Inspection on 19/08/05 for Bromley Park Nursing Home

This inspection was carried out on 19th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bromley Park Nursing Home 02/07/07

Bromley Park Nursing Home 13/07/06

Bromley Park Nursing Home 06/02/06

Bromley Park Nursing Home 18/06/05

Bromley Park Nursing Home 25/02/05

Bromley Park Nursing Home 20/09/04

Bromley Park Nursing Home 17/11/03

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

CARE HOMES FOR OLDER PEOPLE Bromley Park Nursing Home 75 Bromley Road Beckenham Kent BR3 5PA Lead Inspector Rosemary Blenkinsopp Unannounced 19 August 2005 09:00 am 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. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bromley Park Nursing Home Address 75 Bromley Road, Beckenham, Kent BR3 5PA 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) 020 8650 5504 020 8650 6085 Nellsar Limited Jacqueline Hayward-Gant Care Home with Nursing 50 Category(ies) of Dementia (50) registration, with number of places Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice issued 29 April 1997. Date of last inspection 18/06/05 Brief Description of the Service: Bromley Park Nursing Home has been registered to its current owners since 1993. It is a large, detached house in a residential area of Beckenham, and provides nursing care to a maximum of 50 residents, of either sex who are suffering with Dementia. The building has been adapted for its purpose and has had an extension added. Bedrooms are sited throughout the building and there is a lift giving access to all floors. Communal areas are on the ground floor. There is a large back garden and car parking to the front of the building. There is a bus stop outside the home. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced as part of ongoing monitoring of the home. The inspectors also followed up the actions taken to address previous requirements and recommendations. Arising out of the previous inspection were ten requirements, three of which were to be addressed immediately. Two inspectors undertook the inspection. Bedroom and communal areas were inspected including the main kitchen area. Some improvements had been made in these areas, which are detailed under the environmental section, including general improvements in the cleanliness in the kitchen. However, the Provider had agreed to restrict admissions to one resident per week until standards improve. Care practices and routines in the home have been revised following inspections by the CSCI. A selection of care plans, medication records and health and safety documentation were inspected. General observation of the care practices, contact and interaction between staff and residents were noted. Some residents were still in night attire late morning, breakfast service continuing until 10.15 am, and residents were sitting in the lounge in dressing gowns at 12.00 midday. One individual identified as being outside the home’s registration category; enforcement is currently being undertaken in respect of this issue and the resident concerned is being found an alternative placement. What the service does well: What has improved since the last inspection? Parts of the environment had benefited from replacement of old furniture and fittings. The domestic was seen to address cleaning of areas where no residents were sleeping, this had been the case at previous unannounced inspections. Medication procedures had improved both in practice and record keeping. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 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. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 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 Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 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) EVIDENCE: No standards were assessed in this section. Since the last unannounced inspection voluntary agreement has been reached to stop all admissions for the period of one month and thereafter one admission a week was agreed. The category of registration has been changed to reflect the category of Dementia – Elderly. Reviews are being conducted on two residents who were outside of the category, as identified by the inspectors at previous inspections. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10. Care plans need to be more robust in content to accurately reflect the needs of residents. Documentation must be easily accessible and user-friendly to maximise its use. EVIDENCE: Care plans were randomly selected. The care plan of one resident indicated two injuries in a short period of time - a fractured clavicle then a fractured hip. There was limited information relating to these injuries or how they occurred. There were risk assessments in place, however, these were limited in content and interventions. These issues have been addressed through a separate communication to the manager. The care plan of one resident, who is currently under review, was inspected. His assessment and care plan identified uncooperative, difficult and unpredictable behaviour, however, the daily events focused mainly on his physical needs, with little reference to his identified problems. Moving and handling risk assessments and falls risk assessments were checked and in place for four residents. Sixteen accidents had been recorded between the period 4/08/05 and 17/08/05 information was recorded correctly. