Inspection on 02/07/07 for Bromley Park Nursing Home

This inspection was carried out on 2nd July 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.

Other inspections for this house

Bromley Park Nursing Home 13/07/06

Bromley Park Nursing Home 06/02/06

Bromley Park Nursing Home 19/08/05

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 Miss Rosemary Blenkinsopp Unannounced Inspection 2nd and 17th July 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 Bromley Park Nursing Home DS0000010129.V340390.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. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 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 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) 020 8650 5504 020 8650 6085 bromley.park@nellsar.com Nellsar Limited Jacqueline Hayward-Gant Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 29 April 1997 Date of last inspection 20th November 2006 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 are two lifts providing access to all floors. Communal areas are sited 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. The weekly fees are £550 for Bromley Social Services residents and up to £800 per week for private funded residents. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced visit by two inspectors over a one day period. A second site visit was necessary which was conducted by appointment by one inspector. Prior to the inspection the home had completed and returned the AQAA and this provided information, which was used at the site visit. At the first site visit the two inspectors spent time in different areas of the home observing practice including signs of residents well being and staff interaction. A selection of care plans were selected for inspection and those residents included in the case tracking by the inspectors. The inspectors where possible, met with the residents and their relatives. Comment cards were sent out to those relatives who were not present at the site visit and to the multi disciplinary members involved in that residents care. Staff were met on both of the site visits both individually and as part of a group. Staff personnel files and training records were selected for inspection. Other documentation inspected included quality assurance audits and those records relating to health and safety within the home. Over all the inspectors could evidence that significant improvements had been made in many areas of the home. A good atmosphere prevailed within the home and staff were more positive about their work citing increased training especially in Dementia care, and supervision as factors. What the service does well: The Proprietors and the Management Team have always been receptive to requirements and recommendations made by the CSCI and have endeavoured to work collaboratively with the inspection team. Progress in some areas has been slow and difficult to address but on this site visit improvements were evident. The home is managed by a qualified nurse who has a good knowledge of the client group and uses this expertise to ensure residents are admitted appropriately. Over the last two years the home has had a stable staff group who have provided consistent care and have developed as a team. The introduction of a deputy Manager has provided more staff support and supervision of care and record keeping. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Care plan documentation had improved although staff must act in a timely manner when issues are identified such as weigh loss. Reviews should have enough detail within them to reflect the progress or otherwise made on care plan problems. Staff need to be vigilant to ensure all residents receive sufficient food and fluids without long gaps occurring There are areas in the home, which would benefit from upgrading including some carpets and redecoration. In addition the home must ensure that all toilets, baths and showers are in full working order to address residents care. The home must ensure that all staff who are working in the home have a sufficient command of the English language to be able to converse with residents and visitors. Those staff who are recruited through agencies must have all of their documentation stored safely to maintain confidentiality. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 7 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. Bromley Park Nursing Home DS0000010129.V340390.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 Bromley Park Nursing Home DS0000010129.V340390.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents admitted into this home are subject to robust assessment procedures to ensure that they are with in the registration category and that all of their needs can be met. Information from other members of the multi disciplinary team is obtained prior to admission as well as relatives, where possible. This information assists the admission process to enable staff to meet resident’s needs. EVIDENCE: The first file inspected, to determine assessment procedures, included a preadmission assessment, which was completed by the Home Manager. This resident had been admitted from hospital. The resident had been referred by Bromley Social Services and was admitted in Jan. 2005. Oxleas Primary Care Trust had provided assessment information prior to admission. The resident was re-assessed by the homes’ Deputy Manager two years after the original Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 10 admission completed in June 2007. The original assessment of need, from Bromley Social Services was also in the file. In a second file there was evidence of a pre-admission assessment being completed by the Home Manager; as well as referral information from the PRU hospital and the local PCT. The relative had completed an initial application form for placement in the home and had been involved in completing an end of life care plan. The inspector requested the assessment of one resident, which was a separate to those care plans case tracked. The information included a comprehensive assessment conducted by Bromley Park Nursing Home. Other information included a hospital discharge letter and a discharge summary from a previous care home. This resident was self funding hence there was no community care assessment or care manager involved although there was a letter from the Local Authority regarding self funding. The resident had not had a trial visit prior to admission. Residents are invited to spend a day at the home where possible and relatives are encouraged to visit. The Manager also seeks information from the residents previous GP to further enhance assessment information. The home has a brochure, which is issued within 24 hours of the initial enquiry for placement. The home has taken a decision that all future residents must be non smoking to be admitted. The Statement of Purpose and Service User Guide were available in the hall. Relatives are asked to read and sign for these documents. Privately funded residents are provided with a contract, which outlines the level of service. . The Local Authority contracts are in place although these are sometimes subject to delay. The Manager insists that relatives are given enough time to consider the contract and are not simply asked to sign without full understanding. Bromley Park Nursing Home DS0000010129.V340390.