Inspection on 26/06/07 for Brandon Park Nursing Home

This inspection was carried out on 26th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brandon Park Nursing Home 25/06/08

Brandon Park Nursing Home 23/05/06

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 Jane Offord Key Unannounced Inspection 26th June 2007 09:45 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 DS0000024341.V344833.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. DS0000024341.V344833.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 elmyl@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) 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 DS0000024341.V344833.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006. Brief Description of the Service: Brandon Park Nursing Home is set within Brandon Country Park, which is an area of Thetford Forest. The home is a short drive from Brandon village, which has a Post Office, library, café, shops, a health centre and rail and bus links. The care home with nursing is registered to provide care for 55 older people 5 of whom may have a diagnosis of dementia. The Grade II listed building has been converted and extended to provide suitable accommodation. 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 residents’ bedrooms. The home’s own mature gardens lead 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 so there is often aircraft noise evident during the daytime. The fees for a single room range between £600.00 and £850.00 weekly and for a double room the fees are £550.00. The fees do not cover the cost of hairdressing, toiletries, chiropody and newspapers. DS0000024341.V344833.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on a weekday between 9.45 and 16.30. The registered manager has recently been seconded to another of the organisation’s homes and was not present. The deputy manager and the regional support manager who have been running the home during the absence of the manager were both present and assisted with the inspection process. This report has been compiled using information available and evidence found during the inspection. During the day a tour of the home was undertaken with the deputy manager but all parts were later revisited. A number of files and documents were inspected including three residents’ care plans, three new staff files, the duty rotas, some maintenance records, quality assurance (QA) results and the complaints log. Some residents and staff were spoken with, the lunchtime meal was seen served and part of a medication administration round was followed. On the day of inspection the home was clean and tidy with no unpleasant odours. Residents looked comfortable and were using all areas of the home. Visitors came and went and were made welcome. Interactions between staff and residents were friendly and appropriate. The lunchtime meal looked appetising and was enjoyed by those residents spoken with. What the service does well: What has improved since the last inspection? The level and range of activities has increased. The activities co-ordinator has encouraged residents to take part in outside work to improve an enclosed patio area for use. DS0000024341.V344833.R01.S.doc Version 5.2 Page 6 Some redecoration of a number of bedrooms and corridors has been undertaken since the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000024341.V344833.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024341.V344833.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. Quality in this outcome area is good. People who use this service can expect to have an assessment of need completed before they are admitted and assurance that their needs can be met by the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files of three fairly newly admitted residents were seen and each contained documentation for a pre-admission assessment of needs. The areas covered included communication, mobility, nutrition, personal hygiene, continence, sleep and oral care. Other potential needs assessed were the resident’s lifestyle and social needs, their mental state and cognition, level of anxiety or challenging behaviour and their final wishes. Further information recorded was past medical history, any known allergies, medication and skin integrity. The service does not offer intermediate care. DS0000024341.V344833.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. People who use this service can expect to have a plan of care to help meet their individual needs and be treated with respect but cannot be assured that all medication is correctly recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three residents’ files seen all contained a care plan to assist staff in supporting the resident as they chose. The interventions covered areas of need such as personal hygiene, night needs, pain control, continence care and nutritional needs. There was evidence that some plans were generated in response to risk assessments that were completed for skin integrity, falls and moving and handling. One resident had been assessed using a Waterlow score for skin integrity and was at very high risk of developing pressure sores. DS0000024341.V344833.R01.S.doc Version 5.2 Page 10 The care plan contained interventions for reducing the risk to skin and included the colour and size of hoist and slide sheet required for transfers to minimise trauma. Another resident had a wound that was being dressed regularly and there was a record of the evaluation of progress. Other risk assessments were for the use of a wheelchair, bed rails and bathing. One resident had an intervention for social needs that included, ‘XXXX likes to talk about their work on the farm’. The care plan for a resident with a diagnosis of dementia and short term memory loss had no interventions for guiding staff to manage those issues. Another resident with diabetes had no interventions for managing the condition, the diet or medication needed, the frequency of blood sugar testing or the recognition of any symptoms to indicate blood sugar levels were too high or too low. Each file had details of the resident’s GP and other health professionals involved with the resident. There was a record of visits to or by health professionals and any treatment prescribed. Staff were observed knocking on doors before entering rooms and addressing residents respectfully. Staff were heard to offer residents choices about where they wanted to eat