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Inspection on 15/04/05 for Brockhampton Court Nursing Home

Also see our care home review for Brockhampton Court Nursing Home for more information

This inspection was carried out on 15th April 2005.

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 Home provides a high standard of care and facilities for the residents. The environment is homely, comfortable, clean and well maintained. The extensive grounds are also well maintained and accessible to all of the residents. Residents spoken to felt that the quality of the care was good and that their needs were being met. Staff were described as being `awfully good` they are `kind but always busy`. Residents spoken with all `felt safe` living at Brockhampton Court. One resident said that they `liked the Home because it is clean, doesn`t smell and like the staff`. Staff put a lot of effort into ensuring that residents know what is going on in the Home each month by producing a monthly newsletter called the `Brock News`. Meals are nutritious and nicely presented. Residents can choose to eat their meals at the beautifully laid tables in the dining room, in the library with guests or in the privacy of their own room.

What has improved since the last inspection?

The requirement from the last inspection report has been achieved by the Home. The manager has carried out an audit of the quality of the care and systems in place at the Home. Views have been sought from residents, relatives, visitors; staff and visiting professionals and the outcomes have been put together in a report, which is available at the entrance to the Home.

What the care home could do better:

A number of the care plans require improving so that the resident`s needs are identified and staff know what individual care is required. Staff must be employed correctly to ensure that the residents living at the Home are protected from people who should not be working there.

