents who are mentally frail. Staff are committed to providing a safe environment for residents to live in, through undertaking training and monitoring incidents that could affect residents welfare. EVIDENCE: The home is managed by Mrs Lisa Elmy an experienced manager and qualified Registered General Nurse (RGN). Throughout the inspection, Mrs Elmy took Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 26 any feedback constructively, and where areas of development were discussed, showed commitment to ensuring work was undertaken to address the issues. Prior to the inspection, during general discussions and comments made on CSCI relative/residents comments cards, indicated that some staff may have become dissatisfied working at the home. To ensure all staff were given an opportunity to write any concerns, anonymously if they wish, 40 CSCI staff surveys, and SAE where sent to the home, with a return date of 18 May 2006. At the time of the inspection, no cards had been returned, which was mentioned to the Manager. Four were received on the 24 May 2006, all anonymous, which had all replied ‘yes’ to the question was the home well run. During the inspection the inspector found the staff to be approachable and helpful, freely answering any questions. Staff were seen to support each other, and the atmosphere although busy, was friendly. As part of the homes annual quality assurance review, BUPA undertook a ‘Care Home Resident Satisfaction Survey’ during 2005. The outcome of the survey was published in the autumn of 2005. Residents were asked to give a rating between ‘Excellent’ and ‘Totally unacceptable’. Out of the 28 surveys that had been given out –26 had been returned. They were asked to give an overall rating for the quality of service they received. The report showed that 19 rated the service as ‘excellent, 42 as ‘very good’ and 38 ‘quite good’. Comments made had also been published, which ranged from ‘service is very good, if you ask for something they will get or do it for me’, to ‘sufficient for my needs’. The manager confirmed that the home uses the information gained, as part of the staff on-going ‘personal best’ programme, which staff use to work on any areas of the service, which needs to be developed to improved. With only 28 questionnaires being given out to the potential when full -55 residents, the home needs to look at how they can obtain feedback in a suitable format, from residents who are unable to complete their ‘satisfaction survey’. As the home is registered to care for 5 people with dementia, it is important that they look at how their feedback from those residents, and also residents with differing levels of confusion. In undertaking this they will be able to try and evaluate the resident’s wellbeing, using the home’s ‘Personal Best’ principle to improve any shortfalls. The homes system for recording and storing residents monies held for safe keeping was not reviewed during this visit, as they were looked in detail as part of a complaints investigation (February 2006). The investigation focusing on 1 resident’s finances identified that the home had good systems in place for the safekeeping and recording of monies held. The Manager confirmed that all care staff now receives regular 2-monthly supervision, and checks were in place to monitor this was happening. They went on to say that each trained nurse is now responsible for undertaking a Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 27 carer’s supervision. Staff (4) who had completed the CSCI comment cards had confirmed that they received regular supervision. During a complaints investigation (February 2006), the home’s system for reporting and recording incidents involving residents was looked it. Records showed that when an incident happens, such as a resident falling, this was fully documented in an incident report, and held on the resident’s file. The home also supplies their Head Office with information on all incidents, as well as undertaking their monthly audit, to monitor resident’s safety and ensure appropriate risk assessments have been undertaken. Care plans held completed falls, assessment, and any action taken to minimise the risk. Training records looked at confirmed staff receive training to ensure residents safety, which included manual handling, infection control, and Food Hygiene. The Manager was asked to supply a list of staff who had attended Fire Training, which was printed off from the computer. The ‘employee diary’ gave information on when staff last attended Fire Training, and when their refresher training was due. Although staff receive Health & Safety training, they are not always taking action to ensure equipment is stored correctly, and not causing a hazard (see Environment section of this report). Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 2 2 Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 29 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 OP8 OP7 Regulation 12 (1) (a) 15 (1) Requirement The home must ensure systems are in place, and monitored, to ensure all residents receive appropriate, flexible support to be able to maintain a good level of personal hygiene. More information must be been given on resident’s individual communication difficulties, and the level of support given to promote independence. This should include the use of aids, and advice sought from external agencies and support networks. Records must be kept of all medication received into the home. Staff must complete MAR sheets accurately, to confirm medication has been given, or as otherwise stated. The registered person must make sure that there is suitable storage for equipment. (This is a repeat requirement from 6/1/06) Timescale for action 16/07/06 2. OP8 OP7 15 (1) 01/08/06 3. OP37 OP9 13 (2) 17 23/06/06 4. OP22 23(2)(I) 01/09/06 Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 30 5. OP12 16 (2) (m) (n) The home must ensure on an individual basis, that residents have access to range of activities that suit their individual interests and needs. The registered person must ensure that all parts of the home are free from hazards; this is with regard to laundry trolleys stored in the bathrooms. The home must ensure staff follow safe infection control procedures; this is in regard to clean linen being stored in bathrooms and on toilet seats. The home must review their staffing levels to ensure that they have sufficient staff on duty over a 24-hour period, that meets the assessed, physical, mental and social health needs of the residents. 01/09/06 6. OP21 OP38 13(4)(a) 26/06/06 7. OP26 OP38 13 (3) 26/06/06 8. OP27 18 (1) (a) 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations The home to ensure that Social Funded residents have been given information on costs payable, should liaise with Social Care Services, so they are able to record on the pre-admission paperwork, the date (and any reference number) when the information was given to the resident, as proof, whilst awaiting a copy of the contract. Where residents refuse personal care, staff should evidence what action has been taken, for example trying DS0000024341.V296384.R01.S.doc Version 5.2 Page 31 2. OP8 OP7 Brandon Park Nursing Home again during different times of the day. 3. OP14 Staff should review any practices that have developed over time, such as when they replace flannels and towels, to ensure that they are flexible to the resident’s needs. The home should look at using specialist feedback, such as dementia mapping, to be able to receive feedback from residents who are mentally frail. 4. OP33 Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Brandon Park Nursing Home DS0000024341.V296384.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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