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Inspection on 07/11/05 for Bransfield Manor Rest Home

Also see our care home review for Bransfield Manor Rest Home for more information

This inspection was carried out on 7th November 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a committed and experienced staff team and an ongoing staff training and development programme. The homeowner, manager and those staff on duty evidently knew the service users well. Knowledge and understanding of service users` individual needs was well demonstrated. The manager and staff were observed to be friendly, caring and professional in their approach towards service users. Admission procedures ensured service users had sufficient information on which to base decisions on the suitability of the home to meet their needs. Opportunity was available for service users to visit and spend time at the home prior to moving in. Assessment processes reduced the risk of admitting individuals` whose needs cannot be met. The environment was warm and comfortable and most bedrooms were personalised. Care staff maintained areas accessible to service users in a clean and hygienic condition and odour control was satisfactorily managed. The appearance of service users demonstrated due attention to personal care needs. Service users expressed overall satisfaction with their care and the dayto-day operation of the home. Four service users independently stated that staff were "very good" and " very kind". The overall conclusion was that service users were receiving a good standard of personal care.

What has improved since the last inspection?

The home had partially complied with requirements made at the time of the last inspection. This included repair of a lock on an item of furniture in a bedroom and provision of statutory moving and handling and fire safety refresher staff training. It was positive to note a sliding sheet and uni-slide had been recently purchased to aid staff in moving and handling practices. Also that effort had been made to extend opportunity for a choice of food, predominately of the evening meal and ensure provision made of a vegetarian option. The manager reported effort made to gather life history information for individuals with a diagnosis of dementia or mental disorders during the assessment and trial admission period. This was drawn upon for formulating care plans and used to ensure an individualised approach to care practices. It was positive to observe that the manager had completed the NVQ Level 4 management certificated modules since the last inspection. She had recently commenced studying for the Registered Managers Award qualification. This was not affecting the management of the home as the manager attended college on her day off and studied in her own time.

What the care home could do better:

Observations identified a number of health and safety hazards, infection control risks and potential fire hazards. The need for improvement in risk assessment and safety audits was also identified and attention required to systems for identifying and reporting repairs to ensure these were effective. Standards of cleanliness and decoration and ventilation in the kitchen also required review. The care plan sampled required further development and attention to risk assessments. The need for improvement in some areas of care documentation and increase in frequency for reviewing and evaluating care plans was discussed. Noting significant shortfalls in risk assessment, attention to maintenance and attention to records, further probing established insufficient time allocated for the manager to fully fulfil her range of management responsibilities. Since May there had been regular shortfalls in the allocation of management supernumerary hours as a consequence of planned and unplanned staff absences. This was having an adverse impact on the home`s day-to-day management and administration. Whilst it is acknowledged that some staff training had taken place since the time of the last inspection, further attention was required in this area of the home`s operation. The need to ensure that staff receive all mandatory training and service specific training was discussed.

