Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nancy Saich
Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home
Name of care home: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS 0190067111 0190068339 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aspenframe Ltd care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD Mental disorder, excluding learning disability or dementia - Code MD Dementia - Code DE The maximum number of people who can be accommodated is: 57 Date of last inspection 57 57 0 57 Over 65 0 0 57 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Branthwaite Care Home is situated on the outskirts of Workington. The home is a care home that can provide nursing care for 57 people. Eight of whom may have a Mental Disorder, excluding learning disability or dementia and this accommodation is within the separate Harrington specialist unit. All of the bedrooms are single occupancy and most have en suite facilities. There are pleasant communal areas with a lounge/ conservatory at the front of the home and one smaller lounge at the other end of the home. There is also a conservatory and dining room at the rear of the home. Outside, there are raised gardens by the rear conservatory, and to the front and side of the home are paved areas. Information about the service is made available in a statement of purpose and service user guide that is on display in the foyer along with inspection reports. The fees currently charged by the services range from £326.00 to £474.00 and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Care Homes for Older People Page 5 of 31 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the main or key inspection for the year. The lead inspector Nancy Saich asked the company to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year. This was completed promptly with plenty of detail by the nurse manager and the general manager. We then sent out postal surveys to people who live in the home and their relatives and friends and to the staff group. We had a good response to these surveys and we quote from them in the report. The responses were fairly positive and gave us a good picture of what its like to live and work in the home. The lead inspector made an unannounced visit to the home on the above date. This started around 8 a.m and she was joined by Angela Branch, a pharmacy inspector
Care Homes for Older People Page 6 of 31 about an hour later. Both inspectors met with the general manager, nurses and carers and spent some time with people who live in the service. We toured the building, sat in lounges and shared a meal with residents. We also looked at files and documents that backed up what was said and what was seen. What the care home does well: This home is good at giving people information about the service. They also encourage people to visit before they decide to come into the home. Management complete a full assessment of peoples needs so that they can start to give good care straight away when they do come in. I had plenty of information so I could decide. People in this home can choose how they spend their time. Staff were seen helping people to make choices about when to get up and where they wanted to be. I can do what I want really. I spend a lot of time in my room but join in some activities and sit with the others for some of my meals. We were around at breakfast and lunch and we saw good quality and well prepared meals being served. People told us: The food is very good. I enjoy my meals - I have eaten better since I came in. Its good quality and nicely cooked and theres plenty of cups of tea too! This service continues to manage complaints and concerns correctly. We spoke to people about how secure they felt and they were happy in the home. We asked if they thought there was anything abusive happening and they confirmed that they were well protected from harm and abuse. Staff were confident that they could deal with anything untoward and knew how to keep people safe and free from harm. I wouldnt hesitate to tell the new managers if I thought something is wrong. I have learnt to trust them very quickly and feel they would listen to my concerns. Staff told us: There is good communication. The managers attend handovers...we can discuss any concerns... On the day of our visit the home was clean, orderly and free from odours. There were no obvious hazards seen. We do want management to look at arrangements for catering and we talk about this in the next section. We checked on money kept on behalf of people and found this to be in order. Staffing levels in the home were good and people felt there were enough suitably trained staff to meet their needs. They seem to have more staff than before. Nice to have some new blood. Staff were happy with the staffing levels. Sickness problems have been dealt with...improved greatly....there is always enough staff now. Care Homes for Older People
Page 8 of 31 New staff are only taken on once their background and qualifications have been checked on thoroughly. New staff are given an induction so they understand their role. Staff told us: The service is good at making new staff welcome and helping them to understand the job. The home has a reasonably good system for checking on the quality of care and services provided. We were pleased to see that the new management team had started to use these systems and work on some of their own so that things could run smoothly and to the benefit of people in the home. We had evidence to show that a new manager is in the process of registering with us and that the new management team have made plans for future developments. They have good systems in place to make sure that things like fire safety, risk management and manual handling procedures are in place and that these run smoothly to give people a safe and well ordered home. What has improved since the last inspection? We could see that the written plans that tell staff what people need and want had all been worked on and had improved. We judged that the new management team could see the value of doing these with as much detail as possible so that delivery of care could improve. We made some recommendations on the day but had evidence to show that changes were planned to include more details in plans. Staff were happy with these changes: Care plans have improved and are beginning to give us the kind of information we need. We saw general improvements to the way medication is managed. We did pick up on some matters that need to be looked at again so that people always get medicines given appropriately. We had evidence to show that the way care is carried out had improved. There were still one or two minor things that were a little institutional but the management team gave us evidence to show that they were working on these with the staff team. We saw staff working well with people and showing a good understanding of them as individuals. People told us the staff were: Very kind and helpful. Some are better than others I suppose but things do seem improved...more staff and more