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Inspection on 29/01/07 for Brierton Lodge Nursing Home

Also see our care home review for Brierton Lodge Nursing Home for more information

This inspection was carried out on 29th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users residing in the home generally have very complex nursing and mental health needs. However, care is provided by a committed team of staff who at all times promote service user choice and support service users to achieve their optimum independence within a safe environment. The home has recently been acquired by the BUPA organisation and as such a planned programme of investment is currently underway, recent refurbishments having now being completed to the first floor of the building and future developments planned. The company appears to place great emphasis on supporting and developing its staff to deliver the best quality of care for its service users. Therefore the staff have access to internal and external training programmes with the opportunity for further development within the company, e.g. a senior nurse has recently taken on a field based training role which at the same time has given the opportunity for 2 trained nurses in the home to acquire more managerial responsibility.

What has improved since the last inspection?

Service users individual care files show that staff have invested time and effort to develop and improve the way in which information is documented from which a plan of care can be produced. There is also evidence of further work taking place to improve the way in which care is planned and delivered, i.e. the Quest Individual Assessment tool. Since the last inspection work has also been carried out on the use of bed rails; a risk assessment tool on usage has been introduced and requires staff to obtain the service users consent before bed rails are used. Improvements have been made to the catering service whereby staff have attended a training programme relating to new guidance on the safe handling and preparation of food. There is also evidence in the care files that the weight of the more vulnerable service users is being monitored and recorded. Since the previous inspection Regulation 26 reports under the Care Standards Act 2000 have been sent in on a monthly basis to CSCI`s local office providing evidence of the registered provider`s assessment of the home. Examination of the policies and procedures for disposal of medicines show that the service is meeting its statutory responsibilities and that only the required levels of medicines are being stored. Staff spoken to were able to discuss in detail and with confidence the home`s policies and procedures relating to the protection of vulnerable adults. There is evidence to show that on-going training is being provided by the service. A schedule of current and future staff training needs has been produced. Policies and procedures relating to fire safety have been reviewed and updated following a recent fire in the kitchen.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Brierton Lodge Nursing Home Brierton Lane Hartlepool TS25 5DP Lead Inspector Lesley - Anne Moore Unannounced Inspection 29th – 31stJanuary 2007 09:30 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.V328602.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V328602.R01.S.doc Version 5.2 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 carol.barnard@brierton.ansplc.co.uk 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.V328602.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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. Three 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. The home may accommodate named individuals as set out in letters to the registered person dated 17 May 2006 and 15 September 2006 which establishes the basis on which the individuals` needs will be met by the home. Where necessary the home`s Statement of Purpose shall reflect any changes in service provision required for this arrangement. This condition may not apply to anyone else, other than the named individuals, who falls outside the registered category. 28th September 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. The majority of 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. The accommodation consists of 54 single bedrooms and 4 double bedrooms all with en suite facilities. Adequate toilet and bathing facilities are provided. The first floor accommodation has recently undergone an extensive refurbishment to provide living accommodation of a high standard. There is a committed team of care and support staff. The current weekly fees charged are between £343 - £576 with additional charges for haidressing, newspapers and travel where required. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 2 visits on 29 and 31 January and lasted for approximately 12 hours. The Registered Manager supplied some information on the pre-inspection questionnaire. A number of service user surveys and relatives/visitors comment cards were completed and returned. Time was taken speaking with staff, service users and their relatives, the Operational Manager for BUPA who was visiting at the time and the Northern Estates Manager for BUPA by telephone. The inspection focussed on key standard outcomes for service users and to check whether the requirements and recommendations made at the previous inspection had been implemented; in particular to confirm that more comprehensive information is available in the assessment and care planning documentation and specifically in relation to nutrition and need for bedrails; that monthly reports under Regulation 26 of the Care Homes Regulations 2001 are being provided to CSCI; that medicines that are no longer required are being safely disposed of under the home’s policies and procedures; that policies and procedures relating to the protection of vulnerable adults is under constant review and details the action to be taken if an allegation arises including the appropriate person to contact; that the redecoration programme continues; that staffing levels are under constant review to meet the needs of all service users and in particular those with challenging behaviour; that a schedule of staff training needs has been compiled to include training already completed and future training needs; and that staff meetings are being held on a regular basis. On entering the home there was a lot of activity at the start of the day with staff assisting service users with their daily routines. However, the service users appeared happy, well cared for, and were interacting well with staff. Although the home accommodates service users in 2 separate areas with either nursing or mental health needs, the home operates as 1 unit in which both areas share the same policies and procedures. What the service