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 10 The morning medication procedure was partially observed. The procedure was safe and addressed in an unhurried manner by one of the RGNs on duty. The medication charts were in a printed format. Medication charts were completed with residents’ photographs and allergies. The quantity of medication received was signed in. One hand transcribed medication had the quantity received, omitted. On the bedroom door of one resident was a notice stating MRSA. This is confidential information and should not be published in this manner. The optician was in the home. In the office there was a drawer full of spectacles, some in cases, some labelled, some not. These were possibly not belonging to current residents. The content of the drawer was as follows: 31 pairs of spectacles 18 empty spectacle cases 9 pairs of spectacles which were not named The majority of spectacles were issued by The Outside Clinic. In the event that residents need spectacles or any prosthesis, these must be applied. All those not required should be returned to the appropriate department. Please see requirements 1 and 2. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 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) 12,14,15. Efforts have been made to change the routines to improve the residents’ quality of life. However this still does not address individuality and choice. EVIDENCE: Since the previous unannounced inspection conducted 18 June 2005 there have been a number of visits conducted to the home. These visits have focused on care practice, individual choice, dignity and respect issues. It was apparent that the morning routines have changed. The new routines rely on staff assisting residents in getting up, having breakfast then, at some stage in the morning, being assisted to dress into day clothes. Some residents were still in night attire and dressing gowns as the inspectors departed at 12 midday. Many were sleepy whilst up in the day area. One gentleman had his name sewn on to the outside of his slippers. Other avenues should be explored to incorporate residents’ choice and dignity into their day. It is debatable what input residents had into their day. The TV was playing in one part of the lounge. Apart from the serving of the tea by one staff member, contact and interaction with the residents was limited. There was notification of an afternoon activity, however, more contact and interaction is needed for residents to experience variation and stimulation in their lives. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 12 Breakfast was being served in the dining room; this was the second sitting. Many of the residents were still in their night attire, residents sitting in wheelchairs asleep. Staff made attempts to assist the residents to eat; however the interaction between staff and residents was minimal. The RGN in charge of the home was assisting with the breakfast service, however, it was evident that there were not enough staff on duty to help feed the residents. Some residents were still waiting for their breakfast at 10.15 am. The dining room was reasonably clean and tidy and the newly acquired furniture was in good condition. Two tables had cloths on them; all tables had condiments and a small vase of flowers. Please see requirement 3. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: No standards were assessed in this section. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,22,23,24,25,26. Some improvements to the environment have been made although a sustained ongoing rolling programme of re-decoration and replacement of furniture/ fittings needs to be implemented. EVIDENCE: The hall thermometer registered 80oF, although portable fans were in use in an attempt to address this. In the lounge the pressure relieving cushions were fully functioning. Chairs were cleaner although many looked worn. Jugs of fluids were available in the lounge although at the point of leaving these had not been offered to residents. Many residents are unable to initiate helping themselves to a drink either by way of physical incapacity or mental incapacity. A hot drink was given to residents mid morning by a staff member. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 15 There was a malodour in the lounge. The reality orientation board was correct. The walls in the communcal sitting area were marked and in one corner the plasterwork was crumbling. The newspapers were available. In the small lounge the floor was slippery underfoot, the inspectors themselves slipping on the floor. In bathroom B5 there was faeces on the seat and in the toilet bowl, it was very unpleasant. One resident stated that the bathrooms B5 & B6 were freezing and on this day they felt so. The sluice room was open and should be locked. Carpet extraction fluid and cleaner was stored in toilet T6, which was open and potentially a health and safety hazard to residents; all products should be stored in line with COSHH Regulations. Several bedrooms were inspected and the standard was variable. Generally soap and towels were available although not in all cases. In many bedrooms call bell leads were disconnected. This has been raised on previous occasions and action to address this was confirmed by the home. Decoration, furniture and screening in some double rooms were inadequate, with no armchairs, insufficient storage space and some poor quality bed linen. In one bedroom a plastic picture frame was on top of a light fitting and this felt very hot and was a potential danger. One bedroom was hazardous with items on the floor, including trailing wires. Staff were alerted to these items. To the side of the garden there were items of old furniture, which were in the processes of being removed. The cleanliness of the kitchen was much improved from the previous inspection. Efforts had been made to implement the cleaning schedule and the documentation relating to the cleaning schedule had been completed. The cook on duty, (who works as the cook covering Wednesday, Thursday and Friday 7am –2pm and as a carer in the home Wednesday and Thursday 2pm-7pm) appeared to be competent. She stated that she had achieved her basic food hygiene certificate and had knowledge of the menu. Breakfast comprised cereal, porridge, choice of egg and bacon or egg on toast, bread