time to get everything the way I want. People told us that activities had improved under new management and they were keen to do different things and to get out more. We saw the beginnings of improvements to activities for people with dementia and were pleased to see that they were involved in all group activities in the main part of the home. Care Homes for Older People Page 9 of 31 I think the changes to activities has been the best thing. I will go to all of it...bingo, skittles, concerts...I dont care! I am looking forward to getting out more too...either on trips or into the garden...stops me feeling weary. The company have improved bedrooms and shared areas, providing new carpets and redecorating. We could see that furniture had been rearranged so that people can socialise more easily in lounges. General improvements have been made to all areas and we saw plans to continue with this. We liked the way staff had made sure the environment was suitable for people who have memory problems and who may feel restless. We judged that there is a more settled staff team in this service and staff were positive about management and senior staff. Training and development had also improved in the last few months. There is now a well planned programme of training for all staff. Staff told us they now receive one-to-one supervision and appraisal and this has helped them with their practice. One person told us how much she felt she had benefited from the mentoring she received from the new management team. It is so much better now...I can ask without being made to feel stupid. My practice has improved as I know I will get support. Everyone we met thought along the same lines and we had positive feedback about management in all the surveys we received. Branthwaite is now a much better place to work since the new manager has been appointed. The general feel of the home has improved since the home manager came into post. She will work with us if we need her to...has helped with the way we give care. We judged that the new management team with a general manager and two clinical nurse managers had already started to improve how things are in the home. Two of these people have only been in the home for only a few months and already they have made a lot of changes for the better. The company have developed a plan to show how they want the service to change and move on. We judged that there has been improvements to care planning, medication management, staff development and in management systems. We look forward to hearing about how things progress in the service once the Harrington Unit is opened and a full staff team is in place. What they could do better: We want the management team to continue to work on all the details of the written plans of care so that all the needs an individual has are recorded and acted upon. This needs to include more detail of medication so that people will receive medicines appropriately. We want staff to have more training and guidance on how controlled drugs should be disposed of. We want management to look at the staffing levels and arrangements in place for the catering operation in the home as currently these could be changed so that staff time and resources are made better use of. Care Homes for Older People
Page 10 of 31 We also want the company to give the manager as much support as necessary so that she can proceed with her application to be registered with the Care Quality Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 31 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted to the service once they had been given suitable information and once the staff team are sure that they can give them appropriate levels of care and services. Evidence: We saw a number of documents that describe the type of care and services this home provides. We were also given a brochure about the work of the company who own the service. These were very detailed and explained the general nursing provision, their specialist care of people with dementia and their proposed service for people with other care needs. They are proposing to provide a specialist service for people who have acquired brain injury or other neurological conditions. These documents were detailed and comprehensive. We did notice one or two typing errors in these printed documents and the general manager agreed to have these changed as quickly as possible. Care Homes for Older People Page 13 of 31 Evidence: We met with a number of people who had not lived in the home for very long. They confirmed for us that someone from the management team had come to see them to make sure that their needs are understood. Some people told us that they had visited the home before they made the decision to live there. We looked at individual files and saw that detailed assessments had taken place and that new residents had basic care plans in place within the first couple of days after admission. Care Homes for Older People Page 14 of 31 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team need to continue to make improvements on care planning and the management of medication so that people receive good levels of care. Evidence: We read a number of the written plans that help people who live in the home to get the level of care and services that they need and want. We could see by looking at individual files that people had been consulted and that all of these care plans had been updated and rewritten in the last four or five months. We judged that there had been a considerable improvement in the content of these very important plans. People told us that they were aware of these changes. We also saw that the management team undertake regular quality checks of these plans. We judged that some plans had a lot of relevant details about peoples care and nursing needs and many of them were of a very high standard.Some plans were, however, lacking in detail. For example some people needed more information related to spriritual or cultural needs. One or two plans needed to be written up a little more clearly in terms of personal care or nursing tasks. One person told us in a survey that
