Inspection on 28/09/05 for Brierton Lodge Nursing Home

This inspection was carried out on 28th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brierton Lodge Nursing Home 12/03/08

Brierton Lodge Nursing Home 29/01/07

Brierton Lodge Nursing Home 18/04/05

Brierton Lodge Nursing Home 08/12/04

Brierton Lodge Nursing Home 11/08/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

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

CARE HOMES FOR OLDER PEOPLE Brierton Lodge Nursing Home Brierton Lane Hartlepool TS25 5DP Lead Inspector Mr. Paul Emmerson Announced Inspection 9:30 28 September 2005 th 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 Brierton Lodge Nursing Home DS0000000150.V251869.R01.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. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brierton Lodge Nursing Home Address Brierton Lane Hartlepool TS25 5DP 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) 01429 868786 01429 267129 ANS Homes Limited Mrs Caroline Mary Barnard Care Home 62 Category(ies) of Dementia - over 65 years of age (31), Mental registration, with number disorder, excluding learning disability or of places dementia (31), Old age, not falling within any other category (31), Physical disability (31) Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 31 residents aged 60 years and over can be accommodated on the Dementia and Mental Disorder Unit. 31 older people aged 60 years and over can be accommodated on the older persons unit. Four named individuals who are under the age category can reside in the home. Physical Disability Adults over the age of 55 years are able to be accommodated on the older persons unit.. 18th April 2005 Date of last inspection Brief Description of the Service: Brierton Lodge is a purpose built care home for up to 62 people with nursing needs. Virtually all admissions to the home are from hospital through Continuing Health Care arrangements. The home operates two specific units: on the ground floor it provides care for older people and people with physical disabilities; on the first floor care is provided for people with dementia and mental health needs. The home is square shaped, built around a central enclosed garden. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. By law we have to inspect all care homes at least twice a year. This announced inspection was carried out in accordance with this obligation. The inspection took place over 7 hours, on the morning and afternoon of Wednesday 28th September 2005. In line with current CSCI policy on ‘Proportionality’, the inspection focused upon a number of key standard outcomes for service users. The key standard outcomes not inspected on this occasion were assessed during the last inspection of the home. Two inspectors, Paul Emmerson & Sue Lowther, carried out the inspection. They looked around the building and a number of records were examined. 6 service users, the manager, 9 members of staff, 8 visitors and a GP were spoken to. What the service does well: What has improved since the last inspection? As required in the last inspection report, the home’s Statement of Purpose document has been updated to provide further information about room sizes. Action has been taken to address other issues raised in the last report. For example, locks have been fitted to sluice room doors. Catering arrangements have also been reviewed. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 6 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. Brierton Lodge Nursing Home DS0000000150.V251869.R01.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 Brierton Lodge Nursing Home DS0000000150.V251869.R01.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): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. EVIDENCE: NA Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 9 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): 7,8,9,10 &11. Individual care plans are in place, however these need to be more comprehensive to ensure that all care needs are appropriately met. Service users can be confident that their privacy and dignity is protected and that they are treated with respect. At the time of this inspection medication was not always being managed correctly, with some practices considered to be unsafe. EVIDENCE: The inspectors spent time in the company of the people who live at Brierton Lodge and saw that their care needs are being met and people are comfortable in their home. Management and staff ensure that service users’ health care needs are met. Where specialist intervention is required it is sought. Records confirm that contact with GPs and other health professionals, such as the community psychiatric nurse, the dietician and the continence nurse, is maintained. A visiting GP spoken to said, “Things seem well organised, there’s good working relationships, I’ve no concerns”. A service user interviewed said, “They Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 10 do their best to see I’m looked after, they go out of their way to see I’m comfortable”. Relatives spoken to provided positive feedback. One person said, “I have found staff extremely kind to both my husband and myself. Nothing is a bother to them”. Another relative said, “Staff are very professional and caring”. A service user plan has been developed for each service user that identifies needs associated with health and personal care. 6 care plans were examined. These were found to identify basic needs, but were not always evaluated on a monthly basis to ensure that changing needs are met. In particular, nutritional assessments require review to ensure that people who cannot be weighed have other factors considered on a more frequent basis, for example ‘do their clothes still fit or are they too big etc’. Further, risk assessments on the use of bed rails were not comprehensive and did not demonstrate how the decision