Inspection on 15/08/08 for Bromson Hill Nursing Home

This inspection was carried out on 15th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bromson Hill Nursing Home 17/08/07

Bromson Hill Nursing Home 14/02/07

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 19/12/2008.

CARE HOMES FOR OLDER PEOPLE Bromson Hill Nursing Home Ashorne Warwick Warwickshire CV35 9AD Lead Inspector Yvette Delaney Unannounced Inspection 15th August 2008 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 Bromson Hill Nursing Home DS0000062186.V369383.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.V369383.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 01926 650396 Rachelvowles@aol.com www.alphacarehomes.com Alpha Health Care Limited 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.V369383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2007 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. There are established gardens, which are well maintained and accessible to all residents including those who may require wheelchair access. Information provided at the confirmed the fees for living in the home to range between £468 and £680. Residents pay additional charges for the services of the hairdresser, Chiropodist and newspapers. Bromson Hill Nursing Home DS0000062186.V369383.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 0 Star. This means that people who use the service experience poor outcomes. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by five people living in the home, four relatives ( three of whom gave their views in service users survey’s) and three members of staff, giving their views of the service. An annual quality assurance assessment (AQAA) was completed and returned by the manager in time for the inspection. Information provided in the annual assessment by the home manager has been used to inform this report. The inspection included meeting most people living at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and the home manager. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the service does well: Staff told us that they feel that the home does well by providing “… A comfortable, homely, friendly and caring surrounding for those in their twilight years in need of twenty four hour nursing care.” Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 6 “Overall the home is good. In particular the auxiliary staff are excellent.” “The care workers are all very kind.” “The room is lovely. The view is lovely. Staff are great although not always enough.” Residents are happy with the activities and events which take place in the home and the local community. The level of activities provides residents with mental and physical stimulation. This increases their well being and quality of life while living in the home. What has improved since the last inspection? What they could do better: Ten requirements were made at this inspection visit. Staff must make sure that: People admitted to the home for respite care (Short stay) have their care needs re-assessed at each visit to the home so that any changes are identified. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 7 They are able to demonstrate that they are still able to meet the care needs of people using this service. This will help to make sure that people receive person centered care. They are able to demonstrate their ability to meet the current and changing care needs of each person admitted to the home. This will ensure that people receive person centered care. Care plans are written from comprehensive assessments of peoples needs and provide staff with clear guidance on how to meet the care needs of people living in the home. This will ensure that people receive person centered care. All persons living in the home have an up to date care plan, which clearly identifies all their health and personal care needs. This must include people who are admitted for short term care. This will help to make sure that residents receive person centred support which meets their needs. Up to date assessments of residents care needs are carried out and are supported by the completion of an appropriate up to date risk assessment. This will help to make sure that appropriate care plans can be developed to minimise the risk and protect the person for harm. Nursing staff make sure that medicines they administer to residents are taken by the residents before the nurse signs the MAR chart. The signature confirms that the nurse is sure that the medicine has been taken by the correct resident. This will help to make sure that residents are taking their prescribed medicines safely. Safe practices must be maintained in the home to make sure that the risk of cross infection is reduced. To include addressing: Preparation and pre-cooking of food before it is to be used. Appropriate storage of food in the fridge and freezers. Correct labelling and dating of stored food. The cleaning of aids and equipment used in the home. Cleaning standards in the kitchen and kitchen storage areas. The hot trolley in the kitchen, which is said to be out of order. This will help to decrease the risk of cross infection in the home and promote the health and wellbeing of people who live in the home. Staffing levels are reviewed to make sure that sufficient numbers are on duty at all times. Attention must be given to numbers on each shift worked in the home, peak times of activity in the home and when staff are required to attend training. This will ensure that residents care needs can be met safely at all times. The standards of health and safety management within the home are improved. So that the home is kept free from hazards, which could affect the Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 8 health and wellbeing of people living in the home due to cross infection. Particular attention must be given to: Making sure there is safe and clear access in the kitchen. Poor practices, which encourage cross infection Poor food hygiene practices. Poor practices observed in and around the kitchen area. This will support resident’s protection from the risk of harm. Risk assessments must be carried out for maintaining safe working practices in all areas of the home. The outcome of risk assessments must be recorded with clear instructions for staff on how to manage the risks identified. 