CARE HOMES FOR OLDER PEOPLE
Brecklands Nursing Home 28 Burnham Avenue Bognor Regis West Sussex P021 2JU Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 11th January 2006 03:00 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 Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Brecklands Nursing Home Address 28 Burnham Avenue Bognor Regis West Sussex P021 2JU 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) 01243 863218 01243 869769 Mrs Janet Mary Cole Mrs Lynda Rehman Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th August 2005 Brief Description of the Service: Brecklands nursing home is a privately owned care home providing nursing care for up to nineteen residents in the category of older people. The home is a detached two-storey property in a residential area of the town of Bognor Regis. It is close to the town centre, within easy access to all local amenities and is half a mile from the sea front. Accommodation is provided in fifteen single and two double rooms. Four of the single rooms have en-suite facilities. A lounge with adjoined conservatory and a smaller dining room provide the communal space. A seating area is available on the first floor. I Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived at 3pm and left the home at 7.30pm. The registered manager was not on duty during the inspection and a second visit was made to the home on Thursday 2nd February 2006, to follow up some issues with the registered manager. The nurse in charge at the time of the inspection assisted the inspector during the visit. In the course of the inspection seven residents, three visitors and four members of staff were spoken with. A tour of the premises took place. Some residents individual records were examined in detail and other documents were read as was needed. Following the last inspection four requirements and one recommendation were made. At this inspection XXXX had been met. What the service does well:
Residents live in a homely setting which was clean, tidy and warm. The furnishings and fixtures were domestic which gave a comfortable feel to the home. Residents spoken with said they liked the way it was “homely” and that it was “always clean”. There was a variety of activities on offer for the residents, should they wish to join in. These included things which people with different needs and abilities could do and although encouraged to be sociable, residents said their choices were respected. Residents could decide how to live within the home, choosing what time to get up, go to bed, where to spend their time and whether to go out of the home, if they were able to do so safely. The home is managed by an experienced person who has the skills and knowledge to meet the needs of the residents. Staff are supported and supervised in their work and feel they can ask the manager for guidance if they need to. The resident’s benefit from a stable staff team. They said it was “nice to see familiar friendly faces” to look after them. Staff were polite and respectful when talking to the residents and visitors. Visitors said they could come at any time, felt welcomed and “part of the furniture”, they could stay as long as they liked and be involved in the care of their loved one, should they wish. One visitor was given meals with his relative, which was of obvious comfort to him. The individual plans of care for the residents contained a good amount of information which gave a clear picture of their social and physical needs. The information was relevant and up to date. Assessments for health care needs were completed and other professionals involved when necessary. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 4. Residents received clear terms and conditions for their stay in the home. Residents needs were assessed prior to them becoming accommodated in the home. Staff required more training to make sure they could appropriately meet the needs of the residents. EVIDENCE: A copy of the terms and conditions, which included the services and facilities provided, was present for each resident. This included all necessary information to meet the standard. Residents were not accommodated in the home unless an assessment of their needs had been carried out, by a suitably qualified person. Where appropriate assessments from other health professionals had been obtained. The manager confirmed that no resident would be admitted to the home without an assessment of their need having been completed. Residents and visitors spoken with said they felt confident that the staff were meeting their needs, or those of their relative. They said more junior staff were supported by the manager and other qualified nurses. On speaking to the manager there was a lack of training for the staff in the home. A trainer
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 9 used to visit the home and provide excellent and up to date varied training. Unfortunately this opportunity has ceased some time ago and attempts were being made to identify further appropriate training courses. It was discussed that some training was necessary for the staff to safely meet the needs of the residents. An example was moving and handling, and this was needed as a matter of urgency. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9. Residents had an individual plan of care. The health care needs of the residents were met. The procedures for administration of medication in the home protected the residents. Standard ten was assessed and met at the last inspection. EVIDENCE: All residents in the care home had a plan of care documented. These contained a good amount of information which assisted the staff to care for the resident. The residents choices, in some areas of daily life, were recorded. The care plans were drawn up from various assessments of health care need and were reviewed and up to date. Various health care assessments were recorded for each resident. Staff were aware of the need to keep health assessments up to date and to involve other professionals, should this be necessary. At the time of the last inspection nutritional risk assessments and bed rail risk assessments were not in use. At this inspection the use of bed rails was included on the moving and handling risk assessment. It was discussed that a specific assessment, identifying the various risks and alternatives, should be in place. A nutritional assessment was present for two residents who had been identified as being at risk of poor