their meals and whether they wanted to return to their room for a nap after lunch. Staff encouraged residents to be as independent as they were able with gentle prompting and guidance. Part of a medication administration round was observed. The medication administration records (MAR sheets) folder contained a list of specimen signatures of nurses authorised to give medication. Most MAR sheets had identification photographs of the residents attached to them. There were no gaps noted in the signature boxes and prescriptions offering the choice of dose i.e. one tablet or two noted the amount given. The back of the MAR sheet was used to record the reason any medication was not given as prescribed. The nurse dispensed medicines with a non-touch technique and offered residents the choice of taking pain killers that were prescribed on an ‘as required’ basis. The trolley was secured each time it was left for the nurse to give out the medicines. A spot check on the stocks of paracetamol tablets for three residents showed that only one store matched the numbers recorded on the MAR sheets. The controlled drugs (CD) register was seen and a random check on the CDs showed they tallied with the records. DS0000024341.V344833.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. People who use this service can expect to have a lifestyle to meet their expectations and receive nutritious and appetising meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs two activities co-ordinators who prepare a weekly activities programme that is displayed on the notice board for residents’ information. On the day of inspection preparation for a garden fete later in the month was being done during the morning and there was a musical afternoon with an outside entertainer. The previous day a number of residents had been accompanied on a visit to the Norfolk Broads and been on a boat trip. Regular visits are made to the Visitors Centre in the Country Park, which is within a short distance of the home. The co-ordinators use the BUPA activities book that gives prompts for special days to celebrate such as St. David’s Day, when the lounge was decorated with daffodils. Other dates of interest are noted like World Book week and the day rationing was first introduced in World War II to promote discussion and memories with the residents. DS0000024341.V344833.R01.S.doc Version 5.2 Page 12 The activities co-ordinators keep records of the participation of each resident in the planned pastimes or if they spend time in 1:1 with a resident in their room. One resident spoken with said they enjoyed the musical events and made a point of attending when outside entertainers visited the home. An enclosed courtyard that was neglected has been a project led by the activities co-ordinator and has been tidied and had pots, many which had been decorated by the residents, of plants and herbs placed around it. Residents have helped with the process and planting either physically or with advice. There is garden furniture and umbrellas there and plans to hold outdoor musical sessions and teas when the weather is suitable. It is an attractive and secure area for residents to use and has improved the view for residents whose windows overlook the courtyard. The home has an open visiting policy and a number of visitors came and went during the day. They were welcomed and directed to the resident they wished to see. Arrangements to meet in private can be made, as there are some smaller lounge areas that are less frequented available if required. All the residents’ files seen contained contact details of their next of kin and the relationship to the resident. The files seen all contained the spiritual persuasion of the resident, if any, and in some cases their final wishes. The home has contact with a number of representatives of different religions from Church of England and Roman Catholic to Baptist and Jehovah’s Witness. The kitchen was visited and found to be clean and tidy. Temperatures of refrigerators and freezers were recorded daily and showed they were functioning within safe limits for food storage. There was a wide range of dry ingredients and fresh fruit and vegetables. The menus offered a cooked breakfast and cereal, prunes or grapefruit and the main meal each day had an alternative if required for example, mince and onion pie or cod mornay. In addition jacket potatoes with a variety of fillings were always available. Supper had a choice of soup, sandwiches and a snack such as kedgeree with a light dessert like fruit cocktail and cream. Residents spoken with said they enjoyed the meals offered and liked the range of choice available. DS0000024341.V344833.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. People who use this service can expect to have complaints taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI has not received a complaint about this service and the complaints log in the home contained only one entry in this year. The complaint concerned the cleanliness of some bed rail bumpers and was responded to with immediate action and a written response. The home has a robust complaints policy that is displayed on the notice board. The protection of vulnerable adults (POVA) policy reflects the guidelines from the Vulnerable Adult Protection Committee of Suffolk. Staff spoken with said they had had updated POVA training and this was confirmed by the training matrix. Staff spoken with were clear about their duty of care and the home has a whistle blowing policy to protect staff who raise concerns. DS0000024341.V344833.