Random inspection report
Care homes for older people
Name: Address: Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS two star good service 14/04/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Nancy Saich Date: 1 5 0 1 2 0 1 0 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): Name of registered manager (if applicable) Mrs Margaret Rose Visick Type of registration: Number of places registered: Conditions of registration: Category(ies) : Aspenframe Ltd care home 57 Number of places (if applicable): Under 65 Over 65 0 0 57 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 57 57 0 57 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
Care Homes for Older People 1 4 0 4 2 0 0 9 Page 2 of 14 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 in the above categories. There are three distinct areas in the home - the general nursing unit, a memory care unit for people with dementia and the Harrington Unit that helps people who have complex mental health needs including challenging behaviour. All of the bedrooms are single occupancy and 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 £398 to £945 per week and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Care Homes for Older People Page 3 of 14 What we found:
We made an unannounced visit to the home on the above date. We did not look at all of the National Minimum Standards on the day as this was a random inspection. The focus of this random inspection was on the care provided in the Memory Care unit and the Harrington unit. These parts of the home care for people with dementia and people with challenging behaviour. We left postal surveys in the home for people who live there and for staff. We met with people in both units and read peoples individual files and some of the written plans of care. We also checked on a range of documents related to how staff are recruited, deployed and trained. We checked on records of accidents, incidents and matters of adult safeguarding. We spoke to some of the staff and nurses on duty and to the manager and to one of the nurses in depth. We also had information from a variety of other sources both before and after our visit. We looked at the updated Statement of Purpose for the home. We discovered that some things related to the Harrington unit had yet to be developed. These include staff training and therapeutic programmes of care. This Statement of Purpose and the brochure also says that they can deal with challenging behaviour appropriately. We did not find enough evidence on the day to show that this is being suitably managed. There was insufficient evidence during the visit to show that the service promotes what they describe for the Dementia Care unit - this unit provides...a setting that is also designed to stimulate memories and senses. We judged that more work needs to be done so that service users benefit from the design features of the unit. We looked at files related to the initial assessment of new people to the service. We found that some files did not have full assessments of need and that some files lacked background details. We checked on a number of written care plans for people on the Harrington Unit. Some aspects of these and other care plans did have detailed assessments and actions to be taken. However we discovered that there were weaknesses and gaps in some plans especially where people challenged the service. We discussed this with the manager and the nurse responsible for these specialised units. We saw at least one person who needed support with their personal care and were told that specific directions for managing the symptoms of their dementia had not been written into the care plans and staff did not have clear guidance about how to deal with specific behaviours. On the day of our visit we did not see any member of staff who approached people in an inappropriate manner. We did have some information from a number of sources that indicated that people with dementia or challenging behaviour were sometimes not treated appropriately. A safeguarding referral was made by us and an investigation, led by Social Service, is underway. Care Homes for Older People Page 4 of 14 There was evidence to show that people do receive visits from health care practitioners and that nurses on the unit do undertake nursing tasks. One person had a fairly urgent chiropody need but the staff had not been able to source an urgent chiropody referral. Nurses had tried to deal with this but they told us and the notes showed that they had been unable to do this as the person would not allow them to intervene. We looked at another record where the notes showed a change in behaviour that might have been related to a mental health need. There was no contingency plan in place for dealing with the behaviour. We asked people in both of these specialist units about activities and we discovered that although there is an activities organiser employed (and another person about to start as an activities person) there is no special programmes available that help people with dementia or with other mental health or behavioural problems. The people on the Harrington Unit said they had nothing planned and didnt do much. Some people did do some chores around this unit but their record of activities showed that they spent most of their time watching television. The Statement of Purpose says that there are daily programmes for people on this unit but the senior staff told us they had not worked on these yet . There was no specific programme of activities for people with dementia but they did join in activities for people in the nursing care part of the home where possible. We learnt of daily activities and entertainments in the main unit and people seemed to enjoy this. On the day of the visit people were asking about the hairdresser. There had been a problem with this due to the weather. When we asked about taking people out to the hairdresser we were told that access to transport was limited.Staff