CARE HOMES FOR OLDER PEOPLE Brockhampton Court Nursing Home Brockhampton Herefordshire HR1 4TQ Lead Inspector Sandra Bromige Unannounced 15 April 2005 at 10:30 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 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. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brockhampton Court Nursing Home Address Brockhampton Herefordshire HR1 4TQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01989 740239 01989 740289 Dr Christopher John Allen Mrs Joanne Debra Parker Care Home with Nursing 43 Category(ies) of OP Old Age - 43 registration, with number PD Physical Disabilities - 43 of places PD(E) Physical Disabilities (over 65) - 43 Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None other than the categories of registration listed above. Date of last inspection 10 December 2004 Brief Description of the Service: Brockhampton Court is a Grade II listed building set in six acres of wellestablished gardens. It is situated in the village of Brockhampton, which is midway between Hereford, Ledbury and Ross-on-Wye. There is a village post office. The provision of public transport is very limited with a local bus which goes to Hereford 1-2 times each week. The Home provides a car driven by a member of staff, which can transport upto three residents at one time to enable them to access local facilities. This cost of this service is inclusive in the fees charged by the Home. The Home was purchased in 1996 by the Provider Dr C J Allen and converted into a care home. It is registered as a care home with nursing for a maximum of 43 residents. The service is able to offer care for adults of both sexes, who have a physical disability or are frail due to old age. At the time of the inspection, of the Homes 33 bedrooms all except one are of single occupancy rooms, the exception being occupied by a married couple. 32 bedrooms have en-suite facilities. There is a passenger lift to all floors. The gardens are well maintained and are accessible to residents. An extension to the rear of the Home is currently in progress as part of an application to the Commission to increase the numbers of registered beds. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 10.30 – 18.10 hours on Friday 15th April 2005. The providers monthly visit reports to the Commission and other communication with and from the Home since the last inspection were all considered as part of the assessment process. The information within this report was obtained by observation, touring parts of the premises, inspection of records, discussion with 7 residents, the manager, 6 staff, and 2 visitors. Building work is in progress at the rear of the Home to build a two-storey extension for the provision of further nursing beds. What the service does well: What has improved since the last inspection? The requirement from the last inspection report has been achieved by the Home. The manager has carried out an audit of the quality of the care and systems in place at the Home. Views have been sought from residents, relatives, visitors; staff and visiting professionals and the outcomes have been put together in a report, which is available at the entrance to the Home. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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 standard(s) 1, 3, & 6. The Homes Statement of Purpose and Service User Guide are satisfactory providing existing and prospective residents with details of the services provided by the Home to enable them to make an informed decision about moving into the Home. Established admission procedures are in place to ensure that residents care needs are able to be met by the Home. EVIDENCE: The Homes Statement of Purpose & Service User guide is on display at the entrance to the Home. In addition to these informative documents are copies of the last two inspection reports, and a copy of the Home’s annual quality audit of the service provided by the Home. Resident’s needs are assessed by the manager prior to admission through visiting them at their current home or whilst visiting Brockhampton Court to view the service and its facilities. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 9 Standard 6 is not relevant to this Home, as they do not offer intermediate care. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10. Care plans do not show that resident’s individual needs are identified and met. These shortfalls have the potential to place residents at risk. The medication is well managed promoting good health. Residents are treated with respect and their privacy is maintained. EVIDENCE: All residents have care records and of the three seen only one showed that the residents care needs were being identified and met. This care plan was being reviewed regular in consultation and agreement with the resident. The other two care records contained risk assessments for moving and handling and skin assessments that had not been completed since admission. Care plans identifying problems and care to be given were not in place for all areas of need. Residents where their individual ability permits are encouraged to administer their own medication. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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 standard(s) 13 & 15. Links with the community are good and support resident’s social opportunities. The meals in the Home are satisfactory, offering choice and variety. EVIDENCE: Many visitors were seen in the Home during the inspection. Residents are able to entertain their visitors in the privacy of their room or in one of the numerous community sitting rooms around the Home. Due to the very rural setting of the Home, a car is provided by the Home that can be used to transport residents to appointments or to engage in social activities and interests. Lunch on the day of the inspection was braised sausages in red wine, creamed potatoes, fresh cauliflower, frozen green beans with apple crumble and cream for dessert. Residents indicated that the food was ‘very good’ and they are able to eat in the dining room, the library or in the privacy of their room. Others were less satisfied and indicated their dissatisfaction about the amount of frozen vegetables served and an alternative not always being served according to their likes and dislikes supplied to the catering staff. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 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 standard(s) 16 & 18. The Home has a good complaints system with evidence that all concerns/complaints from residents, relatives and visitors are taken very seriously and acted upon. Policies for the Protection of Vulnerable Adults are in place. These procedures will only protect residents from abuse if followed at all times. EVIDENCE: The Homes complaint procedure is on display in the Home and published in the Statement of Purpose and Service User guide of which a copy is given to all residents in the Home. A small amendment is needed to change the name of the Commission from the NCSC to CSCI. Residents said that they would report any concerns to the manager, and were confident that she would deal with their concern. Residents indicated that they feel safe living at the Home. Recruitment procedures for the protection of residents are in place. The records of a new member of staff provided evidence that these procedures had not been adhered to as no Protection of Vulnerable Adults first check had been received by the Home prior to this member of staff commencing employment. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19 & 26. The Homes décor, and quality of the furnishings and fittings are of a high standard. The Home is well maintained and presents as a homely and comfortable environment for the residents. The Home is cleaned to a high standard maintaining a pleasant and hygienic environment for residents, staff and visitors. EVIDENCE: Brockhampton Court is a Grade II listed building set in six acres of wellestablished gardens. It is in a very rural location. The entrance has been adapted for suitability of use to mobile and wheelchairs users and level access is provided throughout the Home via a lift or ramped corridors. The Home is well-maintained and regular weekly and monthly checks of fire and water systems are in place for the protection of the residents. Not all of the radiators in the public areas are covered or of a low surface temperature variety. This has been included in the Homes risk assessment. The Home is clean and tidy and free from any unpleasant odours. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Staffing levels and staff morale are good resulting in an enthusiastic workforce that work positively with residents to improve their quality of life. Recruitment procedures have not been followed recently which has the potential to put residents at risk from abuse. EVIDENCE: Staffing levels on the day of the inspection were good. There were 32 residents in the Home with 2 trained staff on duty, 7 care staff, 2 domestic staff, a laundry assistant, a cook, a kitchen assistant and an administrator. In addition to these the manager was on duty and a student nurse was also on placement at the Home. The turnover of staff at the Home is low and staff spoken with had been employed by the Home between 2 – 8 years. One Senior Carer has just completed NVQ level 4. This is excellent practice. The recruitment records of the most recently recruited member of staff did not contain any references and employment had commenced prior to receipt of any Criminal Records Bureau check. This is poor practice and has the potential to put residents at risk of abuse. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 37. The Home regularly reviews aspects of its performance through a programme of self-audit and consultations, which include residents, relatives, visitors, staff and visiting professionals. Not all records are being obtained upon recruitment of staff for the protection of residents. EVIDENCE: The Homes systems for reviewing the quality of the service have progressed since the last inspection. The manager has carried out audits and produced a report. A copy of this report has been sent to the Commission and is also on display at the entrance to the Home. The audit covers areas including care regimes for high dependency residents, nursing documentation, stakeholders’ perceptions of the Home, kitchen service, bathing, social interaction and policy documents. Not all of the records required to be held in the Home were available such as two references for each member of staff and evidence of Criminal Records Bureau checks prior to employment. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 16 Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x 2 x Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 & 17 Requirement Residents care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Care plans must be kept under review. Two written references must be obtained for all staff prior to employment and these records kept in the care home. Staff must not be employed by the Home unless a Criminal Records Bureau check has been applied for and Protcetion of Vulnerable Adults First clearance has been obtained. Timescale for action Immediate & Ongoing 2. 29 17 & 19 Immediate & Ongoing Immediate & Ongoing 3. 29 19 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 15 Good Practice Recommendations Residents should be consulted about the quality of vegetables provided by the Home. Brockhampton Court Nursing Home E52 S27673 Brockhampton Court V221279 150405 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection 178 Widemarsh Street Hereford Herefordshire HR4 9HN 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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