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place, which are reflective of needs and have supporting risk assessments in place. The care plans provide staff with good guidance whereby they can address residents care needs. Evidence of input from members of the multi disciplinary team reflected an holistic approach to care. EVIDENCE: The two inspectors selected two care plans each. The care plans selected were requested by the inspectors and related to those residents wher specific concerns or issues had been raised. One care plan of a new resident was inspected, one of a resident with challenging behaviour, that of a resident prone to falls and a resident with a pressure sore. The care plans were well laid out and information easy to access. Resident’s photographs were in place. Initial assessment information was retained in the file as well as the current care plan risk assessment and daily events. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 12 The care plans were more comprehensive in content covering physical, mental and social activities. The interventions were to a good standard. These were signed by the registered nurse and where possible the next of kin. Most residents in this home do not have the capacity to comprehend the content of care plans. Regular reviews were in place, although more detail should be included to reflect the progress made in respect of problems. Wound care was well documented with supporting photographs and description of the wound. The daily events were comprehensive in content and provided good information in relation to specific problems. The home has added several items of documentation to care plans these include the best interests consultation, companionship /room sharing form, listening form and covert administration policy. These items are to ensure resident are protected and are provided with the best care even in the event that they are unable to make their own decision. One further piece of work was the development of the “end of life “ care documentation, which was in place. This is good practice. In one care plan there was a behavioural chart with regular records made in relation to the residents behaviour and interventions by staff. In relation to health care records there was some good information, in those entries from the CPN and Psychiatrist, although little on other health care provided such as visits by the dentist chiropodist. Letters following up appointments were retained in the file. The second care plan was also well laid out and comprehensive in content .One issue which required more attention from staff was the fact that this resident had lost a significant amount of weight since her admission. Her weight was recorded regularly, however there was no clear guidance in respect of the weight loss. This needs to be addressed. The inspector viewed the information of two residents whose assessment documentation had been inspected .The two care plans were inspected in detail, one plan was for a resident in a shared room, and the other was for a gentleman. In the first care plan there was the assessment information as detailed in the previous section. There was evidence of a companion room assessment and evidence of the relatives’ involvement in the decision to accept a shared room In addition the activity assessment for this resident had been completed by the activities co-ordinator detailing what the resident liked to do and what she enjoyed doing prior to coming into the home. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 13 The care plans were very informative and gave specific details on how the care was to be given, care plans were reviewed monthly being signed by the named nurse, the key worker and relative if available. The care plans and photographs relating to pressure area care were particularly good giving details of how to treat the pressure sore, what dressings to use and recording advice given by the tissue viability nurse. The pressure area was a grade 3 and with the right level of care it was healed within five months. The progress in healing the sore was well documented and photographed. There were care plans relating to the specific requirements of the resident and were individualised; this resident had detailed care plans relating to personal hygiene, nutrition, challenging behaviour and dementia, mobility and incontinence. All appropriate risk assessments were in place and updated regularly. A dementia care observation tool had been completed for this resident. This is an observation audit that is being used in the home relating to the residents well being. There was evidence in the care plan that the resident had seen the optician, the chiropodist, the community psychiatrist, the tissue viability nurse and was seen the GP on a regular basis. In the second file there were care plans individualised to the specific assessed health, personal and social care needs of the resident and how these care needs were to be met. All of the care plans seen had supporting, appropriate risk assessments. There was evidence in the care plans of involvement with the relative when devising the care plan and in the review process. Evidence in the care plans of intervention by health care professionals the GP, community psychiatrist, the optician, chiropodist and dentist. In the staff office were two books headed the bowel” and “ bath book. This was to record information on these matters. This type of recording system is not in line with current care plan documentation, however staff felt that this was a more accurate and accessible record that the individual car plans which number 50 in total. One resident who was treated for a skin tear on the elbow, had a dressing applied, a body map completed and the relative informed. A care plan had been generated relating to the wound and how to care for it. A nutritional assessment had been completed and a weight chart maintained. The resident’s skin integrity assessment, namely the waterlow score, was 29. All the documentation was of a high standard well thought out and informative. This resident had also had a Dementia Care Observation completed, this is a good tool for determining the extent of the residents Dementia and how to best meet the challenges of caring appropriately, particularly if the resident displays forms of challenging behaviour. The Manger coordinates three monthly reviews of residents with the GP. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 14 One issue, which must be carefully addressed, is that documentation needs to be comprehensively and fully reflective of all needs but without becoming overly onerous. The inspector spoke briefly to a nurse from the liaison team who was in reviewing pressure relieving equipment. In her opinion things in the home had improved in the two years she had been attending. She stated that in her opinion the nursing care had improved and staff demonstrated a professional approach to care. She felt wound care was dealt with well and the correct equipment used . Part of the morning medication round was observed. The practice was safe and in line with the policy, namely medications administered to residents then charts signed. The medication trolley were locked when out of sight. The home operates the Nomad system for medications .On those medication charts inspected, there were photographs of the residents and allergies recorded. Medications received into the home were recorded as well as those disposed of. On one chart the medication had been refused for three weeks even though this was a regular medication, this should be referred to the GP for review. The use of stick on labels on medication administration charts (MAR), should be avoided as it occludes other information on the record. Those medications for use “ as required “, need to have full instructions recorded to include the reason for administration, maximum dose and where applicable, the duration period. The home is storing and recording Temezepam as a controlled drug. The records were found to be completed and the amount correct. The fridge temperature records were in place. Those eye drops in use had the dates of opening recorded. The sharps disposal bin was dated on opening. There was a good supply of gloves wipes hand towels and soap. Please see requirement 1. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are in place to address activities of daily living although greater flexibility has been introduced to allow for personal choices and preferences. Activities are provided which are age appropriate varied and provide residents with greater stimulation and enhance their quality of life. EVIDENCE: At the time of the inspection there was a number of activities going on. The Pat therapy dog was in with his owner, the hairdresser was in, and the activities person was undertaking activities. In addition there was a cream tea planned for that afternoon. There was olde tyme music playing in the background. When the dog Prince arrived with his owner one of the residents face lit up and she called out in a gleeful tone. She then proceeded to stroke the dog and pet him; she was very animated and spontaneous. Another gentlemen whom the inspector had seen on a number of occasions had completely changed. On previous occasions he had been observed to be Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 16 isolated and not communicating with residents or staff. On this inspection the resident was seen to engage spontaneously, although limited it was a significant change. He was seen to interact and be actively spending time in the lounge with other residents and at times initiating conversation. The activities coordinator was enthusiastic and she showed the inspector some of the developments in the activities. Firstly the inspector was shown the vegetable/ herb garden, which the PAT dog owner had been involved and had done the majority of the work. This small piece of garden was of interest to several of the residents, who even on the chilly day came and talked about the items growing in it. The PAT therapy dog and his owner are obviously well liked and this was evident throughout the visit. The activities coordinator also received favourable comments and she demonstrated a great enthusiasm and warmth about her role. The home has had permission to develop a sensory garden. This will create a garden where residents can access mobile or otherwise. It will be filled with different scents, colours, plants and flowers. Another area, which had improved, was the presentation of meals. Prior to lunch the tables were set with cloths cutlery, salt pepper and laminated menus. These menus were in clear print. When residents were brought in for lunch the menu was the focus of discussion for them. The lunch when served was nicely presented. Two sittings have been organised to ensure there is enough assistance for all residents. Plate guards, adapted cutlery food supplements and a choice of juice were all available. The inspectors met with several residents during the site visit and comment cards were received following the visit. Comments received were favourable regarding staff and the care of their relatives. Comments such as “the resident was happy and seemed well looked after “ were related to the inspector. One comment received from a relative was the length of time between meals, stating coffee and biscuits are at 11ish and then their relative is taken into lunch at 12 o’ clock. The periods between meals was commented upon several times. In particular relatives commented that the evening meal starts very early around 4ish ,the next main meal is then breakfast ,although evening snacks are provided .This must be carefully monitored to ensure residents are not left long periods between meals. Juice was seen to be available in the communal areas and tea as served mid morning. Two other areas, which are due to be developed; are a cinema area and a sensory room the cinema room had been started with pictures of movie stars and idols on the walls. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 17 The activities coordinator has produced the home’s first newsletter this is a positive way of informing relatives and residents of developments in the home In general there was a very good atmosphere, residents seemed more alert and spontaneous and a variety of activities on offer. The second inspector noted the following : . • Better interaction between staff and residents. • Relatives spoken to were very positive about the home and how much it had improved. • More activities going on and more residents joining in. • Residents looked clean, well groomed and generally happier. Please see requirement 2. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident and relatives are provided with information to make complaints, which is available, and on display. Information on external avenues for referring complaint is also available. Staff in the home are ware of how to action a complaint. Training in adult protection has increased their knowledge on the subject and reiterated the appropriate measures to take when reporting such including referral to external bodies. EVIDENCE: The home has a complaints procedure on display, this information is also included in many of its documents such as the Resident Guide. Complaints procedures are included in the Policies manual and specify time frames for action as well as external avenues for the referral of complaints. Details of all complaints made to the home are recorded in the complaints log, which is located in the Manager’s office . The last complaint was November 2006, which was investigated by the CSCI and Suzannah Simpson Adult Protection Coordinator. The complaints file contains a summary of the initial complaint and copies of all correspondence including where applicable statements. A final response letter offers other avenues should the complaint not be satisfied. Within the Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 19 complaint file itself there should be a specific entry detailing if the complainant is satisfied with the outcome and response to their compliant. It was evident that staff had received training treating to dealing with complaints and felt confident in dealing with them and referring them on. Staff were aware of what to do in the circumstances of suspected abuse. They were aware of how to report it internally and to other external bodies namely Social Services. The permanent staff stated that they covered complaints and adult abuse issues during induction, and had received further training to support their knowledge. The Manager is looking to enhance their knowledge base with further training on this subject. Staff were also aware of what whistle blowing procedures were and how these should be used to report poor practice or other issues. The one member of agency staff, stated that she had received instruction on abuse on her first day, although she demonstrated a limited knowledge, however she was aware of how to report it. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate accommodation for those residents who live in it. Equipment is provided to address residents needs including those with mobility problems. On going maintenance and service of equipment ensure it is safe to live in . EVIDENCE: The home was clean and in the main tidy. The tour was undertaken following the lunch to allow residents time to get up and areas to be addressed. The maintenance man was on site and addressing issues as they arose. The hall way gave a positive impression. It was relaxed with chairs to sit in and a lot of information for relatives to peruse. Photographs of resident’s activities were nicely presented. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 21 The communal areas had benefited from new furniture and pictures. Dining furniture had been replaced .A plasma TV had been purchased which provided a good picture for residents to see. New colour coded prompts had been use throughout the home to enable maximum orientation for residents. Keypads had been applied as a safety measure to exits and internal doors. The paintwork particularly on the first floor corridor was chipped and needed addressing. The carpet in this area should be replaced as it is suffering wear and tear. The lounge would benefit from replacement covering. The box labelled “gas /electric” in the small lounge could be better presented. Portable fans were in use both in communal areas and individual bedrooms with risk assessments in place. Bedrooms were mixed in the level of personalisation, ranging from very individual to sparse. Clocks and calendars were evident although more attention needs to be paid to ensure these are correct. Bathroom 4 was out of order and the curtain was missing. This bathroom needs to be repaired to ensure that the full compliment of baths and toilets in the building are in full working order. Equipment was available including hoists, bath aids, pressure relieving equipment and mobility aids. The residents in the home would benefit from another hoist, which can be used for the purposes of walking and standing residents to improve their mobility and independence. In general the environment had improved and will continue to benefit from on going maintenance, renewal, replacement and servicing of equipment. Please see requirement 3. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers to address residents needs. Staff are subject to t robust recruitment checks, which ensure residents re in safe hands. The provision of on going training both for the statutory topics and those specific to residents needs equips staff with knowledge and skill to fulfil their roles within the home. EVIDENCE: At the time of the inspection the Manager was off with bereavement. The inspection was coordinated by the deputy manger and the regional Manager Mrs Osmotherley. There was eleven staff on duty including four qualified nurses and care staff. In addition there was administrative support, domestics, laundry and catering staff. The handyman was also in the home . The home operates on ten staff in the morning, nine in the afternoon and five at night. The inspectors met with many of the staff throughout the site visit and interview four. Those staff selected for interviews included an agency staff, a qualified staff, a long term permanent staff and a care worker. On the second site visit the inspector met with a group of qualified nurses . They all confirmed Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 23 that in their opinion the homes standard of care had significantly improved. Some of the qualified staff had completed the RMA qualification. Of the care staff eight care staff have completed NVQ level 2, and five are starting July 07. The three catering staff have the Basic Food Hygiene . Currently the home has three vacancies that are filled by regular staff and very occasionally agency workers. Staff confirmed that training had significantly improved and all permanent staff