Inspection on 04/06/09 for Branwell Lodge Nursing Home

This inspection was carried out on 4th June 2009.

CQC found this care home to be providing an Adequate 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Branwell Lodge Nursing Home 09/10/08

Branwell Lodge Nursing Home 22/04/08

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 25/11/2009.

Random inspection report Care homes for adults (18-65 years) Name: Address: Branwell Lodge Nursing Home Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ one star adequate service 09/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Caroline Long Date: 0 4 0 6 2 0 0 9 Information about the care home Name of care home: Address: Branwell Lodge Nursing Home Smith Road Off Southfield Lane Bradford West Yorkshire BD7 3NJ 01274521731 01274523279 andrew.moran@bdct.nhs.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Brunel & Family Housing Association Limited care home 22 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 22 The maximum number of service users who can be accommodated is: 22 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 Date of last inspection Brief description of the care home 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. 0 9 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 2 of 13 Brief description of the care home The home is a purpose built property originally registered in 1980. There is a garden with a patio area and ample car parking space. The accommodation compromises of eight flats with single bedrooms, communal living and 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. Copies of the inspection report are available on request from the home. Care Homes for Adults (18-65 years) Page 3 of 13 What we found: At the key inspection carried out on the 9th October 2008 Branwell Lodge was awarded a one star adequate quality rating, some requirements and recommendations were made and the management provided us with a plan of how they were going to improve. However following this inspection there has been a change of manager and we have recently received two safeguarding issues about the home, about the number of staff working in the home and institutional practices. We therefore carried out this random inspection to look at these issues and find out if the outcomes for people had changed. Two inspectors visited the home unannounced on the 4th June at 3pm and stayed until 7.00 pm. During the visit we looked at two peoples care records, observed staff working with people at Branwell Lodge. We also talked to the temporary manager and four other members of staff. We found there are thirteen people living at Branwell Lodge, who have very complex and different needs. When we last visited we were told everyone who lives at Branwell Lodge was to have their needs re-assessed to find out where would be the best place for them to live. The head of the support works for Yorkshire Housing has told us there is only one person who is still awaiting their community care review and they are awaiting copies of the reviews which have already been carried out. The home is also awaiting the start of the health action plan assessments which are to be carried out by the continuing care team from Bradford District Health Care Trust in July. Branwell Lodge does not have a manager who is registered with the Commission. The assistant manager has been acting as the temporary manager since February this year. She is now supported by a manager from another of Yorkshire Housings nursing homes. We looked at two peoples case records in order to check that a plan had been formulated which would help staff provide support to people according to their needs and wishes. We found for one person there was good information about how the person should be supported with personal care, communication, social and health needs. There was also good detail on how behaviours that challenge the service can be positively managed and the support plans linked well to risk management plans. Staff were aware of the risks and could describe what they do to protect them fully. However more detail was needed in the risk assessments to protect the person from behaviours of another person who lives at the home. It was clear the support plans had been developed form a detailed assessment of the persons needs and had involved family members and staff who knew their needs well. Staff were familiar with what was written in the support plan and could talk confidently about the support they give. They gave good examples of how they maintain privacy and dignity. The plans gave good examples of how to support the person to make choices. We were also able to see they were provided with choices about where they went in the building and where and when they ate their meals. For the second person we found the person had a visual impairment and there was Care Homes for Adults (18-65 years) Page 4 of 13 detailed information about how to care for their needs but this information was not reflected in the risk assessments and staff were not following all of the recommendations. When we talked with staff about the level of impairment and how it affected the person we found the information they gave us was not consistent. This lack of clarity can result in the persons needs not being met. It was also unclear when they had last visited the opticians. Also where one person was looked after with one to one support for twenty four hours a day, there was some confusion about what this meant and whether they could be left for fifteen minute intervals or not. We discussed this with the manager and explained it needs to be properly risk assessed and a management plan put in place to make sure the persons needs are fully met and their safety is