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. People who use this service live in a clean and pleasant environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Brandon Park house is a large, imposing grade II listed building that was built in the 1800s and has had a history of being a hotel. The extension consists of two sympathetically built wings that enclose a sunny courtyard. The grounds extend into the surrounding Country Park that is part of Thetford Forest. Many of the rooms have lovely views over the parkland. A tour of the home was undertaken with the deputy manager and everywhere was found to be clean with no unpleasant odours noted. Furnishings were in keeping with the style of the house and suitable for the client group. DS0000024341.V344833.R01.S.doc Version 5.2 Page 15 High ceilings and windows give the home a light and airy feel. Individual residents’ bedrooms are personalised with small items of furniture, pictures, photographs and ornaments. One resident said, ‘I couldn’t be in a better place’. A number of rooms and corridors have recently been redecorated. It was noted that the bath surround in one resident’s en suite was damaged and in need of repair and that the ceiling plaster on one small landing near the lift needed repairing. The home employs a maintenance person and there is a book kept near the kitchen for staff to report faulty items and repairs needed. These are then ticked and signed when completed. The laundry contained washing machines with a sluice programme and staff were able to explain the management of soiled linen to prevent cross infection. Staff spoken with said they had had training in infection control and this was confirmed by the training matrix. Protective clothing was available and liquid soap and paper towels were provided at hand washing facilities. DS0000024341.V344833.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. People who use this service can expect to be supported by adequate numbers of correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that there were two registered nurses on duty throughout the twenty-four hours. Nine carers assisted them in the morning, six in the afternoon and evening and four during the night. On occasions a registered nurse would work a carers shift meaning the level of expertise was increased. The manager was supernumerary and an ancillary team including an administrator, a receptionist, two activities co-ordinators, housekeepers, kitchen staff and a maintenance person supported the care team. Staff spoken with said they felt there were enough staff to meet the present needs of the residents, and residents said their call bells were answered quickly when they rang for assistance. Three new staff files were inspected and they all contained two references and evidence of identity checks. POVA 1st and criminal records bureau (CRB) checks had been done and a full work history recorded. Each file had a photograph of the ember of staff and a copy of the terms and conditions of their employment. DS0000024341.V344833.R01.S.doc Version 5.2 Page 17 There was evidence that each staff member had undergone an induction training that covered areas of care such as fire awareness, infection control, moving and handling, food hygiene, understanding dementia and POVA issues. The training matrix showed that these areas of knowledge were updated and other subjects such as health and safety, first aid, control of substances hazardous to health (COSHH) regulations and risk assessment were also covered. Staff spoken with confirmed the training they had received. DS0000024341.V344833.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is good. People who use this service can expect to have their opinion of the service sought and their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a first level trained nurse with a number of years experience in care home management. They are at present on secondment to another of BUPA’s homes and Brandon Park is being managed by the deputy manager and an area manager, both of whom were present on the day of inspection. CSCI have been kept informed of the interim management arrangements while the registered manager is on secondment. DS0000024341.V344833.R01.S.doc Version 5.2 Page 19 The BUPA organisation carries out quality assurance surveys in its homes regularly. The most recent results for Brandon Park were positive with 83 of responses saying that overall the staff were excellent. 96 said the environment was good or excellent and 89 said the activities provided were good or excellent. The home’s administrator manages residents’ personal monies. The home does not keep individual cash amounts but has a petty cash pool to supply residents with money. Residents’ money is kept in a communal cheque account that gives individual interest and provides statements if requested by residents or relatives. All receipts for items purchased for residents are kept and there is a computerised record to allow an audit trail. A number of certificates for equipment and the fire log were seen. The home had a gas safety inspection in February 2007 and the certificate is valid for a year. The lift was serviced in May 2007. The hoists were inspected in February and March 2007 and there was evidence that faulty slings were removed from use. Records showed that fire alarms are tested weekly and fire equipment, doors and emergency lighting monthly. During the inspection an alarm on a pressure-relieving mattress was heard sounding. The nurse was aware of it but had not reported it or did not know if anything had been done about it. The resident was not in the bed at the time and the matter was brought to the notice of the deputy manager. The home has general risk assessments for the environment for residents using stairs, trips slips and falls, hot water, COSHH products and trespassers causing injury or damage as the home is accessible to people who use Brandon Country Park. DS0000024341.V344833.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000024341.V344833.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NONE. 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 OP7 Regulation 15 (1) Requirement Residents’ care plans must include interventions for all assessed needs to ensure people receive support as they would wish and that health needs are correctly met. Medication administration and recording practice must be enforced to allow for a clear audit trail of medicines to ensure residents receive the correct dose of medication and their property is not misused. Repair to the bath surround and ceiling identified to the deputy manager must be carried out to ensure residents live in wellmaintained and pleasant surroundings. Timescale for action 26/06/07 2. OP9 13 (2) 26/06/07 3. OP19 23 (2) (b) 31/07/07 DS0000024341.V344833.R01.S.doc Version 5.2 Page 22 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 OP38 Good Practice Recommendations A system for ensuring faulty equipment is reported and dealt with as soon as it is noted should be enforced with all staff being made aware of the importance so residents have correctly functioning equipment to meet their needs. DS0000024341.V344833.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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