CARE HOMES FOR OLDER PEOPLE
Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS Lead Inspector
Colette Hibbert Unannounced Inspection 3rd January 2006 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 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.V275499.R01.S.doc Version 5.1 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.V275499.R01.S.doc Version 5.1 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 2005 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 40 people, 5 of whom may be aged between 18 and 64 with a physical disability. All of the rooms are for single occupancy. En suite facilities were provided in all but three rooms and those three had wash hand basins in the room with toilet and bathing facilities close by. There were pleasant communal areas. This comprised: One lounge/ conservatory at the front of the home and one smaller lounge at the other end of the home. There was also a conservatory and dining room at the rear of the home. The front lounge had a small area put aside for dining. Outside, there were raised gardens by the rear conservatory, and to the front and side of the home were paved areas with tubs and pots positioned for service users, visitors and staff to enjoy. These grounds were accessible to all residents. There was a large car park to the front and side of the home and access into the home was via a gentle slope allowing access for those in wheelchairs. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection starting at 08.30; finishing at 15.30 the manager was present throughout. During the inspection time was spend with the residents, talking to them individually and in groups. Family members, visitors, a GP, Social Worker, and a Vicar were also spoken to. A selection of records relating to the care of residents and the day to day running of the home were looked at, and all parts of the building including private and communal accommodation were visited. What the service does well: What has improved since the last inspection?
The home has continued with training for the staff with several care staff almost finishing NVQ II. They have had training from the Adult Protection Team and various other day courses have been attended. 2 new carpets have been fitted to residents’ bedrooms. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 7 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.V275499.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 There is a thorough admission procedure in place to ensure the home can meet the residents’ needs prior to admission. EVIDENCE: Residents spoken to said that they had been visited by the manager prior to admission for a ‘chat’. Some said that they and/or their families had looked around the home before moving in. One resident said that he had looked at several homes before ‘picking this one’. A comprehensive assessment is carried out and stored within the care plan along with social workers report and hospital assessments to give a full picture of the persons health and social care need Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 and 11 Some of the care plans within the home did not provide adequate information putting the resident at risk from not receiving appropriate care. Medication procedures within the home are unsafe and put the residents at risk. Residents’ wishes at time of death had been discussed and documented. EVIDENCE: Several care plans were looked at and some were found not to be accurate or to provide the relevant information to enable staff to provide appropriate care. One resident had been admitted early December and apart from the preadmission assessment and daily entry no assessment or risk assessments had been carried out. This would put the resident at risk from not receiving appropriate care and the home could fail to meet his needs. Another resident had a catheter replaced on 17/06/05 and was due to be replaced again in 12 weeks. There was no record of this taking place and staff were unsure what had happened. This puts the residents health at risk. A requirement is made on this issue. Poor professional practices were seen as the medication trolley was left unattended and open in an area that residents could have easily helped themselves. This is putting the residents at risk and procedures for the
Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 10 administration of medication must be reviewed, and staff supervision and training given as appropriate. Residents’ wishes at death had been documented and also families had been consulted. One resident said his wife has not long died in the home and he said that she could not have had ‘ better care or love shown to her’ Most of the staff attended her funeral, which he found a great comfort. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 and 15 The residents are given choices in some areas but not all aspects of their life, especially meal times. The meals although well presented do not provide a balanced pleasing diet to enable the residents to maintain a healthy lifestyle. There are limited external social activities organised for the residents to maintain contact with the outside community. EVIDENCE: Residents spoken to said that they did not get a choice at meal times. Breakfast was porridge, cereal, toast marmalade sandwiches, tea coffee or juice. The care staff served and assisted with this, some residents were in the lounge others in the dinning room or in their own bedrooms. Lunchtime was mash potatoes, carrots, broccoli, and pork casserole followed by semolina or yogurt. All residents were given the same lunch no one had anything different. The residents said the meals were the same ‘week in - week out’ they were described as ‘ok’ by several of the residents. There was no record kept of what the residents had chosen as no choice was given, so there was no system in place to monitor the diets that the residents were taking. One resident said they have sandwiches every tea- time with ‘no choice of filling’ the cook confirmed it was sausage roll and sandwiches for tea. Some of the resident’s required pureed food and this was served in an appealing manner. Meal times were relaxed and the care staff took their time and provided assistance for
Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 12 residents who required it. The store cupboard had no fresh fruit and vegetables available and the delivery was not due for 3 days. The freezers were well stocked. Residents said that they had several entertainments and activities within the home but that they would enjoy more outings. One resident said that they had been to St. Bees in the summer but it was difficult getting transport that would cater for the number of wheel chairs. The manager said it was also difficult getting the staff to support the days out but they hoped to improve this for the residents within the next year and plan a programme of outings. One resident said in summer they go to the local hotel for a drink and sit outside in the garden. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 The home has a complaints procedure which residents and families are aware of. There are systems in place to protect the residents from abuse. EVIDENCE: Residents and visitors all felt that they could if needed make a complaint. They were confident that any concerns would be dealt with in a confidential manner and acted upon. All the residents said that they would be able to talk to the manager. Some of the residents said that they had been asked if they wished to vote and another said that he had been given support from the staff when he had to see his solicitor following his wife’s death. He was given privacy. Staff had been given training on adult protection and those spoken to said were aware of the policies and procedures in place Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24, The home is in need of some updating work and repairs in various areas to provide a safe and comfortable environment for its’ residents. The staffs’ current health and safety practices are putting residents and visitors at risk. EVIDENCE: The carpets in the main corridor are marked and badly stained in places and in need of cleaning. The bath panels in the communal bathrooms had been removed to allow access for the hoist. This had exposed the sharp metal bath fixings and bath feet. This could cause injury to the residents and must be amended. The corners of the communal bath in unit 2 had sharp broken corners which had been part covered in tape but remained a risk for the residents. The roof in the back conservatory was leaking and several buckets were placed to catch the water, consequentially this area was used as a wheel chair store. Several of the residents’ on suite bathrooms had holes in the carpet where equipment had been removed. This could be a potential risk for residents falling. In one of the bedrooms the carpet is very slippy and the staff have
Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 15 placed a notice on the door to advice people of the risk. This must be replaced, as it is not a safe environment for the resident, staff or visitors to the home. Several of the clinical waste bins with the residents’ rooms do not have lids causing a problem with infection control within the home. Some of the radiator covers within the residents’ bedroom are sharp and damaged and could cause injury to the residents and needs to be repaired or replaced. The oven in the kitchen was dirty and had stale food on the base; there was no cleaning rota in place and no documentation since April 2005. This must be rectified to provide a clean working environment; poor standards of hygiene will affect the resident’s health. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,and30 The appropriate number of staff are provided each shift. The home is well understaffed for qualified nurses, which mean that longer hours are worked which could affect the standard of care provided. Some poor professional practices were observed which could put the residents at risk. EVIDENCE: On duty during the morning there was the Manager, 2 qualified nurses 6 care assistants, 3 cleaners, 1 laundry lady, 2 cooks, 1 maintenance man and the administrator. The home has been experiencing a shortage of qualified nurses for some time and would benefit from recruiting extra staff to improve the long term care of the residents. The emergency bell was ringing on unit 2 for approximately 5 minutes with no care staff to be found, the qualified nurse was on the telephone to a doctor. The inspector asked a member of staff from unit 1 to answer the call bell, which she did. The care staff had gone for their break at the same time leaving the unit well understaffed and putting the residents safety at risk. This practice must be reviewed to provide constant assistance for the residents. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33 37 and 38 The Manager needs to look towards strengthening the leadership team to provide continuity of care standards for the residents. Procedures for the welfare and safety of residents need to be reviewed as at times the residents could be at risk. Archiving of old documents relating to staff and residents must be improved to maintain confidentiality. EVIDENCE: The present manager has been in post for some time and the residents and staff all speak very well of her. One resident said that she ‘is friendly but will sort out any problems quickly, and quietly’ There is not a clear deputy, and when the manager is holiday one of the residents said that they would just ‘wait until she was back on shift’. This is something that the providers should look to amending for the benefit of the residents and continuity within the home.
Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 18 The kitchen was left unattended for a period of time during the morning. There was a pan of potatoes boiling on the gas hob and the grill had just been used and was very hot, if a resident had walked in they would be at risk from burn or scold injuries. Cleaning fluid is still being used from bottles without adequate labels; this was a requirement at the last inspection and will be repeated. A jug of thick pink liquid was found on a shelf in the corridor, the residents could have ingested this. It was liquid soap and should be stored securely away from the residents. Within one of the open storage areas there were piles of notes relating to exresidents and staff. All staff and residents have access to this area and it is not appropriate to have confidential notes stored in a public place. This needs to be addressed to retain confidentiality and privacy. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 19 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 X 2 X 2 X X STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X X 2 2 Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15.1 Requirement All care plans must show how resident’s needs in respect of health and welfare are to be met. The home must ensure that staff are trained appropriately to do the work they are to perform Residents must be offered written choices at meal times and records must be kept The registered person must ensure that appropriate numbers of staff are left on duty at break times. A programme and action plan for renewal of the fabric and decoration of the premises must be produced. Recruitment must take place to increase the qualified nurses available for the rota. Records must be stored securely within the home. Staff must ensure the health and safety of the residents from hot water or hot surfaces at all times. All cleaning products must be in labelled bottles in accordance
DS0000010100.V275499.R01.S.doc Timescale for action 28/02/06 2 3 4 OP9.4 OP15.7 OP18.1 18. (i) 16.2(i) 13.4(c) 28/02/06 28/02/06 31/01/06 5 OP19.2 23.2 (b, c, d) 18.1(a) 17.1(b) 13.4(c) 31/03/06 6 7 8 OP27.1 OP37.3 OP38.3 31/03/06 31/01/06 31/01/06 9 OP38.3 13 31/01/06 Branthwaite Nursing Home Version 5.1 Page 21 with COSHH Regulations This is an outstanding requirement from the last 2 reports.06/07/05 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 13 Good Practice Recommendations A planned programme of outings for residents to maintain links with the local community. Branthwaite Nursing Home DS0000010100.V275499.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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