CARE HOMES FOR OLDER PEOPLE
Brandon Park Nursing Home Brandon Country Park, Bury Road Brandon Suffolk IP27 0SU Lead Inspector
Helen Fontaine Unannounced Inspection 3rd January 2006 11:00 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.V276023.R01.S.doc Version 5.1 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.V276023.R01.S.doc Version 5.1 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.V276023.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th October 2005 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 residents, whose first need is nursing, but also has 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.V276023.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Brandon Park Nursing Home took place over five hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Two requirements and one recommendation were set at the previous inspection and the home has complied with all of the required action. Three further requirements and two recommendations were identified at this inspection. The manager and the provider manager were present and their assistance during the inspection was very much appreciated. A tour of the home was undertaken and a number of documents were looked at. Four residents, two visitors and one member of staff and the homes cook were spoken to. What the service does well: What has improved since the last inspection?
The issue of the home putting in writing to the Commission for Social Care Inspection the necessary changes to the Statement of Purpose. Residents are consulted and are able to make an informed choice and one resident had chosen to move to a shared room The requirement from the last inspection around infection control has been sorted out and all areas were found to be clean and hygienic. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 the following standard(s): 1 Admissions to the home are well planned and service users have an opportunity to visit and look at the facilities on offer. EVIDENCE: The homes statement of purpose has been changed following a variation in their registration. The statement of purpose was available for both residents and visitors to the home, with a copy on the table by the door. The document had sections highlighted in bold lettering and covered the necessary areas that gave information about the home. As an example one section in the document was about religious facilities in the home, which covered all the services held in the home. Church of England, Roman Catholic, Methodist, Baptist and Jehovah’s Witness. All had the details and the dates and times of the services held in the home. The statement of purpose also covered complaints and details about how to complain. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 People who use this service can expect to be treated with respect, have their health needs met, but did not have a care plan drawn up that they were involved in. Residents can be assured that the recording of medication that has been administered will protect them. EVIDENCE: The care plans for two residents were looked at; one was the care plan of the newest resident to the home. The care plans were found at the last inspection to be in depth and covered all areas. The care plan for the newest resident did not evidence to the inspector that they had been involved in their care plan. Neither the wording of the document or any comments by the resident were on the care plan. The home must make sure that the residents are involved in their care plans, that their views and comments are documented. It is also important that views of all the family members that visit the resident are included and any issues that they may raise are addressed. The policies, procedures and practices around medication were looked at during this inspection. The policies and procedures documentation is headed ‘responsibility and information’; the manager said that staff are given copies of areas that are important. The section headed Objectives states that the
Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 10 manager is the person responsible for ensuring that the medication policies for the National Minimal Standards, Guild and the British National Formuly and other areas that staff need to be trained in. The next page of the document is about residents that are admitted into the home, respite care, who can administer medication, the administration of medicines and the administration of medication by specialist techniques. It then covers the areas of controlled drugs, storage of medicines; homely remedies policy, planned and unplanned discharges from the home. The document also covers the area around giving consent; pacifically stating that it has to be informed consent and states that consent by a relative is not sufficient. During the inspection the medication trolleys were seen, there were two trolleys one for upstairs and one for the ground floor. Most of medication was in bubble packs, with some medication in a small plastic basket with the residents name on. The medication administration recording record sheets were looked at and random sections checked. They were found to be documented correctly and all had been signed, each of the sheets had a photo of the resident at the front. The manager said that after the lunch time medication all the medication is taken out and re-stocked for the evening and morning. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents can expect that their meals are served in pleasant surroundings and a choice is always available. EVIDENCE: During the inspection the kitchen was visited and the homes new cook was spoken to. The cook is very keen to be more creative with menus and the day of the inspection there were two choices for both main course and sweet. There was a white board on the kitchen wall; this had all the residents with their room number that had preferences. It also documented on the board which residents needed a special diet or had allergies to any foods. The cook said that the residents do get one fresh vegetable a day, the other vegetables were frozen. On the day of the inspection the fresh vegetable was leeks, there was also creamed or sauté potatoes. Residents spoken to said that the food was good, one resident commented that they had eaten so many mince pies that they would look like one. Some of the residents had various views on the food, but when asked pacifically about any issues felt the food was good. One resident said that they went down to the dinning room for their meal and found they had to wait for a long time before the meal was served. The inspector observed that residents were seated for their meal just after 12 noon and at 12.40, over half an hour later they were still waiting to be served. The inspector checked at just after 1 pm and found
Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 12 that the residents all had their meals. The inspector observed that staff were taking residents meals to their rooms during the time the residents were waiting in the dinning room. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service expect to be protected from abuse. EVIDENCE: All the residents spoken to during the inspection said that they felt that they were safe. One resident commented that as the home was near the Air force base with planes flying over, they were protected as much as is possible. The resident also added that the home did protect them and they felt very safe. The homes policies and procedures for adult abuse were looked at, the home did have the Local Authority adult abuse procedure. The home also has the provider procedure for adult abuse, this was headed abuse of a resident. The homes trainer had been on the Local Authority course and undertook all the staffs training. The homes complaint log was looked at and there had been six complaints during the year 2005. One complaint made on the 19th of the month was responded to on the 29th of the month, well within the timescale in the homes procedure. During the tour of the home, most of the residents felt that their views would be listened to. However there were some comments about concerns that were not listened too. A discussion with the manager and the provider took place, they felt that these were more about minor issues but it would be looked into. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 26 This home provides a clean and well-maintained environment but is not storing aids and equipment safely. EVIDENCE: A tour of the home was undertaken during the inspection and all areas of the home were found do be clean and hygienic. This is a difficult balance for a home that provides nursing care to achieve in keeping it hygienic and it remaining a home. Although the home was clean, it was noted during the tour that an area of flooring on the top landing was stained. The provider manager, who had toured the home earlier, had also noted the stains and was in discussion with the manager about getting this cleaned. One corridor in the home had a number of hoists, wheel chair and cleaning trolleys down one side. The home does need to make sure that all aids and equipment including wheelchairs are stored appropriately. There is a risk to residents and staff, if the equipment is not stored appropriately.
Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 15 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): 28, 29 and 30 The home recruitment practices are robust and offer protection to service users. Staff are trained to do their job. EVIDENCE: The home’s recruitment practices and training were looked at and the home does have its own trainer. During the inspection the staff were undertaking their National Vocational Training and the home currently has 58 of its staff trained to National Vocational Training level two. The files of new staff were looked at and found to have a contents sheet, new starter checklist, next of kin, and application form with photo. There was also a job description, letter of appointment, terms and conditions, two references, Criminal Record Bureau check and Protection of Vulnerable Adults first check. The home has a good training programme, this was seen during the inspection and listed the numbers of staff attending courses. As an example in October 2005 staff had undertaken Fire training and moving and handling. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service can expect to live in a home that is well managed, but health and safety issues are leaving residents at risk. EVIDENCE: The manager of the home has been in post for sometime and does have their National Vocational Qualification level four. A deputy and an admin assistant, as well as good support from the provider manager assist the manager. The home does undertake a quality assurance and quality monitoring system and the care home resident satisfaction survey 2005 was looked at. The document was single A4 sheet and had questions on both sides. The document invites readers to feed back to the home and says that the home aims to constantly improve services. Question one asks how the home is rated overall, with tick boxes beside, excellent, very good, quite good, neither good nor poor, quite poor, very poor, totally unacceptable. Question two covers the areas of friendliness of the staff, respectfulness of the staff, level of privacy,
Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 17 quality of care, if the staff know your needs, promptness of staff responding, level of attention, the amount of information given and the amount of choices. These headings have tick boxes of, excellent, good, average, poor, totally unacceptable. Question three covers, a range of activities, meals, administration support, laundry, cleanliness, maintenance, gardens, décor of room, décor of communal rooms and overall impression. Question four asks how much you agree or disagree that the home treats you as an individual and questions five asks what would be the one improvement that you would make to the home. The questionnaire concludes by thanking the person completing the form and asks for it to be returned. The form can be returned anonymously or the person’s details can be completed. These forms are then sent to the provider and in 2004 the home gained 67 and 86 from the satisfaction survey. The manager also undertakes their own audit of activities, the activities documented were, bingo, pub outings, sing a long, church services, music and movement, games as an example. The residents are asked to tick excellent, good, average or poor against these activities. The homes procedures for handling residents money was looked at and the home does offer the residents a personal allowance account. This can be set up with the home by the residents themselves or their relatives and they receive a print out of their account. All monies given to residents from their accounts have two signatures, one example was seen during the inspection. Residents can also manage their own finances, this is entirely their own choice. During the tour of the home it was noted that in two areas, cans of a hazardous substance were left out. These were handed to the manager for moving to an appropriate place, as these would be a hazard to residents. The home must make sure that hazardous substances are stored in the appropriate secured place. The homes maintenance systems were all documented, however they were not all available for inspection as the maintenance man was not available. The manager and the provider manager said that the maintenance man was very good at keeping all the necessary documentation and making sure everything was maintained properly. Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 18 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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X X 1 X X X 2 STAFFING Standard No Score 27 X 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 1 Brandon Park Nursing Home DS0000024341.V276023.R01.S.doc Version 5.1 Page 19 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 OP7 Regulation 15(2) Timescale for action The registered person must 03/04/06 make sure that the care plan is available to and involves the service user The registered person must 03/04/06 make sure that there is suitable storage for equipment. The registered person must 03/04/06 ensure that all parts of the home are free from hazards; this is with regard to the tins of spray. Requirement 2. OP22 23(2)(I) 3. OP38 13(4)(a) 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. 2. Refer to Standard OP15 OP26 Good Practice Recommendations The home should make sure that residents are not having to waiting longer than necessary to be served their meal. The stains in the carpet on the top landing should be removed by cleaning or the carpet being replaced.
DS0000024341.V276023.R01.S.doc Version 5.1 Page 20 Brandon Park Nursing Home 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
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