Inspection on 14/02/07 for Bromson Hill Nursing Home

This inspection was carried out on 14th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Bromson Hill Nursing Home 15/08/08

Bromson Hill Nursing Home 17/08/07

Bromson Hill Nursing Home 07/02/06

Bromson Hill Nursing Home 02/08/05

Bromson Hill Nursing Home 15/02/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bromson Hill Nursing Home Ashorne Warwick Warwickshire CV35 9AD Lead Inspector Yvette Delaney Key Unannounced Inspection 14th February 2007 12:00 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 Bromson Hill Nursing Home DS0000062186.V323769.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. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromson Hill Nursing Home Address Ashorne Warwick Warwickshire CV35 9AD 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) 01926 651166 Alphacarehomes.com Alpha Health Care Limited *** Post Vacant *** Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Alpha Health Care Ltd owns Bromson Hill Nursing Home. The home is a converted manor house, which has been extended to provide accommodation for up to 34 elderly residents who may require nursing care. The home is situated in the Warwickshire countryside close to Ashorne village. The house provides accommodation on two floors, which is accessible via a passenger lift or stairs. Accommodation is provided in both single and shared bedrooms. The homes décor and furnishings are to a high standard and are domestic and homely. There are established gardens, which are well maintained and accessible to all residents including those who may require wheelchair access. The owner of the home has advised that the current fees for residents ranges between £500 and £750 per week. Residents pay additional charges for the services of the hairdresser, Chiropodist and newspapers. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This inspection visit was unannounced and took place over two days between the hours of 11:00 am and 7:00 pm on the 14 and 27 February 2007. The deputy manager was present at the inspection. The Pharmacist Inspector for the Commission carried out an inspection on 27 February 2007 to assess medicine administration practices in the home. The report as written by the pharmacist is included in this report. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Three questionnaires were returned. One completed by a relative on behalf of a resident and two from relatives. The responses received are included where appropriate within this report. The manager of the home completed and returned a pre-inspection questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Two residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to resident care, staff training, recruitment, health, and safety were examined. Three relatives were seen and spoken with during this visit. Five staff, which includes the deputy manager and the kitchen assistant, were spoken with on a one to one basis on topics, which include care practices in the home, training attended, meals and their experience of working in the home. Further information to identify the outcomes for residents’ was also gained through observation of residents and staff and discussion with residents. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Potential residents must be suitably assessed to ensure that the home is not admitting residents who are outside of the category for which they are registered. Care plans must be consistently updated to ensure they reflect the current care needs of residents. The medicine management must improve to safeguard the service users within the home. Staffing levels and skill mix of staff in the home need to be reviewed observation showed that this is having a negative effect on the standard of care and practices in the home. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 7 A review of the quality of meals provided for residents must be carried out. This should involve input from residents so that their views are considered. A plan of action must be developed to ensure that staff receive training and update on health related issues specific to residents for who they provide care. A plan of action must be developed to show how the number of staff with an NVQ 2 qualification is to be increased. The programme of supervision for staff needs to identify positives as well as ‘problems’ in performance and include a process to identify training needs for staff. 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. Bromson Hill Nursing Home DS0000062186.V323769.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 Bromson Hill Nursing Home DS0000062186.V323769.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): 3 Quality in this outcome area is adequate. People do not always have all their care needs identified and planned for before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents spoken with were able to confirm that someone from the home had visited them in their own home before admission. One family member confirmed that their mother had been visited while still in hospital to carry out an assessment of her needs. Records examined and read show that resident s are assessed before admission, providing the opportunity for both parties to make an informed decision as to whether or not their needs can be met. However, concerns were discussed with the deputy manager about the admission of three residents who have a primary diagnosis of dementia, which means that the home is operating outside of their current registration. Seven residents were identified with a diagnosis of dementia three of which were Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 10 recent admissions. An immediate requirement was issued requesting that the manager make an application to the Commission for a variation to the homes current registration to admit people of ‘Old Age’ and who do not fall within any other category. Each resident’s care plan is written using the information from the initial assessment. Bromson Hill nursing home does not provide intermediate care but does on occasions provide short stay respite care. One resident was currently spending a short period in the home whilst their carer had a period of respite. Bromson Hill nursing home does not provide intermediate care but does on occasions provide short stay respite care. Bromson Hill Nursing Home DS0000062186.V323769.