Care Homes for Older People Page 15 of 31 Evidence: one element of their plan was not always followed. Some plans for people with dementia needed to be more specific so that staff understand the right kind of approach to take when someone is disorientated or unhappy. Currently some plans are not specific enough for the person. They say things like orientate, reassure and refer to support services. We judged that staff need to know the right support for each individual when they are distressed or disorientated. We were informed that a new manager with nurse training in mental health will be taking the lead on developing a more person centred approach to care plans and we look forward to this development. The pharmacist inspector also looked at care plans relating to medication and we found that the quality of information was variable. For example plans were in place for a person receiving when required medication so that staff understood the appropriate use of this to ensure safe and consistent treatment. However the care plan for a person with swallowing difficulties failed to record how medication was to be administered. It did not show that the method currently used had been agreed as necessary, safe, and in their best interest as part of a multidisciplinary approach. When a sedative was given the records did not consistently justify the reasons why this was needed. Nurses need to ensure that records are completed accurately to show that care plans have been followed and to make sure residents receive appropriate treatment. We discussed care plans in depth with management and the general manager had also seen deficits in her regular audits. She gave us evidence to show that these were being worked on. We have made recommendations about the plans but look forward to seeing the improvements already acheived continuing. The pharmacist Inspector found that medication was handled adequately. Records for the receipt, administration and disposal of medication were good and there were few gaps in information. This meant that on the whole the treatment received by residents was clear. We counted a large sample of medicines and compared the quantities against records to check that they could be accounted for and to show that they were administered as prescribed. The majority of these samples were in order. However there were some minor discrepancies seen but we had evidence to show that the manager regularly audits medication and this has enabled these matters to be highlighted and addressed. We discussed medication review with the general manager. It is recommended that this be requested for new residents soon after admission to the home and regularly again after so that treatment is up-to-date and is appropriate to the changing needs. Medicines liable to misuse, called Controlled Care Homes for Older People Page 16 of 31 Evidence: Drugs, were checked. We saw one recent case where medication was inappropriately removed from the home. It is recommended that staff receive further training on the correct procedure for disposal of Controlled Drugs. We could see in files and by observation on the day that staff in this home do deal with clinical nursing tasks well. People we spoke to were happy with the way things like dressings and other procedures were done. They also consult G.Ps and use specialist nurses for advice and updates to practice. There were one or two plans that needed a little more detail and one person needed some very specialised support. We could see that staff do consult Community Psychiatric nurses but we want to see advice being written into plans in more detail. We met a health care professional on the day who was happy with the treatment given to people in the home and who said the staff team were keen to learn and were dealing with skin care for frail people very well so that risk of pressure sores and other skin problems were minimised. People do have access to G.Ps and other health care practitioners and a number of daily reports and spoken evidence showed us that for a number of people being resident in the home had improved their physical health tremendously. Both inspectors observed staff interacting well with residents. Most staff had a friendly but respectful attitude towards residents and on several occasions we saw people responding warmly to individual members of the team. We received a small number of surveys and all of these said the staff were respectful and responsive. When we spoke to staff we realised that they had some very good insights into peoples needs and a good understanding of that persons background and preferences. We did see one or two minor things that reflected a more institutionalised approach to peoples care but we also noted that senior staff challenged carers about these things. We saw in staff meeting minutes and in individual staff files that good practice approaches to care is central to the improvements being made by the new management team. Care Homes for Older People Page 17 of 31 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home are being helped to express their wishes about their lifestyle and are being given enough support to have a more fulfilled life. Evidence: The inspection started just after 8 a.m and some people were up and dressed and others were taking more time to get ready. Some people chose to stay in bed until later in the morning. Staff told us that people who had complex nursing needs could choose to have more time in bed and that they carefully monitored this. People told us they could choose how they spent their days and that there were no fixed rules about what they did. Some people like their own rooms and others prefer to socialise. We met a number of visitors on the day and we could see they were relaxed about coming to the home and were offered refreshments. Relatives and friends were happy with the way staff communicated and a number of people sought out management to talk to about their relatives. People told us that local groups came to visit the home and these local activities are part of a wider programme of activities. The home has an activities co-ordinator who is building up varied hobbies and interests for individuals and groups. We spoke to
Care Homes for Older People Page 18 of 31 Evidence: staff on the specialist dementia care unit and they have already started to think of different activities people with dementia may enjoy. We saw staff engaging with residents during the afternoon and the people involved were enjoying a sociable get together that some relatives were also involved in. People told us they had been going out to local entertainments and that there was a reasonably good range of things on offer. We saw photographs of the recent Easter Bonnet party, an evening party with an entertainer and people spoke about how they enjoyed bingo, excercises and skittles. It was good to see that individuals with complex needs are given 1-to-1 time with staff where possible. We shared a nicely prepared lunch with people on the specialist Memory Care unit and this was a very peaceful and sociable occasion. Staff had made changes that allowed people to feel relaxed at mealtimes. The nurse on duty said this approach helped people who did not eat well to relax enough to enjoy their food. Residents on both units told us they had choice and that the quality was very good. The cook explained that the menus were nutritionally balanced but that she had scope to give people the kind of meals they were used to. Care Homes for Older People Page 19 of 31 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this service feel secure because they are listened to and are protected from harm and abuse. Evidence: We checked on the record of complaints held by the general manager. We saw evidence to show that she had managed concerns and complaints appropriately within the timescales. Surveys and conversations with people gave us evidence that there was enough information and confidence in the management team and the company to allow complaints