did try to help people with this after we had discussed this issue. There was no specific details of how the unit was managing a particular therapeutic approach called Doll therapy and we judged from speaking to staff that this was not always managed appropriately. Some life story work was being done and staff and users alike seemed to enjoy this. Not everyone had been involved in this life story work and there was only a few examples of co-ordinated reminiscence work going on in the home. We saw people eating nicely presented meals and being given suitable choices at meal times. Some people have nutritional plans in place. Care plans do need to give more guidance to staff when people refuse meals or fluids or have behavioural issues around eating and drinking. We checked on the records kept about complaints and safeguarding. We discovered that one person had made an allegation of assault and this had not been taken forward appropriately. Instead there were written testimonies saying this person made unfounded allegations. This persons allegation had not been believed. This should have been accepted and reported to external agencies in a timely manner that follows local protocols. The manager completed her training as a trainer on safeguarding vulnerable people in 2007. She holds regular sessions on this vital subject. We spoke to the manager and her deputy about safeguarding and they were fully aware of what was abusive but were not
Care Homes for Older People Page 5 of 14 confident when asked about what they would investigate themselves and what they would refer. The training also includes discussions on privacy, dignity and respect. The sessions last for two and and a half hours. A number of people (approximately 22 staff members) had not attended this training. This included the deputy and other nurses who may have to make urgent safeguarding referrals. Some people had not had training in this since 2007 despite the fact that the local arrangements for managing safeguarding had changed. Staff told us that people did not attend this as they were not paid for training. We had received a complaint about the service and had passed this on to the company and this was in the process of being dealt with when we made our random visit and a full report received shortly after the visit. The home was reasonably tidy and clean during our visit. Part of the Memory Care unit and the entire Harrington Unit is a new build and the environment is of a high standard. We had been told by various people that staffing levels were poor at times. We had a complaint about this and the company looked at this. Their initial investigation found that around the holiday period there had been staff shortages. We discovered that on one particular night there were only two nurses and two staff to care for all the residents. The two carers on duty were very new to the service and they had insufficient training and induction. We were concerned that these levels of staffing might compromise peoples safety - especially when there were issues with behaviour management on the specialist units when it would be difficult for staff to manage two units. We checked on recruitments and we judged that the manager followed the company procedures correctly. We do, however, recommend that the manager and the company look towards an initial supervision session with anyone who has anything of note on their background checks. We asked for a copy of the most up to date training plan. The manager gave us a copy of recent training that she had arranged. The training she had offered since she came into post was varied and covered a lot of subjects. She did tell us that not all of the training had been delivered and that some in-house courses were poorly attended.This plan concluded in November 2009 and she had as yet not prepared a new training plan. Staff had told us that they had not received training in certain areas and that training was never paid for and people often had to do this on their days off. Senior staff told us that some training had not taken place due to problems related to the weather and also said that a number of sessions were poorly attended. The fact that training days are not paid may mean that a number of staff feel unable or unwilling to attend. We looked at the records for people who worked during some of the Christmas shifts that were understaffed. We could not find induction records for some staff. Those records we saw did not contain all the information that is expected at induction. We were told that a new induction programme was being introduced.Two new carers had not received any training but worked in the home when the home was understaffed. There were a number of people who had no manual handling training recorded but were helping people to move around the home on the day. Care Homes for Older People Page 6 of 14 We were told that nurses do keep their clinical practice up to date but there was insufficient evidence produced on the day to show recent clinical supervision. We checked on a number of files at random and one had no evidence at all of training, supervision or development and other files had significant gaps. There was no evidence in the home to show what external training events they had attended. At least three nurses had received no core training in the home (on subjects like safeguarding, manual handling or fire safety) since their initial induction. We looked at numbers of people undertaking National Vocational Qualifications in Care and this was high but we judged that staff undertaking this might be at a disadvantage as some of them had not attended the training that backs up this qualification. Some training on offer lasted for only two and a half hours. These short training sessions were often on complex matters like safe manual handling and on protecting people from harm. A number of the courses on offer lasted for longer but again poor attendance was evident. For example there is an obvious