CARE HOMES FOR OLDER PEOPLE Bransfield Manor Rest Home Bransfield Manor Church Lane Godstone Surrey RH9 8BW Lead Inspector Pat Collins Unannounced Inspection 7th November 2005 12:30 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 Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 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. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bransfield Manor Rest Home Address Bransfield Manor Church Lane Godstone Surrey RH9 8BW 01883 742927 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) Family Care Private Company Limited Wanni Aylward Care Home 17 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (17), Sensory Impairment over 65 years of age (1) Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The combined total of residents falling into the category DE(E) and/or MD(E) must not exceed six (6) 5th May 2005 Date of last inspection Brief Description of the Service: Bransfield Manor is a care home registered for provision of personal care for older people from the age of 65 years. The home has a combined total of six places for the care of older people with either a diagnosed dementia or mental disorder, excluding learning disability. Additionally within the total numbers one placement may include an older person with a sensory impairment. The building is a large, detached Victorian property, situated in a semi –rural location, off a quiet country lane. The home is a short distance by car to Godstone village and accessible to larger shopping facilities in nearby towns. Bedroom accommodation is on three floors accessible by chairlift. Bedrooms on the second floor are only suitable for fully ambulant service users however. Communal lounge and dining facilities are available on the ground floor and assisted bathing facilities. Though the home has extensive gardens, the undulating, large rear garden is not suitable for use by service users. In fine weather service users enjoy sitting in a pleasant designated courtyard area to the side of the home or by the front door overlooking the car park. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on one day, over a period of five and a half hours. The home manager was present and the homeowner arrived towards the end of the inspection. The inspector spoke with ten of the seventeen service users during the inspection. Two members of staff on duty were also consulted during the course of their duties. A tour of the home was undertaken and a number of records examined as part of the inspection process. The inspector would like to thank management and staff and the service users for their hospitality and cooperation throughout the inspection. What the service does well: What has improved since the last inspection? The home had partially complied with requirements made at the time of the last inspection. This included repair of a lock on an item of furniture in a bedroom and provision of statutory moving and handling and fire safety refresher staff training. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 6 It was positive to note a sliding sheet and uni-slide had been recently purchased to aid staff in moving and handling practices. Also that effort had been made to extend opportunity for a choice of food, predominately of the evening meal and ensure provision made of a vegetarian option. The manager reported effort made to gather life history information for individuals with a diagnosis of dementia or mental disorders during the assessment and trial admission period. This was drawn upon for formulating care plans and used to ensure an individualised approach to care practices. It was positive to observe that the manager had completed the NVQ Level 4 management certificated modules since the last inspection. She had recently commenced studying for the Registered Managers Award qualification. This was not affecting the management of the home as the manager attended college on her day off and studied in her own time. What they could do better: Observations identified a number of health and safety hazards, infection control risks and potential fire hazards. The need for improvement in risk assessment and safety audits was also identified and attention required to systems for identifying and reporting repairs to ensure these were effective. Standards of cleanliness and decoration and ventilation in the kitchen also required review. The care plan sampled required further development and attention to risk assessments. The need for improvement in some areas of care documentation and increase in frequency for reviewing and evaluating care plans was discussed. Noting significant shortfalls in risk assessment, attention to maintenance and attention to records, further probing established insufficient time allocated for the manager to fully fulfil her range of management responsibilities. Since May there had been regular shortfalls in the allocation of management supernumerary hours as a consequence of planned and unplanned staff absences. This was having an adverse impact on the home’s day-to-day management and administration. Whilst it is acknowledged that some staff training had taken place since the time of the last inspection, further attention was required in this area of the home’s operation. The need to ensure that staff receive all mandatory training and service specific training was discussed. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 7 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. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 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 Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 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 Pre-admission and assessment procedures would be further enhanced by use of a recognised assessment tool. Admissions were on the basis of informed choice and the manager carried out pre-admission visits to meet prospective service and their carers to be sure needs could be met. EVIDENCE: The statement of purpose and service users guide contained all statutory information and had been professionally produced. These were maintained in the office and stated by the manager to be offered to prospective service users and/or their representative to read together with a copy of the latest inspection report. These documents required updating to include details of the registered manager. It was agreed that copies of both revised documents would be then supplied to the commission. Pre-admission assessment processes discussed with the manager appeared effective to ensure assessed needs could be met by the home. The need to use a recognised assessment tool was discussed, particularly for those individuals who do not have needs assessments carried out by care management. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 10 The manager informed the inspector that prospective service users were encourage to spend time in the home prior to admission. It was also stated that advice received at the time of the last inspection had been taken on board and effort was now made to obtain life history information for service users and or their representatives/ relatives. This is of particular value for those individuals with dementia or mental disorders and useful when formulating care plans. The views of individual service users consulted was that the home met their needs and they were overall satisfied. A comment received from a service user was “ although there is no where like one’s own home, it is nice here and staff are kind and caring”. This individual identified staff she considered worthy of particular praise. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Observations confirmed that mostly these standards were being met effectively though some attention was necessary to aspects of care planning, risk assessments and record keeping. Information gathered during the course of the inspection gave confidence in arrangements for identifying and meeting individual needs. EVIDENCE: Information documented in care plans and provided by staff and service users indicated that the home’s operation and routines promoted independence and choice for service users in their daily lives. This was within a risk management framework. Discussions took place with the manager and information was cross – referenced with care records relating to the approach to achieving a suitable balance of risks versus rights of a particular service user. The behaviours exhibited by this individual could at times challenge services. Currently this persons needs appeared satisfactorily managed with support from psychiatric health professionals. A signed protocol was in place for rapid adjustment to this person’s medication regime in response to a significant change in needs. Advice was offered by the inspector on areas of behaviour currently being managed by the home that should appropriately be reflected in Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 12 this individual’s care plan. Also for this service user’s risk assessments to be further developed. It is acknowledged however that the care plan was overall well constructed and informative. Observations of the failure to review the care plan and risk assessments for this individual for some months was attributed to time management pressures on the manager. This was of particular concern given this individual’s recent history of fluctuating moods and behaviour management issues. Discussions with the manager included the need for due recognition to be given to evidencing through record keeping practices, robust risk assessment of road safety, ongoing safety in relation to use of stairs and other risks associated with independent activities of daily living for this individual. Observations confirmed no change since the last inspection to report writing practices in care plans discussed on that occasion. Entries of “no change” and “ no problem” were still routinely recorded which did not adequately reflect service users welfare on a given day. Management might consider a change to record keeping practices to supplement this information with a monthly summary record keeping system written by key workers. Feedback from service users confirmed they were overall satisfied with the care received. Comments from one service user suggesting the need for review of this individual’s care plan was discussed with the manager and provider and it was agreed this would be carried out. It is acknowledged that explanation was received that this individual was sometimes resistive to elements personal hygiene care, which may explain the response that this service user was only “sometimes” happy with the care received. Arrangements for meeting service users health care needs were in place. Service users were registered with three medical practices and had access to annual health care examinations. The manager confirmed all service users had opportunity for receiving flu vaccinations this year. The district nurses were currently visiting one service user and there was input to the needs of individual service users from a continence advisor. Whilst medication practices were not examined in any depth, observations confirmed satisfactory medication storage and administration arrangements during the course of the inspection. A monitored dosage medication system was operating. The home has a written policy for the care of dying and action to be taken in the event of death, which was examined. The manager confirmed that the district nursing service had been supportive to the home in the care of a former service user who had a terminal illness. They had loaned to the home essential equipment including a pressure-relieving mattress and offered direct input and guidance on the care of this individual. Discussed was the need for consideration to be given to sensitively exploring service users wishes, where practicable, concerning terminal care and arrangements after death. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 13 Personal care was delivered in private. The need for a safety lock to be fitted to the ground floor bathroom door that leads into a service users bedroom to improve arrangements for privacy was discussed with the manager. The service user occupying this bedroom and relevant third parties should receive assurances that the lock will be used only when another service users occupy the bathroom. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 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 and 15 The routines of daily living activities were reasonably flexible to respond to changes in need and the personal preferences and capacities of service users. Visitors were welcomed and catering arrangements offered a degree of choice. EVIDENCE: The home’s routines respected service users’ preferences and choice in use of communal areas. Individual service users preferences to remain in their rooms and to take their meals in their rooms was respected and accommodated. A service user sat in the lounge stated she could go to her room whenever she chose and that staff were respectful of her privacy. The home had some organised activities for service users provided by external personnel, for example gentle armchair exercises and art and craft sessions. A service user stated that she sometimes enjoyed “playing games”. The background music playing in the entrance seating area was considered appropriate. Individual service users in the lounge had access to a television, which was on though few service users appeared interested in the programmes on at times when the inspector was in this area. Two service users were observed to independently go out for walks during the course of the inspection. The manager stated risk assessments were in place for this activity. One service user attended a weekly day centre session where she had lunch out. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 15 Transport arrangements were by taxi, which was self-funded. A service user enjoyed attending church every Sunday and transport organised through her friends. Individual service users informed the inspector that they went out with friends and relatives from time to time, which they enjoyed. A service user stated “visitors were made welcome by staff”. Observations confirmed the presence of two visitors in the home at different times during the course of the inspection. Consultation with both confirmed satisfaction with standards of care. One visitor stated that the home was in this person’s opinion “very good”. Whilst catering standards were not examined in any depth observations included the preparation of meals, arrangement for purchasing food and its storage and consultation with the cook and manager regarding menu planning. The menu displayed was not in accordance with the meal served at the time of the inspection at lunchtime. This was explained to be due to staff on duty the day before having forgot to defrost the chicken, which was on the menu. A record was maintained however of any meal substitutions on a daily basis. The meal served at lunch- time was substantial in quantity and offered a vegetarian option to meet the dietary preference of two service users. The cook confirmed she was aware of service users likes and dislikes and emphasised that these were accommodated. A choice of evening meal was offered including a hot and cold dish. Comments from service users about meals varied with some individuals very satisfied with meals provided. Others expressed the view that they would appreciate more variation. The manager informed the inspector that since the last inspection effort had been made to consult service users to provide more variation. Comments about the kitchen environment are recorded in the section relevant to standard 26. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 16 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): 17, 18 Service users legal rights were protected though information should be available to facilitate access to advocacy services if necessary. Adult Protection training for staff was ongoing and the home’s policies and procedures ensure service users were protected from abuse. EVIDENCE: Adult protection procedures were in place and some staff had undertaken adult protection training organised by Surrey County Council. Discussed was the requirement for all staff to undertake adult protection training as part of their foundation training within the first six months of their employment. Basic adult protection awareness must be included in the home’s induction programme. Discussion took place with the provider and manager on the need for all new staff to have enhanced CRB disclosures carried out by them prior to staff taking up post. This follows on from discussion in this matter at the time of the last inspection relating to the non – portability of disclosures. It was noted that there had been no new staff recruited since the last inspection however the employee identified to require a new CRB disclosure had still not made application for the same. The delay was explained to be due to failure to produce the necessary ID documents. The manager was requested to expedite making application as a priority. Observations confirmed records maintained of power of attorney and enduring power of attorney arrangements. At the time of the inspection it was confirmed by the manager that all service users had named representatives and had no Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 17 need of advocacy services. It was suggested to the manager that she research local advocacy services to ensure this information is held in the home in the event it is required in the future. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 18 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 The environment was domestic in character, warm and comfortable. Attention was required to environmental hazards identified, the standard of maintenance and the décor, ventilation and cleanliness in the kitchen area. EVIDENCE: The requirement had been met for a lock to be replaced on an item of furniture in a service users bedroom since the last inspection. Observations confirmed that work was imminent for installation of an immersion heater to enhance existing provision. Overall the home was clean and standard of furniture comfortable and in a good state of repair. Communal areas were light and effort had been made to personalise individual private space. Observations confirmed not all service users had a lockable item of furniture in bedrooms. It was stated this was made available on request. Safety locks were fitted to some bedroom doors and individual service users were said to have been issued with keys to bedroom doors. Discussed was the need to ensure where service users were issued with bedroom keys that a safety lock replaced the old type locks that were considered unsuitable and unsafe. In the event that a service user left Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 19 the key in this type of lock on the inside this could delay staff access in the event of an emergency. The requirement for a lockable item of furniture to be available in bedrooms and suitable locks fitted to bedroom doors in accordance with the national minimum standards for older people was discussed with the manager. If this provision is not routinely made the service users guide should make clear that these will be provided on request. The spacious combined lounge/dining room overlooked the large external garden that bordered fields afforded a pleasant, interesting natural outlook for service users’ enjoyment. The exterior of the building was generally in an adequate state of repair and decoration. The rear garden was not well maintained however and the undulating garden surface and steps that were not well maintained were noted to be unsafe for use by service users, staff or visitors. A compensatory external area for service users to sit and enjoy fine weather was made available in a courtyard to the side of the building. Attention was drawn to the need to deep clean paintwork in the kitchen to ensure pipe work and skirting boards and walls were free from grease and dirt. The kitchen environment would be improved through redecoration. There was no natural ventilation in this area and condensation was noted to be problematic. The two extractors in this area though functioning were limited in capacity. Discussed with the manager was the need for consultation with the Environmental Health Officer regarding the practice in the summer of working with the kitchen door open without fitting a fly screens. Observations identified a number of safety hazards in the environment. These included health and safety hazards to vulnerable service users who have dementia through the open storage of hazardous substances, for example mouth - wash in communal bathrooms. Infection control hazards were evident through communal use of toiletries and barrier creams and requirement made for individualised provision of both. Additionally bars of soap are an infection control hazard in communal bathrooms and toilets and must be replaced by liquid soap and provision of paper towels for hand washing. Observations identified a number of call bells that were not functioning in bedrooms and a bathroom. Additionally on the second floor where bedroom accommodation was provided for two service users, the alarm on the door leading to the fire escape stairs was not working. Safety precautions for the prevention of accidental burns relating to hot surface radiator temperatures were in place and radiator covers had been fitted to the central heating radiators. Attention was drawn to the potential danger of burns posed by unguarded secondary heaters supplied in some bedrooms. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 20 Observation made of extensive combustible materials stored in the cellar, which could be a potential fire hazard. Additionally two doors leading onto the corridor on the second floor had holes in them where locks had been removed. Discussed was the importance of filling these holes in as these reduced the effectiveness of these doors in the event of fire. Discussion took place with the provider and manager regarding the practice of wedging doors to the kitchen and in the corridor outside the kitchen. The inspector confirmed her intention to consult the local Fire Officer for guidance on behalf of the provider to reduce these potential fire safety risks. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 21 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 and 30 Staffing levels must be continuously reviewed to ensure the generic role of care staff that undertake cleaning and laundry duties does not detract from the hours necessary for provision of personal care. Based on available information current levels of dependency was moderate and night staffing levels of one waking care assistant supported by an on-call care assistant, asleep on the premises, appeared adequate. Night staffing levels must be monitored however to ensure safe moving and handling practices. Though some mandatory staff training had taken place since the last inspection additional mandatory training was outstanding. EVIDENCE: A record had been produced to evidence CRB Disclosures for staff. Advice given was for this to include the type of disclosure and for the perforated slip from the disclosure to be attached to this record. The home still does not have adequate systems to enable management to identify staff’s training needs. A central record of staff training would enable the manager to monitor this area of the home’s operation more effectively. Observations confirmed that service specific training relating to mental disorders for the team remained outstanding. Also some staff require adult protection training, first aid training, health and safety and infection control training and updates. Two staff were noted to have NVQ Level 2 certificates and one staff member had attained NVQ Level 3. A further staff member was currently undertaking NVQ Level 3. It was noted that the home employed a Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 22 number of nurses on the care team. Moving and handling training and fire safety training had been provided for the team by external trainers since the last inspection. The manager stated the generic role of care staff in which they were responsible for cleaning and laundry duties to be manageable at this time. The current level of dependency was not high. Observation made however of pressures on management time for some months suggests that it was not cost effective for the manager to engage in cleaning duties at the expense of her management responsibilities. Discussed with the manager was the need to consider improvements for managing planned and unplanned care staff leave more effectively in the future. The staff were observed to be diligent and professional in their approach to their duties. Those consulted stated they enjoyed working at the home. Service users mostly commented in positive terms about the kindness of staff who some described to “be very hard working and very good”. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 23 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, 34, 37 and 38 Whilst it was evident the manager was competent and suitably experienced shortfalls were evident in the home’s management and administration and in systems for ensuring the safety of service users. Observations concluded this was a result of failure to allocate sufficient management time to enable the manager to fulfil the full range of her responsibilities. Service users financial interests were safeguarded by the home’s policies and procedures. EVIDENCE: The manager is registered by the Commission for Social Care Inspection and has a professional qualification. She is a Registered Mental Health Nurse. Since the time of the last inspection the manager had completed NVQ level 4 management modules and was now studying for the Registered Managers Award qualification. The manager was clearly competent to fulfil her role and responsibilities however a number of shortfalls detailed in this report highlighted inadequate time allocated for management and administration Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 24 tasks. Discussed with the manager and the provider was the requirement for a minimum of two shifts a week in future to be designated as supernumerary time for the manager. This should be clearly identified on the rota. Staff absences must in future be better managed to ensure management hours are not routinely used to cover staffing shortfalls. Observations highlighted weaknesses in fire and health and safety risk assessments that require developing and additional time allocated to conducting audits. It was not evident that the provider was carrying out monthly reviews of standards and of care in accordance with statutory requirements and for preparing a written report of such visits. Whilst it is recognised that the provider is working in his office at the home at least twice a week he is not in day-to-day charge of the home. This requirement therefore is applicable. Such measures afford a monthly external review of the home’s conduct and will hopefully in future identify shortfalls in standards and risks at an earlier stage. At the time of the inspection evidence was not available to demonstrate portable electrical appliance testing carried out by the due date. It was agreed this information would be forwarded to CSCI and additionally a copy of the home’s electrical certificate, which could not be found. Observation was made of cleaning materials stored on open shelving in the laundry accessible through the bathroom. The door the laundry room was secured by a bolt. Other cleaning materials were locked securely in a first floor cupboard. Observations confirmed the outstanding food safety hazard brought forward from the last inspection. On this occasion a plate of corned beef and a bowl of custard had been stored unlabelled in the fridge. Records examined were well organised though some required developing and updating. Observations identified the need to store accident records confidentiality for compliance with data protection legislation. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 2 1 3 3 2 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x 3 x x 2 1 Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 26 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 OP1OP 1, 24 Regulation 6 (a)(b) Requirement For the statement of Purpose and Service Users Guide to be updated with details of the manager. The Service Users Guide should also refer to provision made on request of a safety lock on bedrooms doors and key, subject to risk assessment and of a lockable item of furniture in bedrooms. For use of a recognised assessment tool for preadmission assessment procedures. For care plans and risk assessments to be further developed and reviewed at least monthly. Staff should ensure care notes are recorded in sufficient detail. For a safety lock to be fitted to the door of the ground floor communal bathroom providing direct access from a bedroom. Reassurances should be given to service users occupying this bedroom that this door will be unlocked when the bathroom is unoccupied. DS0000042991.V257355.R01.S.doc Timescale for action 07/01/06 2 OP3OP 3 14(10(a) 07/01/06 3 OP7OP 7 12(1) 13(4) 14(2) 15(2) 12(4)(a) 07/12/05 4 OP7OP 10 07/01/06 Bransfield Manor Rest Home Version 5.0 Page 27 5 6 OP26OP 10, 26 OP38OP 15, 38 12(4)(a), 13 (3) 18(1)(a) 7 OP25OP 19, 25 16(2)(j) 8 OP25OP 19, 25 16(2)(g) 9 10 11 OP38OP 19,22, 38 OP38OP 19, 38 OP38OP 19, 25, 38 12(1) 13(4) 23(2) 12(1) 13(4) 12(1) 13(4) 23(1)(a) 12 OP26OP 26 13(3) 13 OP26OP 26 13(3) 14 OP30OP 30 18(1)(a) For an individualised approach to the storage and use of toiletries. For food stored in the fridge to be covered and labelled. This requirement is brought forward from the last inspection. For paintwork in the kitchen to be deep cleaned and a cleaning schedule implemented. Ideally this area would benefit from redecoration. For review of the adequacy of ventilation in the kitchen. Advice should be sought from the Environmental Health Officer in the practice of working in the kitchen with the back door open for ventilation in hot weather without fitting a fly screen. For call bells to be located in all bedrooms and for these to be functioning. For the second floor fire escape door alarm to be repaired. For risk assessments to be carried out on the surface temperature of secondary heaters used in some bedrooms. A satisfactory solution must be found to reduce any risk of accidental burns. For improvement in infection control in the home by replacing bars of soap in communal toilets, bathrooms and shared bedrooms with liquid soap dispensers. Provision must be made of paper towels and dispensers in these areas. For an individualised approach to use of barrier creams for external application. These creams must be labelled with service users names and stored safely. For service specific training to be provided for the team. This DS0000042991.V257355.R01.S.doc 07/12/05 08/11/05 07/12/05 07/01/06 08/11/05 08/11/05 14/11/05 07/12/05 08/11/05 07/01/06 Page 28 Bransfield Manor Rest Home Version 5.0 15 OP29OP 29 19(1)(a) 16 OP30OP 30 18(1)(a) (c)(i)(ii) 17 OP31OP 31 10(1) 18 OP31OP 31, 37, 38 12(1) 13(a)(b) (c) 19 OP31OP 31, 37 18(1) 20 OP31OP 31, 37, 38 26(2)(3) (4)(a)(b) (c) requirement is brought forward from the last inspection. For application to be made for CRB Disclosures for any staff that took up post after 26th July 2004 on the basis of CRB Disclosures obtained through former employers. CRB Disclosures are no longer portable. This requirement is brought forward from the last inspection. For provision of outstanding foundation training to the team. This includes first aid, adult protection, health and safety and infection control training. It is important to ensure that in future foundation training is completed within the first six months of employment. For the manager to allocate two shifts per week as supernumerary time to management and administration tasks. For the fire risk assessment and health and safety risk assessments to be further developed and regular audits carried out to identify risks in the environment and repairs and maintenance issues. For the manager to develop systems and records of staff training to enable ease of identification of individual and collective staff training and development needs. For compliance with the statutory requirement for providers not in day – to – day charge of homes to visit the home unannounced on a monthly basis and interview staff, service users and their representatives in order to form DS0000042991.V257355.R01.S.doc 14/11/05 07/02/06 14/11/05 08/11/05 07/12/05 07/12/05 Bransfield Manor Rest Home Version 5.0 Page 29 21 OP37OP 37 10(1), 17(1)(b) 23(4)(a) (c)(v) 22 OP38OP 38 23 OP38OP 38 12(1)(a), 13(4)(a) (c) 24 OP38OP 38 10(1), 23(2)(b) (c) an opinion of the standard of care. To also inspect the premises and records of events and of any complaints and prepare a written report on the conduct of the home which must be available for inspection. For accident records to be confidentially stored in accordance with data protection legislation. For consultation with the fire officer for advice on fire hazards observed in the home at the time of the inspection. These were the practice of wedging the kitchen door and corridor door (on the ground floor) for operational treasons; the storage of a very large quantity of combustible items in the cellar and holes in doors, which reduce their effectiveness in the event of a fire. For risk assessments to be carried out for the storage of mouthwash and toiletries accessible to vulnerable service users who could be at risk of harm if accidentally swallowed. For copies of documents to be forwarded to the CSCI evidencing a current electrical certificate and regular testing of portable electrical appliances. This information was not available at the time of the inspection. 07/12/05 07/12/05 14/11/05 07/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 30 No. 1 Refer to Standard OP19OP 19, 38 Good Practice Recommendations For the rear garden to be tidied and landscaped and made safe and accessible for service users’ use. Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Bransfield Manor Rest Home DS0000042991.V257355.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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