Inspection on 20/09/05 for Bricklehampton Hall Nursing Home

This inspection was carried out on 20th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bricklehampton Hall Nursing Home 16/05/07

Bricklehampton Hall Nursing Home 08/02/06

Bricklehampton Hall Nursing Home 02/03/05

Bricklehampton Hall Nursing Home 30/11/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Bricklehampton Hall Nursing Home Bricklehampton Nr Pershore Worcestershire WR10 3HQ Lead Inspector Mandy Burton Unannounced Inspection 20th September 2005 09:00 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 Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 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. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bricklehampton Hall Nursing Home Address Bricklehampton Nr Pershore Worcestershire WR10 3HQ 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) 01386 710573 01386 710460 Classic Care Limited Mrs Shirley Ann Archer Care Home 55 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (55), of places Physical disability (10), Physical disability over 65 years of age (3) Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Number not exceed 55 Elderly Continuing Care Date of last inspection 2 March 2005 Brief Description of the Service: Bricklehampton Hall is situated in a rural setting near Pershore and Evesham. The hall is a Regency building, which stands within seven acres of gardens and grounds, with views over the Bredon Hills. Over recent years the buildings and grounds have been considerably upgraded to a very high standard, in a style, which is in keeping with the period of the building. The home currently provides nursing care for fifty-five residents in spacious rooms with modern nursing equipment and facilities. The home provides a choice of ensuite, single and double rooms. Residents are able to have a telephone line in their bedrooms. Meals are prepared in a kitchen, which has been upgraded to a high standard. Menus are varied and take into consideration individual choice. There is a call bell in all bedrooms, communal areas, toilets and bathrooms. Emergency call pendants are also available for residents who wish to walk out in the grounds unattended. Activities and social events are organised by the activities organiser. Visitors are welcome at any reasonable time. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9am. It took place over a period of five and a half hours. A partial tour of the home took place and a selection of care and staff records were examined. Three residents, three members of staff and a visitor were spoken to. What the service does well: What has improved since the last inspection? What they could do better: Further developing documentation used for assessments would ensure accuracy in recording. Including more specific detail in care plans in respect of each individual will ensure continuity of care. By reviewing recording systems for the monitoring of the temperature of the drug fridge would ensure that any maintenance issues are highlighted for attention at the earliest opportunity. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 6 Introducing a system whereby boxes of medication are dated on opening will further enhance the home’s ability to carrying out auditing. 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. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 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 Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 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): 3 and 4. Residents’ individual needs are assessed prior to them moving into the home, which enables staff to ensure that they can continue to receive the appropriate care and support when they move into the home. EVIDENCE: All residents are assessed by a trained nurse prior to their admission to the home. Information obtained from the residents and their respective carers enables staff from the home to establish the individual care needs of each resident and to determine if these needs can be met by the home. Written records are kept of all assessments carried out. A record was seen of an assessment documented for one resident. It was suggested that the home considers redeveloping existing documentation for recording assessments, as it was not clear from the dates on the record seen if the documentation had been completed before or on the residents admission to the home. Records seen showed that support or equipment identified as necessary during the assessment was put in place ready for when residents were admitted to the home. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 9 The home has a system whereby an admission checklist is completed for every resident. The checklist covers all aspect of admission from the presentation of the resident’s room to all aspects of the nursing process. This system is very effective in ensuring procedures are adhered to and that each resident receives the appropriate information and care on their admission to the home. In addition to pre-admission assessment staff in the home ensure that whenever residents are admitted to hospital they do not return home until a nurse has carried out an assessment to ensure the home can continue to meet their needs. Staff spoken to were noted to have a good understanding of the individual needs and preferences of residents in their care. Relationships between staff and residents were very friendly and relaxed. Staff were observed interacting and assisting residents in a caring and sensitive manner. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 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, 9 and 10. The health care needs of residents in this home are well met with evidence of ongoing multidisciplinary working. Although in general terms care plans are of a good standard, they could be improved by the inclusion of more specific detail in respect of each individual to ensure continuity of care. Personal support is offered to residents in a way that ensures that their privacy and dignity is respected. Systems for the administration of medication are good and ensure residents’ medication needs are met. EVIDENCE: Care plans were documented for each resident. Plans had been developed in accordance with the assessed needs of each individual resident. A random selection of plans were examined. Although in general terms care plans are of a good standard, they could be improved by the inclusion of more specific detail in respect of each individual to ensure continuity of care. It was noted that infection control measures were in place for staff caring for one resident until laboratory results had been obtained. The residents care plan had not been updated to reflect the procedures staff were to follow. Staff in the home have an awareness of the mental health needs of residents and in practice provide ongoing support to ensure the emotional and social needs of residents are met. Discussions took place about ensuring that these Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 11 needs and the support being given to each resident was evident in their respective care plans. Health care screening in the home was very good and records showed staff responded appropriately to any changes in the health and wellbeing of residents and accessed specialist advice and intervention as necessary. Records showed residents receiving regular reviews by a medical practitioner. Systems are in place to ensure that pressure sore assessments and body mapping is incorporated as part of the admission process. Wound care management is good and specialist advice from the tissue viability nurse is accessed as necessary. Discussion took place about ensuring any changes in treatment are entered in care plans as soon as possible to ensure continuity of care. There was evidence that staff were encouraging residents to be involved in the care planning process. Moving and handling assessments were completed for each resident and reviewed on a regular basis and when needs changed. A selection of medication administration records including controlled drugs were examined and noted to be satisfactory. The deputy matron reported that medication audits had been introduced since the last inspection. Medication administration records were initially audited on a daily basis and any shortfalls were identified and appropriate action taken where necessary. This process has now been maintained at weekly intervals and records are kept of all audits that are undertaken. Records relating to the daily monitoring of the temperature of the drug fridge were seen. Records showed several occasions where temperatures were recorded outside of the required levels. There was no evidence to support action taken by staff when this had occurred and it was therefore recommended that staff make a record of their action taken to address this problem when it occurs. A medication audit was carried for two residents. It was suggested that staff record the date boxes of tablets are opened in future to enable auditing to be more effective. Appropriate arrangements are in place for the receipt, disposal and storage of medicines. Observations made during this visit indicated that residents in the home were treated with respect and their dignity maintained. The atmosphere was very relaxed and relationships between residents and staff were seen to be warm and friendly. Residents spoken to said staff treated them well. Staff were observed knocking on doors before entering residents rooms. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 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): 14. Residents in this home are actively encouraged to make choices and decisions on a day to day basis including choosing how and where they wish to spend their time. EVIDENCE: Residents spoken to were able to confirm that they are able to make choices in respect of activities of daily living for example choosing when to get up, what to wear and how and where they wish to spend their time. The home has a variety of communal areas, which are accessible to all residents providing opportunities for them to spend time alone or with others. Residents are able to choose from a varied menu at each mealtime. Residents confirmed they could receive visitors at any reasonable time and that visits could take place in private. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. The complaints process in this home is very good and enables residents to discuss any concerns they may have at anytime and be assured they will be taken seriously by staff. EVIDENCE: The home has a written complaints policy and procedure in place. Management and staff have created an atmosphere within the home whereby anyone is encouraged to raise any concerns they may have at any time. This enables the home to ensure issues do not escalate and also provides an opportunity to evaluate services provided and to explore opportunities for improvement. Records of complaints received by the home were seen which showed that investigations had been carried out and appropriate action had been taken where necessary to deal with issues arising from the outcome of investigations. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26. The standard of the environment within this home is very good and provides residents with an attractive, homely and safe place to live in. EVIDENCE: Bricklehampton Hall is very well maintained and provides a comfortable and homely environment for residents to live in. The home is surrounded by extensive gardens, which are accessible to all residents including those who may be dependant on the use of a wheelchair or have limited mobility. One resident spoke about the pleasure they get from being able to go out in their wheelchair into the gardens. Since the last inspection work has been completed to create a paved garden area within the grounds, which include a number of attractive raised flowerbeds. In addition to this some new garden seating furniture has been purchased for residents and visitors to use. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 15 The home benefits from having a variety of communal areas, which are all accessible to residents. Resident were observed moving between rooms as preferred. Residents rooms are spacious and furnished to a high standard, the majority of which have views over open countryside. Residents spoke of being able to bring personal possessions with them into the home as desired. Staff in the home have access to a variety of equipment for the safe moving and handling of residents. Since the last inspection an additional hoist has been purchased. All rooms accessible to residents are fitted with an emergency nurse call system. In addition to this neck pendants are also available to residents accessing the grounds or for those residents who may be unable to easily access nurse call points. Records seen showed evidence that risk assessments are completed before a decision is made to use bedsides and that appropriate consent is obtained The laundry facilities were seen and noted to be satisfactory, with appropriate infection control measures in place. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. Adequate numbers of staff are on duty, which ensures residents ‘ individual needs can be met and they are kept safe. Appropriate training is made available to all staff, which ensures that they have the necessary skills and knowledge to care for residents. Residents are protected from the risk of abuse by the home’s thorough recruitment processes. EVIDENCE: On the morning of the inspection 55 residents were residing in the home and the home was adequately staffed to meet the needs of those residents. The atmosphere in the home was very relaxed and staff were observed undertaking their duties in a very unhurried manner. A resident spoken to said they felt there was enough staff on duty to meet their individual needs and that when they asked for assistance staff responded promptly. There is a strong commitment to staff training and training is made available to all staff which is appropriate to the duties they have to perform. Two registered nurses were on training course on the day of this visit. Staff spoken to were positive about the opportunities made available to them. The home also acts as a placement for student nurses from a local university. A student was present during this visit and it was evident that staff were providing a high standard of support and guidance and that both parties were benefiting from the placement. Staff records were seen for two members of staff, which demonstrated that the home’s recruitment policies and procedures are adhered to and that suitable safeguards are in place. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 17 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): 36, 37 and 38. Staff are provided with the support and guidance necessary to enable them to care for the individual needs of residents. Health and safety practices are good, ensuring residents have a safe place to live in. EVIDENCE: Since the home’s last inspection there has been a change in the day-to-day management of the home and the former deputy matron has recently taken on the matron’s position. It was evident from discussions with staff and from observations made that the change in management has had no detrimental effect on the service, and the home continues to be well managed. The matron was attending management training and was not on site on the morning of this inspection. Procedures are in place for all staff to receive regular supervision from senior staff. Records seen of supervision that has taken place showed that staff Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 18 receive ongoing encouraged. support and guidance and personal development is Positive health and safety practices are promoted. Fire training for all staff is ongoing. Risk assessments are in place in relation to all areas of the home both internally and externally. The quality of assessments was good and there was clear detail as to the action to be taken in order to reduce or eliminate and risks identified. In addition to this any risks identified on a day-to-day basis are assessed and dealt with immediately. Written records are kept of all accidents that occur and records seen show appropriate action is taken by staff at time of the incident. Audits are undertaken on a monthly basis of all accidents that occur. Policies and procedures are in place to direct practice, which are updated on an ongoing basis. It was reported that several policies had been amended since the last inspection to reflect changes in practice and in one instance as a result of feedback from staff attending a fire warden’s course. Records were seen in respect of the maintenance of aids and equipment and fire safety equipment, all of which were noted to be satisfactory. Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 19 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 X 3 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 X 4 4 X 4 4 4 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 3 3 Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations It is recommended that the home seek to improve systems for the recording of pre- admission assessments so that it is clear from the documentation when the assessment was carried out. It is recommended that the content of care plans are reviewed on a regular basis to ensure that they contain sufficient detail as to how individual physical and mental health care needs are to be met. It is recommended that systems for the recording of the temperature of the drug fridge are reviewed to ensure staff document action taken by them when readings are outside of normal ranges. It is strongly recommended that staff date boxes of medication on opening to enable effective auditing to be carried out. 2 OP7 3 OP9 4 OP9 Bricklehampton Hall Nursing Home DS0000004098.V249040.R02.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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