need for everyone who might work in the specialist units to have full training on challenging behaviour. A day long course was offered in November but only four staff and the manager attended. Only around twenty people had attended food safety training. A number of people had not attended fire training or drills and the manager said that they had not given new starters two drills in the first month of their employment. Some staff who are left in charge of the home have not attended fire training or drills and would have to deal with managing a fire situation. The home has problems in relation to staff development and training and although we only looked at a few supervision sessions we were told by the manager that supervision where people could discuss problems, report any abuse and ask for training that would meet their needs was not up to date. We saw some supervision that lacked detail; we saw some where people had had their job role clarified after working in the home for a number of weeks. We saw that some nurses had not attended training or fire drills but there were no supervision records that looked at why they did not attend. What the care home does well:
The service writes some very detailed assessments and care plans about some aspects of some peoples care needs. A number of people told us they were satisfied or happy living in the home and that staff treated them well. The home provides entertainments and activities that are suitable for some people in the service and people are encouraged to participate as much as possible. They have taken on another activities organiser to help with this. Well presented and good quality food was on offer on the day. The two specialist units are newly built and they provide a safe and comfortable environment for people with complex needs. We saw a number of very comfortable and personalised bedrooms. The manager follows the companys procedures when recruiting staff and new recruits
Care Homes for Older People Page 7 of 14 have suitable background checks completed. Staff are encouraged to register for National Vocational Qualifications. A varied training plan was on offer in the last year. What they could do better: 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 2. Care Homes for Older People Page 8 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 14 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, 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 1 3 14 It is required that a full assessment of needs is completed prior to admission. This must be done to ensure that new people enter the home only when a suitably trained and competent person has assessed their care needs and ascertained that the service can meet these needs. 12/03/2010 2 7 15 It is required that all care 12/03/2010 plans are reviewed and that where people have challenging behaviour due to their mental health needs, detailed guidance and strategies are devised and written into the care plan. This must be done to ensure that all staff know how to manage people who have complex and challenging responses to care interactions. 3 8 13 It is required that each 12/03/2010
Page 10 of 14 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 person with complex mental or physical health needs has suitable health intervention plans that will help staff deal with urgent medical or psychiatric problems This must be done so that people with complex needs receive speedy interventions when their health or behavioural needs change. 4 12 16 A programme of social and 12/03/2010 therapeutic activities must be developed for people with organic mental health problems and for people with functional mental health issues. This should take into account ability and any special needs or requirements. Where necessary individual programmes must be drawn up. This must be done to combat lack of stimulation, disorientation and challenging behaviours in vulnerable people. 5 18 13 It is required that, through training or by other means, all staff understand their responsibilities and job role in relation to safeguarding vulnerable adults. This must be done so that staff understand what is abusive and so that they also understand how to report, or
Care Homes for Older People Page 11 of 14 12/03/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 where appropriate, manage any safeguarding issues. 6 27 18 It is required that there are 12/03/2010 sufficent numbers of staff on duty at all times. This must be done so that staffing levels are always in line with the needs and dependancy levels of the people who live in the home. 7 36 18 It is required that staff are 12/03/2010 inducted, supervised and trained so that the staff team can meet the needs of the people in the home. This must be done so that all staff understand their job role and the work tasks that they must undertake. 8 38 13 It is required that all staff attend updates to manual handling training and that their competence in this is checked by persons trained to do so. This must be done to comply with legislation and to ensure that safe manual handling is carried out and that both staff and residents are kept as safe as possible. 12/03/2010 Care Homes for Older People Page 12 of 14 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 1 It is recommended that information contained in the Statement of Purpose reflects the therapeutic care and services provided and gives a true account of training received by staff. It is recommended that nutritional planning is reviewed for people whose mental health needs may lead to problems with maintaining good levels of nutrition and hydration. It is recommended that the company discuss with staff any matters of note that arise during background checks of new recruits and that this is recorded as part of ongoing supervision and development. 2 7 3 29 Care Homes for Older People Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 14 of 14 - 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!