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 11 nutrition. This should be extended to more residents when eating and drinking or weight loss or gain was identified as an issue. Assessments and plans for the risk and management of pressure sore development were in place. At the last inspection a requirement was made that all bed rails must have protectors in place to prevent injury. At this inspection these were present for all residents with bed rails. Residents and relatives spoken with were satisfied that the health and personal care needs were being well met by the staff. They were happy that other professionals were involved and advice sought, when necessary. The medication in the home is administered to the residents by the qualified nursing staff. Medication is stored in a specific room in the home. The door to this room was not shut or locked during the inspection. Some medication was not locked away, but left out on the side. All medication must be appropriately and safely stored. The door to the room where medication is kept should be locked at all times. The medication administration records were appropriately kept. Hand written additions were signed and witnessed. Medication was disposed of in line with current guidance. Residents were able to administer their own medication, when staff thought they were safely able to do this. This assessment of safety should be recorded, including the safe storage of the medication, and kept under review. All prescribed medication, including external preparations, should be signed for when administered by staff. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14 Residents said there were some activities in the home and they were assisted to join in if they wished. Residents were encouraged and supported to keep contact with family and friends. Visitors said they were welcomed into the home. Individual choices about daily life and the routine in the home was understood and respected by the staff. Standard fifteen was assessed and met at the last inspection. EVIDENCE: The activities which took place in the home included a very popular gardening club, entertainers visiting, one to one board games, manicures, discussions, videos and music. Residents spoken with said there were activities to join in with, should they wish, but their decision not to was respected. Individual residents had newspapers, books, talking books, television, radios and music centres in their own bedrooms, should they wish. Staff had a knowledge of the favoured leisure activities of the residents. Residents were able to go out of the home unaccompanied, should they be safely able to do this. Others discussed how they got out in the good weather, to the seafront and sat in the garden. It was discussed that a recorded social history of the resident would help staff to have a more detailed picture of the person and their past lives. This may help to develop individual or group interests in the home.
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 13 Visitors were seen to be welcomed into the home at various times. They said they could visit their relative when they wished and assist in their care, if they wanted and were able to be part of it. Those visitors spoken with said staff always welcomed them and gave important information about their relative, whenever necessary. Visitors could see their relative in private, or in the communal areas, as they wished. One relative was given meals with the resident. They said this was a “lovely thing for staff to do” and they felt “very cared about as well.” Staff spoken with were aware of the varied choices of the residents, regarding their daily routine. They knew the preferred times for getting up and going to bed, but said they would always ask the resident each day. Some preferences were written on the care plans. Residents said staff asked their choices and respected them. One resident who liked to go out of the home alone, had a door key and freedom to live how they wished, within the home. Information regarding the local advocacy service, for any resident who wished to access this, was available in the home. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed. Standards 16 and 18 were assessed and met at the last inspection. EVIDENCE: Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22 and 26 The home was well maintained. Some improvements to the environment had been made since the last inspection. An issue of fire safety was raised. There were adequate number of toilets and bathrooms. Not all were in use for residents and some presented a limited amount of space. The specialist equipment required for the residents accommodated at this time was available in the home. The home was clean and pleasant. One bathroom was in need of repair and redecoration, in order to meet infection control guidelines. EVIDENCE: At this inspection the home was clean, warm, tidy and pleasant. Staff and visitors commented on the homely atmosphere and the fact it was always clean. Since the last inspection some improvements to the environment had been made. The windows at the front of the house had been replaced. This improved the overall look of the home and residents in the affected bedrooms said there were less draughts than previously. A requirement to replace an illfitting carpet in the doorway of a bathroom had been carried out. Residents said should they raise any maintenance issues these were dealt with quickly.
