Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 29/04/08 for Branthwaite Nursing Home

Also see our care home review for Branthwaite Nursing Home for more information

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

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. The home works with other healthcare agencies and gets specialist help for residents when this is needed.People coming to the home are given information about it to help them in making a decision. People living in the home we talked with spoke well of the staff and the help and support they get from them. 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. Regular audits of medication are done and this will help to improve the management of medicines to keep people safe. Staff give medication at the time that is best for the people who live there.

What has improved since the last inspection?

The service has been updating the information it gives to prospective and existing residents and making this easily available to people to help them decide bout using the service. Care plans are being developed in a way the focuses more on the individual and their perspective. People`s opinions are also being sought about the service through quality surveys and regular meetings to help improve the service for them. The service has put effort into improving medication practices and has overall maintained the improvement in longstanding problems in this area. The service makes sure that medicines never run out so that people are always able to have the treatment they need. The provision of activities and recreation has been improved and a broader range of activities, including local groups, is now offered including trips out for people. Menus have also been reviewed and people living there told us that the choice and standard of food has improved. The improvements in the system for recording and acting on complaints have been maintained and staff are offered training on adult protection to promote resident`s welfare. All refurbishments have been completed and improved the environment for people living there, including some new shower facilities. The manager and staff have been working hard to maintain the improvements they made at the last visit and need to continue to do this and listen to residents to keep developing the service.

What the care home could do better:

When changes in condition occur and a doctor has stated `palliative care` is needed then an appropriate care pathway should be put in place to make sure that persons palliative care needs can be assessed and met. When actions are stated in care plans following an assessment for an individualthey should be followed to ensure individuals safety and dignity is maintained. When people are using wheelchairs the footplates should be in place to ensure safe working practice and promote people`s safety whilst using them. People should have prompt access to chiropody services when an individual need is identified. Where nutritional risk assessments indicate a high risk weights should be monitored as stated in the plan of care for that person to make sure action is taken quickly if needed. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Social activities and support has been improved but the assessments need to be a consistently good level so those with visual and communication problems are fully included in social interactions. The service must make sure that all records relating to medication, including Controlled Drugs, are accurate to prevent mistakes being made. Care plans for medication should be more detailed so that treatment is delivered to people in a safe and consistent manner. Medicines should be administered from their original packs and not kept in pots to be given at a later time, or loose in boxes, as tablets could get mixed up and cause harm. The manager should ensure that the staff training programme is followed and the work being done to bring mandatory staff training levels up to date is continued so residents can rely on having a competent and trained staff group in place. Staff should receive a minimum of three paid days training per year to ensure they receive the training they need to be competent in their roles. Staff should receive regular formal supervision to support them in their role and this should be recorded.

CARE HOMES FOR OLDER PEOPLE Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS Lead Inspector Marian Whittam Unannounced Inspection 29th April 2008 09::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.V359022.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.V359022.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 Ltd Mrs Pauline Armstrong Care Home 57 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8), Old age, not falling within any of places other category (49), Physical disability (49) Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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 (maximum number of places: 8) The maximum number of people who can be accommodated is: 57 Date of last inspection 2nd November 2007 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 currently charged by the services range from £326.00 to 474.00 and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit that forms part of a key inspection carried out at Branthwaite Nursing Home by two inspectors. We (The Commission For Social Care Inspection, CSCI) were in the home for a total of six and a half hours including a 2 hour ‘short observational framework for inspectors’ (SOFI). The CSCI pharmacist inspector also visited on the same 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 and a half hours. Information about the service was gathered in different ways: • An Annual Quality Assurance Assessment document completed by the manager, identifying what the service does well and what could be improved. • Revised Statement of Purpose • The service history • Observations made by us in the home during the visit. Also a ‘short observation framework for inspectors’ (SOFI) was carried out. This observational tool is used to observe interaction between residents and staff and gain information and insight into how well people’s needs are being met. • Completed questionnaire survey forms from people living in the home. • 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. The specialist Harrington Unit has no residents at present and so was not assessed. 