Inspection on 22/04/08 for Branwell Lodge Nursing Home

This inspection was carried out on 22nd April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Branwell Lodge Nursing Home 04/06/09

Branwell Lodge Nursing Home 09/10/08

Branwell Lodge Nursing Home 25/04/07

Branwell Lodge Nursing Home 16/05/06

Branwell Lodge Nursing Home 20/10/05

Branwell Lodge Nursing Home 24/01/05

Branwell Lodge Nursing Home 15/09/04

Branwell Lodge Nursing Home 28/06/04

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

CARE HOME ADULTS 18-65 Branwell Lodge Nursing Home Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ Lead Inspector Caroline Long Key Unannounced Inspection 22nd April 2008 10:00 Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 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 Branwell Lodge Nursing Home DS0000019900.V363067.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 Adults 18-65. 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. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Branwell Lodge Nursing Home Address Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ 01274 521731 01274 523279 andrew.moran@bdct.nhs.uk 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) Brunel & Family Housing Association Limited Mrs Wendy Rushworth Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning disability - Code LD The maximum number of service users who can be accommodated is: 22 25th April 2007 2. Date of last inspection Brief Description of the Service: Branwell Lodge is a 20 bedded registered care home providing nursing care for people with varying degrees of learning disabilities and challenging behaviour situated approximately 3 miles from Bradford city centre. The shops and local community facilities are within walking distance. The home is a purpose built property originally registered in 1980. There are pleasant gardens with patio area and ample car parking space. The accommodation compromises of eight flats with single bedrooms, communal living/ kitchen areas, and bathrooms. Brunel Support Works, who are responsible for the ancillary staff at the home and general maintenance, have been merged with Yorkshire Housing Association. The Bradford District Care Trust provides all the care and nursing staff. The basic cost of services as of 29/04/08 are between £440 and £520 per week, however this is not the cost to the person using the service. Their costs are dependent on local authority funding and benefit entitlement. Copies of the inspection report are available on request from the home. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Branwell Lodge is registered to provide nursing care to people with a learning disability. Over the years the home has admitted some people who display challenging behaviour, which has had a negative impact on the lives of other people living in the home who have different needs. Following a number of incidents and adult protection issues, the service was reviewed last year by Bradford District Care Trust and everyone living at the home has had their needs reassessed. The assessments showed that some people should be moved to other homes so that their needs can be met more appropriately. This process has begun and there are ongoing multi-agency adult protection meetings to monitor and review progress. However progress has been slow and, in light of recent incidents that have occurred, the provider must now make sure that people, whose reassessment shows their needs cannot be met at Branwell Lodge, are supported to move promptly as their protection and safety must be a priority. This is what we used to write this report:• • • • We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual quality assessment questionnaire (AQAA). We contacted relatives and advocates who visit the home to get their views. Two inspectors visited the home unannounced. This visit lasted over nine hours and included talking to the staff and the registered manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. We spent time talking with two people who live in the home and two relatives who were visiting. We looked at three people’s care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters which were raised at the last inspection. • • • Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The provider must make sure people are safe in their own home. There must be enough staff to make sure people are safe and can take part in activities both during the day and in the evening. People must be provided with the opportunity and support to carry out meaningful activities during the day and to take part in the local community if they wish. This prevents people from becoming isolated and provides them with a better quality of life. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 7 People must be provided with a plan of their care, which they or their family have contributed to and made choices about. This plan should be written in a form which they can understand and contain their personal preferences. This plan and the assessments of any risks involved need to be reviewed, as the person’s needs change. This means people are cared for and supported in the way they prefer and like. There needs to be one complaints procedure that is easy to follow and the provider is responsible for, which helps concerns to be responded to quickly and resolved. All written information should be available in pictorial or any other format that will helps people understand what they mean. An alternative should be found for the baby monitors. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. 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. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 and 5. People who use this service experience adequate quality outcomes in this area. People will only be admitted to Branwell Lodge when it is clear that the home is the best place for them to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no new admissions to the home since 2006. It is our understanding there will be no new admissions until the process of moving people has been completed and we can be assured that the home can meet the needs of everyone living there. There is now a new admissions procedure in place and the registered manager explained people would be assessed before moving into the home to make sure the staff had the skills and experience necessary to care for people properly. Branwell Lodge consists of eight flats with either two or three bedrooms, and a bathroom and living space; there is also a communal lounge and dining room for everyone. The registered manager explained that people do not have a Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 10 choice about whom they share with because of availability of rooms. This has resulted in some people sharing flats who are unable to get along. Two of the contracts looked at had been signed by people‘s representatives, however the contracts were not in pictorial format or in large print. They contain jargon and would not be easy for the people living in the home to understand. To make sure people are aware of their rights the contract they should be in a format which people living in the home can understand and efforts need to be made by the home or the advocacy service to explain them. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People who use this service experience adequate quality outcomes in this area. Although the staff understand the right of individuals to take control of their lives and to make their own decisions this does not always happen in practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three people’s case records in detail. All the care plans were slightly different, some were not very person centred, and this means they did not focus upon people’s personal preferences. Also parts had not been reviewed regularly, as people’s needs had changed. All were not in large print or pictorial format and there was little evidence that the people had any understanding of them or were regularly involved in making decisions about their lives. Examples were: One person’s care plan showed that a review had taken place in November 2007. There were two copies of the typed review notes. One copy had been Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 12 amended and signed by the person’s parent, but not by staff, the other had not been amended and was signed only by a staff member. The amendment stated that the parent ‘is not totally happy with the care and would like to see improvements.’ Further explanation as to why this person is not happy needs to be included to enable the staff to improve the care they are providing. Another stated one person liked the ‘snoozelan’ room as one of their activities. This is a room sensory room, with lighting which helped people relax. However this room is no longer available. There was a review about the activities arranged by day services, which included plenty of detail about the person’s preferences, but this has not been reflected in the main body of the plan. Talking with the individual’s relative also confirmed to us how important these activities are and how they needed to be reflected in the plan to make sure they had a full and meaningful lifestyle. Although risk assessments were completed, and these now covered the night medication, they had not all been reviewed regularly. For one person an area of possible risk was not assessed fully. This was brought to the attention of the registered manager. The registered manager was aware the care plans need to be more person centred, and need to be consistently reviewed. In response she had developed a new plan, which she hoped to introduce soon. Talking to staff identified that they were aware of people’s needs and were trying to offer people choices about their daily life, although they felt limited by the number of staff on duty. A visitor also confirmed that their relative has a key to their flat and ‘comes and goes as they please’. Although people are able to make basic choices about their life, such as when to go to bed and get up, there was information to show that they were not always encouraged or supported to make more important decisions which affect their lives. Examples were when an independent advocacy service had visited the home during the year to help people to express their views and give them support to make decisions about their lives there had been a slowness and possible reluctance by staff to encourage people to use the service. Another advocate explained how one of the referrals had wrongly described how the person was able to communicate. And where one person had indicated they wanted to move out of the home and the staff appeared reluctant to accept this person’s choice. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 13 There is a key worker system, which means people have a named member of staff who they can go to. This member of staff will spend more time with the person and get to know them better, so making sure people receive the care and support in the way they prefer. An example of how this has improved staff practice was where they had fully recognised the cultural needs of one person in detail and had been helping them to access support from the community. The records we saw showed that there are regular meetings with people living in the home to seek their views. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 People who use this service experience adequate quality outcomes in this area. People’s choice of activities and the support they receive to develop their life skills is limited due to staff resources. This judgement has been made using available evidence including a visit to this service EVIDENCE: Looking through four care plans, there does not appear to be a formal activity plan for each person. Individual daily records are kept of the activities everyone has been involved in. During the day some people choose to attend a day care centre, while other people prefer to stay at home. People who stay at home did various things such as going out for meals, going for a walk or a bus ride, visits to the theatre and the IMAX cinema in Bradford. People also played board games and did Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 15 other activities in the home. There were also records of people going on day trips to the seaside, such as Blackpool or Skegness. We were told that one person who attends a day centre on weekdays has a wide range of activities organised by the centre, which are planned to suit their preferences. We saw evidence in the care plans that the home is aware of how to meet people’s culturally diverse needs. For example, halal meat is provided for Muslims and there was a lot of information about meeting other needs of people who follow this faith. When we visited we saw people choosing whether to remain in their flats or sit in the communal area. A relative explained that their relative had a key to their flat. The home has a minibus and a ‘people carrier’ car, which are used to take people out and to their day centre. However during our visit we saw that most of the staff time was taken up with providing people with care and support and keeping people safe. From talking to staff, the opportunities to take people out depend on whether or not staff are available. Staff explained this is because some people have very high staffing needs and when they are at home there are not enough staff to take other people out. One person’s updated life plan mentions two activities they would like to take part in, but there was no information to show that these had been followed up, or even that anyone had explored ways of accessing these opportunities. There was evidence that one person was being encouraged to go out for most of the day as they did not get on with other people living in the home and going out may not have always been their choice. At previous inspections requirements have been made to provide all people with a choice of fulfilling activities and support to enjoy the full range of opportunities and activities in the community. The registered manager told us the providers are recruiting for one or two activity assistants. This seems to be taking a long time; meanwhile people are not able to take part in the wide range of activities that should be available to them. The situation is worse at weekends, when more people are at home and there is the same number of staff on duty as during the week. Four relatives discussed how they were able to visit people regularly, and one explained how the home had enabled their relative to visit them at their own home. People are involved in planning the menu, which is available in picture format. We talked to the chef who, although he was from an agency and only there for Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 16 a week, was very knowledgeable about people’s dietary needs and said he would always provide alternative meals if people wished. On the day of the visit there were toasted sandwiches and home made soup for lunch, beef curry or cheese salad for dinner, followed by fresh fruit salad. Very nice homemade cakes were also available. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18, 19 and 20. People who use this service experience adequate quality outcomes in this area. People have access to health services to enable them to remain in good physical health, however their emotional needs are not always met. The administration of medication needs to be improved to make sure mistakes are not made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was information about people’s health care needs in their care plans, which showed that people were able to access local health care facilities such as the general practitioner, specialist nurses and the psychiatric services. However there are some people living together who are incompatible and this is causing them distress. For these people their emotional health needs are not being fully met or considered. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 18 Comments made by people with an interest in the service were mixed, such as: ‘My relative seems to be well looked after and cared for at Branwell.’ ‘I feel my relative is well looked after to the best of their ability, they are always clean and tidy when they visit me and look forward to returning to Branwell Lodge.’ One relative explained how the personal care had improved over the last year following the change of staff at Branwell Lodge. Half of the staff are male, this enables people to have their personal care needs carried out by a gender they feel most comfortable with. We saw staff talking to people in a warm, kind and friendly manner, when we talked to the staff they understood people‘s needs and they were able to talk about ways in which they promoted people‘s dignity. However, the independent advocates did provide an example of a incident when a persons dignity was not respected whilst visiting people in a morning they were introduced to a person who was still in bed. The home’s medications are kept securely in locked cabinets in a locked room. The Medicine Administration Record (MAR) charts are clear and, with a few exceptions, are signed by the nurse administering the medication to confirm that the dose has been offered to the person. People’s medicines are taken to them individually and they are given the time they need to take them. Most of the medicines are supplied in a monitored dosage system, but there are a significant number of solid and liquid medicines that are administered directly from the original packaging. Where these are carried forward from one four week MAR chart to the next, a ‘brought forward’ system needs to be put in place, to show the total quantity of each of these medicines. Those medicines that could be reconciled were mostly accurate, but some did not completely tally. One person had some ‘as required’ tablets that were more than three years old and should have been destroyed within a year of the dispensing date. Putting these systems in place will help to make sure people are being given their correct medication. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use this service experience poor quality outcomes in this area. People are not provided with the support and information they need to raise concerns about the service. People are put at risk of abuse because safeguarding issues are not always speedily and satisfactorily resolved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has two complaints procedures. The registered provider is Brunel Housing, but because Bradford District Care Trust provides the nursing and care staff and jointly manages the home, the staff have followed the Trust’s complaints procedure rather than Brunel‘s. This has resulted in confusion and has meant that some issues are unresolved. However from 1st March 2008 this has changed and it has been agreed that Brunel Housing are now taking responsibility for responding to and taking action to resolve all complaints. Branwell Lodge have a record of all the complaints made. From the previous inspection in April 2007 until March 2008 there have been nine complaints recorded. These include complaints about people looking dishevelled and staff attitude. There is also a complaint made in October 2007 and two from January 2008, from relatives about people living in the home being assaulted. Although they have been responded to by letter, the concerns have not been resolved. We have received one complaint since the last inspection in April Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 20 2007, which was about one person living in the home being assaulted by another person. This was passed to the Bradford Adult Protection Team to investigate. It is important people know who to complain to, when they can expect a response and who is responsible for resolving the issue. To make sure this happens people need to be provided with clear and consistent information, which they can easily understand and read. For those who have difficulty in communicating their needs, and have no close relatives, the home needs to make sure they have access to independent advocates. Following the last inspection there have been fourteen incidents, which have been fully investigated under the safeguarding adults procedures concerning the actions of staff and people living in Branwell Lodge. In response to these incidents and following a review of the service everyone living in the home was assessed to make sure the home was the right place for him or her to live. Three people have since moved to more suitable accommodation and some people have been given more individual support. However, there are still some people for whom Branwell Lodge is not the best place for them to live and when we visited we had serious concerns about some people’s safety. These concerns had also been raised with the provider by a relative of one person. Following our visit we have written to the provider and also had a meeting to make sure that action is taken to keep people safe in the home. Some incidents have occurred in communal areas which means that other people living in the home either avoid the communal areas or feel threatened using them. One relative explained how they leaned forward when sitting in the communal lounge when one person passed, as they were fearful they might be hit at the back of the head. Care staff told us that some people were not compatible which resulted in them not being safe and their needs not being met. The registered manager has raised these concerns with the provider These matters are being monitored and reviewed under the safeguarding procedures with the Bradford Adult Protection Team. Staff are completing incident forms, this is required so the staff can identify any patterns and send these to the behavioural support team so they can provide the staff with advice about how to manage people‘s behaviour better. However although the incident forms are completed when physical intervention is used they have not always detailed the type used. To protect people living Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 21 in the home and staff a detailed record of the type of physical intervention used should be kept. Most staff have had training about how to protect vulnerable people and how to calm a situation when a person exhibits behaviour which is challenging. The service review carried out by Bradford District Care Trust recommended the use of advocates. However the advocacy service said there was a reluctance to refer people and one person who was at risk had not yet been referred despite asking. People are supported to manage their own finances. Each person has a bank account and detailed records are kept of all financial transactions carried out by the individual or by staff on their behalf. People’s money is securely stored and is available to them at any time they want cash. The accounts are very well organised, clear and accurate. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 People who use this service experience adequate quality outcomes in this area. People live in a clean and well-maintained home however the furnishings may not always suit their needs. This judgement has been made using available evidence including a visit to this service EVIDENCE: Branwell Lodge provides accommodation for people in flats, as well as having a shared sitting and dining room. The home is clean and fresh and has recently been re-decorated. We were invited into two people’s flats. They have single bedrooms and share a lounge/kitchen/diner and the bathroom with their flatmates. There was some personalisation of the rooms, but more could be done to make the rooms more attractive and homely. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 23 The shared lounge/dining room was large, bright and airy and had recently had new furniture. However, the room had been furnished with robust furniture suitable to withstand rough treatment, although during our visit some dining chairs were returned from being repaired. This room has been furnished to meet the needs of the minority of the people who are liable to damage the furnishings. This means that the furniture is utilitarian and does not look welcoming, nor are the armchairs and sofas homely or particularly comfortable. One person who visits the home described it as ‘like a hospital ward.’ We saw that two way ‘baby monitors’ were in use for some people, so that staff could listen and make sure they were all right, when alone. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. This is a breach of people’s right to privacy. A more suitable system needs to be provided. When we visited the home was clean and fresh. Staff have received training in infection control and there were ample supplies of gloves, aprons and hand wash around the home to help prevent the spread of infections. The laundry is clean, well organised and suitably equipped. Proper sluicing arrangements are in place for soiled linen and infection control procedures are followed. We were told that people’s clothes are ironed in their flats, with the individual assisting to sort and put away their clothes if they wish. There used to be a ‘Snoozelan’ room for calming relaxation, but we were told that as few people used it and it would cost a lot of money to refurbish, people had agreed to close the facility. People have keys for their rooms, if they wish, but it was not clear if everyone had chosen who they wanted to share their flat with. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. People who use this service experience poor quality outcomes in this area. People receive support from staff that are properly recruited and who are appropriately trained and supervised. However the staffing levels severely restrict the ability of the service to deliver person centred support and keep people safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nineteen people currently live at Branwell Lodge. When we visited the home there was the registered manager, a staff nurse and six support workers for a day shift from 7 am to 9 pm. The rotas and staff confirmed these are the normal numbers. However there are two people who require one member of staff each and one person who requires two staff to support them, this is to keep them and other people safe. The nurse also has to carry out the organisation of the shift and administer the medication. This leaves the nurse and two support workers for the remaining sixteen people living in the home. People also often have to be accompanied to the doctors or hospital appointments by staff. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 25 At night this is reduced to one nurse and two support workers, however one nurse explained the person who needs the support of two staff does not go to bed until after midnight. Also when an incident occurs and physical intervention is used there needs to be enough people present to keep the person safe. Requirements have been made at the previous inspections for staffing levels to be reviewed to make sure that there are sufficient staff on duty to meet the needs of people using the service at all times. This requirement has not been met and the level of staffing at present does not keep people safe and severely restricts the ability of the service to deliver person centred support, or provide activities that people may request. All the staff spoken to during our visit said these numbers were not sufficient. Two relatives also supported this view, especially during the night. Staff recruitment procedures make sure that staff are checked to a very safe standard. Prospective staff complete an application form and attend formal interviews. Written references and POVA (Protection of Vulnerable Adults) First checks are made and staff are not permitted to work in the home until they have a CRB (Criminal Records Bureau) check. Staff training records showed a comprehensive training programme. All staff complete a home specific induction programme. A range of other training including health and safety training is provided. Specialist training such as break away and conflict resolution has been completed to ensure people’s specific needs are met. This provides staff with the knowledge and skills to perform their duties in a competent manner. However there was no evidence staff had been provided with training about the Mental Capacity Act. Staff thought that the training provided is good and that the staff team was very supportive. The staff said records confirmed that they receive supervision every four to six weeks and staff meetings are held regularly. The relatives explained there had been a change of staff in the home and they felt this had improved the staff team and led to better care for the people living there. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42. People who use this service experience poor quality outcomes in this area. The difficult liaison between Bradford District Care Trust and Brunel Housing has had an effect on the day-to-day management of the home, resulting in it not always being run in people’s best interests. This judgement has been made using available evidence including a visit to this service EVIDENCE: The organisation registered with us as the provider is Brunel Housing, however Bradford District Care Trust employs the nursing and care staff. This has proved a difficult liaison, with staff trying to follow direction from both Bradford District Care Trust and Brunel Housing, which has resulted in difficulty in resolving issues quickly and poor outcomes for people living in the home. Both organisations have now recognised the issues this has caused and are working towards improving the way the service is managed. Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 27 However over the last year this has had an effect on the day-to-day management of the service and has made the processes of who is managing and running the home less transparent and open. This means that despite the staff’s best efforts the service has not always been run in the best interest of those who live there. Quality assurance surveys are now being sent to the relatives of the people who live at the home. The last survey was in June 2007. The results were analysed and a management report was written and sent to the registered providers for action, where necessary. The home has been re-decorated as a result of what people said in the surveys. The registered manager also holds regular meetings with the people who live at the home and their relatives. The registered manager has a business plan for the home and the staffing and non-staffing expenditure budgets are detailed and show clearly the financial position of the service. The home’s maintenance records were looked at and those that were in the file were in order. However, they are not all there as the service companies send them to the organisation’s office and they are not always forwarded to the service. For example, the shaft lift was last serviced on 4 March 2008, but the last certificate was dated 8 November 2007. The fire brigade carried out an inspection in February 2008 and their recommendations have been put in place. The fire alarms are tested weekly and all the staff have had fire safety training. The kitchen had an environmental health inspection in June 2007 and was awarded the highest score of five stars for cleanliness and hygiene. On the day of our visit we saw that hot food, refrigerator and deep freezer temperatures were being checked daily. Food stored in the deep freezer was wrapped, but not date-labelled, as there were no labels available Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 1 2 X X 3 X Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement Everyone living in the home must have an up to date written plan that includes all his or her personal and health care needs and their goals and aspirations. • The plan must include clear guidance to staff about the support that they have to provide to meet people’s needs. • People living in the home or their representatives must be involved in the development of, and agree with, the plan. • The plan must be kept under regular review and people living in the home or their representative made aware of any revisions. This is to make sure people are provided with a consistently good standard of care in the way they prefer. Timescale for action 01/07/08 2 YA9 13(4) (b) and (c) Where areas of risk are identified 01/06/08 a risk assessment must be completed. The risk assessment should be reviewed and agreed DS0000019900.V363067.R01.S.doc Version 5.2 Page 30 Branwell Lodge Nursing Home 3. YA12 16 with the people living in the home or their representatives. All people must be provided with a choice of fulfilling activities and supported to enjoy the full range of opportunities and activities in the community. This was required in the last inspection reports on the 16/07/06 and 25/04/07. The home must have a complaints procedure: • Which people living in the home can understand. • Is clearly displayed throughout the home. • Where independent advocacy is available for those who people need support to make their views known. • Where the provider is ultimately responsible for investigating, responding to and resolving all the concerns and complaints. You must make arrangements to make sure people living at Branwell Lodge are protected from assault and abuse at all times. A ‘serious concerns’ letter has been sent to the responsible individual asking them to tell us how they are going to do this by the 28/04/08. 01/06/08 4 YA22 22 01/06/08 5 YA23 13 (6) 28/04/08 6. YA33 18 Staffing levels must be reviewed to make sure that there are sufficient staff on duty to meet the needs of people using the service at all times. This was required in the last inspection reports on the 16/07/06 and 25/04/07. DS0000019900.V363067.R01.S.doc 29/04/08 Branwell Lodge Nursing Home Version 5.2 Page 31 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 YA1 Good Practice Recommendations All written information should be available in pictorial or any other format that will helps people understand what they mean. People should have a choice about whom they share their flat with. To make sure there are no mistakes made when administering medication, where medicines are carried forward from one four week MAR chart to the next, a ‘brought forward’ system needs to be put in place, to show the total quantity of each of these medicines. An alternative should be found for the baby monitors. These devices are not appropriate for use with adults as they can be overheard by anyone else who is in the room with the receiver and, in some cases, can also be heard on similar devices outside the home. 2 3 YA2 YA20 4 YA29 Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Branwell Lodge Nursing Home DS0000019900.V363067.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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