Inspection on 05/07/07 for Branthwaite Nursing Home

This inspection was carried out on 5th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

Other inspections for this house

Branthwaite Nursing Home 04/05/10

Branthwaite Nursing Home 16/03/10

Branthwaite Nursing Home 15/01/10

Branthwaite Nursing Home 14/04/09

Branthwaite Nursing Home 29/04/08

Branthwaite Nursing Home 02/11/07

Branthwaite Nursing Home 03/07/06

Branthwaite Nursing Home 03/01/06

Branthwaite Nursing Home 05/07/05

Branthwaite Nursing Home 14/10/04

Branthwaite Nursing Home 14/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Branthwaite Nursing Home Branthwaite Road Workington Cumbria CA14 4SS Lead Inspector Marian Whittam Unannounced Inspection 5th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Branthwaite Nursing Home DS0000010100.V338230.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.V338230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Branthwaite Nursing Home Address Branthwaite Road Workington Cumbria CA14 4SS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01900 67111 01900 68339 Aspenframe Limited Mrs Pauline Armstrong Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: - up to 40 service users in the category of OP (Older People over 65 years of age, not falling within any other category) - up to 5 service users in the category of PD (Adults with a Physical Disability) The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The en suite bathroom in the room named Keddie 2 must be fully redecorated by 28th February 2005. 3rd July 2006 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 have 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 are raised gardens by the rear conservatory, and to the front and side of the home are paved areas. Some information is made available in a statement of purpose and service user guide but this is not on display. The fees charged by the services range from £373.00 to £396.00 and this does not include personal toiletries, personal newspapers, magazines and hairdressing. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 5th July 2007. The inspector and regulation manager undertaking the visit looked around the home and spoke with the manager, people living there, visiting relatives, professionals and with staff members, both nursing and care staff, including the cook, domestics, activities organiser and laundry staff. Staff recruitment records, complaint investigation records, training records and care plans were examined and a selection of other records required by regulation. Time was spent in communal areas observing staff and residents activities and interactions during the day. Information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection was provided by the manager. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activities including written concerns and complaints raised with CSCI by people coming into contact with the service. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their experiences of the home What the service does well: Residents’ care needs are being assessed prior to admission to the home and information obtained from other agencies where appropriate to develop a care plan for people. Generally the home is kept clean and tidy and people spoke well of cleaning and laundry staff and some care staff. People living there are able to bring in their own things from home, pictures, ornaments and suitable items of furniture and to make their rooms more homely and personal. All the bedrooms in the home are for single occupancy. Some people using the service made positive comments on living there, one person felt their “room is nice” and a relative said “staff are welcoming and always offer a cup of tea”. Residents are able to look after and take their own medicines if they want to and are able to do so and help them stay independent in this respect. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The information in the statement of purpose combined with the service user guide needs reviewing to make sure it is accurate and comprehensive. This includes making sure some items of information required by the regulations are included and made clear especially around making it clear how needs will be met. This kind of information, in formats suited to different capabilities, is necessary so people can make a fully informed choice about whether or not the home is suitable and able to meet their particular needs. To develop good practice the manager should look at ways of making sure that sufficient time and effort is always taken to support people making the life changing decision to live in the home and work towards developing a person centred and individualised approach to admission processes and care planning in general. Ways of involving and engaging with people living in the home need to be improved so they feel their voices are heard. This includes improving the way complaints are recorded and investigated so people can have confidence in the system. The manager should conduct a review of the quality monitoring practices in the home to find ways to improve the involvement of residents and stakeholders and make sure the present systems are working to improve quality for people living there. Medicines kept on other people’s behalf are not always being handled properly and poor records are kept to protect their health. Improvements are needed Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 7 to make sure medicines are not allowed to run out so residents always have the treatment they need to promote good health. Improvements are needed to make sure medicines are always given as prescribed so that residents receive the right treatment and procedures for crushing medication before administration need improving so that this is done safely. The manager should complete the supervision and assessment of staff that was started in the handling of medication to improve staff training on this and improve on regular formal supervision in general. Staffing levels on all shifts and skill mix need to be improved so there are always enough staff on duty with appropriate experience and skills staff to be able to meet resident’s individual needs at all times. This is allied to the need to improve the detail and recording of staff training and have a development programme. Providers need to improve the level of support they give to staff