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 16 Those spoken with were pleased with their surroundings. It was discussed with the manager, at the last inspection, that fire doors must not be wedged open. Advice was given to consult with the fire service regarding suitable alternatives to keep fire doors open, which would meet with their guidance. This advice had been obtained, but no devices were in place and fire doors remained wedged open. A requirement was made that this practice cease. The manager confirmed, on the second visit to the home, that some appropriate devices had been bought and would be fitted in the near future. The requirement remains in place and will be monitored at the next inspection. The fire training for staff had been completed in December 2005. There were toilets available close to the communal sitting areas and on all corridors for the bedrooms. Some residents were unable to use the toilets and commodes were provided in their bedrooms. One toilet and bathroom was used for storage. If this area remains accessible to residents it must be safe for them to use. Some of the toilets, especially on the ground floor, had restricted space for residents with walking aids, or needing assistance. Consideration for the safety of the residents should be given when using these toilets. Raised toilet seats and frames were present to assist the residents. One bathroom on the first floor was showing signs of wear. Some areas were damaged and could not be adequately cleaned for infection control purposes. This bathroom must be in good repair. Equipment to assist residents with restricted mobility was present in the home. This included a hoist, stand aid, bath seats and grab rails. Other specialist equipment was not required at the time of this inspection. It was discussed with the manager that some bedrooms and bathrooms had a limited amount of space, or the layout was awkward, when specialist equipment was necessary. Although this was taken into account during the assessment process, the residents needs could change whilst they were at the home and additional equipment be needed. It was required that a written risk assessment, for the suitability of any bedroom, be carried out for all residents. This should include the provision and use of any equipment and be kept under review. The home was clean and free from offensive odour at the time of the inspection. Protective clothing was available for the staff. Some staff had received training in infection control. All staff should have this training up to date. It was discussed with the manager that the hot water in some hand wash basins was excessively hot. It was not possible to wash your hands under this water and this could discourage staff from appropriate hand washing, after assisting a resident. This should be considered in a review of the hand washing procedures in the home. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The numbers and skill mix of the staff was adequate to meet the needs of the residents, at the time of this inspection. Staff required training to make sure they had up to date knowledge and skills to meet the needs of the residents. Since the last inspection necessary checks for staff working in the care home had been obtained. No new staff had been employed. EVIDENCE: At the time of this inspection there was an adequate number of staff on duty. The duty rota showed a qualified nurse was on duty at all times. It was discussed with the manager that the nurse in charge, during this inspection, was working for seventeen consecutive hours, in charge of the home. The manager explained this nurse was covering a shift for sickness and wanted to work these hours. This was not usual practice in the home. The care assistants on duty had experience to meet the needs of the residents and knew them well. One member of staff had completed the NVQ level two with two others on the course. The manager was aware they should have fifty percent of staff with this qualification. As discussed other training was necessary to make sure staff had the skills and knowledge to meet the residents needs adequately and safely. The induction and foundation training should meet the current guidance. The manager was working to identify an appropriate source of training for the staff. She was aware of the requirement to make sure staff were up to date with their knowledge and skills. Training for staff in the safe
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 18 moving and handling of residents was booked for later in the month. Staff had completed training in the protection of vulnerable adults. At the time of the last inspection four staff were working in the home without the appropriate checks having been carried out. At this inspection these checks had been completed. No new staff had been recruited. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36 and 38 The home is managed by an experienced and skilled person, who is respected by staff and residents. Staff receive appropriate supervision by more experienced staff. There was an awareness of the health and safety for residents and staff in the home. Some further assessments and management of risk were required. Standards 33 and 35 were assessed and met at the last inspection. EVIDENCE: The registered manager is a qualified general nurse. She has many years experience working with older people and of managing a care home. She confirmed that she attends appropriate training courses and keeps her practice up to date. She does not hold a management qualification and was aware this was necessary. Staff and residents spoke highly of the manager, saying she was approachable, kind and caring. They said she would “go out of her way” to be helpful and had a “genuine interest” in the welfare of residents and their families.
Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 20 Staff said they felt well supported by the manager and other qualified staff. They all work together to assist the residents, which gives the staff opportunity to observe practice and offer advice. Since the last inspection more formal supervision had taken place and this was recorded. Staff had an awareness of the health and safety of residents in the home. Some had received training and the basics had been covered during induction. It was recommended at the last inspection that the methods used for moving and handling residents should be reviewed. At this inspection this had not been done and no further training had been delivered. A requirement for this is made. Some further assessments of risk were needed with management strategies to reduce these where possible. These should include the size and layout of the bedrooms, bathrooms and toilets and suitability for residents and use of equipment, self-medication and use of bed rails. Other risks identified should be assessed as necessary. The requirement made at the last inspection to remove a trip hazard had been completed. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 3 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 2 Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 22 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. 2. Standard OP9 OP19 Regulation 13(2) 23(4)(c) (i) 23(2)(d) 13(5) 18(c ) 23(2)(f) Requirement All medication kept in the care home must be safely stored. Fire doors must be closed at all times, unless held open by a device which meets the guidance of the fire service. The bathroom on the first floor must be in good repair. Safe systems for moving and handling must be in place. This must include staff training. All staff must have training for the work they are to perform. The size and layout of the rooms must be suitable for the needs of the resident. Assessments of suitability of the bedrooms should be done for residents. Timescale for action 31/03/06 11/01/06 3. 4. 5. 6. OP21 OP38 OP30 OP38 30/04/06 31/03/06 30/04/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 23 1. 2. 3. 4. OP8 OP9 OP12 OP21 More thorough risk assessments should be done for the use of bed rails. Nutritional risk assessments should be carried out. Risk assessments for the self-administration of medication should be done. A recorded social history of each resident would help staff to understand their past lives and interests. Bathrooms and toilets which are accessible for residents should be safe for them to use. Consideration to space restrictions, in some toilets, should be given when advising or assisting residents to use them. Brecklands Nursing Home DS0000024124.V277328.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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