CARE HOMES FOR OLDER PEOPLE
Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS Lead Inspector
Marian Whittam Unannounced Inspection 2nd November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Branthwaite Nursing Home Address Branthwaite Road Workington Cumbria CA14 4SS 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) 01900 67111 01900 68339 Aspenframe Limited Mrs Pauline Armstrong Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: - up to 40 service users in the category of OP (Older People over 65 years of age, not falling within any other category) - up to 5 service users in the category of PD (Adults with a Physical Disability) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The en suite bathroom in the room named Keddie 2 must be fully redecorated by 28th February 2005. 5th July 2007 2. 3. Date of last inspection Brief Description of the Service: 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 for 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 charged by the services range from £373.00 to £396.00 and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit that forms part of a second key inspection carried out at Branthwaite took place over two days. On the first day we (The Commission For Social Care Inspection, CSCI) were in the home for a total of 5 hours. The CSCI pharmacist inspector visited on the second day and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager Pauline Armstrong, other staff and residents. The pharmacy inspection took four hours. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment document completed by the manager at their first key inspection, identifying what the service does well and what could be improved. • Revised Statement of Purpose. • Improvement Plan submitted following the last key inspection. • The service history • Interviews with residents, visitors and staff on the day of the visit. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined. We also looked around the new extension that forms the specialist Harrington Unit, which has no residents at present. What the service does well:
All residents are fully assessed prior to admission to ensure all needs can be identified and met and information obtained from other agencies where appropriate to develop a care plan for people. All the bedrooms in the home are for single occupancy and people living there are able to bring in their own things from home, pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. Residents are provided with a safe, clean, and comfortable place to live Some people using the service made positive comments on living there, one person who has lived there several years told us, “ I am very happy here”. The service had good systems in place for handling and monitoring Controlled Drugs.
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The manager should consider making sure the information in the Statement of Purpose/service user guide can be available in formats to suit different capabilities such as the visually or hearing impaired. The statement of purpose should include the relevant qualifications of the staff working at the home. The manager should consider ways to further improve opportunities for individuals to be supported to identify their interests and goals and work to
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 7 achieve them. For quality assurance improvement it is recommended that the manager regularly audits the complaints process to monitor its effectiveness. Record keeping for medication must be improved and medicines administered safely to reduce risk to residents’ health. The service must review procedures for ordering medicines to make sure that they never run out and residents always have the treatment they require. The service should make sure that medicines are stored at the right temperature to protect their quality. Medication audits by the manager need to be more thorough to protect residents from errors and the temperature of the medicines fridge should be monitored to protect the quality of the medicines stored there. Recruitment processes should be consistently applied in all respects to make sure they always promote the safety of people living in the home. The training matrix being used shows that there are still significant numbers of staff needing training brought up to date on Moving and Handling, Adult Protection, Infection control, and health and safety and some fire training. It is important that this training is done quickly as planned especially as the Statement of Purpose, given to prospective residents, says all staff have such levels of training. To further develop practice the manager should consider looking at ways to make the assessment and admission process more personalised to the individual. Wound care plans and assessments should be kept up to date so all nursing staff manage them effectively as planned. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 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 Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This service provides prospective residents and/or their representatives with information to help them choose a home that will meet their needs. EVIDENCE: We looked at the Statement of Purpose/service user guide for Branthwaite and this document has been updated so that it gives more information about the services offered and on how the management intends to monitor the quality of care in the home. There is an overview of training given to staff, although training records show not all staff have the training stated in the document. There are no numbers of people having done the training or holding relevant qualifications such as NVQ. The current Statement of Purpose is in a standard written format and on display in the entrance porch, together with a copy of the resident’s guide and the last inspection report. The manager should, to