to attend training and the time off to get the training and qualifications they need to do the work asked of them. Monitoring overall of staff practices needs improvement such as staff using the terms of address preferred by the people living in the home, making sure good practice is maintained. Choice and variety of food needs improving, as despite the manager producing a menu offering a choice of meals it is not being followed. Improvements are needed to promote choice, call bell systems suited to people’s capabilities need to be accessible in all rooms and areas used by residents. Whilst major refurbishment are underway the manager must address the need to assess any potential risks to residents from the work going on and as far as possible eliminate these to ensure their safety and well being. The sluice should be kept clean and hygienic whilst work is going on to promote good infection control and be to secure whilst cleaning products are in there. Records of fire training indicate that night staff have not been having fire training at appropriate intervals to protect residents. Despite the good work being done by the activities organiser to develop activities there is not an activities programme on display or in different formats to provide up to date information about activities. The manager should also look at ways of forging links with local churches and clergy to provide all residents with more opportunities for religious observance. 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.V338230.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.V338230.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before they come to live in the home but the Statement of Purpose is not easily accessible, up to date and in sufficient detail to support people in making an informed choice about the home’s ability to meet their needs before coming in. EVIDENCE: There is a statement of purpose combined with the service user guide to provide information about the service for people living there or thinking of coming to live there. These are not on display in the home or in place for reference in bedrooms nor is there a copy of the last inspection report accessible in the document or on display. Some of the information needs reviewing to give a more detailed picture of the services. There is no information on the number of staff working in the home, their relevant Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 10 qualifications and experience and linked with this information on the range of care needs the home offers to meet is not detailed. For example there is no information on how specific needs of people with dementia will be met yet care plans looked at show there are people living in the home who had been assessed as having degrees of this condition. Information on how the complex needs of people with physical disabilities will be met or the equipment or facilities provided to support them is not evident. Information in the document on the arrangements in place for dealing with complaints is brief and lacking details of how to make a complaint or the stages and timescales of the process. There is no information on the number and sizes of the rooms in the home and no specific information about fire precautions and the emergency procedures in operation that would need to be followed in event of an emergency. To improve availability of information the manager should consider making the statement of purpose/ service user guide available to residents and prospective residents in alternate formats such as large print or audio to meet different needs. This level of information is necessary so people can make a fully informed choice about whether or not the home is suitable for them and able to meet their particular needs. Responses from residents and relatives surveys indicate that some people felt they had not been given enough information before they moved in. One person commented that, “More promised or maybe more expected than received”. Although one person did say that they came in to see and choose their room from those available a few days before they came in, which they found beneficial. To develop good practice the manager should look at ways of making sure that sufficient time and effort is always taken during admission to support people making the life changing decision to live in the home. Care plans show that the manager carries out basic assessments of individual’s needs before they come into the home to live and that reviews of personal care needs are being done after admission. Information recorded about social interests, individual’s emotional support needs, care and family involvement and social contacts and relationships in the admission assessments are brief. A care management plan is also obtained from social services, where this is appropriate, to provide more information about that person and their needs. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being assessed and planned for within individual care plans but residents health and welfare are at risk when medicines kept on their behalf are not well handled EVIDENCE: All people living in the home have a care plan stating the actions to be taken by staff in respect of people’s needs and assessments of risk including in relation to skin care, moving and handling and nutritional needs. People who use the service are able to get access to health care services through their GP or by referral to specialist nursing services. Nursing problems and assessments in the care plans are being reviewed and for the most part updated to reflect a change in condition or need. Although some care plans do not make it clear exactly what personal care has been given each day. The plan for one said the person was to have a bath once a week and when needed this was not recorded in their plan as having been done or the reason why not, although daily records were looked at over a 12 day period. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 12 There is no evidence in the plan of how residents or their representatives are being involved in drawing up their plans to reflect their individual needs, preferences and goals. Some care plans seen did not have information on social and individual preferences and life histories to illustrate the whole person and their aspirations. Although some people spoken with said they were happy with their care, and that staff are “kind and helpful”. This kind of involvement could give staff greater insight into the personal perspectives of the people living there and on how they themselves want to be supported and their individuality and independence promoted. The approach to care planning evident from the written plan is not person centred and staff spoken with confirmed that they did focus on the clinical aspects of care in the plan when they reviewed and updated it. Medicines were kept at the right temperature so residents received good quality products. Residents were able to remain independent by looking after and taking their own medicines if they wished and were able to do so. A resident who was spoken to was very pleased to be able to do this. However, medicines kept on other people’s behalf were not always handled properly and this failed to protect their health. There was evidence of lack of care when giving medicines and poor records were kept. Some records were not signed when medicines were given and some were signed when medicines were not given. Some medicines that needed disposal were not recorded and could not be found. At the last pharmacy inspection the manager had started supervision and assessment of medication handling by staff. This had not been completed for all staff who handle medication for residents. Where doctors made changes to medicines these were started promptly. However, some medicines were not given as the doctor intended and this could make residents ill. For example, the directions for a sleeping tablet were not followed. The direction said it must not be given every night yet it was given regularly placing the resident at risk of receiving treatment they don’t need, over-sedation and increased risk of falls. Medicines, for example strong painkillers and steroids, ran out so residents did not have the treatment they needed with serious risk to their health. Medication was sometimes crushed before administration and the service failed to record that this was done safely and had been discussed with people involved in the care of the resident such as the doctor, family members and pharmacist. One resident spoken with was not always left in a suitable position by care staff to use equipment to promote their independence and so could not able to easily call for assistance. Survey responses indicate that “ staff don’t always come when called” and when the inspector rang a call bell in a toilet and no staff responded. Another resident was unhappy that they were called pet names by staff and not the preferred names in their care plan. The inspector asked 3 different members of staff to get a cup of tea for a distressed resident, which they did after 40 minutes. These actions do not indicate that care approaches always uphold respect for the individual, their choices and independence. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are limited recreational opportunities for people living in the home and people’s lifestyles are not always flexible reflecting individual choices. EVIDENCE: Some visitors spoken with at the visit said they are made welcome in the home, one said they were always offered a cup of tea. Visitors were seen and spoken with as they visited their relatives and they were able to visit in the communal areas or in bedrooms. There is an activities organiser for 20 hours a week who outlined how they are working with people living there and talking with them to build up and record a picture of what they like and want to do. There is limited information in care plans about social background, individual interests and capabilities, in some plans there is no social information. The organiser arranges group activities such as bingo, dominos, bowls and also helps people with individual activities such as reading to them, chatting and doing hand massages. In fine weather people can sit outside, take walks around the immediate area, have sing -songs, slide shows and occasionally Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 14 visiting entertainers. One person noted how much they had enjoyed it when “ the entertainments lady took me out in the grounds in my wheelchair and she took me to town once, which I enjoyed”. Shopping trips are undertaken if the organiser can get volunteers to support and assist. Survey responses indicate people would like more trips out and activities outside the home. One resident said there are occasional trips but these can be “summarily cancelled if there are staff shortages”. There is not an activities programme on display to provide up to date accessible information about activities and when and where they will happen. One resident holds a weekly church meeting with their own church group and some of the other resident’s choose to attend this. There is no evidence of established links with local churches or the opportunity for communion or confession. The manager should look at ways of forging links with local churches, religious organisations and clergy to provide all residents with more opportunities for their preferred religious observance. One person commented they did not know of any religious service in the home but would like a “short service one afternoon”. Those who wish to can go out to their own churches if they can be collected to go. There is no information obviously available or on display on external advocacy and support services who may act in resident’s interests if they wish. From speaking to people living in the home, their relatives and from their survey responses and letters to CSCI there is an indication that people are not always able to exercise choice in some areas of their personal care and daily lives. More than one person commented that they were helped to get up and go to bed at times that don’t always suit them, “it is more to suit the staff”. The manager showed the inspectors a weekly resident’s menu that has been developed. This is not on display and on speaking with the cook it was evident that the printed menu shown to the inspectors was not being followed in practice. The food served at lunchtime was not that on the menu. The cook said there was a choice being offered and people were asked the day before what they wanted. One person commented however that they “Often order a meal and receive something else that was not ordered”. Another resident commented that they thought the food was “boring and repetitive” but that it “was improving”. Observation at lunch- time suggested that it is not an unhurried and relaxed event. Of the 2 dining rooms in use, one was being used by just 2 people and the other dining room was busy and crowded with the remaining residents, not dining in their rooms, using it as well as the staff serving lunch from the hot trolley, assisting people and taking food out to people from the trolley. One resident in their bedroom was observed left to eat their meal lying flat in bed. Their lunch had been left on the bed table over the bed and they could not see what was on their plate or eat it in comfort and or safely. Staff including the manager could not explain why this person had not been helped to sit up to eat their meal. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaint and adult protection procedures are in place but some residents and relatives do not feel confident in the present systems and that their concerns are being listened to and fully investigated. EVIDENCE: Five complaints/concerns have been raised with or brought to the attention of CSCI during the month preceding the inspection regarding standards of care, staffing, communication between manager and staff, the standard of meals provided and lack of choice and the lack of call bells or means of getting assistance. Some of these were recorded in the homes complaint book some copied to CSCI were not. Two complaints received by CSCI were referred back to the registered provider to investigate and act upon. Feedback from surveys and through discussion with residents, relatives and other people coming into contact with the service who have used the complaint process is that complaints and concerns raised are not always thoroughly investigated and taken seriously by management and not responded to with permanent solutions. Comments expressed to inspectors illustrated this feeling, “ I feel let down as concerns are not always acted upon” and another said “ I spoke to the manager a number of times, who never seems to know about anything I bring up”. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 16 There is a complaints procedure on display although it does not match the more detailed updated one in the contracts and should be updated to match and make sure there is clear information. The procedure is not available in other formats to suit different capabilities. The records of complaints made to the home are not logged in detail, there are no details of the investigation process and how this was carried out and no details of the actions that are taken or planned to prevent any recurrence. Although people contacting CSCI had made complaints to the manager verbally there was no record of some of the matters raised in the log. A clear and detailed procedure needs to be easily accessible, a detailed recording system must be in use and records kept of all complaints made, the details of the investigation, outcomes and the action planned or taken. In this way people can have more confidence that their complaints are being listened to, taken seriously and acted upon. For quality assurance it is recommended that the manager regularly audits the complaints process to monitor effectiveness. There are procedures in place to safeguard adults and the registered manager and a member of nursing staff have recently attended training on this so they can train other staff in the protection of vulnerable adults (POVA). Staff confirm they have yet to have this training and dates are being arranged by the manager so all staff can have this training. There is information on whistle blowing for staff. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are being put at risk due to lack of assessment of potential risk whilst refurbishment work is going on in the home and because of inaccessible call systems in some areas. EVIDENCE: An extension has been built in the grounds of the home and a major programme of redecoration and refurbishment is underway within the home to improve the facilities and environment for people living there. The providers have developed a comprehensive plan for refurbishment and improvement of the existing building as required at previous inspections. On completion of this the environment within the home should be greatly improved. This work is currently being done whilst residents are still living in and using the bedrooms, bathrooms and communal areas of the home. This means that Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 18 in the short term access to some parts of the home is restricted in the interests of safety. During this time the registered manager must make sure that appropriate risk assessments are done based on an assessment of individual’s vulnerability. This will help identify and promote, as far as possible, the elimination of risks to the safety and well being of people living there whilst work is going on. There are workmen, joiners and decorators at work and walls had been stripped of paper in communal areas. This detracts in the short term from the comfort and possible safety of the home that can affect the daily quality of life of people living there. Residents and relatives have commented on this through surveys and in discussion during the visit. One person living there commented in the survey “ At the moment there is an extension being built and rooms refurbished and it causes problems”. Relatives have also commented on the disruption and that people have been moved around to accommodate work. Several bedrooms have been redecorated and people living there have been able to personalise them. There were no obvious unpleasant odours in the home except for the smell of new painting. People living in the home comment that usually the home is clean and one commented that “the cleaners are friendly and efficient”. Specialist equipment is provided although observation and discussion with people coming into contact with the service indicates it has not always been made easily accessible by people needing it so their independence can be maintained. Call systems with an accessible alarm facility are not always accessible in some areas of the home. People using the front lounge did not have access to such systems and when asked confirmed that was always the case. The home was warm and well lit and resident’s bedrooms seen were clean. The laundry was well organised and tidy although areas used for staff changing were cluttered and untidy with decorating materials. There is a sluicing facility and a disinfector but the sluice room was also dirty, unhygienic and cluttered with painting items and cloths. The door was wedged open and there were cleaning and disinfecting liquids kept there easily accessible to residents and so placed them at risk. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is or poor. 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 not always adequate to meet resident’s personal care needs in an individualised way. EVIDENCE: The home has had problems with recruiting and retaining staff and 16 members of staff have left in the last year. Residents and relatives have commented on this high staff turnover, some contacting CSCI with their concerns. One comment illustrates a general theme in survey responses and letters, “Most of the long term experienced staff have left this place, due to circumstances they are not happy with”. Consequently there are times when staff levels are low and there are new and less experienced staff coming into the home. Residents choice in their daily lives may be affected by such problems as staffing shortages mean there may not always be staff who know them well or available at all times to support the needs, activities and aspirations of people living there in an individualised and person centred way. One resident was not given their meal on one day and this went unnoticed by staff and one person said, “ staff don’t always come when I call, staff levels are not adequate” and another commented, “ “staff shortages mean that there can be a long wait even in an emergency”. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 20 On the day of the visit there were two registered nurses (RGN) on the rota for the morning shift, one of whom had to leave for a period to attend an appointment. There were also 5 care assistants on the rota for the shift. One care assistant was off sick, although cover was obtained later in the morning. Two more care assistants went off sick before lunch and 3 of the 5 carers originally on duty were new staff. Hence staff levels and expertise fluctuated over the shift. Staff confirmed that a high level of staff sickness and staff not turning up for work was causing problems and affecting morale. The skill mix is variable and the rota shows that staff alter it to suit them selves and this can also affect the skill mix. The manager should monitor this to prevent the skill mix of staff being adversely affected. On the late shift there were also 2 registered nurses and 5 carers, one of whom was sick and 2 were doing double shifts to cover. It is not satisfactory if meeting basic personal care needs is seen as the limit of the support provided. Staffing levels on all shifts and the skill mix must be able to meet resident’s individual needs at all times. Staff training is recognised as important by the manager who encourages staff to attend. However she cannot always ensure they do so as staff are expected to attend training in their own time and so at their own expense. NVQ training is in progress in the home and needs to continue and but this too is done in care staff’s own personal time. The manager and provider need to ensure that staff get appropriate support to attend at least the mandatory training for resident safety and for the work they do. Assistance that includes some paid time to get the qualifications or training they need to be able to demonstrate competence in their work and meet the home’s stated aims. Levels of training and development for the current year are hard to assess, as there is not a clear annual training and development plan or personal training profiles in place for staff. Speaking with new staff and examining recruitment files indicates that basic induction training is given to new staff. To make training planning and monitoring more consistent, especially for mandatory training, a clearer planning system is recommended showing clearly what training has been given, what is needed and when it is due so nothing is overlooked. Speaking with staff indicated that they did not have individual training profiles and some had not had moving and handling training since starting work or infection control. There is no clear evidence of regular supervision being given to staff although the manager is now involving nursing staff in this and so is seeking to address the problem. Recruitment practices were found to be in good order, staff have had Criminal Records Bureau (ORB) checks and checks against the Protection of Vulnerable adults (POVA) register to promote the safety and interests of residents. References have been taken up before employment and proof of identification. It is a matter of good practice that the manager has done an audit on this system earlier in the year to monitor effectiveness. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a lack of overall quality monitoring and resident inclusion by management although financial interests are being safeguarded for people living there. EVIDENCE: The home has a suitably qualified registered manager with experience of working with older people. However although staff found the manager accessible there was no evidence from speaking with residents, relatives and staff that the home has a supportive cohesive care team that focuses on those who use it. Staff morale was low and their answers in discussion indicate they Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 22 do not feel valued in their work or supported by the organisation they are working for. The manager has started having residents meetings that are a good starting point for getting people’s views. The manager needs to continue to develop ways to involve residents more in the way the home is run and how services for them are being developed to reflect what they want from their home. More than one person commented that they felt the home has changed since they came to live there, one said, “ I gather it had a better sense of caring before the new owners took over” and another that “At the time I moved into the home it was the best in the area, but things have changed”. These and other comments made to inspectors suggest that some people living there and coming into contact with the service have not perceived management changes and approaches as entirely positive. There are some quality assurance