to be managed effectively. Staff had received training and information about how to keep people safe and free from harm. People who live in the home said that there was nothing worrying them but if they were concerned they would talk to management or to trusted staff members. Staff were able to explain to us what the company procedures were, what they thought was abusive and how they would deal with an issue of this nature. Care Homes for Older People Page 20 of 31 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service provides a relaxed and secure environment that is beneficial to people with both physical and mental health needs. Evidence: This home is situated in a semi-rural situation but on a main road within easy travelling distance of Workington. There is limited public transport but the home has good provision for parking. All accomodation is on the ground floor and has been designed for people who may have problems with their mobility. The home has a call bell system and suitable aids and adaptations so that people may move around easily in the environment and call for assistance when needed. All of the bedrooms have ensuite facilities. The home has two distinct units - one named The Branthwaite Unit and this is the original building. The other unit - The Harrington Unit is yet to receive residents. The Branthwaite unit accomodates people who need general nursing care and, in a seperate area, people who have dementia. Originally this part of the building was a private hospital. We judged that the company and the management had worked very hard to make this unit as homely as possible and they continue with a programme of updates and improvements to all parts of the building. They have redecorated and put down new carpets and have arranged furniture and fittings so that even large areas
Care Homes for Older People Page 21 of 31 Evidence: feel more homely. The part of the home for people with dementia has benefitted from thoughtful changes in decor that make the environment as relaxed as possible for people who may be disorientated. We visited the new Harrington unit and we judged that this part of the home will give people spacious and restful accomodation. This new unit will take people with dementia who have complex nursing needs in one part and the other side of this building is for people with other types of dementia related illnesses and may cater for younger residents. We saw that staff had started to work in this unit so that there were plenty of visual clues and reminders for people with memory loss. Management and staff were keen to start working in this new Memory Care unit and they had lots of plans about how this would work in practice. We especially liked some of the pictures and touch boards in the hall ways and we could see that the mangement had started to use some of the most recent practice advice for giving people with memory deficit a safe and relaxing home. We checked on the laundry and in toilets and bathrooms. We found that infection control measures were in place and staff told us that they had received training updates on these matters. The areas of the building used by residents were clean, orderly and odour free on the day of the visit. Care Homes for Older People Page 22 of 31 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service has enough suitably trained and experienced staff to give good levels of care. Evidence: We were given four weeks worth of staff rosters and we could see from this that the home is suitably staffed. We learned that there had been some changes and re writes of these rosters and we spoke to management about their ongoing work that will make sure that people are cared for by staff with the right skills on each shift. Most staff told us they thought the home was suitably staffed. People living in the home thought there were enough staff on duty most of the time. However when we visited the main kitchen we judged that the kitchen was not as clean and organised as it might be. We looked at the jobs to be done in this area and we want the general manager to look at staffing levels for kitchen domestics. This matter was dealt with when we were still in the home but we make a general recommendation that catering arrangements are reviewed in line with changes and increase in resident numbers. Nursing staff in the home are suitably qualified and there has been a new recruitment of a nurse with experience and expertise in care of people with dementia. We learnt that general nurses keep up to date with good practice. We spoke to a specialist nurse
Care Homes for Older People Page 23 of 31 Evidence: who visits the home and she was happy with the way nurses follow her advice and with their practical application of advice. More than three quarters of the care staff have National Vocational Qualifications in care at level 2 or above. These levels of training were seen in practice on the day and many of the staff were very skilled with a good approach to people in the home. We also saw the training programme that was in operation. The new management team had devised this and it was almost half way complete. Staff told us they had enjoyed this new programme and had learnt a lot. They were keen to do more and this was reflected in the minutes of staff meetings and in supervision notes. We judged that this first plan of the new managment team had given staff very good updates to infection control, food hygiene, end of life care,moving and handling, nutrition, first aid, health and safety and the start of dementia awareness training. We looked at the staff files for new staff as well as established team members. We found that new team members did not start to work with people or have any information about them until references and checks were complete. New starters had criminal records bureau checks and management had made sure there had been no issues if they had worked in other care settings. Nurses had suitable checks on their qualifications, registration and training. Care Homes for Older People Page 24 of 31 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new management team have made considerable improvements in a short space of time and this is giving people improved care and services in most areas. Evidence: Currently the home does not have a manager registered with the Care Quality Commission. However we were told by the company that the nurse who manages the Branthwaite unit is to apply and she is progressing her application. We had evidence that this process had started and that she has a suitable background to make this application. Since the last inspection the company has appointed both a general manager and a nurse manager. Some staff were a little unsure of the roles of these two people but the general feeling from speaking to staff and from reading surveys was that these two individuals had brought about a lot of positive changes in the home. We were also informed that the company had just appointed someone with experience of nursing people with mental health needs to manage the new Harrington unit.