had been reached with regard to their use. A high proportion of service users had bed rails in use and this was discussed with the Manager and a member of staff who agreed to review the use of these for each service user. Several service users had previously been detained in hospital under Section 3 of the Mental Health Act. However, the care plans within the home did not contain the relevant documentation to confirm that they had been discharged to the home appropriately and under the relevant section of The Mental Health Act. The home’s systems relating to medication were checked. Policies, procedures and systems currently in place relating to the receipt, recording, storage, handling, administration and disposal of medicines are generally adequate. However, during the inspection it became evident that the disposal of drugs was not always being managed correctly and was therefore a potential risk to the health and wellbeing of service users. Drugs, which should have been disposed of, as the service user was no longer in the home, were still stored in the treatment room. The manager advised that several staff had received training with regard to death and that specialist services, for example Macmillan Nurses, are called if required. Comments received from relatives and service users confirmed that people are treated with dignity and respect and that their privacy is maintained. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 11 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): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. EVIDENCE: NA Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 12 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 & 18. Complaints and adult protection systems in the home serve to safeguard service users. EVIDENCE: Information about complaints, how and who to make them to, is made available to service users and their families through information displayed on the home’s notice boards, in a ‘Welcome Directory’ and in the home’s ‘Service Users Guide’. Service users’ views are obtained through regular contact and an ‘open door policy’. Although formal ‘Residents Meetings’ are not held, the manager runs quarterly ‘Residents / Family Surgeries’ as an additional forum to discuss any concerns or potential difficulties. In an inspection comment card returned to CSCI, one service user wrote, “I am very happy with the care I receive and find most of the staff and carers do their very best at all times. We find that if we have a problem that we can talk to all the nursing staff and management”. Staff interviewed voiced a commitment to the service users they work with and to upholding service users’ rights. A number of the staff interviewed said they had received training relating to whistle-blowing and adult protection. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 13 The home, through its parent company and the local Adult Protection Committee has detailed complaints and adult protection procedures. Copies of these were seen to be available for staff use. Policy and procedure documents relating to adult protection provide information and guidance to staff. However, these documents should be reviewed to ensure that they include contact arrangements and the initial action to be taken (things to do and things not to do) if an allegation of abuse arises. Brierton Lodge Nursing Home DS0000000150.V251869.R01.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): None of these outcomes / standards were assessed on this occasion. They were examined during the last inspection of the home. However, as highlighted in previous inspection reports, the registered manager should continue with the ongoing redecoration programme. EVIDENCE: NA Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 15 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 & 30. Sufficient staff are currently employed. The home has a settled, well trained and well led staff team. EVIDENCE: From discussions with management and staff, and from an examination of duty rosters, sufficient staff are employed within the home. There is a settled staff team. Most of the staff spoken to have worked at Brierton Lodge for between 5 and 10 years. For staffing purposes, the home’s waking day runs from 8 am to 8 pm. On morning shifts, 2 qualified nurses and 4 care assistants are rostered on each floor of the home. Where service users’ needs increase, staffing levels are adjusted to provide an additional carer. On afternoon shifts, 2 qualified nurses and 3 care assistants are rostered on each floor. After 8 pm, staffing levels are: 1 qualified nurse and 2 care assistants on each floor. Although these staffing levels should be kept under review, they are considered adequate to be adequate to meet the needs of the people currently accommodated. However, in an inspection comment card returned to CSCI, one relative wrote, “I do feel that there should be more staff on night duty and maybe another nurse for when things get a little busy”. Another person wrote, I have found Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 16 staff extremely kind … nothing is a bother to them”. However, this person added, “Even one extra carer upstairs would be a great help, especially when a resident needs one to one care”. Another person wrote, “Staff do an excellent job, but at times they are overwhelmed by the number of patients”. Some staff spoken to also said that evening periods can be very busy, particularly on the home’s first floor. Staffing levels should be reviewed and where necessary adjusted to ensure that sufficient staff are rostered to meet service users’ needs and in particular those service users with more challenging behaviour who may require closer or more frequent supervision. This review should also consider the number of domestic staff rostered. In an inspection comment card returned to CSCI, one visitor