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Inspection on 03/07/06 for Branthwaite Nursing Home

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

This inspection was carried out on 3rd July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Residents` care and social needs are assessed prior to admission, the residents` are visited by the manager to discuss admission. This put the residents and their families at ease and they felt the home `would be prepared for them`. The care staff have a good relationship with the residents and the residents speak very highly of them, one residents said that `nothing was too much trouble` and `they work very hard`

What has improved since the last inspection?

Records are being kept on the choice of meals offered to residents. Staff in the kitchen are working to a new cleaning schedule which has improved the cleanliness of the kitchen and staff have separate breaks to ensure a safer environment. Storage has improved through out the building and old equipment is being disposed. Cleaning fluid is being used from the appropriate containers

What the care home could do better:

Care plan for the residents need to be accurate and contain current information of the residents care needs. Staff need to have training in medication administration to promote good clinical practices. An audit system must be put in place for the receipt, administration and disposal of medication. Staff should have training appropriate to the needs of the residents including POVA. Staff should be receiving supervision six times a year to provide support and guidance on work related issues. Staff need to improve clinical practices to promote infection control within the home. Staff should promote the residents` privacy and dignity and knock when they are entering the residents` bedrooms. The environment is in need of decoration and up dating in many areas and there must be an action plan developed to improve the environment for the people who live in this home. All bathrooms need to be renovated and made more homely, and several rooms need to have the carpets replaced. Staff must also look to improving the security of the building to keep the residents safe. The home must look to develop a four week rota menu plan that contains a wholesome and varied diet. The residents should be given the opportunity to have input into the activities organised within the home and also be able to have a say in the planning of their day.

