Inspection on 06/02/06 for Bromley Park Nursing Home

This inspection was carried out on 6th February 2006.

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

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

Other inspections for this house

Bromley Park Nursing Home 02/07/07

Bromley Park Nursing Home 13/07/06

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 6th February 2006 10:00 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.V279061.R01.S.doc Version 5.1 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.V279061.R01.S.doc Version 5.1 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 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.V279061.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 29 April 1997 Date of last inspection 19 August 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 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 DS0000010129.V279061.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced by three CSCI staff, two inspectors and one Regulation Manager. All three inspectors focused on different items. The progress on the previous requirements was monitored as well as those issues which had been identified at numerous visits conducted since June 2005. The environment was toured, including communal areas, individual bedrooms, and the kitchen and laundry areas. Records relating to care, including the assessments, individual care plans and supporting risk assessments were inspected, as was the medication documentation. Staff personnel records relating to recruitment were also inspected. The inspection staff felt that there had been improvements in several areas with staff and the management working hard to address previous requirements. What the service does well: What has improved since the last inspection? What they could do better: Once again the care plans and associated risk assessments were not adequately completed or reflective of the complex needs that some residents have. These documents are the basis on which staff address the care to residents, and must be comprehensive in content. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 6 Within the personnel files some of the references provided prior to employment were inappropriate as these were from friends/colleagues whereas professional references should be taken up. Evidence of CRB clearance was not always in place. The laundry areas must be refurbished as a priority with particular attention being paid to the flooring and ventilation of the area. 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 DS0000010129.V279061.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed in this section. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Care plan documentation and supporting risk assessments are not sufficiently comprehensive in content to fully reflect the resident’s needs. These documents do not provide enough information on which staff can adequately address the resident’s care. EVIDENCE: Care plans were selected in respect of those residents whom the inspector had met or had identified concerns about, e.g. bandages to legs, bruising etc., during the tour. The care plan of one male resident contained an application form, a discharge letter from the referring hospital and an assessment by the staff in the home. The inspector was unable to locate a copy of the letter confirming that the home was able to meet all of the residents assessed care needs. It was clearly documented that this resident had expressive dysphasia, although this was not reflected in the care plan. Under the functional assessment his speech was assessed as severely impaired. Further input to aid his communication should be explored. The care plan elements were mainly Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 10 physical heath issues, although this home is purely for residents with Dementia. Mental health and psychological issues must be included in the care plan. Daily events were not informative with phrases such as “quiet day” and “comfortable night “. His waterlow score was very high although this was still on a monthly review. Any area, which is identified as high risk, needs to be frequently monitored and appropriate action taken to address the issue. There was also information relating to previous episodes of wandering, which must be formally risk assessed and supported by robust care plans to prevent harm to the resident. A second care plan of a recently admitted resident was similar in content and completion, although less so, with relevant areas such as nutrition, continence and skin integrity not fully completed. Other care plan documentation detailed the resident’s problems as “Dementia” and “ incontinence”, areas relating to identified problems need to be specific, both of these issues, are far reaching and do not detail the actual problem. Staff should be very careful when completing documentation particularly risk assessments to ensure that these are completed fully and are manageable. The use of words such as “constant observation”, and “continual observation“ are unworkable unless the resident is on one-to-one care. No-one in this home has been on this level of observation for many years. The care plans are under review as the current system is difficult to extract information from and unwieldy. The medication systems were inspected including the record keeping, storage and procedure. In the medication information file were details of the supplying chemist. The medication fridge had supporting records for the temperature in place. On the individual medication charts, photographs of the residents were in place and allergies were recorded. Some medications received into the home were not always recorded. Any amendments to medication records should have two staff signatures in place to confirm the amendment is accurate. On some occasions the “as required” medications were insufficiently detailed in respect of the reason why the medication should be administered. Also with medications such as major tranquillizers and psychotropic drugs, a maximum dose must be indicated, and the duration that the “as required “ medication is to be used. Some instructions for medication administration was confusing – all information relating to medication administration must be clear and concise. Three residents were receiving prescribed controlled drugs, information relating to the recording of these medications was in place, except that some staff had signed with a first name only - full staff signatures are required. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 11 The GP was in visiting during the inspection. He confirmed that he holds a surgery fortnightly and visits whenever the home requests him to do so. There is an emergency service provided through “EM Doc”, out of hours. He confirmed that he had a good relationship with the staff in the home and the supplying pharmacist. Please see requirements 1 and 2. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The home provides some choices in activities of daily living, however, routines and task orientation are still evident. This is not helped by the size of the home or the resident group, many of whom are unable to make choices or decisions. EVIDENCE: The residents have a choice of hot food at all mealtimes. Currently there are four diabetic and thirteen residents who require soft diets. There are a number of residents who require food supplements. The dining area has much improved although the noise levels at mealtimes are disturbing. One relative met with the inspector and he related positive comments regarding the care provided and stated that he had confidence in the staff group. He visits regularly and had spent Christmas and New Year in the home. Two relatives were seen with a resident. The resident had recently been admitted and to date they were unable to comment fully on the service although had nothing negative to state. The pat-a-dog, therapy dog, was in the home. It was obvious that the residents enjoyed this and engaged where possible. As an added benefit the dog’s owner spent periods chatting to the visitors. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 13 One student related that she felt that the home was task orientated in its approach to care, this has been a feature in many of the previous visits to this home. Alternative ways of providing care in a home of this size should be explored to promote a more individual lifestyle. Please see recommendation 1. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: No standards were assessed in this section. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. The environment has improved, however, in this older style building ongoing maintenance is required to keep it to a reasonable standard. EVIDENCE: Generally the environment had improved in cleanliness. Areas toured included personal bedrooms and communal areas. Bathrooms and toilets were inspected during the tour. It was noted, in the entrance hall, that a new window panel had been fitted which allowed air to flow and maintained the temperature at a more appropriate level. Net curtains, to provide privacy to the bedrooms located at the front of the house, were in place. The windows in the ground floor dining room are not restricted. This is a ground floor level although there is quite a drop from the window to the ground and these should be restricted as a safety precaution. The bedrooms were generally clean, although some were malodorous. Bed making was underway. Some were personalised. In some bedrooms there were very few toiletries and a limited amount of towels, which was particularly Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 16 evident in shared bedrooms. Efforts must be made to promote reality orientation e.g. remove old Christmas cards which were evident in one area. Some bedrooms felt cramped e.g. bedroom 28 where the TV was very close to the bed. In the ground floor double bedroom the radiator cover was detached. In some bedrooms personal information relating to residents was on display in the bedrooms. This information must be maintained more discreetly. Pressure relieving equipment was in use and there was evidence of hoists. Some pressure relieving mattresses had their alarms muted. Staff must ensure that these are fully functioning and that alarms, which indicate problems, are not muted. Bathroom B5 had been out of service since 26/1/06. The toilet, T1, was also out of service. Bathroom B5 has a specialist Parker bath in place and must be repaired as soon as possible. The sluice area opposite bedroom 27 was open and unattended. This must be kept locked when not in use. The kitchen had generally improved both in terms of the documentation to support safe food practices, and the cleanliness of the area. There are systems for separating laundry with colour coded laundry bags and trolleys. The laundry is in need of refurbishment and particular attention should be paid to the concrete flooring, which currently is uneven. The Manager advised this was on the plan of works to be addressed. The laundry baskets for individual items were in adequately labelled and this could easily cause a mix up of clothing. All equipment was in working order and both washing machines have a sluice cycle. Please see requirements 3 and 4. Please see recommendation 2. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Staffing is provided in adequate numbers, however ,the adaptation staff need extensive supervision and guidance. This needs to be factored in when addressing the staffing rotas. Gaps in staff recruitment introduce an element of risk to residents. EVIDENCE: The home works to a staffing notice issued under the Registered Homes Act 1984, at times it has been unable to meet this, and notification to the CSCI has been forwarded. At the time of the inspection there was a student on a two-week placement through Greenwich University. She stated that she had a structured programme via the University and was well supported by the Manager. The three domestic staff in the home are all undertaking the NVQ level 1, in cleaning and support, one has completed this process. The domestic staff that met with the inspector confirmed that they received supervision from the Manager. The inspector was unable to verify that the staff had received training relating to COSHH, manual handling or issues relating to Dementia and challenging behaviour. This needs to be addressed. The kitchen was inspected as well as the menus. The permanent cook holds the City and Guilds 7016 parts 1 and 2, and she is updated in basic food hygiene. She confirmed that she has a yearly update in food hazard training Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 18 and has done manual handling. Again she herself had received no training relating to the resident group such as Dementia or challenging behaviour. She does not receive supervision or an annual appraisal. Two qualified staff met with the inspector and they related different comments regarding their work in the nursing home, one particularly felt that the number of adaptation staff was very stressful and time consuming. Induction and ongoing supervision for care and qualified staff was said to be in place. Four personnel files were examined and showed an improved but inconsistent picture. Two staff files failed to evidence CRB checks whilst the other two were in order. The obtaining of two references was not always apparent, neither were signed contracts of employment and records of supervision. The general management of the information on files needs regular scrutiny for example “leave to remain” dates etc. Attention to detail and regular monitoring is crucial to success in this area. However, there was clear improvement in the ordering of staff records generally. Currently the home is without a permanent administrator; temporary cover is in place from another facility. The appointment of an administrator must be actioned as soon as possible as this increases the administrative work for the Manager, who is already fully employed addressing care and staff issues. Please see requirements 5 and 6. Please see recommendation 3. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,36,38. Health and safety records confirmed ongoing maintenance of the equipment and building. Staff records reflected training in health and safety although the inspector was unable to confirm that all staff had received statutory training at regular intervals. EVIDENCE: A selection of health and safety certificates were inspected and found to be current, including the service of the two lifts October 2005. The electrical inspection reports including Portable Appliance Testing (PAT), was in date. Lifting equipment inspections under the LOLER regulations, ever six months, was addressed January 2006. The hot water temperatures were satisfactory or running rather cool on those tested. The gas appliances had been serviced January 2006. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 20 The fire service report was dated 8/10/2005 and the fire officer had visited 4/11/05. An updated fire risk assessment was forwarded to the CSCI office. Records relating to emergency light testing and checking fire escapes were also on place. Fire drills had been conducted throughout the month of November with various numbers of staff attending. All staff must receive regular updates in fire training including the ancillary staff and the night workers. It is recommended the night staff have four fire drills a year and the day staff have two. Other mandatory topics, including health and safety training, were variable and in some cases the inspector was unable to confirm that this had been addressed. Residents’ monies have supporting receipts retained with numbers which correlate with the transaction. The Manager is the only person in the home who deals with finances to reduce the margin for error. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X 2 X 2 Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Manager must ensure that care plans reflect needs, are reviewed at appropriate intervals and have supporting risk assessments in place. Previous timeframe for action 30/9/05. This requirement is now outstanding. The Registered Manager must ensure that robust and comprehensive information is available relating to all medications, including that for PRN medications, full staff signatures and clear instructions. The Registered Manager must ensure that all parts of the care home are clean, tidy and fully maintained in working order, including bathrooms, equipment and all additional safety measures. Timescale for action 30/03/06 2. OP9 13 30/03/06 3. OP24 23 30/03/06 Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 23 4 OP25 23 5 OP28 & 30 18 6 OP29 19 The Registered Manager must ensure that all parts of the care home are safe including the provision of window restrictors in the ground floor were needed. The Registered Manager must ensure that all staff are provide with mandatory training at appropriate intervals and specific training related to the resident group. The Registered Manager must ensure that all recruitment checks are undertaken before staff are employed 30/03/06 30/03/06 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP24 OP36 Good Practice Recommendations The Registered Manger should explore alternative ways of addressing care focusing on individuality, choice and preferences. The Registered Manager should ensure that towels, toiletries and cosmetics are provided for all the individual residents in the home and replaced as required The Registered Manager should ensure that all staff receive supervision and appraisal at regular intervals. Bromley Park Nursing Home DS0000010129.V279061.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Sidcup Local Office 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 DS0000010129.V279061.R01.S.doc Version 5.1 Page 25 - 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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