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 Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 9 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.V369383.R01.S.doc Version 5.2 Page 10 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.V369383.R01.S.doc Version 5.2 Page 11 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, 2, 3, 4 and 5, Standard 6 does not apply to this home as people are not admitted for immediate care. Quality in this outcome area is adequate. There is scope to develop information about Bromson Hill Nursing Home further to make sure that full, accurate and up to date information is available to people who wish to use the service. People have the opportunity to visit the home before making the decision about where to live. People entering the home for short stays do not have their needs re-assessed before re-admission to the home. This means that people are not informed that the home can continue to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us in their completed AQAA that people moving into the home are given copies of the Service User Guide and Statement of Purpose. The home outlines the values, philosophy of the home as well as what services they can expect from the home. Both documents were seen and were updated in February 2008. Copies of both documents were available in some Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 12 of the resident’s bedrooms. Information regarding the size of rooms available to be used by the residents had not been included in the Statement of Purpose. This would give people who are involved in a decision about whether to move into the home additional information as to whether the size of the bedrooms would be suitable to meet their needs. Information in the AQAA told us that all newly admitted residents are given a contract. Contracts seen set out the terms and conditions for living in the home. The home also told us that residents and their families are given advance warning of any imminent price changes. Some residents and their families told us that they were not happy about the fees charged. One resident told us that they are paying over £1000 per week. This issue was discussed with the area manager and home manager and information shared with us after the inspection visit showed that fees currently charged ranged from £450 to £750 per week. People who are thinking about moving into the home have the opportunity to visit the home before they make a decision. A family member of a resident said: “I visited unannounced and was shown round. I chose Bromson Hill for my mother because of its good reputation.” A resident said: “The children came to see it (the home) and they decided it was great a place. I came for one day to visit and I liked it.” The manager told us that visitors who are expressing an interest in the home are invited to have lunch at the home, meet other residents and talk to staff. Two of the three care files examined showed us that as potential residents they had a pre-admission assessment to determine if the home can meet their needs. The remaining care file was for a person who had been admitted for respite care. There was no evidence to show that the resident had been reassessed to determine any change in their care needs since their last admission to the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 13 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 and 11 Quality in this outcome area is poor. The healthcare needs have not been identified for all residents, which means that people living in the home are at risk of receiving inappropriate care. Staff do not follow safe medication practices at all times to make sure that the management and administration of medicines in the home is maintained at a safe level. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files were examined for three residents. These were for one person recently admitted to the home, a resident who had expressed concerns about the home and the third for a resident that had recently died. The homes’ completed AQAA told us that residents and their families are given the option to be involved in planning the care of individuals based on the resident’s assessed needs. Disclaimer forms were seen in care files asking residents and/or family members to sign to say whether they wanted to be involved in this process. One of the residents involved in the case tracking had refused to sign as they did not feel this was necessary. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 14 Information provided in the AQAA told us that the home has improved care planning. The contents of care files for people living in the home showed some improvements but this was not consistent in the three care files examined. Care plans did not fully identify the action staff need to take to meet the needs of people in their care. Care plans were not thoroughly re-assessed to show changes in care needs. Daily reports were not consistently written to demonstrate the daily life, health and wellbeing of residents. The following gives some examples of these concerns: The care plan for the resident admitted for respite care shows that they were admitted on 14 August 2008. In the daily progress sheet nursing staff noted that the resident had a temperature and was vomiting, red marks around the groin area and marks and minor lesions on their skin. Staff also noted that the resident was more confused at this visit as compared to previous admissions to the home. There was no information show that the person’s needs had been re-assessed and therefore care plans available did not reflect their current care needs. Care plans had not been developed to instruct staff on how to manage the physical and mental concerns mentioned above. There were two care plans for ‘mobilisation’ one dated 2:04:07 and the other 14:06:08 for two previous admissions. An up to date plan of care on managing the resident’s mobility following a fall and subsequent treatment for a fracture had not been written to make sure staff knew how to manage the resident. There was also a care plan for nutrition this was dated the 14:06:08 and had been written two months before the residents current admission. Instructions for staff were to ‘Offer a assistance with cutting food if required’ but further instructions state ‘offer a soft diet due to swallowing problems. The failure to reassess and find out whether the care needs of people admitted for short periods of stay has changed means that the home cannot guarantee that the care they are giving will meet the current needs of all residents in the home. One of the residents followed through the case tracking process, had been admitted to receive care during the end stages of their life. The end of life care plan contained very little information. The information provided just gave details of where they wanted to be buried and details of the undertakers to be used in the event of their death. There was no information to show what care they would like to receive during the time leading up to their death. Information available gave no suggestion that the wishes of the resident and or the people representing them had been discussed. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 15 Other issues related to the care files and discussed with the managers at the inspection were the absence of daily entries giving details of the health and wellbeing of people living in the home. Daily reports showed that on some occasions written entries were not made for up to seven days. The time the written entries were made were not always stated. The care plan for one of the resident’s with mental health problems showed that their care needs had been identified. The resident liked to live their life around routines they had set for themselves. The care plans had been written to reflect this and guidance in care plans prompted staff to follow instructions set by the resident. Care staff were also guided to make sure that the resident was happy with the way their care had been delivered. For example information available in the care plan told staff what support to give to help the person with dressing, which includes choosing what clothes they want to wear. Information in care files show that residents have access to the services of other professionals in the wider community. This includes the services of a GP, chiropodist, MacMillan nurses, a dentist and community psychiatric nurses. A family member told us “The staff have called for the doctor when necessary and have informed me if I have to take my mother for any other appointments.” Risk assessments are carried out in the home to determine the ability of each resident to maintain their own safety in relation to their day to day life. Risk assessments completed include nutrition, mobility, moving and handling and falls. Residents’ living in Bromson Hill commented in their questionnaire responses and during the visit on the standard of care they felt they were receiving. A resident felt that the care only meets their care needs on the surface, which in conversation they saw as staff meeting their minimum needs possible. They told us that bath/shower day would be cancelled because the staff would say that they are short of staff, which meant that they would not get a bath or shower that week. The person also said that sometimes they would be expected to go without a bath or shower into the second week. Allocating people a bath or shower once a week suggests institutionalised practice. This could not be evidenced as some residents told us that a bath or shower once a week is enough for them. Other comments made include: “Sometimes I have to wait for a long time before someone comes to take me to the toilet, I need to have two to help. I know they are short of staff, which Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 16 is where the problem lies.” Staff told us in relation to the care of people living in the home that “It would be nice (time allowing!) to have staff meetings to discuss changes to residents care i.e. after Dr’s visits. Many staff are part-time and it can be difficult to keep up to date with changes unless you specifically ask.” “We all generally care for our residents’ welfare.” The home has recently started using a new medication system. A monitored dosage (‘blister packed’) system is used. Previously the nurses used to see all the prescriptions prior to dispensing and then use these to check the medicines and charts received into the home. This practice had stopped as the new pharmacist takes control of ordering and collection of prescriptions. The current system does not show good practice. Due to this change the home no longer checks the prescriptions or the medicines received into the home or have ultimate control of what is ordered. Medication is safely stored in locked trolleys, which are kept in locked clinical rooms. An audit of the medication prescribed for people involved in case tracking demonstrated that medicines had been administered as prescribed and medicine administration records were maintained. The manager showed us evidence of audits carried out on medicine practices. Poor practice was observed on the day of the inspection. A medicine round showed that the nurse left the medicines with some of the residents but did not make sure that they had taken them. Medication charts had been signed by the nurse to say that the medication had been taken. Residents were well dressed and looked comfortable. People living in the home were seen to be treated with respect and their dignity maintained at the time of this inspection. For example, people living in the home were being called by their preferred name and staff were observed to be attentive to residents needs. Comments made in this report, however do not confirm that maintaining the dignity of respects and showing for them is observed at all times. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 17 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 area is adequate. People living in the home are actively supported and encouraged to maintain their independence, interests, and take part in activities which would enhance their quality of life. People benefit from a varied and nutritious diet; however the presentation of soft and liquidised meals does not support a resident’s appetite. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity sheet was seen for September 2008. This shows afternoon activities planned for the month of September. Planned activities include music and movement, prize bingo, ‘play your cards right’, carpet bowls and a trip to Chesterton Windmill. Residents were able to say that they enjoyed taking part in regular planned activities. One resident said ‘yesterday we had a game of bowls’. Trips are organised for residents outside the home using the home’s mini bus. The activity sheet is titled ‘Dates for your Diary’ further information such as birthday’s, date of Chiropodist visit and the date of the evening church service. The activity’s coordinator was in the home on the second day of the inspection. This person works part time and also does an occasional shift as a care Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 18 assistant. A family member told us that their relative had settled into the home well but felt that they would benefit from more stimulation, which could possibly be provided if there were more staff on duty. Other comments from residents and their relatives were positive about activities and events that take place: “Activities take place on 3 days a week, which I believe mum, enjoys.” “A great effort is made for social occasions for relatives and residents.” Staff commented that one of the areas that they feel the home does well is in the level of activities provided for residents. There was concern however that this is sometimes affected by the lack of funding from the company. A resident echoed these thoughts by saying the activities are one of the better aspects of the home at the moment. Another resident said that they don’t really like to take part…, just like sitting and watching.” Family and friends were seen to visit the home throughout the day showing the home’s open visiting policy in operation. Relatives visited residents in their bedroom or in the lounge. Family members were seen to support their relative with their personal care needs while they visited. Relatives were able to make a drink or have a meal with their family member if they wished to. Although there was a choice of two meals for the main course at lunch time care staff did not actively express the two choices to residents. Care staff were heard to incorrectly name and describe the second dish, which was a ‘potato bake’. This action did not promote the choices available to residents or encourage them to try something different. There was a lot of concern expressed in questionnaires by residents and relatives about the meals served in the home. Comments made include: “Mum has told me on several occasions that she doesn’t enjoy the meals (Apart from supper) and complains of them being bland and boring. However, she thinks there has been a slight improvement over the past week or so.” “I think more fresh ingredients could be used. I like the way the tables are properly set for meals.” “Supper is awful. Sandwiches are not very good could do better.” Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 19 Sandwiches were seen in the fridge on the morning of the first day of the inspection already prepared for supper time. The different types of sandwiches, all made with white bread contained cheese, eggs and fish. The sandwiches were all mixed together and there was a strong smell of eggs coming from the tray containing the sandwiches. Another resident commented in their questionnaire: “More fresh food, rather than frozen and more choice of sandwiches. And maybe fresh bread once a week would be nice.” On the day of inspection improvements were noted in the meals served to residents at lunch time. The inspector had a meal with some of the residents sitting in the dining room. The meal was tasty and residents were openly heard to speak up and compliment the meal, which was roast pork, vegetables and potatoes. The dessert was apple pie and cream, lemon mousse or fruit salad for residents on soft diet or who are diabetics. Residents’ meals were served from a hot trolley in the dining room. On both visits to the home the hot trolley was seen to be in need of cleaning. This encourages the risk of contamination from bacteria. The serving of food was not organised. There was no structure to show who the main person was serving the meals and to show that staff were clear as to their role at meal times. Care staff working a long day 8:00 am to 8.00pm were also served their lunch from this hot trolley. Dining tables were laid and condiments were on the table with small artificial flower arrangements. The choice of whether gravy was wanted was not given as care staff poured gravy over the food before giving resident’s their main meal Talking to the cook he said that the meal was not intended to be served in this way. Due to the decorating and refurbishment programme taking place in the home, some residents were served their meal in the lounge. Residents had small tables they used next to their chairs and were supported to make themselves comfortable so they could eat. The meals were taken from the trolley on trays into the lounge. None of the meals were covered to protect the food from any infection and help maintain the temperature of the food. On the first day of the inspection the soft food meals were prepared and put onto plates, which were covered an hour before the meals were to be served. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 20 This would mean that the food stayed plated on the trolley for more that an hour before being served to residents. A trolley used to take meals to residents in their bedrooms was also prepared. Neither trolley’s were hot food trolleys. Preparing and serving the meals in this way is not good practice and the food would need to be re-heated before it was served or the residents would have cold unappetising food served to them. The cook told us that the soft meals would be micro-waved before being served to residents. Care staff were observed to provide discreet assistance to residents who needed support at mealtime to meet the needs of individual people. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 21 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 area is good. People using the service have their complaints listened to and acted upon. Action is taken by the home to safeguard people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of the complaints procedure is provided in a separate booklet for service users. A detailed complaints procedure is also available and accessible to residents, staff and visitors in the home. Residents told us that they would speak to Janis the manager or whoever was in charge if they were not happy. Some residents said that they were not sure how to make a complaint. The manager told us that records of complaints received by the home are passed to the head office for investigation. Complaints received by the home relate to concerns about meals, care and staff. Comments from questionnaires about the handling of complaints told us that: “…Staff are able to listen and act on what we say.” There has been one complaint received by us since the last inspection. This is being investigated by the home with the local social services department. The outcome of this will be included in the next report. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 22 The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Training records examined indicates that staff had received training in the protection of vulnerable adults. Comments made by residents about waiting for a long time before being taken to the toilet included under personal care section of this report and a further comment “Sometimes they (Staff) listen and sometimes they don’t. Some are rough and inpatient. These suggest that residents do not feel fully protected at all times. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 23 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, 21, 22, 23, 24 and 26 Quality in this outcome area is poor. People live in a home which is maintained and homely but standards of cleanliness and hygiene are poor. This means that people who live and work in the home are at risk of harm to their health due to cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is presently undergoing redecoration and refurbishment. The space available for residents in the main communal lounge is currently compromised due to the ongoing refurbishment taking place. The space available in the dining room is limited and some residents are eating their meals in the lounge. Residents are aware that this is for a limited time while the home is being decorated. This work is being undertaken by outside contractors and a member of staff is employed to carry out routine maintenance of the premises daily. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 24 Resident’s bedrooms are being decorated and some bedroom furniture is being replaced. Some of the new furniture being used is modern and not in keeping with the age of the house. A relative commented in their questionnaire: “Bromson Hill is being re-furbished – this is good that it will be freshened up. But we would like you to remember that we chose the home partly because of its old fashioned ‘grandeur’. “ Some residents had taken the opportunity to personalise their bedrooms with items from their own home. The home provides private accommodation for each resident which includes a telephone (Paid for by the resident or their family). Resident’s have access to en suite facilities, which consist of a toilet, and sink. Although we were told in the AQAA that there are sufficient bath facilities available in the home. We found at the inspection that the bath on the ground floor of the home is out of order and has been like this for some time. This means that there is no accessible bath for residents living on the ground floor of the home. Adaptive equipment to be used to support the care needs of residents is available in the home. Some of the equipment provided by the home helps people with limited mobility. Equipment seen include two manually operated hoists, electronic hoists, Zimmer frames, wheel chairs and walking sticks. Some equipment looks old and dirty for example a raised toilet seat was dirty with faeces. A relative commented in the questionnaire they completed that the “Standard of hygiene in mothers en suite often poor – traces of faeces in pan indicate inadequate cleaning intervals and had to ask several times for toilet brush for her own use.” Service records available show that equipment has been serviced and confirmed as fit for purpose. Comments received from staff working in the home told us that there is a need for “…More up to date equipment, hoists, baths, showers, hand washing facilities in all rooms and footstools.” Staff have received training in the use of this equipment and were seen to operate the equipment safely. Information in the AQAA told us that every effort is made to reduce the risk of infection. There are policies and procedures in place to control infection and that there is an infection control lead who is responsible for making sure that standards are maintained. Observations in the kitchen on the first day of inspection showed that safe practices were not carried out to prevent cross contamination and therefore promote the health and well being of people living in the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 25 At the last key inspection carried out in August 2008 observations seen in and around the kitchen area found that staff were carrying out poor practices. At this visit we found that procedures in the kitchen showed very little improvement. A tour found that the kitchen and kitchen storage areas were not clean and well maintained. We were told that a hot trolley in the kitchen was out of order, however the trolley was being used. The heating element on the top of the trolley could be seen. The top of the trolley was dirty, grubby with food and there was a dead fly. Bins in the kitchen blocked the walkway around the kitchen and one bin was placed by a trolley containing clean plates. A dirty trolley was brought into the clean area of the kitchen, although there is a separate dirty area. Pre-cooked food stored in the fridge/freezers had not been covered or labelled correctly. The frozen food, were labelled with the names of residents but not dated. A piece of beef, which looked burnt had been roasted and marked with the date it should be eaten. The written label on the beef said ‘For Sunday 24/08, there was no date to show when it had been cooked and the cling film in which it was wrapped was disintegrating and peeling away from the meat. There was also a jug containing about 500 mls of fat, 20 mls of which were meat juices. The jug was labelled to be used for the gravy for the meat. The cook that had cooked these was not working on the day of the inspection. The cook on duty did not know when the foods had been prepared. Packet of foods had been opened and not re-sealed or put into sealed containers; these include sponge and