wrote, “At times the smell of urine (upstairs) is overpowering, which we noticed was not present this week which happened to coincide with your inspection. We understand that this is an ongoing problem, but the fact it could be eliminated for your visit makes us feel it could be better controlled all the time”. Recruitment procedures within the home are safe. CRB (Criminal Records Bureau) disclosure checks are carried out for all staff. A copy of each person’s birth certificate and a photograph is kept in their personnel file; these documents are copied when completing the Criminal Records Bureau disclosure. Applicants for employment complete an application form and 2 references are obtained. A reference from the last employer is requested, plus another; any gaps in employment are explored. Each member of staff receives a contract of employment and a job description. Staff training is given a high priority. 70 of care staff have an NVQ (National Vocational Qualification) at level 2 or above. A number of domestic, laundry and catering staff also have NVQ level 2 qualifications appropriate to their roles. Although she still works nurse care hours, a senior nurse employed by the home has a training co-ordination role; this arrangement works well. In addition to NVQ and core training in for example moving and handling and fire safety, training courses covering risk assessment, palliative care and bereavement counselling have been arranged or planned. However, from discussions with staff and observations made during the inspection, benefit would be obtained if staff were to be given additional training relating to challenging behaviour. Further, although it is acknowledged that staff training needs are identified, and individual staff training records are kept, benefit would be obtained from collating individual training needs into a document setting out the overall collective training needs of the whole staff team. Brierton Lodge Nursing Home DS0000000150.V251869.R01.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): 31, 33, 35, 37 & 38. Brierton Lodge is well run. Appropriate quality assurance systems are in place to identify and rectify any concerns. EVIDENCE: The home’s manager is a registered nurse, has a Registered Managers Award and provides leadership to the home’s staff team. Staff interviewed spoke of good communication and effective teamwork. Service users’ views are obtained through regular contact and an ‘open door policy’. Although formal ‘Residents Meetings’ are not held, the manager runs quarterly ‘Residents / Family Surgeries’ as an additional forum to discuss any concerns or potential difficulties. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 18 One relative spoken to said, “Any problems the staff sort them out, but I could go to the manager who is very efficient and helpful”. However, although it is acknowledged that staff meetings are held, those arranged in recent months have been cancelled at short notice. Staff meetings should be held more frequently. Quality assurance systems operating in the home ensure that the home runs smoothly. Routine audits, for example relating to health and safety are carried out and any issues raised are rectified. Associated records required by regulation to be kept within the home are to a good standard. However, monthly reports required under Regulation 26 of the Care Homes Regulations 2001 must be provided to CSCI. Appropriate systems are in place to ensure service users’ health and safety is protected. However, as highlighted in the previous inspection report, issues raised by the fire officer in a recent visit must be addressed. Further, assessments relating to the use of bed-rails should be reviewed to ensure that they are only used if necessary. Brierton Lodge Nursing Home DS0000000150.V251869.R01.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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 & OP8 Regulation 15 (1&2). Requirement Timescale for action 31/01/06 2. OP37 26 3. OP38 23(4) More comprehensive information is required in the homes assessment and care planning documentation in particular with regard to nutrition and bedrails. Monthly reports required under 01/01/06 Regulation 26 of the Care Homes Regulations 2001 must be provided to CSCI. 31/01/06 As highlighted in the previous inspection report, issues raised by the fire officer in a recent visit must be addressed. Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 21 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. 2. Refer to Standard OP9 OP18 Good Practice Recommendations Medication no longer required for use by an individual service user must be appropriately disposed of after 7 days. Policy and procedure documents relating to adult protection should be reviewed to ensure they include contact arrangements and the initial action to be taken (things to do and not to do) if an allegation of abuse arises. As highlighted in previous inspection reports, the registered manager should continue with the ongoing redecoration programme. Staffing levels should be reviewed and where necessary adjusted to ensure that sufficient staff are rostered to meet service users’ needs and in particular those service users with more challenging behaviour. Although it is acknowledged that staff training needs are identified, and individual staff training records are kept, benefit would be obtained from collating individual training needs into a document setting out the overall collective training needs of the whole staff team. Staff meetings should be held more frequently. 3. 4. OP19 OP27 5. OP30 6. OP32 Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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. Extracts may not be used or reproduced without the express permission of CSCI Brierton Lodge Nursing Home DS0000000150.V251869.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!