maintained. This showed us the staff are making improvements, the peoples support plans are more person centred however gaps still exist in the support plans and risk assessments which need to be addressed. There was evidence people were having health action plan assessments carried out and were referred to health care professionals. When we visited we communicated with a person using makaton, we asked the staff what were peoples chosen methods of communication and received some conflicting responses. Some of the people living at Branwell Lodge have lived within a residential setting for many years and are well known to the staff who may have cared for them in other home and hospital settings. The staff therefore have knowledge about what methods people have used to communicate with others. To help people the management should consider developing for each person a communication profile and providing staff with the necessary training to help them communicate with people. Staff told us they had noticed an increase recently in the provision of activity, both in the home and in the wider community. They said they were encouraged to arrange and organise activities and outings with people. They said they had recently taken people out for tea and been to the theatre. They also said people enjoyed going for walks to the local shops too. We observed staff interacting with people at the home, carrying out a variety of different activities. These included, hand massages, art work and listening to music with people. Staff said that the manager makes sure there are extra staff on duty so there are enough staff for organised activities such as theatre trips. Although we could see an improvement we also observed many people need one to one support to carry out any activities, so some people were unoccupied for all or most of our visit. There was plenty of social interaction between the staff and people who use the service. It was clear that staff and people who use the service get on well. Whenever anyone who lives at the home came into the main lounge/dining area, staff always responded well to them, greeting them warmly, asking them if they wanted or needed anything. In the main, people were supported well at mealtime. Staff sat beside one person to offer the support they needed with their meal at a pace that suited the person. They respected Care Homes for Adults (18-65 years) Page 5 of 13 the persons choice to decline to finish the meal. One other person also needed staffs support to eat their meal. The staff member did not sit down beside the person and stood above them. This did not look to be a comfortable and relaxed mealtime for this person. However, the staff member seemed to realise this and then did sit at the side of the person to continue to offer support. Some people who use the service are nutritionally at risk. The staff and chef in the home are fully aware of the need to nutritionally enhance food and gave good examples of how this is done. For example, adding extra butter and cream to foods and using full fat milk. The chef said they were also involved in any meetings with dieticains for people who live at the home. This is good practice and makes sure peoples nutritional needs are met well. Records of the food and drink people have had are kept. We noticed that there were some gaps in these records when people had been out for meals. Staff should also record what people have eaten on those occasions too. Staff gave examples of how they meet peoples cultural needs. It has been identified that one person speaks a language that a member of staff speaks. This person is enabled to spend time with that staff member on a one to one basis every day. We observed the person and staff member during this time and it was apparent they got on well and the person enjoyed this opportunity to use their own language. The chef also said they could cater for special diets and said she would get Hal al meat for anyone who was Muslim within the service. However there remains some institutional practices within the home which the management need to continue addressing. For instance people who live at the home are given plastic aprons as protective clothing when eating their meals. Some people were given an apron and did not appear to need one. The plastic aprons are not discreet and do not promote peoples dignity at meal times. Staff told us due to the numbers they make sure people have their pyjamas on before the night staff come on. The environment remains very institutional and does not have many homely features. We observed staff administering medication for some people. This was carried out thoughtfully. People were asked if they were ready to take their medication and were offered a drink with it. Staff had also identified problems with people being unable or unwilling to take their medication and had sought advice from the persons General Practitioner on the use of alternatives. People living at Branwell Lodge have very complex needs, are sometimes incompatible and display challenging behaviours this can put them at risk. So we looked at how they are kept safe and protected. We found for most incidents a serious incident form is completed, these are collated by Bradford District Care Trust. However we found where there was a safeguarding issue this information is not always sent to Bradford Adult Protection Safeguarding Unit and the manager was not reviewing them. In Branwell Lodge it is crucial all incidents are recorded and looked at by the management and all safeguarding issues are reported to Bradford Adult Protection unit. This enables them to identify any patterns of peoples behaviour and to enables staff to plan appropriately for peoples care. Care Homes for