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. The home works with other healthcare agencies and gets specialist help for residents when this is needed. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 6 People coming to the home are given information about it to help them in making a decision. People living in the home we talked with spoke well of the staff and the help and support they get from them. 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. Regular audits of medication are done and this will help to improve the management of medicines to keep people safe. Staff give medication at the time that is best for the people who live there. What has improved since the last inspection? What they could do better: When changes in condition occur and a doctor has stated ‘palliative care’ is needed then an appropriate care pathway should be put in place to make sure that persons palliative care needs can be assessed and met. When actions are stated in care plans following an assessment for an individual Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 7 they should be followed to ensure individuals safety and dignity is maintained. When people are using wheelchairs the footplates should be in place to ensure safe working practice and promote people’s safety whilst using them. People should have prompt access to chiropody services when an individual need is identified. Where nutritional risk assessments indicate a high risk weights should be monitored as stated in the plan of care for that person to make sure action is taken quickly if needed. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Social activities and support has been improved but the assessments need to be a consistently good level so those with visual and communication problems are fully included in social interactions. The service must make sure that all records relating to medication, including Controlled Drugs, are accurate to prevent mistakes being made. Care plans for medication should be more detailed so that treatment is delivered to people in a safe and consistent manner. Medicines should be administered from their original packs and not kept in pots to be given at a later time, or loose in boxes, as tablets could get mixed up and cause harm. The manager should ensure that the staff training programme is followed and the work being done to bring mandatory staff training levels up to date is continued so residents can rely on having a competent and trained staff group in place. Staff should receive a minimum of three paid days training per year to ensure they receive the training they need to be competent in their roles. Staff should receive regular formal supervision to support them in their role and this should be recorded. 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.V359022.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.V359022.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 1,3,4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and facilities is available before and following admission so people have information to help them make an informed choice. Assessments of people’s needs are done before coming to live there to make sure they can be met. EVIDENCE: We looked at the Statement of Purpose/service user guide for Branthwaite and this document has been updated so that it gives up to date information about the services offered and on how the management intends to monitor the quality of care in the home. We discussed with the manager an item in the document that was not accurate and it was removed during the visit. There is an overview of training that is offered to staff, although training records show not all staff have had the training stated in the document. There Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 10 are no numbers of people having done specific training but the manager had included the numbers of staff holding important relevant qualifications such as NVQ. The current Statement of Purpose is on display in the entrance area, together with a copy of the resident’s guide and the last inspection report. If needed and requested this information can be provided in different formats to meet prospective residents particular needs. A separate file in the foyer contained letters and cards sent by families to express their views and thanks for the care given to their relatives. The activities file was also kept with these. This combination gave prospective residents and families more information to help them in there choice of a home. The home had a number of empty rooms and these had been set up as examples for people to view when visiting. A copy of the complaints procedure, a resident’s charter and a welcome letter are placed in the bedrooms. These are all good practices in helping people to make informed choices. Overall people said they had enough information before coming in. One person commented that, “ the manager came to see me at home and gave me all the information about the home and care”. We looked at four people’s care plans and the pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained the relevant information from which to develop an individual’s care plan. The assessments covered 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. The manager discussed with us how the service intends to continue to develop its pre admission assessments to make them more individualised. Where the assessment has been done by social services a copy is included in the care plan. Where appropriate other care agencies and professionals have been involved in providing information before admission and advice after admission. We examined the care plan, and spoke with, a new resident with more complex nursing needs and had been given the opportunity to have a phased introduction to the home from care within their own home. Carers carried on visiting and supporting them after moving in to ensure that they settled in as well as possible. The service does not provide intermediate care. Branthwaite Nursing Home DS0000010100.V359022.