pudding mixtures. Boxes were stored on the floor. Foods stored in the fridge were either not dated or sealed properly. Examples of these are two boiled eggs in a plastic container and sliced beef. The issues discussed expose people who live and work in the home to the risk of harm to their health due to the risk of cross infection. Fridge and freezer temperatures were regularly recorded and records show that these were maintained within acceptable levels. The laundry in the home is small. Laundry staff keep the area well organised and clean and dirty areas are identified. Residents looked well groomed and no concerns were raised by service users about the laundering of their clothing. A tour of the outside of the home showed that a gate had been erected to help keep the cat and dog that had been causing problems out of the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 26 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 area is adequate. There are not sufficient numbers and skill mix of staff on duty on each shift to make sure people have safe and appropriate support at all times. People living in the home receive care from qualified staff that are competent and suitable to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of duty rotas dated from 25 August 2008 to 14 September 2008 show that there is one nurse on each shift and that the number of care staff on duty over a 24 hour period varied on the early and late shift. As indicated on the table below rotas show that over a three week period there were between three and six care staff on an early shift, three to four care staff on a late shift and two care staff on a night shift. On each shift there was one nurse on duty. Early Staff Nurses Carers 1 3-6 Late 1 3-4 Night 1 2 The three weeks duty rotas examined show that staffing levels are not consistently maintained at safe levels. On the second day of the inspection, Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 27 two of the carers were agency staff. Observing their practice and interaction with residents showed that they were not familiar with the residents needs. It was noted that for most of the time agency staff worked with a permanent member of staff. A cook, kitchen assistant, laundry assistant and domestic staff were also on duty. The manager is supernumerary. The number of staff on the rota does not reflect the numbers actually working in the home. Staffing levels are not maintained at safe levels to make sure that people receive appropriate care at all times by a sufficient number of skilled staff. Staff told us that: “Hours have been cut down from 8 hr shifts to 6 hr shifts but still the same care has to be given. Its rush rush all the time. I feel adequate care is not given…, agency cover has not been allowed for months. Carers get 12 hour shifts frequently.” Residents and relatives told us about staffing that: “There does appear to be a staff shortage. Fewer members of staff than 6 months ago.” Residents told us that staff are usually available when they need them only if they are not under pressure through a shortage of staff. “I think that in any establishment of this nature there will always be slight ‘niggles’ but over recent months there has been a rapid decline because of the lack of staff – cleanliness, food, lack of attention to residents are main issues.” A further resident commented that staff are “Not always attendant sometimes I have to wait a long time before someone comes.” The manager told us that the organisation has authorised the use of agency staff in the home. On the day of the inspection two agency staff were working long days. Lists were seen to confirm the bookings of agency staff to cover a two week period. The lists show that the same members of staff were booked with the agency as far as possible. This will help to make sure that people living in the home are cared for by the same members of staff. The personnel files of six recently recruited staff members were examined and they contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 28 obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable elderly people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training in Health and Safety, Infection Control, Fire Training, Moving and Handling, Abuse Awareness and Food Safety. Staff felt that the induction covered everything they needed to know. Staff also commented that training sessions are planned but very often due to staff shortages they cannot always attend. Other comments on training told us that the service could do better by providing more adequate training and not just lectures. A suggestion was that training is needed “… For staff attitudes towards the service user…” Staff feedback on the running of the home was received through questionnaires they had completed and returned to us. Conversations were also held with care staff. Comments received show that staff enjoy their work; however responses show that staff morale is low at the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 29 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 and 38 Quality in this outcome area is poor. People do not have confidence in the way the care home is being managed. Appropriate health and safety practices are not consistently carried out to make sure the health, safety and welfare of people are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager started working in the home in August 2007 she has experience of working with the elderly. She has completed a NVQ 4 qualification in Management and has gained the Registered Manager Award. On the first day of the inspection the area manager for the home was present at the inspection. On the second day of the inspection the manager and area manager were both present. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 30 The organisation has set up a structure to identify clear lines of accountability in the home. There are concerns about the ability of staff to work as a team, which has an affect on how the home is managed and run. A resident summed it up in their questionnaire by telling us: “My whole impression is disorganisation with staff doing their own thing. The RGN’s (Registered Nurses) need to lead and supervise the staff effectively. Responses in questionnaires returned to us showed that the level of staff motivation is low. Some of the comments made by staff in questionnaires they returned to the Commission told us: “I feel that communication between management and staff is very poor.” “Help, support and communication is very poor at Bromson Hill. If you have a problem it’s not dealt with, you have to just suffer.” “I feel the only support is from colleagues and not management.” “…recently the higher management levels are not supportive and do not motivate – morale at the moment is low. ‘Higher’ management are very negative in their attitude to staff at this moment in time.” “… (The home has changed to) a dull, no support environment with a lot of unhappy employee’s and service users, who won’t speak up because they are afraid to.” On a more positive note we were also told that: “The home manager is approachable.” “I do think that generally the home is friendly and we all work as a team supporting each other. Talking to relatives they generally say how helpful and friendly we are.” Residents meetings are held monthly these are usually well attended by both residents and relatives. Minutes for a meeting held in August 2008 were read. The minutes were detailed and provided outcomes of the issues discussed and the action to be taken by the home to make improvements. Issues discussed include meals served in the home and the refurbishment in the home. The quality of food served in the home is one of the areas residents often express Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 31 their views on. Various changes have taken place in the home such as appointing a new cook to help improve the meals served in the home. Actions taken so far have not proved to be successful. The personal monies of people living in the home are kept securely and accurate records of income and expenditure are maintained. Audits are carried out to confirm that residents’ monies are managed safely. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence of these checks were seen in maintenance records examples of these confirmed that the fire alarm was checked weekly, emergency lighting, fire equipment and water temperatures were checked monthly. Examples of some of the servicing of equipment carried out in the home includes: hoists 7 March 2008 and 11 June 2008, water Legionella screening 25 June 2008 and the electrical installation certificate was dated 2 June 2008. Observations at this inspection demonstrate that Health and safety management in the home are not of a high standard as unsafe cleanliness and infection control practices were observed. Concerns regarding the standards of hygiene in the kitchen have been discussed under the section in this report headed ‘Environment’. The issues above together with other areas discussed in this report under ‘Health and Personal Care’ and ‘Staffing’ do not confirm that safe practices are maintained to promote the health, safety and welfare of people living in the home. Practices evidenced and some comments (included in this report) made by people using the service describing the outcomes they are receiving while living in the home, does not show that the home is being run in the best interests of people living in the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 32 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 2 3 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 2 2 X 3 X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 2 X 3 X X 1 Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 33 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 OP3 Regulation 14 Requirement The care needs of people admitted to the home for respite care (Short stay) must have their care needs re-assessed so that any changes are identified. The home must be able to demonstrate that they still able to meet the care needs of people using this service. This will ensure that people receive person centered care. The home must be able to demonstrate their ability to meet the current and changing care needs of each person admitted to the home. This will ensure that people receive person centered care. Care plans must be written from comprehensive assessments of peoples needs and provide staff with clear guidance on how to meet the care needs of people living in the home. This will ensure that people receive person centered care. Timescale for action 31/10/08 2 OP4 14(1)(d) 31/10/08 3 OP7 15 31/10/08 Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 34 4 OP7 15(1) 5 OP8 12 6 OP9 13(2) 7 OP26 13 All persons living in the home must have an up to date care plan, which clearly identifies all their health and personal care needs. This must include people who are admitted for short term care. This will help to make sure that residents receive person centred support which meets their needs. The home must make sure that up to date assessments of residents care needs carried out are supported by the completion of an appropriate up to date risk assessment. This will help to make sure that appropriate care plans can be developed to minimise the risk and protect the person for harm. Nursing staff must make sure that medicines they administer to residents are taken by the residents before the nurse signs the MAR chart. The signature confirms that the nurse is sure that the medicine has been taken by the correct resident. This will help to make sure that residents are taking their prescribed medicines safely. Safe practices must be maintained in the home to make sure that the risk of cross infection is reduced. To include addressing: Preparation and pre-cooking of food before it is to be used. Appropriate storage of food in the fridge and freezers. Correct labelling and dating of stored food. The cleaning of aids and equipment used in the home. Cleaning standards in the kitchen and kitchen storage areas. The hot trolley in the kitchen, DS0000062186.V369383.R01.S.doc 31/10/08 31/10/08 30/09/08 30/11/08 Bromson Hill Nursing Home Version 5.2 Page 35 which is said to be out of order. This will help to decrease the risk of cross infection in the home and promote the health and wellbeing of people who live in the home. 8 OP27 18 Staffing levels must be reviewed 30/11/08 to ensure that sufficient numbers are on duty at all times. Attention must be given to numbers on each shift worked in the home, peak times of activity in the home and when staff are required to attend training. This will ensure that residents care needs can be met safely at all times. 