tools in use and some audits of systems taking place but the manager should be looking to review existing quality monitoring practices as evidence within this report suggests systems are not wholly effective in meeting the aims, objectives and statement of purpose of the home or the expectations of all its residents. The manager should conduct a review of the quality monitoring practices in the home to find ways to involve residents and stakeholders and make sure the systems are working to improve quality for people living there. The home had systems in place to safeguard resident’s monies and a check showed transactions are recorded and accurate. Because of the way it is recorded fire training records are kept it is difficult to follow but training for night staff at 3 monthly intervals as has not been taking place for all staff and this must be done and clearly recorded. Training records generally need to be organised better. Information provided by the manager in the homes own assessment says servicing and maintenance of equipment in use is being done. Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X 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 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 2 X X 3 2 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 3 2 2 X 3 2 X 2 Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) (2) 5 (1) (2) Requirement The registered person must make sure an up to date statement of purpose and service user guide is in place and made easily available to any one using or thinking of using the service to provide accurate information and to support an informed choice. Medicines must be given as prescribed so that residents receive the right treatment This was to be met by 18/06/07 Procedures for crushing medication before administration must be reviewed so that this is done safely. Medicines must never be allowed to run out. This was to be met by 18/06/07 Records for receipt, administration and disposal of medicines must be accurate to show that medicines are handled properly. Timescale for action 01/09/07 2. OP9 13 (2) 10/07/07 3. OP9 13 (2) 10/07/07 4. OP9 13 (2) 10/07/07 5. OP9 17 10/07/07 Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 25 6. OP16 22 (2) (3) and 17 (2) Schedule 4 7. OP19 13 (4) 8. OP27 18 (1) (a) 9. OP38 23 (4) The registered manager must make sure that any complaint made under the procedure is always recorded, fully investigated and actions planned and taken to resolve this so people can be confident their complaints will be acted upon. Risk assessments must be undertaken taking account of individual’s vulnerability whilst any redecoration work on the home continues so that potential risks to people living there can be identified and as far as possible eliminated to ensure their safety and well being. Staffing levels on all shifts and skill mix must be able to meet resident’s individual needs at all times. Previous timescale 30/10/06 The previous timescale of 30/04/07 applies and 02/05/07 Fire training must be brought up to date for all staff to safeguard residents interests and clear records kept of this training. 01/08/07 27/07/07 27/07/07 27/07/07 Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 26 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 OP3 Good Practice Recommendations To develop good practice the manager should look at ways of making sure that sufficient time and effort is taken to support people making the life changing decision to live in the home and develop a more person centred admission process. Consideration should be given to making it clear within personal plans how people living there are being actively involved in creating and developing their care plans and their personal perspectives on how they want to be supported and their independence promoted. The personal care stated in care plans should be recorded when it is carried out or the reason why it has not been done stated to make sure hygiene needs are not overlooked. It is recommended that packs of medicines be marked with the date of opening to assist with checks for proper handling. It is recommended that the manager complete the supervision and assessment all staff in the handling of medication Staff should use the terms of address preferred by the people living in the home. The manager should consult with residents to look at ways to develop consistent links and opportunities for religious observance to reflect different needs and preferences. The menu offering a choice of meals should be adhered to so a choice of a varied and nutritious diet is respected and promoted. The manager should make sure the complaints procedure on display is up to date and contains clear information and is available in different formats if needed. For quality assurance it is recommended that the manager does audits of the complaints process to monitor effectiveness of the system The registered manager should monitor to ensure that specialist equipment used by residents is always accessible 2. OP7 3. OP8 4. 5. 6. 7. 8. 9. 10 11. OP9 OP9 OP10 OP12 OP15 OP16 OP16 OP22 Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 27 12. OP26 The sluice should be kept clean and hygienic to promote good infection control and be to secure whilst cleaning products are in there. Because of the high staff turnover the manager should consider conducting ‘exit interviews’ with departing staff to try to identify the reasons why people leave and any recurring themes so action can be taken to rectify identified problems. The registered person should ensure that there is a clear staff training and development programme and that staff are given at least minimum assistance and time off to get training and qualifications they need to do the work asked of them and to meet the care and safety needs of people living in the home. The manager should conduct a review of the quality monitoring practices in the home to find ways to involve residents and stakeholders and make sure the systems are working to improve quality for people living there. Formal supervision should be given to staff on a regular basis at least 6 times a year and recorded to support staff and their training and development. 13. OP27 14. OP30 15. OP33 16. OP36 Branthwaite Nursing Home DS0000010100.V338230.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V338230.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!