CARE HOMES FOR OLDER PEOPLE Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS Lead Inspector Colette Hibbert Unannounced Inspection 10:00 3rd July 2006 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.V289245.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.V289245.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.V289245.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. 2. Date of last inspection 3rd January 2006 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. 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.V289245.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home took place on 3rd July 2006 commencing at 10:00 and finishing at 16:00. Before the site visit information had been gathered on the service from the providers. Information on the service provided was gathered from residents using questionnaires before the visit. Concerns raised by residents and relatives were included in the planning of the inspection. The morning was spent looking around the home talking with residents in the lounge and in their own bedrooms, speaking with staff and observing activities and looking at care plans. Staff personnel and training files were looked at in the afternoon as well as other records required by regulation. What the service does well: What has improved since the last inspection? Records are being kept on the choice of meals offered to residents. Staff in the kitchen are working to a new cleaning schedule which has improved the cleanliness of the kitchen and staff have separate breaks to ensure a safer environment. Storage has improved through out the building and old equipment is being disposed. Cleaning fluid is being used from the appropriate containers Branthwaite Nursing Home DS0000010100.V289245.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.V289245.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.V289245.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): 1,3 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents felt that due to the information given to them and visiting the home prior to admission they were able to make an informed choice. EVIDENCE: Residents spoken with said that they had received information about the home before they made any decision about living there. One relative said that they had been visited by the manager and they had ‘ a good chat about what care was needed’ and it made them feel that the home would be prepared. Another resident said that they looked around with their family and they had chosen the home because they were made very welcome. Branthwaite Nursing Home DS0000010100.V289245.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): 7,8,9,and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans did not reflect a full assessment of the residents care needs, which puts the residents at risk of their care needs not being met. Poor professional practices were observed for administration of medication putting residents at risk from receiving incorrect medication. Resident’s dignity and privacy is not maintained. EVIDENCE: The home is in the process of updating and changing the care plan system. The care plans had some detailed information in them but did not reflect a full assessment of the residents needs, but this should improve with the new systems being introduced. One residents care plan stated that they had a catheter in situ, this had been removed some time previous but the care plan documentation did not reflect this. Residents with PEG tubes in situ had no documentation within their care plans for care of this tube or the prescribed feed regime that they should be receiving. Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 10 This needs to be included to provide guidelines for staff to deliver appropriate care. A requirement was made at the last inspection for care plans to show up to date and accurate information, this has not been met and will be repeated. Medications entering the home are not documented and there is not an audit system in place to monitor medications in stock and any returns. The residents who were taking Digoxin did not always have their pulse taken prior to administration and staff were advised to do this and keep a record. In one resident’s bedroom a pot of tablets had been left on the bedside cabinet, the resident was unable to take the medication without assistance. This is poor professional practice and puts residents at risk. At the last inspection a recommendation was made for staff training on medication administration and it will be repeated. Several times during the day staff were observed entering residents rooms without knocking this is not maintaining the residents privacy. Branthwaite Nursing Home DS0000010100.V289245.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): 12,13,14,and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents can maintain contact with their families but the amount of social activities provided is very limited. Residents are not encouraged to exercise choice and control over their lives as many decisions are made according to availability of staff. The diet is not a balanced or varied one but the residents are offered a limited choice. EVIDENCE: Residents families are made welcome when they visit, one relative said that they visited every day and that the staff always made them feel welcome. One resident said that they now held a local church meeting in the conservatory every week and the staff made the visitors ‘at home’ At present the home does not have an activities co-ordinator, the previous two member of staff had left and the posts have not been filled. Staff spoken with said that they do not have time to do activities as they are busy with personal care. The home does have the use of a mini bus for two weeks but as it is not adapted for wheelchairs it restricts the number of residents that can benefit from this facility. The residents spoken with said that sometimes someone come to sing to them but that ‘was about it’. One resident said that they had a Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 12 hospital appointment and that they were worried that staff may not be available to assist them as their usual helper was on maternity leave. The kitchen stores were not well stocked with fresh produce and the cook said that the next delivery was at the end of the week. The kitchen had a list of the meals ordered by the residents and the cook said that the care staff had asked the residents what they would like. One resident said that the meals were not very good and he was ‘sick of mash potato’ he often asked his son to bring food in and the cook would cook it for him. Another resident said that they had to buy their own cereal, as they home did not stock the one they liked. Residents were limited as to the choices they could make in their lives, due to staffing shortages the home routine revolves around the availability of the staff. One resident said that they got up and went to bed at whatever time the staff came to assist them. They felt that they were left to struggle at times, as staff were not available to assist. Branthwaite Nursing Home DS0000010100.V289245.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, and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families felt that any concerns would be taken seriously and acted upon. EVIDENCE: The service has had one complaint to the commission for social care inspection since the last inspection, regarding infection control and clinical practices by staff within the home. This was investigated by the home and acted upon and an adequate report submitted. The home has a complaints procedure and policy in place, residents’, relatives and staff are aware of this. Residents spoken with said that if they had any complaints they would take them to the manager and she would ‘sort them out’ Questionnaire returned by residents and relatives said that they felt that the home would take any complaint seriously and act upon it. Staff were aware of adult protection issues and knew what immediate action to take. Branthwaite Nursing Home DS0000010100.V289245.