Adults (18-65 years) Page 6 of 13 Staff told us there are normally six or seven staff during the day and one nurse and two support workers during the night. They felt they had enough staff to meet peoples needs during the day. Their comments included: Staff levels are fine now. Manager always puts more on if we need them for activities or hospital appointments. The ratios are working fine now. However there are indications that this level of staffing may not always be enough to meet peoples needs fully both during the day and at night when the numbers are significantly reduced to three. We would therefore recommend the numbers of staff are regularly reviewed to make sure peoples needs are fully met and they are safe. A number of staff have recently left or been transferred from the home. This has resulted in the use of agency staff to cover the vacancies. Staff said they always try to get regular agency staff, people who have been to the home before and know the needs of the people who live there. Staff told us agency staff are always given a handover sheet, that they are shown round the home and introduced to the people who live there to make sure they are aware of peoples needs. Staff said this had been working well and they didnt feel that people who live at the home were at risk from being supported by someone who did not know their needs. Over the last twelve months there has been two changes in the manager of the home, staff nurses have been moved to other homes. However the movement of permanent staff and the use of agency staff does have an overall negative impact on people in the home who respond better to staff they know well and to a consistent approach to their care. Branwell Lodge at the previous key inspection following a improvement plan was found to provide people with adequate outcomes for people. In order to maintain these outcomes and to improve upon them there has to be consistent and well trained staff and management team. The management team need to have the skills and experience to identify peoples individual care needs and act upon them. We will continue to review the information we receive and our next visit to Branwell Lodge will be dependent upon what this information indicates. What the care home does well: What they could do better: Care Homes for Adults (18-65 years) Page 7 of 13 To keep people safe and to ensure peoples needs are identified and acted upon, the staff must review all serious incidents and report any issues of safeguarding to Bradford Adult Protection Unit. Further work needs to be carried out to be sure everyone has the opportunity to take part in a choice of activities both in the home and in the community. All of peoples health care needs must be considered to make sure they remain safe and fully supported. We have made other recommendations to improve the support and care people receive. These are about communication, care planning, risk assessments, medication, environment, staffing and management. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 12 You must review peoples 01/01/2009 health care needs to make sure they are recieving the support and health care they need. To be sure that peoples health care needs are fully met. Care Homes for Adults (18-65 years) Page 9 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 You must provide everyone 30/06/2009 with the opportunity to carry out activities which are tailored to reflect their individual needs. This will provide people with a fuller and more active lifestyle of their choice. 2 19 12 You must review peoples 30/06/2009 health care needs to make sure they are receiving the support and health care they need. To be sure that people health care needs are fully met. Previous timescale not met 01/01/09 3 23 13 You must make sure any safeguarding issues are reported immediately to Bradford Adult Protection Unit. This is to make sure peole are protected from abuse 30/06/2009 Care Homes for Adults (18-65 years) Page 10 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 23 13 You must put a system in place in Branwell lodge to review the serious incident forms regularly. This will help the staff identify any patterns and make appropriate changes to peoples care. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Care plans and risk assessments need to be person centered and relfect what people want now and in the future and how the care and the support staff have to offer to enable them to do this. To be sure risk assessments are meaningful and identify any possible risk they should be person centred and relevant to the individual. In order to keep an accurate record of the medicines that are supplied in their original packaging, a brought forward system should be put in place for all medication. This would show the quantity of any medicines that are carried forward from one four-week MAR chart to the next, in addition to any new supply of the medication. Nurses medication training should be updated regularly. To make sure people are safe you must provide staff with clear instructions about what obersvation and support is required for people when providing one to one care. To help people communicate and staff to understand peoples best way to communicate you should review the way people communicate and make sure people have a communication profile. The communal areas should be less institutional and provide a comfortable place for people to meet. Page 11 of 13 2 9 3 9 4 18 5 18 6 24 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 33 The numbers and skills of the staff should be regularly reviewed to make sure peoples needs are always met. Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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