31/10/08 The standards of health and safety management within the home must be improved. So that the home is kept free from hazards, which could affect the health and wellbeing of people living in the home due to cross infection. Particular attention must be given to: Making sure there is safe and clear access in the kitchen. Poor practices, which encourage cross infection Poor food hygiene practices. Poor practices observed in and around the kitchen area. This will support resident’s protection from the risk of harm. Risk assessments must be carried out for maintaining safe working practices in all areas of the home. The outcome of risk assessments must be recorded with clear instructions for staff on how to manage the risks identified. 9 OP38 13 10 OP38 13 30/11/08 Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 36 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 OP1 Good Practice Recommendations The Statement of Purpose should contain information on the size of the rooms available for use by people wishing to move into the home. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. People who make a decision to move into the care home should receive confirmation that the home is able to meet their needs. This will help people to fell confident about the choice they make. Written entries in resident’s care files should be dated, timed and signed with the signature of the person making the entry. This will help to ensure that a legible and effective audit trail is available to track the care given to people living in the home. The Home should see the prescriptions prior to dispensing and check the medicine charts and medication in against a copy of these before they are administered. This is to ensure that the service users receive their medicines as the doctor intended. A system should be installed to check all new service users’ medication with the prescriber at the earliest opportunity to ensure that they receive the current drug regime only. The home should make sure that residents are treated with respect and their dignity maintained at all times in their daily life in the home. This will help to improve their quality of life while living in the home. An appropriate ‘End of Life’ care plan should be developed and written with the resident and their family members or their representative. The plans should contain details of the care the resident wishes to receive during the period leading up to their death and after. This will ensure that they will be treated with dignity and respect at a very sensitive time. DS0000062186.V369383.R01.S.doc Version 5.2 Page 37 2 OP4 3 OP7 4 OP9 5 OP9 6 OP10 7 OP11 Bromson Hill Nursing Home 8 9 OP14 OP15 10 OP15 11 OP15 12 OP16 13 OP18 14 OP21 15 OP22 16 OP30 17 OP31 The home must ensure that residents are given the opportunity to make informed choices at meal times. This will help to support residents to have a varied diet. Meals served from the heated trolley or kitchen to residents who choose to have their meals in their bedrooms or in another room, should be covered. This will help to make sure that the food served is not exposed to bacteria while being delivered to the resident. Residents must receive wholesome and nutritious food, which is properly prepared. This will help to make sure that people who live in the home receive varied meal choices that they will enjoy and help to increase their appetite. Staff should make sure that soft and liquidised meals are presented in a manner which is attractive and appealing. Consideration must be given to texture, flavour and appearance. This will help to maintain or increase a persons’ appetite and support their nutritional needs. The home should make sure that people using their services know how to make a complaint. This will help to make sure that the people are confident that their complaints will be taken seriously. The home must examine how people living in the home can express any concerns they may have about the way their care is delivered to them. This will make sure that residents are free to speak out if they feel in any way at risk of harm. There should be sufficient working bath and shower facilities on each floor of the home, which are safe to use and easily accessible by people living in the home. This will help to make sure that residents have access to suitable facilities which meet their individual personal hygiene needs. Aids and equipment provide by the care home for use by people living in the home must be suitable for their purpose, safe to use and kept clean. This will help to make sure that care and support is provided safely by staff to residents in their care. Staff should not be taken off the floor to attend training, if this means that the level of staff needed to provide care for residents is depleted. This action could affect the safety and well being of people living in the home. An appointed manager for the care home should forward an application to be considered for the role as Registered Manager for the home. This will help to make sure that people live in a home that is well led and managed in a way that puts their best interests at the centre of the organisation. DS0000062186.V369383.R01.S.doc Version 5.2 Page 38 Bromson Hill Nursing Home 18 OP32 19 OP33 Practices, procedures, communication and other systems in the home should be reviewed to find out why people living in the home don’t feel that they are benefiting from the current management approach at all levels of the organisation. This will help to improve the quality of the service provided to people who use the home. People living in the home should be openly encouraged to voice their views on all aspects of the service they receive while living in the home. The home should consider if forming a relatives/residents forum, which would provide feedback on positive comments or concerns to the management team would be of best interest for people living in the home. Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 39 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. Extracts may not be used or reproduced without the express permission of CSCI Bromson Hill Nursing Home DS0000062186.V369383.R01.S.doc Version 5.2 Page 40 - 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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