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 10 help develop good practice, consider making sure this information can be available in formats to suit different capabilities such as the visually or hearing impaired or in pictorial formats. The manager completes a needs assessment before any resident is admitted to help make sure the home can meet their needs. Details from these assessments are used when the care plans are prepared. Where the person had come to the home through care management arrangements the home had obtained a copy of the assessment from social services. The assessments cover the personal, social and health care needs of people so individual needs can be identified and the home can assure people it can meet them before they come in. To further develop practice the manager should consider looking at ways to make the assessment and admission process more personalised to the individual. Information recorded about social interests and communication needs has however improved and more information is now being gathered on this. There is a Statement of Purpose for the new Harrington Specialist unit for people with neuropsychiatry type illnesses. This unit has no residents as yet so it is not possible to assess the stated aims against the services being provided. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being assessed and planned for within individual care plans but medication continues to be poorly managed placing resident’s health at risk. EVIDENCE: All people living in the home have a care plan stating the actions to be taken by staff to meet their assessed care needs. The plans include assessments of risk in relation to skin care, moving and handling and nutritional needs. During the visit we looked at a sample of five care plans. We found that nursing problems and assessments in the care plans are being reviewed and for the most part updated to reflect a change in condition or need. Although for one person their wound care management plans had not been reviewed and updated since August, so their progress was difficult to monitor as a result. Records for receipt, administration and disposal of medicines were not always accurate so that it was impossible to track all medicines to show that they
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 12 were handled properly and this also placed residents at risk from errors. Some records for administration of medicines, especially eye drops, were not signed and it was not possible to see if residents had received their treatment. Some medicines that were refused by residents were not recorded for disposal and could not be found. Some medicines were not signed for administration at all and it was not clear if residents still needed these or if their doctors had stopped them. These errors could result in residents not getting the correct treatment and this could adversely affect their health. Medicines such as those for pain and epilepsy had been allowed to run out and residents had to go without the treatment they needed. On one day a resident received more medication than they should have, another resident received medication that belonged to someone else no longer in the home. Sometimes tablets were crushed before they were given but records failed to show that proper checks had been made to make sure this was done safely. The manager said she was in the process of updating care plans for medication and this is needed for complex situations such as tube feeding to make sure that administration is done safely. Training was planned for nursing staff on crushing medication for people with swallowing problems. There were no residents who looked after and took their own prescribed medicines. However, one resident was able to take his own over-the-counter vitamin supplement. He said that the nurses always gave him his prescribed medicines regularly and on time. Storage was mainly adequate however the medicines fridge was too cold most of the time and this could affect the quality of the medicines stored there such as insulin. This could make medication unfit for use and could cause harm. Controlled drugs were however well managed and were being checked regularly. The manager did regular audits of medication but these must be more thorough in order to highlight and manage errors such as those found at this inspection. The manager undertook assessment of staff in the handling of medicines and this was nearly complete for all staff with plans to repeat this every six months. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service are given opportunities for recreation and are supported to maintain their independence. The different dietary needs of the residents are being catered for. EVIDENCE: There is a part time activities organiser who has been working with people living there and talking with them to build up and record a picture of what they like and want to do. Information recorded about social interests and communication needs in the care plans has improved and more information is being gathered on this to help inform activities provision. The manager should consider ways to further improve opportunities for individuals to be supported to identify their interests and goals and work to achieve them. The organiser arranges group activities such as bingo, dominos, bowls and also helps people with individual activities such as reading to them, chatting and doing hand massages. The hairdresser also visits the home regularly. In
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 14 fine weather people can sit outside, take walks around the immediate area. There is a resident’s notice board in the entrance area with information on forthcoming events, such as visiting musicians and a Christmas shopping trip and to see the festive lights. The home does have the use of the organisation’s mini bus for residents, which they book in advance. The manager has made arrangements with local churches for more opportunities for religious observance and there is now a monthly communion and service for those who want to attend. Those who want to can be visited by their own religious ministers and follow their religious preferences. A local church choir is also due to visit in December, helping to promote better community involvement with the home. We spoke with the manager about activities in the home and she is hoping to get families more involved in future social events. One person told us that there is “plenty going on” and they had particularly enjoyed the recent Halloween party. People told us they did not have to join in activities if they did not want to and one told us they decided how they spent their time and what they did. Some people did say that staff levels could affect their opportunities for going out although some people went out with their families. A four weekly menu is in use and the food being served was as stated on the menu. People living in the home told us they were being offered a choice of food and several people made positive comments about the food. One person told us the food was “nice” although “not always very hot”. Another who was having fish and chips for their lunch said it was “excellent”. We observed lunch being served and obviously enjoyed by the residents. It was a more relaxed occasion than at the last inspection. The home has reviewed the dining arrangements and this had made mealtimes more relaxed and less rushed as one dining room was being used. This also allowed staff more time with people to monitor and assist them with their meal. The manager and staff have been working to improve this area of people’s lives and now need to maintain the improvements made and build on them. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaint and adult protection procedures are in place and people who use this service are able to express their concerns. Their protection from abuse is being promoted through staff training and relevant procedures. EVIDENCE: The home has policies and procedures in place in relation to complaints and concerns, with details on display throughout the home and in resident’s bedrooms. The complaints procedure is also contained in the resident’s guide that is given to all new residents. The procedure is not available in other formats to suit different capabilities. Since the last inspection CSCI has not received any new complaints about the service. Since the last inspection the manager has put a new recording and investigation system in place for recording and investigating complaints that is a great improvement on the previous method. Details of the complaint and what action is being taken to attend to it are recorded, the follow up actions and the complainant’s agreement with the outcome. We discussed with the manager the need to make sure the records were kept with sufficient detail to give a clear trail of events. This is a new system and the manager needs to make sure it is adhered to, properly monitored and that the improvement can be maintained over time so people have confidence in it. For quality assurance
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 16 it is recommended that the manager regularly audits the complaints process to monitor its effectiveness. Some adult protection/mistreatment of vulnerable adults training has been provided for the staff and more is planned to take place. There are policies and procedures in place covering adult protection and abuse and the home also has a copy of Cumbria Council’s protocol that is available for the staff. There have not been any referrals made under ‘Safeguarding Adults’ procedures. There is information within the home on contacting and using advocacy services if people want this. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21,22, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy a comfortable and homely living environment. The premises have been refurbished and are being maintained and kept clean and generally tidy. EVIDENCE: We conducted a tour of the building looking at the environmental standards within the home. An extension has been built in the grounds of the home and a major programme of redecoration and refurbishment in bedrooms and communal areas has been almost completed within the home to improve the facilities and environment for people living there. This has included new carpets and soft furnishings and made a lighter and more attractive place to
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 18 live. People living there told us they were happy with their rooms and the improvements that had been made. The registered manager has been doing risk assessments to help identify and as far as possible reduce risks to the safety and well being of people living there whilst any work is going on. Currently there are only minor items of work that need completing and should not be too disruptive. Communal areas have been improved thorough the refurbishment and a ’coffee area’ added for use by families and staff. The hairdressing room has also been improved and attractively decorated. There are sufficient bathrooms and toilets to meet the assessed needs and all are suitable for anyone who may have a physical disability, although some still need to be have the improvements completed. There are handrails on the corridors to assist with mobility around the home. The home was warm and well lit and call bells were seen to be accessible. Resident’s bedrooms seen were clean and people living there had personalised them, as they preferred. One person had pictures they had painted themselves displayed in their room and equipment for their painting organised in their room. The laundry was well organised and tidy and the sluice room was being kept locked and was clean and generally tidy. We made a tour of the new Harrington Unit, which was attractively decorated and furnished. It was discussed with the manager that the positioning of the laundry could have implications for the transport of dirty laundry. It may have to pass through resident’s communal areas and where food is eaten. The manager was advised they should address this potential risk before people move in. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of care staff on duty is adequate to meet resident’s personal care needs and their safety is being promoted through suitable recruitment processes. Some shortfalls in staff training may affect the consistency of some areas of care. EVIDENCE: We discussed the staffing arrangements with the manager and examined the nursing and care staff rotas. These were clear and legible and staff were no longer altering shifts without agreement with the manager. The numbers of staff skill mix on shifts was better suited to meet resident’s needs than at the last inspection. The rotas show that new staff had an induction period using common induction standards and work with a more experienced staff member, so improving supervision. The manager is still recruiting staff for the home and the new unit and recruitment practices were found to be generally in satisfactory order. The manager must make sure that recruitment procedures are consistently robust, as on two occasions staff had started work before both references were back or followed up. Staff had Criminal Records Bureau (CRB) checks and also against the Protection of Vulnerable adults (POVA) register to promote the safety and interests of residents.