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 adequate. 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 usually planned for within individual care plans but there were still some aspects of medication handling that needed to be improved so that the people who live there are fully protected from mistakes that could cause harm. 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, including in relation to skin care, moving and handling and nutritional needs. During the visit we looked at a sample of four care plans. We found that nursing problems and assessments in the care plans are being reviewed although not always updated quickly to reflect a change in condition or need. Each care plan need identified had an accompanying evaluation sheet that had regular entries to review change in needs. However one person whose needs Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 12 had changed on medical instruction to “palliative care” had not been transferred to an appropriate care pathway to make sure those palliative care needs would be met. Daily records showed what personal care was being given, including bathing. However one person whose nutritional assessment indicated a high risk had not had their weight checked as stated in their care plan and it is important that a high risk is closely monitored. We saw that one person needed attention from a chiropodist but no appointments had been made. We drew this to the attention of the manager and staff who were aware of the need and we recommended prompt individual access to chiropody services. We also saw 2 other people using wheelchairs that did not have footplates in place for safety and 2 people in suitable chairs but with their legs dangling without support. One person did not have socks or stockings on their legs for protection as stated in their care plan. We discussed with staff and the manager, who were able to tell us about the person’s needs, the need to follow care plans and maintain safety and dignity at all times. A recent addition to care plan section has been a Capacity to Consent evaluation and outcomes. This is good practice where an individual’s capacity is compromised by their condition. In some care plans resident’s own perception of their conditions and needs had been included, for one person this was around incontinence, for another there was a plan to help staff with communication needs. Surveys and people who spoke to us indicated that they felt they received the care and support they needed. One short term resident told us, “Had a very good stay, everyone has been helpful. I would like to go back to Branthwaite in the future”. The management of medicines was mostly adequate and the manager did regular audits to ensure improvement in this area. Most medicines records were well completed but mistakes still crept in. For example, on occasion’s records said medicines had been given when they had not. On the morning of the pharmacy inspection we saw medicines being taken from the medicines trolley to give to a person but the record had already been signed. These medicines had also been dispensed into a medicine pot and were kept loose in the trolley with a slip of paper with the persons name on. Further loose tablets were also found that had been removed from blister packs. This increases the risk of medicines getting mixed up, and signing the records before medicines are given could also result in important treatment being forgotten. Staff ordered and looked after prescribed medicines on behalf of the people who lived there and made sure that they never ran out. Staff tried to make sure that people received their treatment at the time that was best for them. One person who we spoke to said that they looked after and took their own over-the-counter remedies. Care plans were examined but did not record this so that there was no guidance for staff to follow if the person had problems coping with it. There were also no records to show that staff had checked that these remedies were safe to take with other prescribed medication. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 13 Other care plans relating to medicines were checked and were variable in their level of detail. For example, whereas one care plan gave clear information relating to medication another lacked detail relating to the complex administration of medication through a tube into the stomach. Clear guidance is needed in the care plans so that staff followed safe and consistent practices that protected the people who live there from harm. Services must, by law, keep good records of medicines that are liable to misuse, called Controlled Drugs, in a bound register and these were not always accurate. Occasional records in the register had been over-written and scribbled so that it was not possible to read them clearly. Other records clearly stated that medicines had been administered when in fact they had been refused and destroyed. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 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 are able to make lifestyle and day to day choices, follow their own interests if they want and maintain social and family contacts. The different dietary needs of the residents are being catered for. EVIDENCE: The service has been continuing to develop and improve its range of activities and recreational opportunities for people living there and we saw that a good amount of choice is being offered to and exercised by people in their daily lives. The service has undertaken its own activities audit and formulated an action plan from this. Personal profiles and life histories are included in people’s care plans and usually a good social assessment. Although for one person with visual impairments, who would benefit from a more detailed social and activities assessment in their care plan, there was not one in place. However, another person with complex needs had a really good social assessment showing their inclusion in discussions and what they wanted, communication plans and signs and pictures. We saw during the ‘short Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 15 observation framework for inspectors’ (SOFI) session that overall there is a good level of staff engagement and people’s state was mainly positive. Staff engaged with residents in pleasant conversations about relatives and about favourite things, staff took time to sit next to a resident who wanted to chat. This was good validation of the person and contributed to a pleasant atmosphere. We discussed with the manager that the readings of our observations of peoples experiences could have been improved further by staff making the most of opportunities to engage with less able people. For example on a number of occasions staff would come into the room and have a quick look round and go out again, as people had their eyes shut but by observing it was clear they were not asleep. We recommended that social and activities assessments should be at a consistently good level of detail to promote the provision of meaningful activities for those with visual and communication impairments so they are always socially included. The home’s activities coordinator plans and facilitates activities both in the home and in the local community. One survey comment from a resident was that, “The girl who runs the activities is very good and works hard at everything she does”. There is an activities file on display in the foyer with pictures of events and the activities such as carpet bowls, parties, musical entertainments, religious services and general activities and these are advertised in advance on the residents notice board. One person said that they were really pleased to say that they could play bowls this without any help and that other people who you might think could not do it so well had a go as well with staff helping them. Discussions and observation of staff and coordinator indicated a greater enthusiasm and understanding of individual preferences and different needs than at the previous inspection. One new resident said they liked all the activities on offer and joined in most of them. The home does have the use of the organisation’s mini bus for residents, which they book in advance. The service is developing links with the local Alzheimer’s Society and a recent trip to one of their Tea Dances had been greatly enjoyed by those participating. There arrangements with local churches for opportunities for religious observance and there is a monthly communion and service for those who want to attend. One person told us they had plenty to do and was pleased to have been offered a larger room that accommodated all their belongings and showed evidence of past hobbies such as painting. They said that the activities coordinator would come down and play dominos with them and how much they enjoyed and looked forward to this. This person was asked by staff if they would like to join in a craft session after lunch but decided they wanted some quiet time to smoke their pipe, and maybe go out for a walk in their wheelchair. Nutritional assessments were found in all care plans examined and plenty of choice was being offered to people at mealtimes. Menus and choices were displayed in the dining room and the cook said she would ask people in the morning what they would like. Where people had pureed or soft foods these Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 16 had been displayed to ensure they still looked appetising. People were asked where they wanted to have their lunch and when assistance was needed it was given discreetly and encouragement given to promote independence. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to express their concerns knowing they will be listened to and acted upon. 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, including the timescales. Survey responses indicate that the majority of people in the home know how to make a complaint and one person who did not know said that, “ Staff are informative and would tell me who to contact if needed”. Three complaints had been received and logged by the service and had been investigated and responded to within the timescales set by their own procedure. Survey responses from residents said that staff listened to them and responded to what they said. One person said, “Most of the staff listen and act on what you say. It is better now since some of the old staff left”. Since the last inspection CSCI has not received any complaints about the service. Since the last inspection the manager has continued to follow and use the service’s improved complaints system that was put in place for recording and investigating complaints more thoroughly. This has been successfully followed and maintained to ensure a much clearer and more detailed recording Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 18 and investigation process so people can have greater confidence their concerns and complaints will be fully followed up. Details of the complaint were clear and what actions had or were in the process of being taken to attend to it were recorded. The follow up actions needed were stated and the complainant’s agreement obtained regarding these and the outcome of the investigation. There are clear and thorough adult safeguarding procedures and whistle blowing in place in line with multi agency guidance on this. These have recently been reviewed and updated. The manager has attended training courses to be able pass on Protection of Vulnerable Adults (POVA) training to staff. Records show that staff have been offered the POVA training and many have done it, so they will know how to respond to any allegations of abuse. There have not been any referrals made under adult protection procedures. Where equipment that may limit freedom is used such as bed rails this is done following a risk assessment and discussions with families using ‘best interests’ where a person cannot on that occasion give consent themselves. Staff we spoke with felt comfortable raising any concerns with the manager. There is information within the home on contacting and using advocacy services if people want this. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 19 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. The environment within the home is of a consistent standard providing resident’s with a well- maintained, well-equipped, clean and homely place to live. EVIDENCE: The home is being well maintained with an overall good standard of decoration and provides a clean, tidy and homely environment for residents. The home was clean and tidy and there were no lingering odours. Significant decorative improvements were made during the earlier refurbishment of the home including carpets and furnishings and this has helped provide a bright, well lit and relaxed atmosphere. There are ample dining and lounge areas for people in the home and these were clean and Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 20 homely with domestic style lighting and good natural ventilation. There is now a pleasant ‘coffee shop’ area that has tea and coffee making facilities and café style tables so visitors and residents can have drinks and sit, although during the visit this was not seen to be used for that. The hairdressing room has also been improved and attractively decorated as part of refurbishments. There are sufficient bathrooms and toilets to meet the assessed needs and all are suitable for anyone who may have a physical disability. Two new showers have been installed and on person has their own shower chair. There are handrails on the corridors to assist with mobility around the home and suitable range of moving and handling equipment and aids in the home that are being serviced and maintained to help residents get about. Records are kept of the testing of water temperatures to minimise the risk of scalding. The home was warm and well lit and call bells were seen to be accessible. Resident’s bedrooms seen were clean and well decorated and the people living there had personalised them, as they preferred. All rooms are single occupancy. The laundry was very clean, well organised and tidy and the sluice room was being kept locked and was clean and generally tidy. The service has infection control procedures in place and staff were observed to be following these as they carried out their duties. Training records showed that infection control training has not been received by all staff in the home and this should be done to help ensure good and safe working practices. We discussed this with the manager who was aware of this need and training plans evidenced that staff were being offered this training again which was booked for sessions in May and July this year. The home has its own maintenance person to attend to day to day matters and the manager does a daily ‘walk round’ premises audit to highlight any areas needing attention. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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 current resident’s personal care needs and their safety is being promoted through suitable recruitment processes. Shortfalls in staff training may affect the consistency in some areas of care. EVIDENCE: We discussed the staffing arrangements with the manager and examined the nursing and care staff rotas. Given the reduced number of residents in the home at present the staff levels during the day and night were suitable to meet their needs. The rotas were clear and there was a suitable skill mix of staff on duty. The activities coordinator works from 12 to 4pm 5 days a week and is available at busier lunch times to assist people who need it with their meals. There is a laundry assistant who maintains good standards and domestic staff keeping the home clean. Staff records and their comments on the recruitment process indicated that the homes procedures are being followed. Satisfactory recruitment and selection procedures, Protection of Vulnerable adult (POVA) and Criminal Record Bureau (CRB) checks and nursing registrations checks have been done been for the new staff. Two references have been taken up before new staff start work. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 22 There has been a significant level of staff turnover in the last year and bank and agency staff have been used to cover when needed. Some residents commented on this saying” Due to high turnover of staff you get used to them and then they leave, but there is usually someone somewhere when you need one”. Staff files have been audited to ensure they are up to date and any disciplinary matters and actions taken with staff recorded. All grades of staff have job descriptions. All staff have their own individual training records and new staff are being given an induction. The manager has an overall training plan and recognises the importance of providing training both mandatory and more broadly. She encourages staff to undertake NVQ training and more staff are taking this or working towards it up but the overall level is below 50 of all staff with this qualification. Several staff have left over the past 12 months and may of those had the qualification so reducing the number of staff with it. As part of their improvement planning for the next 12 months the manager intends to support newer staff, as much as resources allow, to do this course. However the manager cannot always ensure staff attend the training that is put on as staff are expected to attend training in their own time. The manager and provider need to ensure that staff get appropriate support to ensure attendance for at least the mandatory training needed for the work they do. Training records showed that several staff had not done moving and handling training, infection control and not all care staff had food hygiene training. Sessions were due to take place on in the home to update staff on these but there was no guarantee that staff would all attend the training offered in their own time. This makes it difficult for the manager to ensure their training plan can be followed. We recommended that the staff training plan programme is followed and the work being done to bring staff mandatory training levels up to date continued so residents can rely on having a competent and trained staff group in place. We also recommended that the service provide at least the minimum 3 days paid training to help make sure that staff will attend at least mandatory training. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 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. The home is being run in a way that includes the people who live there and promotes their interests and welfare. EVIDENCE: The home has a suitably qualified and experienced manager who is registered with CSCI. 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 continue to improve the service. Talking to staff and residents the manager is seen as accessible and approachable. The manager has carried out annual appraisals with staff and undergone this process herself. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 24 This looks at individuals performance, their training and development needs, their strengths and areas for improvement and the team overall. This is a valuable exercise to help staff and the service develop. However individual formal staff supervision on a regular one to one basis is not being done on a regular basis throughout the year and that should be addressed and brought up to date so staff are formally supervised and good practices and procedures supported throughout the year. In discussion with the manager we emphasised the need to maintain monitoring of working practices and make sure staff consistently follow the policies and procedures in place. There are some quality assurance tools for self-monitoring in use and the service has improved in this area. Audits of systems have taken, including staff files, care plans, medication records and the premises. Some policies and procedures have been reviewed and changed where needed to promote good practice. There are now regular residents and relatives meetings to get people’s views and suggestions and also regular day and night staff meetings to get staff feedback and exchange of information. The home is undertaking quality reviews using residents and relative’s surveys, which are easily available in the home. Results are collated for action to be taken. The home had systems in place to safeguard resident’s monies and a check showed transactions are recorded, accurate and receipts kept. The manager does a weekly audit and the operations manager a spot check and also a full audit periodically. Discussions with the manager, observations and records confirmed that safety checks are being done and moving and handling and emergency equipment is being maintained and serviced through annual service level agreements. The service has a contingency action plan in place for winter and emergency planning. Fire training is up to date for staff and drills are being held and recorded. Some areas of training and updates on Health and Safety, infection control and moving and handling are still underway to bring all staff up to date. We observed that some people using wheelchairs did not have footplates in place for safety and this should be done to ensure safe working practices and people’s safety during use. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 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 3 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 3 3 X 3 2 X 2 Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 01/06/08 1. OP9 13 (2) All records for medication, including Controlled Drugs, must be accurate to keep people safe from errors. Medicines administration records must be signed at the time that they are given RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP7 OP8 OP8 Good Practice Recommendations Where ‘palliative care’ has been ordered by the doctor an appropriate care pathway should be put in place to make sure palliative care needs are met. When actions are stated in care plans for individuals they should be followed to ensure individuals safety and dignity is maintained. People should have prompt access to chiropody services when an individual need is identified. Where nutritional risk assessments indicate a high risk DS0000010100.V359022.R01.S.doc Version 5.2 Page 27 Branthwaite Nursing Home 5. OP9 6. 7. OP9 OP12 8. 9. OP30 OP30 10. 11. OP36 OP38 weights should be monitored as stated in the plan of care for that person. The practice of dispensing tablets into medicine pots in advance of administration, and keeping loose tablets that have been removed from their blisters, should be reviewed to prevent mix-up of tablets and possible harm. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment Social and activities assessments should be at a consistent level of detail to promote the provision of meaningful activities for those with visual and communication impairments to make sure they are socially included. Staff should receive a minimum of three paid days training per year to ensure they receive the training they need to be competent in their roles. The manager should ensure that the staff training programme is followed and the work being done to bring mandatory staff training levels up to date continued 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 and this should be recorded. When people are using wheelchairs the footplates should be in place to promote people’s safety whilst using them. Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 © 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 Branthwaite Nursing Home DS0000010100.V359022.R01.S.doc Version 5.2 Page 29 - 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!