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): 19,20,21,22,24,and 26 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The security of the home must maintain the residents safety. The internal and external areas of the home need to be repaired to provide a safe comfortable environment for the residents. EVIDENCE: On arrival at the front of the building all the doors were open, allowing anyone access to the residents sat unsupervised in the open plan lounge. The home must look at its security arrangement to ensure the safety of the residents in their care. The home still has many repair and maintenance issues, many of the radiator covers in the corridors and residents rooms are in need of repair this was identified at the last inspection. Several of the rooms were in need of decoration or repair and new carpets are needed to provide a homely and comfortable environment for the residents to live in. Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 15 One of the baths had the edges broken and this was taped over, this was highlighted at the last inspection and has not been attended to. The bathrooms looked very clinical and bare and not inviting and homely. Shower facilities are not available for residents to have the choice if they preferred. The main dinning room at the rear of the building is in need of redecoration in places. The two conservatories leading off this have been improved and are now pleasant usable areas for the residents to sit in. There are several small areas within the grounds for residents to sit, and relatives were seen to be using these facilities. The kitchen area was clean and a cleaning rota has been introduced. The home in general was clean and much tidier, and storage facilities have been improved. Several of the clinical waste bins in the residents’ rooms do not have lids causing a problem with infection control within the home, this was identified at the last inspection and a requirement will be made. Branthwaite Nursing Home DS0000010100.V289245.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): 27,28,29,and 30 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The numbers and skill mix of staff on duty were not always meeting the resident’s personal and nursing care needs, as promptly as they would like. Procedures for the recruitment of staff are satisfactory offering protection to people living in the home. Staff training and supervision needs to be given suited to meeting residents’ needs. EVIDENCE: The home is having problems with staff shortages and frequently the care team is under staffed. On some occasions the care team have to cover the kitchen as well as attend to the care needs of the residents. Several of the residents said that they had to wait for attention, but they were aware that the staff were very busy. One resident said that the staff ‘would get to them as soon as they could, the staff are very good and they do their best’ Another resident said that ‘there are a lot of us who need help and we have to wait our turn, the staff never stop you know’ On the morning of the inspection the care team was a member short, and a carer from the morning shift stayed on to cover the afternoon shift. Some residents and relative surveys returned to CSCI also indicated that staff were unable to promptly provide the care and support that the residents in this home required. Staff training records and the training matrix indicated that staff had received some training including Moving and Handling, infection control, First Aid, NVQ Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 17 II and III. Dementia, Male Catheterisation, and the student nurse mentor course. Staff spoken with said that they did not receive supervision on a regular basis, but felt this would be a benefit as it would give an opportunity for guidance and discussion on work related issues. Satisfactory recruitment and selection procedures, Protection of Vulnerable Adults ( POVA ) and Criminal Record Bureau ( CRB ) checks had been followed for the staff Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 18 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): 31,33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. The home is not run in the best interests of the residents but based around the care tasks and staff availability. Poor infection control practices were seen putting the residents at risk. Staff do not receive adequate supervision to provide them with support and guidance for caring for the residents in this home. EVIDENCE: The home manager is registered with CSCI. Residents spoke well of her and said she was ‘approachable’. The home has had a change of management recently and this has been a course of concern and uncertainty for both staff and residents. The home should continue to focus on the individual needs of the residents in all aspects of care and keep them informed of the activities and future of the home. Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 19 Staff must receive supervision on a regular basis to provide a means for guidance and support to enable them to provide appropriate care for the residents within the home. Staff were seen putting used bed linen on the floor and carrying it throughout the building, instead of using appropriate receptacles, this is putting the residents at risk of cross infection. Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 20 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 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 3 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 21 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 Requirement All care plans must show how resident’s needs in respect of health and welfare are to be met. (Timescale 28/02/06 has been extended ) All residents health care needs must be met The home must ensure that staff are trained appropriately to do the work they are to perform Audits system must be in place for receipt, administration and disposal of medication Planned daily activities must be introduced within the home Residents must have more opportunity to go out into the local community Residents must be given more choice within the daily routine of the home A four week menu plan must be developed that is wholesome and varied A plan for the improvement of the decoration and up keep of the home must be submitted. The security of the front of the building must be improved DS0000010100.V289245.R01.S.doc Timescale for action 30/09/06 2 3 4 5 6 7 8 9 10 OP8 OP9 OP9 OP12 OP13 OP14 OP15 OP19 OP20 12 13 17 14 16 12 16 23 13 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 Branthwaite Nursing Home Version 5.1 Page 22 11 OP21 23 12 13 14 15 OP24 OP27 OP30 OP33 14 18 12 24 16 17 OP36 OP38 18 12 Bathroom facilities must be improved to provide residents with a choice and bathrooms must be more homely Bedrooms must be decorated and new carpets fitted. A dated plan must be submitted Staffing levels and skill mix must be able to met residents needs at all times Staff must receive training to suit the residents needs Residents must be given more choice in the planning of their day and independence should be supported. Staff must receive supervision six times a year Staff must improve infection control practices. 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Branthwaite Nursing Home DS0000010100.V289245.R01.S.doc Version 5.1 Page 23 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 © 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.V289245.R01.S.doc Version 5.1 Page 24 - 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!