Inspection on 23/06/08 for Brompton House Nursing & Retirement Home

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Good service.

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

Brompton House Nursing &... 27/03/07

Brompton House Nursing &... 05/01/06

Brompton House Nursing &... 12/07/05

Brompton House Nursing &... 19/01/05

Brompton House Nursing &... 12/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Brompton House Nursing & Retirement Home Station Road Broadway Worcestershire WR12 7DE Lead Inspector Sarah Blake Unannounced Inspection 23rd June 2008 09:45 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 Brompton House Nursing & Retirement Home DS0000004099.V366798.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. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brompton House Nursing & Retirement Home Address Station Road Broadway Worcestershire WR12 7DE 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) 01386 853473 01386 853808 franciam@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Miss Amanda Jane Francis Care Home 45 Category(ies) of Dementia - over 65 years of age (43), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45) Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th March 2007 Brief Description of the Service: Brompton House is a care home providing accommodation, personal care and nursing care for up to 45 older people of either sex. BUPA Health Care owns the home, and the registered manager is Miss Amanda Francis. The home is located on the outskirts of the village of Broadway and within reasonable walking distance of the high street, which provides a range of shopping facilities. It is a large converted house, and was first registered under the Registered Homes Act 1984. Accommodation for residents is provided on the ground and first floor, and all the bedrooms are single occupancy, with en-suite facilities. Access to the first floor is gained through either a staircase or through the use of a central passenger lift (for residents who are mobility impaired). Handrails and grab rails are fitted where appropriate. Lifting aids are available in communal bathrooms. There is parking for a number of vehicles at the front of the house, a courtyard garden to which a number of ground floor rooms have access and a good-sized garden at the rear of the house. Information relating to the fees charged for the service is available on request from the home. Fees do not include the cost of chiropody, hairdressing and newspapers. There is a copy of this report at the home, which is available for people visiting the home to see. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good outcomes. We spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the manager’s comments have been included within this inspection report. We also received completed survey forms from people who use the service and their relatives. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the service does well: People have good opportunities to visit the home to help them decide whether or not it is the right place for them. Senior staff from the home visit to carry out an assessment of their needs before they come to live at the home. People who use the service can be confident that their health needs will be met. Medication is stored appropriately and is administered safely. Staff treat people who use the service with respect. Food is nutritious and well-balanced, and a range of snacks is available twentyfour hours a day. People who use the service know how to raise any concerns. They are confident that they will be listened to, and that the home will respond appropriately. The home is clean and well kept, and the environment is pleasant and homely. Staff are recruited safely, and induction prepares staff well to do the job. Training is ongoing and keeps staff up to date with good practice. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 6 The home is managed well by an experienced and knowledgeable manager. Financial systems within the home protect the residents. The home is a safe environment for the people who use the service. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 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 Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information to enable them to make an informed choice of home. There is a thorough assessment of needs carried out before they come to live at the home. EVIDENCE: We talked to several people about their experience of choosing the home. One person told us “We looked at nine homes, and this was the best”. Everyone we spoke to said they had received sufficient information to enable them to make an informed choice as to whether they wished to live at Brompton House. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 9 On relative told us that she had visited the home several times to make sure that it was suitable. She had visited at various times, and had always been made welcome. We saw copies of the home’s Statement of Purpose and Service User Guide. These contained a good range of useful information. We looked at the records for three people who use the service. These showed that senior staff from the home had visited the prospective residents to find out their needs. One person had been visited in hospital and two in their own homes. We spoke to a visiting relative, who told us that the manager had visited her and she had found this visit very helpful in knowing what to expect when her relative arrived at the home. The pre-admission assessments inspected were thorough and gave staff the information they need to enable them to provide the care needed. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their health needs will be met. Care plans are comprehensive and are regularly reviewed and updated. Medication is stored appropriately and is administered safely. Staff treat people who use the service with respect. Some risk assessments need greater detail, in order to reduce the risk of harm to people who use the service. EVIDENCE: People who use the service told us that there is a high standard of care at the home. One resident remarked, “The staff are always meticulous in the way they look after me”. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 11 We looked at the care records for three people who use the service. Each person had a care plan, which was fully completed and clearly explained what type of support the person needed. The staff had recorded when care had been provided and any changes, which were necessary. These records showed that care was being provided in accordance with the care plans. We saw forms, which showed that people who use the service are asked if they would prefer their care to be given by male or female staff. One person told us that she prefers to have female staff, and the home respects her wishes. We observed staff attending to peoples’ needs. Staff were kind and caring in their manner, and wore gloves and aprons when providing personal care. We saw staff hoisting a person into a wheelchair in the lounge. The staff carried out the manoeuvre safely, but did not cover the person’s legs, to maintain her dignity. However, as soon as the manager noticed this, she immediately asked the staff member to fetch a blanket. The manager told us that she would make sure that all staff are aware of the importance of maintaining people’s dignity. The home has good systems for managing medication. We saw that all medication was stored safely, and that records of medication administration were up to date. Records showed that, for people who may live at the home until the end of their lives, their wishes had been explored with them, and a plan had been drawn up. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides some activities for the people who use the service. These do not meet the needs of all people, and it may be particularly difficult for people with dementia or those who are very frail to access activities. Food is nutritious and well balanced, and a range of snacks is available twenty-four hours a day. EVIDENCE: The home employs an activities coordinator, who organises some events and activities for the residents. We saw the activity plan for June 2008, and it showed that there was not a full programme of activities and there were no activities planned for the evenings or for weekends. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 13 When we spoke to a number of people who use the service, we were told, “There isn’t any entertainment at all” “There was a tea club, but it fizzled out”, and “I go to bed at 7 or 8 in the evening because there’s nothing to do”. One person told us “Since I’ve been here, I’ve been lonely”. However, in our surveys, one person who uses the service told us “There are a variety of activities available if I wish to take part”. We looked at the activities chart for a person with dementia. It showed only five entries over the last nine months, and these included no activities, which were specific to someone with dementia. We saw visitors arriving throughout the day. The staff were welcoming and friendly towards them, and they were offered drinks at the same time as the people who use the service. We looked at menus for the month, and these were found to be varied and nutritious. All the menus are monitored for their nutritional content using a system called Menu Master. We saw lunch being served and the food looked appealing and was well presented. Each table in the dining room had vegetable dishes, so that people could decide for themselves which vegetables they would like. When we spoke to people who use the service, most were complimentary about the food. Comments included “The meals are of a consistently high standard” and “Most of the time meals are very nice”. There is a wide range of snacks, such as cereals and yoghurts, available twenty-four hours a day. Hot drinks are available at any time. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service know how to raise any concerns and are confident they will be listened to, and that the home will respond appropriately. People who use the service have copies of the complaints procedure. Staff are recruited well and are trained in the protection of vulnerable people. This helps to protect the people who use the service. EVIDENCE: The Service User Guide contains a copy of the complaints procedure, and this is given to all people who choose to move into the home. We spoke to five people who use the service and received surveys from a further six people, and they all told us that they knew how to make a complaint. We looked at the complaint’s log, which showed that the home had received four complaints within the past year, and that these had all been resolved satisfactorily. We have not received any complaints about the home within the past year. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 15 People who use the service were confident that the manager would listen to them and would try her best to resolve any concerns. One person told us “Amanda (the manager) is very good at sorting things out”. We looked at three staff files, and these showed that recruitment had been carried out well. All the relevant security checks had been made to ensure that only staff who are of good character are employed in the home. New staff had received induction training, which included training in the protection of vulnerable adults. The staff we spoke to had a good understanding of this, and knew who to speak to if they had any concerns about potential abuse of the people who use the service. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well-kept, and the environment is pleasant and homely. Infection control and prevention is well managed. EVIDENCE: On the day of the inspection, the home was clean and tidy with no unpleasant odours. The people we spoke to told us that the home is generally clean. A relative said that the home is “always really clean and nice to be in”. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 17 The lounge is comfortably furnished, and contains a good selection of books, games and videos. All the corridors in the home have pictures and mirrors on the walls, and this contributes to the homely atmosphere. There is a courtyard garden with an aviary and a gazebo. Part of the garden is a sensory area with scented plants. Some of the bedrooms overlook the courtyard. There is a larger garden to the back of the home, and this is accessed via a steep ramp. The manager told us that there are plans to lower the angle of the ramp, so that this garden area will be accessible to wheelchair users. People who use the service are encouraged to personalise their bedrooms with ornaments and furniture if they wish. Infection control and prevention is well managed. We saw that bathrooms and toilets had paper towels and liquid soap dispensers. Staff were using gloves and aprons whenever they provided personal care for people. The home has good procedures for disposing of waste. At the previous inspection, we saw that the bedrooms had unsuitable bolts on the doors, and we asked the home to replace them with a safer locking system. To date, the home has not done this, but the manager told us that this forms part of the major refurbishment to be done later this year. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are caring and kind towards the people who use the service but there are not always sufficient numbers of staff on duty at weekends to meet the needs of all the people who use the service. Staff are recruited safely, and induction prepares staff to do the job. Training is ongoing and keeps staff up to date with good practice. EVIDENCE: Everyone we spoke to at the home was full of praise for the caring attitude of the staff. Comments included “you can’t fault the carers for kindness” and “Staff are very friendly and very caring indeed”. We received many comments from the people who use the service, both in the surveys and in conversation during the inspection, about the levels of staffing at weekends. The comments included “You don’t get things at the proper time; meals and things”, “Weekends are a bit of a nightmare - staffing is not Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 19 always good” and “It can take a long time to have bells answered, especially at weekends.” We looked at the staffing rosters for weekends, which showed that there were fewer nurses on duty and no management staff. The manager told us that the home is currently advertising for a deputy manager, and she has said that she will review the staffing levels at weekends. The home has some extremely skilled and knowledgeable staff. We saw evidence that staff had received training to enable them to care for the specific needs of the people who use the service. We spoke to several staff, who all showed a good understanding and knowledge of the needs of the people they support. When new staff are employed, they undertake a thorough induction programme, which prepares them for the work they will be doing. This includes training in such areas as health and safety, infection control, moving and handling and fire safety. We saw evidence that this training is regularly updated. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and knowledgeable manager manages the home. Financial systems protect the people who use the service and people benefit from a safe environment. EVIDENCE: Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 21 The home is well run by the experienced and skilled manager. Staff respect her for her knowledge and her strong management style. Staff told us “She sets the tone; this is a well-run, high standard home”, “Amanda is a real stickler for everything to be done properly” and “Brompton House is a nice place to work”. During the inspection, we observed the manager talking to people, who clearly felt comfortable with her. People told us “I couldn’t be in a better place” and “Amanda is so approachable”. We looked at the records for managing peoples’ day to day finances, for those people who are unable to do this themselves. All the records were thorough and up to date. Risk assessments were generally thorough and regularly updated. However, we did see one risk assessment, which could have put the person at risk of harm. This was a risk assessment for the use of a lap strap in a wheelchair. The risks to the person had been identified, but did not include information as to the exact position of the strap. If the strap is not positioned correctly, the person in the wheelchair could become trapped and be injured. The manager has told us that she will make sure that risk assessments are fully completed, to ensure the safety of the people who use the service. Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 Requirement Risk assessments must include sufficient information to ensure that residents are not at risk of harm. Timescale for action 28/07/08 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 OP12 Good Practice Recommendations You should plan activities to take into account the differing needs of the residents, especially the needs of people with dementia. You should review the levels of staffing, to ensure that there are sufficient qualified staff available, and make any adjustments assessed as necessary, to ensure that any request for assistance can be responded to in a timely manner. 2. OP27 Brompton House Nursing & Retirement Home DS0000004099.V366798.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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