Care Homes for Older People Page 25 of 31 Evidence: We had evidence to show that these three people at management level had different but complimentary management, care and clinical skills and experience that should provide a very good management team. We asked the company to clarify the different management roles that these three people would have and we also asked that an application to register a manager was put in hand. The company produced a business plan and have made it clear how the home is to be managed. We had evidence to show that the management team had started to audit things like the care plans and that other quality monitoring tools -- for example daily work task monitoring -- had been started. We could also see that people who live in the service and their families had been consulted about their views of the home. We appreciate that the new management team has only been set up for some four or five months and is not yet complete. The general manager said that the company was in the process of preparing a business and development plan and we have received a first draft of this. We judged that this is an improvement and will help people to be more aware of where the company want to be within the next 12 months. We checked on the financial arrangements for individuals who live in the home and we discovered that these are correctly handled. Most people have private arrangements for their finances and the home only looks after small sums of cash. These were properly accounted and the company does regular audits of these sums. We also looked at some staff supervision notes and we were pleased to see that the staff now have regular one-to-one meetings with a member of the management team. We look forward to the records of these becoming more detailed and more focused on personal development. Nurses in the home are receiving one to one supervision and supported in keeping their practice up to date. We looked at a number of different types of records in the home and generally we could see an improving picture of the way records are kept. There were one or two forms being used that needed updating and the general manager agreed to do this as soon as possible. Policies and procedures have been updated and staff spoken to had a good understanding of these. On the day of the visit we did not see any obvious hazards around the home and there were good risk assessments in place. We had evidence in files and through observation that showed that staff had received training and competence checks in Care Homes for Older People Page 26 of 31 Evidence: moving and handling. We were pleased to see that fire drills and instructions are now being completed on a regular basis. There were good infection control measures in place in the home. We visited the main kitchen and discovered that it had received a good report from Environmental Health last year and there were good systems in place to ensure good standards of food hygiene. The company had replaced the kitchen floor and had installed new worksurfces. Unfortunately on the day of the visit some of the equipment was not working and staff were finding it difficult to keep this area as organised as possible. We had evidence to show that repair or replacement was under way. We do want the company to look at catering arrangements as we judged that delivery of meals to units and washing up could be managed more efficiently. More staff hours might have helped with this and we discuss this further under Staffing. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 It is recommended that management continue to monitor and review each individual care plan so that they become more specific, more individualised and are written in a person centred way so that peoples needs are addressed appropriately. It is recommended that staff accurately record why when required medication is administered to justify their use. It is recommended that medication reviews be requested for new residents soon after admission to the home and regularly thereafter so that treatment is up-to-date and is appropriate to their changing needs. It is recommended that staff receive further training on the correct procedures for disposal of Controlled Drugs. It is recommended that care plans relating to complicated or when required medicines contain clear detail of how they are managed to ensure people received safe and effective treatment. It is recommended that staffing levels in the kitchen are reviewed and improved in line with the tasks expected of catering staff.
Page 29 of 31 2 3 9 9 4 5 9 9 6 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 7 8 31 38 It is recommended that the manager is supported to make an application for registration as soon as possible. It is recommended that all processes in the catering arrangement, including delivery of meals around the home and washing of crockery after meals, are reviewed so that the most efficient systems are used. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