does well: The service users residing in the home generally have very complex nursing and mental health needs. However, care is provided by a committed team of staff who at all times promote service user choice and support service users to achieve their optimum independence within a safe environment. The home has recently been acquired by the BUPA organisation and as such a planned programme of investment is currently underway, recent Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 6 refurbishments having now being completed to the first floor of the building and future developments planned. The company appears to place great emphasis on supporting and developing its staff to deliver the best quality of care for its service users. Therefore the staff have access to internal and external training programmes with the opportunity for further development within the company, e.g. a senior nurse has recently taken on a field based training role which at the same time has given the opportunity for 2 trained nurses in the home to acquire more managerial responsibility. What has improved since the last inspection? What they could do better: Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 7 Individual service user contracts are not available in the home. The service has agreed provision of care on a block contract basis with Social Services and the local Primary Care Trust. The service must ensure that each service user is issued with a contract that clearly sets out the terms and conditions for the provision of accommodation and nursing care and who is responsible for meeting those fees. Inspection of the records of 2 service users recently admitted showed that there were a number of omissions in the information documented. The Manager must ensure that staff are aware of the importance of documenting all relevant information on admission upon which care can be planned to meet service users needs safely. The policies and procedures for disposal of medicines could be further improved by ensuring that 2 trained nurses carry out the disposal of unwanted medicines at all times. An offensive odour was noted in the rooms of 2 service users and in a toilet on the EMI unit. The Manager must take steps to identify and to eliminate all odours as much as possible. A bathroom on the first floor is currently being utilised as a smoking area for those service users in the EMI unit who are unable or reluctant to use the garden area. The Manager must consider other areas that can be used for this purpose. Whilst staffing levels to both areas are generally seen to be satisfactory, the number and skill mix of staff should be under constant review to meet the needs of the service. Service users monies are currently being deposited in a joint non-interest account from which staff are able to make deposits and withdrawals on behalf of the service users. This practice is disadvantaging all service users and particularly those with large sums of money deposited, £14,000 in one instance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 8 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.V328602.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their relatives receive appropriate information about the home including a visit where possible prior to admission to the home. EVIDENCE: Inspection of individual service user records revealed that individual contracts are not available and that care is funded for the majority of service users through the provision of a block contract with either Social Services or the local Primary Care Trust. Details of the contracts are held at the company’s Head Office. Each service user should be provided with a contract that clearly sets out the terms and conditions for the accommodation and nursing care where appropriate and who is responsible for meeting all or part of those fees. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 10 The home provides adequate information within the Statement of Purpose and Service User Guide to prospective service users and they are able to visit the home in advance of placement where possible. A member of staff will also visit the service user in hospital to assess their individual needs in addition to care manager and continuing health care assessments. For those service users admitted for intermediate care, the service is able to demonstrate that it is able to meet individual needs by providing suitable accommodation, equipment and nursing care until such times as the service user is able to return home. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service strongly believes that it is essential to involve service users in the planning of care that affects their quality of life. EVIDENCE: The service has recently developed a form of assessment, ‘Quest Individual Assessment’ which considers activities of daily living and includes prompts for risk assessment to act as a reminder to staff to consider all potential risks to the service user. A care plan is developed from this assessment and includes the health, personal and social care needs of the individual. The care plan is reviewed on a monthly basis and the necessary action taken to respond to any changes in consultation with the service user where appropriate. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 12 A life biography section has recently been added to the admission documentation, ‘A Day in the Life of’, in which staff are able to document details of a service users earlier life. Service users health records are brought from the local hospital and allow a comprehensive record of health care provided by the continuing health care team. The service is also able to provide a physiotherapy service from visiting professionals in a room designed and equipped specifically for this purpose. The records of 2 service users recently admitted into the 2 separate areas of the home were looked at during the inspection. Summaries of assessments undertaken through care management arrangements were available and used as part of the admission procedure in gathering all relevant information. However, for the service user admitted onto the Elderly Mental Ill unit, the Mental Ability Assessment had not been completed. A Care Plan Agreement Form had also not been completed. Similarly, in the Frail Elderly Unit, there were a number of omissions in admission documentation, i.e. Consent/Agreement to photograph a Resident not completed, Risk Assessment for the use of Bed Rails only partially completed and a Life Biography not completed. The Manager should review the admission procedures with the care staff and stress the importance of documenting all information obtained during the initial assessment upon which future care can be planned. Due to the nursing and mental health needs of the service users, there are currently no service users who self-medicate. The home has a medication policy in place in which medicines are generally received, stored, administered and disposed of safely. A service contract is in place for disposal of all waste to include medicines. During the inspection staff expressed anxiety at the number of medicines awaiting collection for disposal that were being stored in an open disposal bin. Access to the treatment area is limited to key holders only and currently medicines are being checked out of the cupboard by 1 trained nurse and recorded as being disposed of in the collection bin. Ensuring that 2 trained nurses undertake this checking and disposal procedure at all times could further reduce risk. Disposal of Controlled Drugs meets statutory requirements. The aims and objectives of the home reinforce the importance of treating service users with respect and dignity in all aspects of their life. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of the home are planned around the service users needs and wishes. Where possible service users are encouraged to take control of their lives. Service users receive a balanced, wholesome diet according to their individual assessed needs and choice. EVIDENCE: Service users are helped in making choices about their daily activities and are given the opportunity to engage in social activity where possible. The service employs an Activity Coordinator who plans activities according to the needs and level of ability of the service users. Trips to the local park, public house and shopping centre are also encouraged and supported by the staff. 1 service user spoke enthusiastically of her shopping trip with the Activities Coordinator to buy a gift for a relative’s new baby. Another service user who is unable to get out described how staff take him in his wheelchair to the home’s sensory garden where he can enjoy some fresh air. Transport for outings is arranged through the local councils dial – a – ride service and also taxi firms offering Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 14 wheelchair access. Evidence of activities and outings arranged is available in a photograph album in the multi-sensory room. Relatives are actively encouraged to visit the home at any time and are kept up to date with service users progress. A number of visitors were seen during the inspection. The dining areas on both units provide a pleasant environment for dining, the first floor dining area having recently undergone a refurbishment. Staff have introduced a new policy whereby visitors are kindly asked not to accompany service users into the dining room but to allow some quiet time for service users to enjoy their meal with minimal distraction. Staff report that this is particularly important on the EMI unit where service users can quite easily become distracted and lose interest in eating. Service users also have the option of having their meals in the privacy of their own rooms should their visitors wish to stay with them. Catering staff are following new guidance recently introduced by the Food Standards Agency, ‘Safer Food, Better Business’ which considers issues such as nutritional content of food, presentation and food temperatures. There is also evidence to show that the weights of vulnerable service users are being monitored and recorded in the care files. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. EVIDENCE: There is a clear and accessible complaints procedure within the home available to service users and their relatives to enable anyone associated with the service to make a complaint or make suggestions for improvement. Records of complaints were looked at during the inspection and provided evidence that any complaint is fully investigated and an accurate record documented of the nature of the complaint and action taken. The policies and procedures regarding protection of service users are of a good standard and are reviewed and updated on a regular basis. Staff receive training on the protection of vulnerable adults. The trained nurses spoken to during the inspection were clear when incidents require external input and which agency to refer the incident to. The service is also committed to following the BUPA Care Homes Philosophy of Care and Resident’s Charter, which considers among other things the fundamental rights, privacy, dignity, independence and choice of service users. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 16 The staff recruitment policy and procedure is adequate showing evidence of the appropriate checks being made prior to staff being employed. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and homely environment. EVIDENCE: The home is currently undergoing an extensive refurbishment programme, the first floor having now been completed with plans to complete the remainder over the next year. The home appears to be a well-maintained environment with the provision of pleasant communal rooms, comfortable dining rooms, a multi-sensory room, a physiotherapy room and a recently completed external sensory garden that is divided into different areas. Service users bedrooms are individualised giving Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 18 the opportunity for personal possessions and a limited number of furnishings to be brought in. During the inspection an offensive odour was noted in one of the toilets on the first floor. The member of staff at the time reported that this was an-going plumbing problem and was currently being addressed. There was also a very strong odour of cigarette smoke in one of the communal bathrooms on the first floor. On questioning, the member of staff explained that this area was used for those service users in the EMI unit who smoke and are either unable or do not wish to use the garden outside. Since the bathroom is used by other service users for bathing, the Manager must consider other areas that service users can have access to and which meet health and safety requirements should they wish to smoke. There was also an offensive odour noted in 2 of the service users rooms on the first floor that was brought to the attention of the staff at the time of the inspection. The Manager should take steps to identify the cause of the odour and take appropriate steps to reduce or eliminate it. There is a selection of general aids such as hoists that are available for use by service users once their needs have been assessed. There is evidence to show that staff are trained in the safe use of aids and equipment. Documented evidence was available to show that all statutory health and safety checks were up to date. A recent fire in the kitchen has prompted a review of the fire policies and procedures in place. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff receive relevant training that is targeted and focused on improving outcomes for service users. EVIDENCE: There is a dedicated long-standing team of trained nurses, care and support staff to meet the needs of the services users with 75 of the care staff reported to hold the National Vocational Qualification (NVQ) Level 2 in Care. Service users comment ‘Girls marvellous, can’t do enough for you’, ‘no reason to complain’, and ‘Definitely very happy, food exceptional’. Discussion with the staff on duty at the time, examination of the duty roster and observation during the inspection demonstrates that appropriate number of staff and skill mix are generally on duty to meet the needs of the service users. However, the previous inspection report and comments received from staff, service users and their relatives suggest that at times staffing levels may appear to be on the low side, and in particular on the EMI unit. The working day runs from 8am to 8pm, split between 2 shifts, generally supported by 2 trained nurses and 4/5 care workers per floor for the morning shift, and 2 trained nurses and 3 care workers for the afternoon shift. 1 trained nurse and Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 20 2 care workers are generally available per floor for the night shift. Staffing levels should be under constant review and where necessary adjusted to ensure that sufficient staff are on duty at any one time to meet service users needs, and in particular those with more challenging behaviour. The service ensures that all staff receive training to support their roles and personal development. A schedule of training completed and future training needs has been developed and details the training that staff members are currently receiving, e.g. managing violence in the work place, dementia training, safe management and administration of drugs for trained staff, infection control, managing investigations and customer enquiries, Investors in People training for Managers, computer training and Personal Best (a BUPA quality initiative). The service ensures that staff are supervised and appraised by the Manager at regular intervals. The home’s recruitment policies and procedures were looked at and provided evidence of a robust system for the benefit of service users. All staff are expected to complete a comprehensive induction period relevant to their area of work, i.e. care staff or support staff. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager has the required qualifications and experience to effectively manage the home. EVIDENCE: The Registered Manager was unavailable at the time of the inspection. However, 2 senior nurses who are responsible for the 2 areas in the home and report directly to the Manager provided much of the information required. The Manager is seen to provide an environment in which staff are supported and developed to deliver a high standard of care for the service users. The leadership style appears to be that of a democratic manager who listens to, Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 22 respects and supports her staff whilst encouraging an open and friendly culture between staff, service users and their relatives and visiting support staff. Staff comment on the Manager as ‘Carole’s supportive’. The Manager holds regular meetings with the staff so that any concerns may be raised and to discuss progress within the home. Relatives are also invited to meetings and given the opportunity to meet with staff and to discuss any worries they may have about their relative. The service also produces a regular newsletter in which service users and their relatives are kept up to date with developments in the home. Inspection of the safe keeping of service users monies showed a system in which monies are pooled together and banked in a non-interest deposit account. Service users are able to have access to their own funds at any time and procedures are in place to show that accurate records are kept of deposits and withdrawals. However, there were seen to be large variations in the amounts deposited, e.g. less than £100 to £14,000, none of which was attracting any interest. The Administrator spoke of the planned future move to individual accounts for service users in line with BUPA policies. The Manager should consider the implications for those service users who do have quite substantial sums of money deposited in a non-interest account and consider whether the current arrangements should be altered in the service users best interests. Detailed health and safety policies safeguard the interests of service users, staff and visitors to the home, and were available for inspection to include regular servicing of fire equipment and gas and electrical appliances. There is evidence to confirm that accident records are duly completed and reviewed to detect any trend emerging in relation to an individual upon which remedial action is then taken. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 23 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 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 X X 3 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 2 X X 3 Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 24 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. 1. Standard OP2 Regulation 5 Requirement The Manager must ensure that each service user is provided with a contract that clearly sets out the terms and conditions for the provision of accommodation and nursing care. The Manager must ensure that staff are documenting in full the assessment of a service users needs on admission using the correct recording system in the care file. The Manager must investigate the cause of the offensive odour in the service users rooms and the toilet on the first floor and take immediate action to either reduce or eliminate the odour. Timescale for action 31/07/07 2. OP3 17 and Schedule 3 31/07/07 4. OP26 16 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 25 No. 1. Refer to Standard OP9 Good Practice Recommendations The safe disposal of medicines could be further improved through the practice of 2 trained nurses witnessing and documenting the procedure. The Manager must find alternative suitable accommodation in which service users in the EMI unit can exercise their right to smoke with supervision. Staffing levels should be under constant review and where necessary adjusted to ensure that sufficient staff are on duty at all times to meet service users’ needs and in particular those service users with more challenging behaviour. The Manager should consider alternative bank accounts in which service users monies could be deposited to allow those with large sums of money to benefit from interest accruing to balances. 2. 3. OP26 OP27 4. OP35 Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brierton Lodge Nursing Home DS0000000150.V328602.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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