had attended dementia training. Statutory training was provided regularly. Other topics which staff had received training in included nutrition, resuscitation, abuse and whistle blowing. Planned training included hazard analysis mentorship and further training on challenging behaviour . Staff stated that they received supervision and this includes discussion on their role and responsibilities, key residents and developments in the home. The agency staff member had been working in the home for three months. She confirmed that she had received induction, which included fire manual handling, tour of the home. She had limited English therefore communication was difficult. The following points relate to the information contained within the Personnel files: • Well -organised information easy to find. • Application forms correctly completed with no gaps in employment history. • Health checks completed • Contracts stating the Terms and conditions of employment. • Evidence of CRB checks and POVA checks being carried out. • Pin numbers for trained nurses checked. • Two references for all staff. • Recruitment and Selection policies and procedures followed.. • Evidence of an induction process being undertaken and documented; induction to Skills Council Standards. On the second site visit the inspector checked the duty rota and confirmed that staffing levels are maintained. Within this file there were copies of agency worker’s passports and CRB records. These were in the office although not securely stored. Agency staff must be subject to robust checks to ensure that they are safe to work in the home, however this information must be retained securely. The Manger must seek to implement alternative methods to satisfy the appropriate checks. Some qualified staff in the home are given supernumerary time to address documentation etc. It is recommended that all qualified nursing staff be given some supernumerary time to keep abreast of documentation, supervision etc. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 24 Please see requirement 4. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed by an experienced nurse who provides consistence support and direction to the home. Health and safety measures provide residents with a safe environment in which to live. Quality assurance measures provide residents and staff with opportunities to influence the service. Audits provide the management team with information on where shortfalls are occurring, which they can address. EVIDENCE: Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 26 The Manager has been in post for seven years . She is a qualified psychiatric nurse and has completed the RMA. The Deputy Manager has been in post for one year, she too is a qualified general nurse and is a trained manual handling instructor. The Managers are supported by Mrs Osmotherley, who is a qualified nurse. The company have appointed a quality assurance Manager who is due to start 16 July 2007. This person will be responsible for auditing and developing quality assurance within the company, in line with CSCI Standards, Regulations and good practice measures . The Manger receives regular supervision from Mrs Osmotherley, which she stated is very beneficial. In addition the proprietors hold regular managers events. These sessions deal with any developments in care or associated areas including developments in the CSCI. The Manager felt these provided a good opportunity for networking and support. There are twelve homes in this group owned by Nellsar. Quality Assurance . Quality assurance has significantly increased in the home both with monitoring from senior management and internal audits conducted through the management team. Regulation 26 visits are conducted monthly and a report on the findings forwarded to the CSCI. These reports provide good information in respect of the service. Relatives meetings are held three monthly and minutes circulated. Relatives are invited to respond to the postal surveys of which two a year are organised. In the hall was the results in graph form of the relatives survey held June 2006, generally positive feedback was received . Internal audits covering aspects of care have been introduced including control of infection, medications and an environmental audit. It is from these audits that issues have been identified including those pertaining to record keeping. The audits will be conducted by the Quality Assurance Manager once in post. Staff confirmed that meetings were held and an open door policy prevailed throughout the home and the organisation. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 27 Health and Safety. The Manager is the health and safety representative for the home and has undertaken a one day training in this. A selection of health and safety measures were noted to be in place during the tour including window restrictors, radiator guards, key pads and equipment for manual handling. Those hoists inspected had stickers confirming servicing under the LOLER regulations. The employer’s liability certificate was current. Certificates for portable appliance testing, legionella, and the fire alarm system were all current. Evidence of weekly fire alarm testing and monthly emergency lighting was in place. Records relating to staff fire induction and training were available. The fire and nurse call had been serviced January 07. Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x X 3 X X x 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 X 18 3 2 X 2 X X 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 3 X X 3 Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 29 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. OP9 Standard Regulation 13 Requirement The Registered Manager must ensure that PRN medications have full instructions including maximum dose, duration and reason for administration of that medication. The Registered Manager must ensure that residents have sufficient nutrition and hydration and that long gaps between meals are avoided. Weight loss must be monitored and actioned in a timely manner. The Registered Manager must ensure that all toilets , baths and showers are in full working order to meet the needs of residents . The Registered Manager must ensure that all staff have personal information safely stored to prevent identity fraud or breech of confidentiality. Timescale for action 30/08/07 2. OP15 16 30/08/07 3. OP21 23 30/11/07 4 OP29 19 30/08/07 Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Bromley Park Nursing Home DS0000010129.V340390.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!