or toast with jam or marmalade. Lunch was being prepared at 9.30am whilst breakfast was still being served, chips were being fried and on checking the hot trolley there was a tray of fish fingers and mixed vegetables (for lunch at 12.15) being kept hot. The lunch menu was a choice of fried fish, cornish pasty, chips, mixed vegetables, rice pudding, ice cream and yoghourt. Food storage had improved although a better system could be implemented for dating opened food packets, bottles and jars as some of the dated labels were falling off and making it difficult to ascertain the correct date of opening. All food supplements checked were stored correctly and were in date. The kitchen windows are screened, fridge Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 16 and freezer temperatures taken, a monitoring check had been carried out, risk assessments were done. Please see requirement 4. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. Staff are not provided in sufficient numbers to address the individual needs of residents. EVIDENCE: The home has a condition of registration which states that they must abide by the previously agreed staffing notice. On the morning of the inspection this was not the case. The home was without an RMN on duty, which is the appropriate qualification for this home in addition there were insufficient care staff. The staffing notice states for the period 08.00- 14.00 that three qualified nurses must be employed, one of whom must be an RMN, plus seven care staff. At the time of the inspection there were three RGN ‘s on duty with six care staff one of which was the allocated bed maker. An immediate requirement was left at the home regarding this issue. There was one agency care staff on duty. She had arrived at 08.45 am. It was her first shift in the home. The inspectors asked what orientation and induction she had received. She stated that she had been shown to the lounge and dining room. She stated that she had received no instruction in health and safety measures. She had immediately started to feed residents on her arrival. It was noted that staff were busy throughout the morning attending to residents needs there was limited supervision of residents in communal areas. It was noted that several training events were advertised on the notice board including infection control and communication skills. Please see requirement 5. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 18 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) 38. Health and safety measures are in place to ensure equipment is maintained. EVIDENCE: The health and safety policy and procedures were checked; there is a copy in the office for staff. The following service certificates were inspected: • • • • • Electrical installation inspected and tested on 02/08/05 in conjunction with BS 7671:2001 (EE wiring Regulations.)- Pacific Security Systems. PAT testing was carried out 04/09/02 –Bob Burgess Electrical. This is overdue Hoists and Parker Baths services January 05 by Wealden Rehabilitation. Stickers should be on every item detailing the service date as detailed under the LOLER Regulations. This was not the case on one item Fire Alarm, Emergency Lighting, Nurse Call and Fire Fighting Equipment inspected 22/03/2005 – Southern Care Maintenance. Lift – inspection certificate dated 15/02/05 by Stannah Lifts G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 19 Bromley Park Nursing Home • • • • • • • • • • Gas installation inspection on 20/03/05 Fire alarm tested weekly Emergency lighting tested weekly Fire training 20/06/05 Fire Drills 08/08/05 day staff. Fire Drill 07/03/05 night staff The Fire Officer visited 20/08/05. He required a key to be placed at the front door which was actioned. The Environmental Health Officer visited March 05. Rentokil Pest Control visits monthly – last visit 14/06/05. One hoist did not have the date of service indicated on it. The staff were unable to locate a current certificate for Legionella testing but water temperatures are checked weekly – although these were not inspected. Please see requirement 6. Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 20 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 x COMPLAINTS AND PROTECTION 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 3 2 Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 21 yes. 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 Requirement The Registered Person must ensure that care plans reflect needs, are reviewed at appropriate intervals and have supporting risk assessments in place. Previous time frame for action 30/9/05 The Registered Manager must ensure that heath care provision is approprately actioned by staff and all information retained in a confidential manner. The Registered Manager must ensure residents are treated individually where privacy and dignity are maintained. Previous time frame for action 30/6/05 The Registered Person must ensure that the premises are retained hazard free and maintained in a homely manner with all items as needed available. The Registered Person must ensure that there are sufficient staff to supervise residents. Previous time frame for action 30/6/05. Timescale for action 30/9/05 2. 8 12 30/9/05 3. 12 12 30/9/05 4. 24 23 30/12/05 5. 27 18 Immediately Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 22 6. 38 23 The Registered Person must ensure that all equipment is tested and inspected at appropriate intervals. 30/9/05 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 Good Practice Recommendations Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup DA14 5RH 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 Bromley Park Nursing Home G51-G01 s10129 Bromley Park UI v243894 190805 Stage 4.doc Version 1.30 Page 24 - 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. 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