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 20 The manager has been addressing the need to have a clear annual training and development plan and personal training profiles in place for staff and was clear about what they still needed to do and how this would be done. There was evidence of training being brought up to date and training sessions planned and in progress to make sure all staff were at the same level. NVQ level 2 training is established in the home and is continuing. The training matrix being used shows that there are still significant numbers of staff needing their training brought up to date on Moving and Handling, Adult Protection, Infection control, and Health and Safety and still some fire training. It is important that this training is done quickly as planned especially as the Statement of Purpose, given to prospective residents, says all staff have such levels of training. The work being already done by the manager and staff demonstrates an improvement in their approach to planned training and development. This work should continue to be developed so that a detailed programme of relevant training is always in place and carried out. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service live in a home that is safe and being run to promote their best interests. EVIDENCE: The home has a suitably qualified registered manager with experience of working with older people and has completed the registered manager’s award. She also undertakes periodic training to develop her skills. In discussion with the manager we found she had an understanding of what needs to be done to improve the service and was being supported in this by the Providers.
Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 22 A Deputy manager has recently been appointed to support the registered manager and help supervise staff. We spoke to staff about morale in the home after a difficult period of change and many staff changes. Some staff felt morale and team working was improving and staff levels were generally better overall. Staff records and staff comments suggest they are not getting regular supervision. However the manager has started to put systems in place to try to put this right. There are some quality assurance tools in use and some audits of systems taking place to monitor quality. Residents meeting are being held and the home is sending out satisfaction surveys to get people’s views and to help identify what people want from the service. These should be collated and displayed when complete. The staff survey has not been done recently and the manager should consider repeating this to get staff feedback on the service and morale. The manager needs to keep working at improving the quality monitoring systems in the home. The home takes care of a small amount of money on behalf of some residents. This is used to pay for hairdressing newspapers and toiletries. Individual records are kept with two members of staff recording and checking each transaction. This helps to ensure that residents’ finances are protected and managed safely. Discussions with the manager, observations and records confirmed that safety checks are being done and equipment is being maintained and serviced through annual service level agreements. Fire training is being brought up to date. Some areas of training on Health and Safety, infection control and moving and handling are still underway to bring all staff up to date. Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 24 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 OP9 Regulation 17 Requirement Records for receipt, administration and disposal of medicines must be accurate to show that medicines are handled properly. This was to be met by 10/07/07 Medicines must be given as prescribed so that residents receive the right treatment This was to be met by 18/06/07 and again by 10/07/07 Procedures for crushing medication before administration must be reviewed so that this is done safely. This was to be met by 10/07/07 Medicines must never be allowed to run out. This was to be met by 18/06/07 and again by 10/07/07. Medicines prescribed for one person must not be used for the treatment of others to prevent
DS0000010100.V349579.R01.S.doc Timescale for action 06/12/07 2. OP9 13 (2) 06/12/07 3. OP9 13 (2) 06/12/07 4. OP9 13 (2) 06/12/07 5. OP9 13 (2) 06/12/07 Branthwaite Nursing Home Version 5.2 Page 25 risks from the wrong treatment being administered RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The manager should consider making sure the information in the Statement of Purpose/service user guide can be available in formats to suit different capabilities such as the visually or hearing impaired. The statement of purpose should include the relevant qualifications of the staff working at the home. To further develop practice the manager should consider looking at ways to make the assessment and admission process more personalised to the individual. Wound care plans and assessments should be kept up to date so all nursing staff manage them effectively as planned. Medication audits need be more thorough to protect residents from errors. The temperature of the medicines fridge should be adjusted to protect the quality of the medicines stored there. The manager should consider ways to further improve opportunities for individuals to be supported to identify their interests and goals and work to achieve them. For quality assurance it is recommended that the manager regularly audits the complaints process to monitor its effectiveness. Recruitment processes should be consistently applied to make sure they always promote the safety of people living in the home. The manager should ensure that the work being done to bring staff training levels up to date are continued and followed quickly so residents can rely on having a competent and trained staff group in place. Staff should receive regular formal supervision to support them in their role. 2. 3. 4. 5. 6. 7. 8. 9. 10. OP1 OP3 OP8 OP9 OP9 OP12 OP16 OP30 OP30 11. OP36 Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 26 Branthwaite Nursing Home DS0000010100.V349579.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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