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): 7, 8, 9 and 10 Quality in this outcome group is poor. Resident’s individual care plans are not updated, which could result in the delivery of inappropriate care. Medication administration practices puts residents at risk of harm. Residents right to privacy and dignity are respected. These judgements have been made using available evidence including a visit to the home. EVIDENCE: The care plan files for two residents were examined and it was noted that the standard of care plan documentation varied and had deteriorated. The files contain some helpful information explaining people’s needs. However, more is needed to ensure that care plans cover the comprehensive range of personal and health care needs presented by the residents living in the home. Care plans also showed that they had not been updated to identify the current care needs of individual residents. For example, a risk assessment for a resident showed that their continence care needs had changed this information was not transferred to the care plan. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 12 Conversations with residents showed that they were happy with the care provided and all felt that they were well looked after. Comments such as “you couldn’t get better care” and that they found the “staff helpful” were expressed. Daily entries are recorded by nurses after each shift, statements were well written and describe how residents spend their day, and note any changes in their general health and well being. Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, dietician and chiropodist. Several residents require dressings for various skin wounds; two of these residents have pressure sores. Dressing and wound charts are maintained to monitor the healing process and nurses in the home undertake dressings. The pharmacist inspector visited the home to assess the management of medication. Six residents medicines charts were looked at and their corresponding medication. Four residents daily records and care plans were looked at to assess the reasons for some medication changes. The home is to change the suppliers of the dispensed medication from the dispensing doctor to a community pharmacy and intends to install a monitored dosage system and have computer printed medicine charts. This should improve the level of medicine management seen within the home. The home has one medication trolley and a large metal cabinet to store surplus medication. The medicine charts were kept on top of the trolley and had not been secured away after use allowing free access to confidential information by staff, residents and visitors to the home. The metal cabinet was not large enough to house all the medicines within and some medicines were kept on the top of the cabinet and had not been locked away. The Controlled Drugs (CDs) cabinet contained the CDs and also money and payslips. This should be reserved for the storage of CDs only to reduce the accessibility of the CDs by staff. Nursing staff, levels were low. Even though the some residents had high, nursing needs only one nurse was on duty at the time of the inspection. This was a common occurrence. The nurse was not given dedicated time to conduct the medicine round which increases the risk of errors and extends the time it takes to complete the round. In times of sickness, agency or bank staff are rarely used and nursing staff are expected to complete all the nursing Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 13 tasks on their own without additional support. This increases the risk of error of mistakes in the administration of medicines in addition to other nursing areas. Six residents charts were audited. All medicines charts were hand written. Details were transcribed from previous charts. Some directions did not match the directions printed on the dispensed label. The home did have a system to check what was actually dispensed and received but this had failed to identity errors on the medicine chart, as it should have done. It was also time consuming and relied on staff recording what they had ordered. An easier system was discussed. Some medicine charts failed to record the exact preparation of the medication or most recent dose. Others recorded medication that was not available in the medicine trolley. Some quantities of medicines had been recorded at the beginning of each month, but it was not routine practice to record any additional boxes opened so audits were difficult to undertake. The medicine charts did not demonstrate exactly what had occurred and would be of little use to prove that the medicines had been administered as prescribed in the future. From calculations, the medicine charts indicated that the medicines had not been administered as prescribed in the majority of cases. Medicines had been signed as administered when they had not been, medicines were unaccounted for and nursing staff had failed to record some transactions at all and many gaps or omissions were found on the medicine charts. Nursing staff are not audited in any way to demonstrate competence in the safe handling of medicines. The communal use of some medicines occurred mainly due to lack of space in the medicine trolley. Any medicine prescribed for one resident remains his or her property and must not be administered to anyone else. One unlabelled box of prescribed medication was found in the trolley and the label had been partially removed. This should have been sent to a clinical waste company for destruction and not left in the trolley for use as a homely remedy. Medicines had been prescribed on a “when required” basis. There were no supporting protocols detailing their use in the medicine chart folder, but reasons for initial prescribing were found in the daily records and care plans. These need to be upgraded and kept with the medicine charts. Generally, though the daily records and care plans supported why medicines had been prescribed and detailed the clinical condition of the residents. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 14 All controlled drug balances were reflected in the CD register, but not the medicine chart, as quantities had not been carried forward. One resident was fed via a PEG tube. The care plans failed to record the correct procedure for administering medicines via this route and no supporting textbooks were available to ensure that nurses have full information to administer medicines via this unlicensed route. The deputy manager was keen to purchase a reference book detailing the correct administration of medicines via this route. A further textbook about medicines was out of date and no current reference source was seen. The deputy manager on duty had a good understanding of the clinical condition and relating medicines for the residents in her care. The deputy manager was keen to improve the medicine management within the home and it was agreed that transferral to a new system would be beneficial. Increased nursing staff levels would also benefit the residents. Bromson Hill Nursing Home DS0000062186.V323769.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): 12, 13, 14 and 15 Quality in this outcome group is good. Resident’s are able to exercise choice and control over their day-to-day life in the home. The quality of meals provided for residents have deteriorated, which could affect their health and well-being. EVIDENCE: There is a varied programme of activities and entertainment taking place both in and outside the home for the benefit of residents. Activities are planned around the likes and interests of residents. A programme of activities is advertised weekly to make residents aware of what is planned and helping them to make a choice as to whether they want to attend. Each resident receives a copy of the weekly activity programme and monthly newsletter produced by the home. On the day of inspection, a church service had taken place. Residents who attended enjoyed the service. Residents were enthusiastic about the activities they are able to take part in, and those spoken with were looking forward to a visit to Leamington Spa for bowling. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 16 Family members are encouraged to take part in activities/events if possible. Residents spoken with said “something takes place every week.” Observations during the inspection showed that staff allowed residents time to undertake their preferred daily living routines. Residents confirmed that they were given choices concerning their day to day lifestyle. Most residents continue to have good contact with their relatives and take part in family events outside of the home. Two lots of visitors were seen to visit their relatives in their bedrooms and in the lounge areas. All relatives confirmed that they were made to feel welcome in the home and were able to visit whenever they chose to do so. Supper was taken in the main dining room a choice of a hot meal pasta bake and a variety of sandwiches were offered. All residents spoken with did not consider the food nutritious or appetising. The residents spoken with felt that the standard and quality of food provided had “gone down.” The pasta bake offered at suppertime on the day of the inspection looked overcooked and dry. The kitchen was clean and well managed. Records of fridge, freezer and high risk cooked food temperatures are maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned and hygienic. Food storage areas were well stocked with a wide range of fresh, tinned and frozen foods. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome group is adequate. Residents feel listened to but are not always protected from the risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is on display and a copy is given to residents on admission. A copy of the procedure is also included in the Statement of Purpose and Service Users Guide. Residents spoken to knew who to speak to if they were unhappy or wanted to make a complaint. In conversation, one relative said, “I would speak to the manager or deputy.” All of the relatives spoken to knew how to make a complaint. Responses received include: “I have put my concerns in writing.” “The staff are easy to speak to and will listen.” A small number of minor concerns have been received by the home and records examined show that these have been resolved to the satisfaction of the people making the complaint. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 18 There have been a number of issues reported since the last inspection related to the protection of vulnerable adults. Issues raised relate to a member of staff disclosing confidential and personal information to two residents. Residents have left the home and found wandering, walking along busy roads. One resident left the home twice. These issues have been resolved by the home to the satisfaction of family members. There has also been an allegation of a care workers attitude towards a resident. In this instance, the family made the decision to remove their relative from the home. Training records show that staff have received formal training in recognising and responding to abuse and adult protection issues. Discussions with staff show that they are aware of how to respond to an allegation of abuse in the care home. Policies and procedures have been updated to include reference to the document ‘No Secrets’ Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 19 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, 22, 24 and 26 Quality in this outcome group is good. Ongoing improvements to the environment ensure safety, maintenance, comfort and cleanliness of the home, which should increase the experience of quality of life for residents. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Bromson Hill Nursing Home is not a purpose built care home but is a domestic setting that has had some modifications to meet the needs of elderly residents. The home is spacious with a number of seating areas for residents and relatives these include two conservatories. A tour of the home found the environment was generally well maintained. All areas of the home seen were clean, bright and airy and odour free. Several of the bedrooms were seen. Residents are encouraged to bring their own Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 20 possessions into the home and it was seen that many of the residents have made their rooms very homely and taken the opportunity to personalise rooms with items from their own home. Residents and relatives spoken with were happy with the accommodation provided. Comments made include: “I was able to bring small items of furniture with me.” “My family have helped to decorate my room.” “I have tried to make it homely with my photographs and pictures.” Equipment to aid the moving and handling of residents were seen in use these include hoists. The condition of some pressure relieving aids had deteriorated over time for example propad (pressure relieving cushion used to sit on) cushions were ripped or cracked. Some equipment and aids used in the home are old and in need of repair, these include hoists and pressure relieving equipment. The stair gate has been removed from the stairs leading to the office. The home has systems in place for the management of dirty laundry and the clothes of everyone living in the home looked clean, clothing was ironed and well looked after. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome group is poor. Staffing levels, skill mix and lack of appropriate training for staff in the home do not ensure that the needs of residents will be met safely at all times. This judgement has been made using available evidence including a visit to the home. EVIDENCE: There was one nurse on duty on the evening of the inspection, supported by four care staff. The home provides sufficient numbers in respect of care staff but the skill mix and ratio of nurses to care staff has the potential to affect the standards of care and safety of residents. Observation of resident’s show that the high dependency needs of residents require increased nursing input. The pre-inspection questionnaire completed by the manager shows that one nurse is provided on each shift. The number of nurses on duty during the course of the inspection does not allow the time for this care to be delivered safely. The nurse on duty took sometime to complete the medication round which was due to having to undertake other duties at the same time. The Pharmacist Inspector at her inspection visit also identified this practice as unsafe, which could put residents at risk. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 22 Maintaining high standards in the care home may also be affected by the lack of care staff with a National Vocational Qualification (NVQ) level 2. There is currently only six of twenty-eight care staff (21 ) with NVQ level 2 qualifications, which is not sufficient to ensure that 50 of care staff on each shift are qualified to this level. Information contained in the completed preinspection received from the manager show that over an eight week period twenty nine shifts had been covered by agency staff, this was mainly care staff. Recently agency nurses who have been left in charge of the home when covering shifts. These practices do not offer continuity for residents accommodated in the home. Training opportunities for staff have improved in the home. Records show that staff have received training in elder abuse and medication update for nurses. However staff have not received training specific to the health care needs of residents living in the home. Three care staff spoken with confirmed that they had received training in COSHH, moving and handling, fire safety and health and safety. Staff were attending training on food hygiene on the day of the inspection. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome group is adequate. Most management arrangements are meeting the needs of the service. Staff are not always appropriately supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has recently been appointed to the home she was not present on the day of the inspection due to being on holiday. This was an unannounced inspection and it is not expected that the manager would be present at the inspection. The manager is currently going through the process of applying to be the registered manager for the home through the Commission for Social Care Inspection. The deputy manager was acting on Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 24 her behalf and was present during the inspection. The deputy was very knowledgeable about the residents living in the home. Staff were aware of their responsibilities and the lines of accountability within the home. Regular staff meetings are held and minutes of one of the meetings were read and show evidence of staff involvement in the running of the home. There is evidence that a structured approach to quality assurance had been implemented. Staff in the home have the responsibility to routinely carry out audit of all systems and practices carried out in the home. The deputy manager confirmed that the policy of the home is not to handle resident’s monies or valuables. Residents at the home receive support from outside of the home to manage their finances, either from their relatives or other advocates. Supervision of staff is divided between the nurses. With only one nurse on duty on each shift it could not be demonstrated when nurses are allocated time separate to caring for residents to carry out supervision. Three care staff spoken with confirmed that they had received supervision. Staff files showed that the outcomes of supervision sessions are not consistently recorded. Topics discussed focussed on problems and were not positive in identifying training needs and the standard of care provided by staff. There was also no indication of the action or activity that staff would be undertaking before their next supervision to demonstrate any progress made. Training records confirm that staff receive training to meet mandatory training requirements. Training attended includes moving and handling, fire safety, first aid and on the day of the inspection, staff were attending a training session on food hygiene. The pre-inspection questionnaire completed by the manager indicates that all relevant health and safety checks are carried out by the home. All certificates, maintenance records and servicing records were available during the inspection for the maintenance and service of major systems. The fire log was checked. These records indicate that fire alarms and lights are tested and that fire drills are carried out at the home. Other records checked include water temperature checks, wheelchair/footplates and the nurse call system. Some equipment and aids used in the home are old and in need of repair, these include hoists and pressure relieving equipment. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 2 X 3 X 3 STAFFING Standard No Score 27 1 28 1 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 2 Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation Requirement Timescale for action 16/02/07 Section 24 The registered person must CSA ensure that all potential residents are suitably assessed Residents who are outside of the category for which the home is registered to operate must not be admitted to the home. 15, Sch.3 The person must ensure that care plans are consistently updated to reflect all the current care needs of the residents. The registered person must ensure that a system is installed to check the prescription before dispensing and to check the dispensed medication received into the home. The registered person must ensure that all medicines charts record the exact details as the doctor prescribed. The quantities of all medicines must be documented to allow audits to take place to demonstrate that the medicines are administered as prescribed. 2 OP7 16/03/07 3 OP9 13(2) 31/03/07 4 OP9 13(2) 31/03/07 Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 27 5 OP9 13(2) The registered person must ensure that the medicine chart is referred to before the drug administration and signed directly afterwards as administered or the reasons for non-administration recorded. The right medicine must be administered to the right service user at the right time and at the right dose and records must reflect practice. The registered person must ensure that nursing staff administer medicines from dispensed and labelled containers to the service users they are prescribed to. The administration of medicines to any other service users must cease. 31/03/07 6 OP9 13(2) 31/03/07 7 OP9 13(2) The registered person must 30/04/07 ensure that all medicines prescribed on a when required basis must have supporting protocols detailing their exact use and all outcomes must be recorded following administration and their use reflected on regularly. The registered person must ensure that: • The Controlled Drug cabinet is reserved for the storage of Controlled Drugs only. All surplus medication is stored in a locked cabinet at all times. All confidential information is not available to people who are not entitled to see it. 31/03/07 8 OP9 13(2) • • Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 28 9 OP9 13(2) 10 OP15 16(2) 11 OP18 13(6) 12 OP22 OP38 23 13 OP27 18(1) The registered person must ensure that an auditing system is installed to demonstrate nursing staff competence in medicine management. The registered person must ensure that residents receive wholesome and food, which is varied and properly prepared. The registered person must make arrangements to ensure that service users are not placed at risk from harm or abuse. The registered person must ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order and suitable for use. The registered person must ensure that there is always sufficient staff on duty with the relevant skills, to meet the needs of the residents in the home. 30/04/07 30/04/07 31/03/07 30/04/07 30/04/07 14 OP27 18(1) Previous requirement of 01/03/06 not met. The registered person must 30/04/07 ensure that the employment of any staff on a temporary basis at the care home will not prevent service users from receiving continuity of care as is reasonable to meet their needs. • Plans must be in place to demonstrate how the use of agency staff will be reduced without affecting staffing levels or the home failing to meet the needs of residents accommodated in the home. The registered person must ensure that at all times sufficient and suitably qualified nurses to meet the needs of residents are working at the care home. DS0000062186.V323769.R01.S.doc 15 OP27 18(2) 30/04/07 Bromson Hill Nursing Home Version 5.2 Page 29 16 OP28 18 (1) The person must provide an 31/05/07 action plan, which details plans for increasing the number of care staff who have a NVQ 2 qualification. The registered person must ensure that all staff employed to work at the care home receive: • • Training appropriate to the work they are to perform; and Suitable assistance, including time off, for obtaining further qualifications appropriate to such work. 31/05/07 17 OP30 18 (1)(c) 18 OP36 18(2) Previous requirement of 01/05/06, not met. The person must ensure that all persons working at the care home are appropriately supervised: • Clear and informative records must be maintained and available for inspection. Nursing staff, undertaking supervision should be given training opportunities to equip them with the appropriate skills required to undertake the role. The outcome of supervision sessions must focus on positive as well as negative outcomes for staff, and identify training and development needs to assist with planning training for the home. 31/05/07 • • Bromson Hill Nursing Home DS0000062186.V323769.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. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that suitable reference sources are purchased to support the administration of medicines via unlicensed routes and other drug information references books are purchased when new editions are published. Bromson Hill Nursing Home DS0000062186.V323769.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Bromson Hill Nursing Home DS0000062186.V323769.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. 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