Inspection on 17/08/07 for Bromson Hill Nursing Home

This inspection was carried out on 17th August 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 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 15/08/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bromson Hill Nursing Home Ashorne Warwick Warwickshire CV35 9AD Lead Inspector Yvette Delaney Key Unannounced Inspection 17th August 2007 11:15 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.V346890.R02.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.V346890.R02.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.V346890.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 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.V346890.R02.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 us is upon outcomes for the residents and their views of the service provided. This process considers the capacity of the service to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was a key unannounced inspection visit, which addresses the essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents (people living in the home). The inspection took place over two days between the hours of 11:15 a.m. and 6:30 p.m. On the day of inspection there were 33 people living in the home. This key inspection visit showed some improvement in areas such as assessment of people before they are offered a place in the home and a significant decrease in the number of agency staff used in the home. There remains however, the need for further improvements if the home is to meet regulations and national minimum standards recommending good practice. Before the inspection the previous registered manager for the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Following receipt of the AQAA, a number of questionnaires were sent out to people who live in the home and their families to ask their views about the home. Fifteen questionnaires were sent out to residents and fifteen to family members or their relatives. Seven residents returned their completed questionnaires and ten were received from family members. Information contained within the AQAA and questionnaires is detailed in this report where appropriate. Four people living in the home were identified for close examination by reading their care plans, risk assessment, daily records and other relevant information. This is part of a process known as case tracking and where evidence of the care provided is matched to outcomes for the residents. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 6 Other records examined during this inspection, include staff recruitment records, training records, social activity records, staff duty rotas, health and safety records and medication records. The homes manager was present throughout the inspection and the inspector was able to tour the home, spend time speaking with residents, six visitors and staff. The inspector would like to thank the people who live in the home and staff for their co-operation and hospitality. What the service does well: Talking to residents and their families during the inspection and comments received in questionnaires highlighted some of the areas in which the home does well. These include: “I have been at Bromson Hill for 5 years and have been very happy. I am happy to call it my home”. “The staff are usually very kind”. “It’s a home from home”. “Looking after physical needs – rooms are well looked after, food is adequate/good, medical care good”. “Looking after emotional needs, especially during a period of bereavement when a close relative of someone living in the home died”. Activities and trips out organised by the home provides appropriate and individual levels of stimulation for people living in the home. Family members are also involved in activities and events arranged in the home. Residents are helped to celebrate special occasions especially birthday’s and anniversary’s. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: People living in the home and families felt that the home could do better in the following ways: “A quicker response to my call bell”. “Continuity of Manager would be excellent”. “There should be more call bells in the lounge”. “I wish they could stay for a little time and talk with me. I get lonely sometimes”. Other areas identified at the inspection where the home could do better include: Care plans must be sufficiently detailed and updated to reflect the current care needs of all people living in the home. This will ensure that people who live in the home receive appropriate care at all times. Records must be maintained to accurately identify training attended by staff. Monitoring training attended by staff makes it easier to identify what areas of training needs to be updated. This practice will enable appropriate training to be arranged and ensure that people who live in the home receive safe and appropriate care. All staffing levels and staff skill mix in the home must be reviewed to ensure that good and safe standards of care and procedures in the home are maintained at all times. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 8 Health and Safety and infection control practices in the home must be reviewed especially in respect of practices in the kitchen. This review and implementation of best practice will ensure that the health and well being of residents is not put at risk of harm. 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.V346890.R02.S.doc Version 5.2 Page 9 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.V346890.R02.S.doc Version 5.2 Page 10 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, as the home does not provide intermediate care. Quality in this outcome area is good. The Statement of Purpose, Service User Guide and contract provides people with sufficient detail about the home to assist in making a decision about whether the home suitable for them. People considering moving into the home have their care needs assessed so that they can be sure the home can meet their needs. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Updated copies of the Statement of Purpose and Service User Guide are given to all residents. These documents and the most recent inspection report are easily accessible to people living in the home and their family’s should they wish to read them. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 11 Residents spoken with were able to confirm that they had received contracts informing them of the terms and conditions for living in the home. In questionnaires returned from people living in the home five out of seven people said that they had received a contract. Residents and their families were able to confirm that they had received information about the home. The manager said that people who are considering moving into the home are assessed to make sure that the care home will be able to meet their needs. People referred to the home by care management teams, which include Social Services and Primary Care Trust complete assessments of individual care needs, which include assessing whether people require nursing care. The pre-admission assessments of two residents recently admitted to the home were examined. Assessments read showed that a thorough assessment had taken place in aspects of personal and health care needs. These include diet and nutrition, mobility and falls history and personal care. The assessments provided staff with sufficient information to confirm the care needs of the individual people. Relatives commented that they had been able to visit the home before their family member was admitted to the home. On the second day of the inspection visit a potential resident and their family were visiting the home. The purpose of their visit was to help them to assess the suitability of the home. The family also joined residents at lunchtime. In conversation, they said that they enjoyed their meal and found residents and staff to be friendly. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 12 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 group is adequate. Care files show improvement however, care plans are not consistently written and reviewed to identify the individual care needs of all people living in the home. Medication records are not consistently maintained to demonstrate that all medicines are administered as prescribed. This puts the health and well being of residents at risk. People living in the home are treated respectfully. This judgement has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Observation during the inspection found that most people living in the home are genuinely well cared for. Residents were well dressed and looked comfortable. Some of the women living in the home liked to wear make up especially lipstick and support and time was offered by staff to help residents ensure they look presentable. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 13 Four people who live in the home were case tracked. This involved looking at their care files, looking at their living accommodation, talking to staff, the residents themselves and some members of their families. Comments made by people who live in the home about their care include: “There are occasionally days when things dont go quite right but on the whole I am satisfied”. The contents of care files for people living in the home showed some improvements but this was not consistent throughout all care plans. Care files contained care assessments, daily records, risk assessment and monitoring records. However, not all residents had appropriate care plans written. Examples of these were seen in the inconsistencies in the writing of care plans. There was a lack of information to indicate how care staff should meet the basic care needs of some residents. An example of this was demonstrated by the absence of a care plan related to oral care although an entry in the care file documented by the dentist following a visit instructed staff that a resident needed help with brushing their teeth. Details were not cross-referenced into a care plan to ensure that staff were aware of the follow up care requested. A resident when commenting in a questionnaire also expressed these concerns: “Carers not always to hand. Long wait at times to receive attention. Attention to detail lacking, sometimes teeth are not cleaned and my pad is not changed from when I get up until bedtime, again staff shortage”. Other comments made by relatives in the questionnaires in reference to care include: “(Resident) Usually clean and tidy but sometimes not (again staffing problems)”. Entries in the residents’ health records and comments by staff confirmed that people are supported to get access to relevant health professionals where required, such as the GP, chiropodist, district nurse, dentist, community psychiatric nurse and optician. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 14 Monthly observation records are maintained to monitor the well being of people living in the home. Records are maintained of residents’ weight gain or loss, blood pressure and pulse. Monitoring a resident’s well being enables staff to take appropriate and timely action if needed. Information regarding any diet restrictions, people’s likes and dislikes are recorded. A list of foods that could be eaten by a resident on a low fat diet was available and kitchen staff were aware of the persons dietary needs. Risk assessments regarding nutrition, the use of bedrails, pressure areas and moving and handling were completed and available in files examined. The pharmacist inspection took place on a different date to the main inspection and lasted two hours. Medication charts and the medication for six people living in the home were examined together with three randomly chosen supporting plans The home now has all the medicine charts printed by the community pharmacist and the majority of medicines are dispensed in a monitored dosage system (MDS). This is where one medicine is dispensed into one sealed blister packaging per day for ease of administration. Medicines that cannot be dispensed in the MDS are dispensed in traditional boxes and bottles. This has resulted in a more ordered system and it was evidenced that the medicines dispensed in the monitored dosage system were administered as prescribed and accurately recorded. Nursing staff now see the prescriptions before they are dispensed and check the medicine charts and medicines upon receipt. The quantities of medicines received are recorded enabling audits to take place. However, balances from previous cycles for medicines dispensed in traditional boxes and bottles are not carried over making it difficult to demonstrate if these have been administered as prescribed. The home has excess quantities of medicines in the surplus cabinet. Medicines are re-ordered and dispensed unnecessarily. They do not adequately check what they need to order or have dispensed. The trolley used to store and transport the medicines on the first floor was too small to safely store the medicines. Because of this, some medicines had been taken out of their boxes and nurses were administering them without labelled instructions to check against increasing the risk of the mal-administration of medicines. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 15 The home now has a Controlled Drug cabinet for the safe storage of Controlled Drugs within the home. However, it was not bolted inside the cabinet and could be removed if necessary. Good practice was seen. Unusual doses were recorded clearly on the medicine charts all Controlled Drug balances were accurate and matched the CD register. Care plans varied in their content. Some clearly supported the medicines prescribed while others needed more work to ensure that new staff can fully support the resident. One nurse was interviewed during the inspection. Her knowledge of the medicines she handled and the clinical condition of the people who live in the home was good enabling her to fully support their needs. The home has installed a quality assurance system, which is undertaken at least once a month to assess whether medicines are generally administered correctly. A more enhanced system was discussed to demonstrate individual nursing staff competence in the safe handling of medicines. Throughout the inspection, staff were observed to be caring and supportive towards residents. The personal care needs of people living in the home are carried out behind closed doors, demonstrating that staff show a suitable regard to peoples privacy. Information in care file demonstrated the support a resident received both psychologically and physically at the time of a family bereavement. Arrangements and assessments were made with the involvement of the family and GP to identify the level of support required and ensure that they were fit to travel. A resident wrote a comment in one of the questionnaires returned about deaths in the home, saying: “There seems to be a policy not to communicate deaths of residents to other residents until sometime later - usually in the next months newsletter. Often these are my friends and I would like to know that I have the opportunity to say goodbye.” This comment was shared with the manager, who said that this could be an issue to be discussed at resident/family meetings. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 16 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 the outcome area is good. People living in the home are supported to maintain their independence, enduring interests and maintain contact with their families and friends, which enhances their quality of life. The method used to serve meals to residents does not guarantee that everyone living in the home will enjoy a nutritious, hot meal. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Praise continues from residents and their families on the level and types of activities that take place both in and outside the home. The activities coordinator together with the residents plans a weekly activity programme. Activities are planned around the likes and interests of people living in the home. Three residents spoken to during lunch said that they choose whether they attend the activities and that they are aware of when activities take place. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 17 A resident pointed out the programme, which is displayed on a notice board in the lounge at a level that is accessible to all residents. Activities planned include sing-along, artwork, one-to-one sessions, music and movement and trips to garden centres. Comments made by residents and family members include: “This (activities) is something, which is much appreciated. … The activities organiser works very hard to organise joint activities, one-to-one sessions and trips out”. “I enjoy some activities more than others. If I don’t take part I enjoy watching others do so”. “This area is very well catered for”. (Activities take place) “Sometimes four, sometimes five times weekly”. People are encouraged to make visits outside of the home with the support of their families or staff. Records are maintained detailing who has participated with activities, their level of interest and whether they enjoyed the activity. The home has an open visiting policy. People living in the home are encouraged to maintain links with their family and friends. Visitors were seen to visit their relatives throughout the day. One husband and wife with a member of their family celebrated their wedding anniversary at lunchtime. A special table was laid and all support was given to help the family make the occasion special. Improvements were noted in the meals served to residents and the inspector had a meal with the residents at lunchtime. The meal was tasty and residents spoken with said that the food had improved and were seen to enjoy their lunch. The dining rooms in the home are well presented. Tables are laid at meal times. Menus examined demonstrated that meals offered are varied and appealing encouraging residents to eat nutritious and balanced diets. Lunch is the main meal of the day. The serving of food was unhurried and residents were offered fish cooked in different ways. This does not offer residents a choice but staff did say that if a resident wanted something different to fish this could be catered for. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 18 The meals were wheeled into the dining room on trolleys. The food was on trays covered by foil. The temperature of the food could not be maintained to ensure that residents received a hot meal, which could make the food unappetising. This method of serving meals was discussed with the manager who said that plans are to purchase a heated trolley. Care staff were observed to provide discreet assistance to residents who needed support at mealtime to meet the needs of individual people. Information regarding any diet restrictions, people’s likes and dislikes are recorded. A list of foods that could be eaten by a resident on a low fat diet was available and kitchen staff were aware of the persons dietary needs. Responses taken from the completed questionnaires received by us also reflect some of the findings of the inspection. Comments made include: “I usually enjoy my food and think that the meals are good. Sometimes the food could be hotter”. “No more fish pie”. “I am on a soft diet, which is necessary but meals (especially suppers) are very repetitive. A lot could be done to improve on all meals in general. A hot serving cabinet is desperately needed by the home”. “On the whole the food is acceptable but very repetitive. A good deal could be done to improve. A hot serving cabinet is urgently needed”. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 19 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 these outcome areas is good. Complaints are taken seriously by the home and there are appropriate policies and procedures to safeguard people living in the home. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors in the home. One relative spoken with said that if they had any concerns they would speak to the manager. Comments from questionnaires were made as follows: “I tell my daughter if I have any concerns. She visits every day”. “Complaints have always been handled well by sister in charge. I have never needed to go beyond this”. “My daughter would do this on my behalf”. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 20 There have not been any complaints received by the Commission since the last inspection. A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that staff had attended recent adult protection training sessions. Residents looked comfortable in the home and comments received through conversation with people using the service expressed that they felt safe in the home. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 21 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, 23, 24, 25 and 26 Quality in these outcome areas is adequate. People live in a pleasant and comfortable home. However standards of hygiene in the kitchen area are poor, this does not ensure that people living in the home are cared for in a safe environment free from infection. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: The home is presented to be homely and spacious with a number of seating areas for residents and relatives these include dining areas, lounge areas and a conservatory. Bedrooms were seen and residents are encouraged to bring in their own possessions. Some residents had taken the opportunity to personalise their bedrooms with items from their own home. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 22 Equipment to aid the moving and handling of residents were seen in use these include hoists. The condition and suitability of some of the hoists used was discussed, as the equipment is old, dirty and require extra physical strength from staff to manoeuvre and operate, which could residents and staff at risk. The following observations were seen in and around the kitchen area. A tour found that the kitchen and kitchen storage areas were not clean and well maintained. A stray dog and cat were sitting in the grounds outside the kitchen. The manager said that these animals belonged to the farm next door to the home. The manager informed that attempts to speak to the owners of the farm about the animals had not been effective and communication remain ongoing. On entering the kitchen while tea was being served the cat had jumped through the window onto the work surface. Food intended for the residents was on the work surface uncovered. How long the cat had been in the kitchen was unknown as there was not a member of staff in the kitchen. The window the cat had jumped through had a fly screen, which was not in use. The two bins used in the kitchen had swing top lids, which means that staff have to touch the lid when throwing away rubbish or waste. One of these had been replaced at the time of the second visit to the home. Records in the kitchen indicate that cleaning procedures had not been carried out. Checks and records were not consistently maintained on the temperature of fridges and freezers, food received into the home and cooked meals served to people who live in the home. Fruit and vegetables had been over ordered and some of these had already started rotting in the fridge. Cooked food stored in the fridge/freezers had not been covered or labelled correctly. Two chickens and a piece of beef had been roasted 2-3 days in advance; these were stored in the bottom of the fridge. Information received from staff confirmed that they were for dinner on Saturday and Sunday of that week. The reason given for this was that there is insufficient kitchen staff to cover the preparation of meals. A Check of the temperatures of the fridges and freezers on the first day of inspection showed that they were not working effectively. Observation on the second day demonstrated that new fridge and freezers had been purchased. 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 infection. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 23 The Environmental Health Officer visited the home on 20th August 2007. Areas were identified for action and a ‘Silver Award’ certificate was issued. The laundry in the home is small, clean and dirty areas are identified. The area was clean and organised. Residents and their residents were happy with the laundering of their clothing by the home laundry staff. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 24 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 adequate. Staffing levels and skill mix of staff provided in all areas of the home is not clearly identified. Accurate information is not available to demonstrate training attended by staff and recruitment procedures are not robust to ensure that the needs of residents will be met safely and that people living in the home are in safe hands at all times. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: Examination of duty rotas show that the number of staff over a 24 hour period provides on average six staff on an early shift, four staff on a late shift and three staff on a night shift as indicated in the table below. Early Staff Nurses Overseas Nurse Practitioner Carers 1 1 4 Late 1 1 3 Night 1 2 Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 25 The duty rota does not make it clear in what capacity the ‘Overseas Nurse Practitioners’ are employed and whether they are counted in the overall staffing numbers or work on a supernumerary basis. The overseas staff are not registered with the Nursing Midwifery Council (NMC) professional body for Registered Nurses in England. Therefore unable to practice as qualified nurses. A further issue about the rota is the title of ‘Nurse Supervisor’ given to staff who have achieved a level 2 National Vocational Qualification (NVQ) in care. The lack of clarification of roles does not make it clear that the skill mix and number of staff on duty is appropriate for the number and dependency levels of people living in the home. There is also a shortage of ancillary staff, especially in the kitchen and laundry areas. The lack of staff in these areas has led to poor standards of hygiene in the kitchen and care staff having to work in the kitchen and laundry in order to maintain the service. These issues were also reflected in the responses from residents and relatives in their questionnaires returned to us. Comments made about staff include: “There are a number of occasions when staff shortages mean some waiting”. “Sometimes I have to wait a while”. “Sometimes there don’t seem enough of them (care staff) to go around”. “Sometimes there seems insufficient staff”. Responses from family members to the questionnaires state: “More staff. I have made friends with a lot of residents relatives and we normally have to go looking for staff to help anyone in distress. This is a regular thing particularly in the afternoon. (I visit 5 days a week)”. “Generally all staff are pleasant and have the right approach but there are some exceptions. Maybe they get tired but this should not reflect on residents and relatives”. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 26 New staff have an induction period, which ensures a basic introduction to the home and is linked to the ‘Skills for Care Council’ induction programme. One to one discussions were held with nurses and care staff who were responsive and very receptive. Staff at the home were observed to be friendly, caring and supportive to people who use the service. Positive interaction was observed between people who live in the home and staff during the inspection. The files for the most recent employed staff were examined. One of the files did not show that safe recruitment procedures are followed at all times to ensure that residents are protected. There was no evidence that the work history of the person was explored. The application form had not been completed, reference was made to ‘see CV’ this was not available in the file on the first day of inspection. The CV was made available on the second day of the inspection and the contents of the CV was examined but offered little information as to the role the person undertook during their past employment. Criminal Record Bureau checks (CRB), Protection of Vulnerable Adults (PoVA) are carried out before a person is employed. References were obtained before the staff commenced employment in the home, but some of those received were not appropriate. Some references did not show whom they had been received from, in what capacity they had known the person and for how long. It was also not easy to link the references to past employment. Staff spoken with were enthusiastic about training and said that opportunities were available to attend training. In discussion with staff, they said that they had attended mandatory training, which include moving and handling and fire training. Up to date training records were not available to confirm what training had been offered and completed by staff. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 27 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 area is adequate. There is no stability in the management of the home from which to ensure consistency in the quality of service provided and that practices are maintained which meet the needs of people living in the home and safeguard their welfare and interests. This judgment has been made from evidence gathered both during and before the visit to the service. EVIDENCE: The registered manager for this home has left and a new manager, who was present at this inspection, has been appointed. The manager had been working in the home for approximately two weeks at the time of this Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 28 inspection, she has not yet applied for registration with the Commission. The manager does have experience of working in care homes for the elderly. Discussions with care staff, and relatives demonstrate that they are aware of the lines of accountability, but are concerned at the constant change in managers. Comments made by family members include: “There have been several changes of manager since the change of ownership. It would be good to have some communication from Alpha re these important appointments”. Information in the completed AQAA received confirms that residents, relatives and visiting professionals are asked to complete quality questionnaires. Staff to make improvements where necessary has followed up the outcome of questionnaires received. The area manager for the home has carried out monthly formal visits to the home to determine how well the home is working and whether residents and their family are happy with the care, they are receiving. Copies of reports detailing the outcome of these visits have been shared with the Commission and have shown positive outcomes. The outcomes of supervision sessions were not clearly recorded and did not demonstrate that a two-way conversation had taken place. The supervision process described by staff should be that they complete a form detailing areas such as training, care practices and any progress they have made in achieving any action agreed since their last supervision. The supervision forms examined were all written in the same handwriting. Observations at the inspection demonstrated that Health and safety management in the home are not always of a high standard as unsafe practices were observed. Concerns regarding the standards of hygiene in the kitchen have been discussed under the section in this report headed ‘Environment’. Other areas of concern related to health and safety observed on the first day of the inspection include the storage of some vegetables on the floor of an outside building attached to the back of the home. A cupboard in this building contained laundry products and the cupboard was not locked. The kitchen storeroom door was propped open with large container of tomato ketchup. A chicken was being defrosted in a bowl, which was much too small resulting in liquid running over the sides. Flies were noted in the kitchen, the fly screen was not in use. A plated meal was in the freezer wrapped in cling film but was not dated or labelled. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 29 The issues above together with other areas discussed in this report do not confirm that health and safety and hygiene standards are followed, which will ensure the health and wellbeing of people living in the home. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 2 3 3 3 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 2 Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 31 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 OP7 Regulation 15(1) Requirement Timescale for action 30/09/07 2 OP7 15(1) 3 OP8 12 4 OP9 13(2) 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 will ensure that they receive person centred support which meets their needs. Care plans must provide staff 30/09/07 with information on how to meet the care needs of people living in the home. This will ensure that people receive person centered care. Care staff must carry out 30/09/07 instructions received from health care professionals and this information cross-referenced into residents care plans. This will ensure that people living in the home receive person centered care and help to prevent deterioration in their health. All medicines must be 31/08/07 administered from dispensed and labelled containers to the service users they are prescribed to ensure they are administered to the correct service user and to check the dosage. DS0000062186.V346890.R02.S.doc Version 5.2 Bromson Hill Nursing Home Page 32 5 OP9 13(2) This requirement was made by the Pharmacist, the original date for action was 26/07/07 The purchase of an additional transportable storage facility is required for the first floor to safely store and transport medicines to the service users. This requirement was made by the Pharmacist, the original date for action was 31/07/07 The quantities of all medicines must be documented (including any balances carried over from previous cycles) to allow audits to take place to demonstrate that the medicines are administered as prescribed. This requirement was made by the Pharmacist, the original date for action was 05/07/07 The Controlled Drug cabinet must be bolted either inside the existing medication cabinet or rag-bolted to a permanent wall so it cannot be removed easily from the premise. This requirement was made by the Pharmacist, the original date for action was 05/07/07 31/08/07 6 OP9 13(2) 31/08/07 7 OP9 13(2) 31/08/07 8 OP19 16(2) Work identified for action by the Environmental Health Authority must be carried out and consultation take place to ensure: • The cat and dog that have taken up residence at the front entrance to the home are not placing residents at risk. • Working practices in the kitchen areas are maintained at an acceptable standard. 30/09/07 Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 33 9 OP19 23 10 OP22 23 11 OP26 13 Risk assessments of the premises must be completed to ensure that safety is maintained in the home at all times, this must include: • Doors must not be propped open Equipment provided at the care home for use by people living in the home or persons who work at the care home must be suitable, safe for use and kept clean. Previous requirement date of 30/04/07 not yet met. Safe standards of food hygiene and health and safety practices must be maintained in the kitchen areas at all times. To include addressing: • Defrosting food • Preparation and pre-cooking of food before it is to be used. • The appropriate use of the fly screen. • Animals outside of the kitchen window and animals accessing the kitchen. • Leaving food intended for consumption uncovered. • Storage of food in the fridge and freezers. • Maintaining appropriate records of the temperature of fridges and freezers used in the home. • Ensuring fridge and freezers are in good working order and appropriately maintained. All other issues identified in this report related to safe practices in the kitchen areas must be addressed. This will ensure the health and welfare of people who live in the home. 30/09/07 30/09/07 31/08/07 Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 34 12 OP27 18(1) Sufficient staff must be on duty in all areas of the home and with the relevant skills, to meet the needs of people living in the home. Previous requirement date of 30/04/07 not yet met. The Registered Manager must ensure that at least 50 of care staff are trained to NVQ level 2. This will ensure that people living in the home are in safe hands at all times. 30/09/07 13 OP28 18 (1) 30/11/07 14 OP29 19 Sch. 2 15 OP30 18(1)(c) Previous requirement date of 31/05/07 not yet met. Full and satisfactory information 30/09/07 must be obtained on all employees to ensure that robust recruitment procedures are in place. Appropriate and relevant references must be requested for all staff being considered for employment in the home. This will ensure that people living in the home are protected from the risk of harm. 30/11/07 All staff must receive training appropriate to the health, personal and safety care needs of the people in their care. For example: • Management of residents who are dying. • Dementia care • Food hygiene and • Health and Safety Evidence must be available to confirm training attended. This will ensure the safety of people who live in the care home, that staff are trained, and competent to meet their care needs. Previous requirement date of 31/05/07 not yet met. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 35 16 OP36 18(2) 17 OP38 13 The registered 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. This will ensure that staff that are competent and safe to deliver appropriate care to people living in the home. Previous requirement date of 30/05/07 not yet met. The standards of health and safety management within the home must be improved. So that residents can be sure that the home is being managed in their best interests and their health, safety and welfare is given the highest priority. This must include addressing: • Poor practices observed in and around the kitchen area. • The suitable of the hoists used in the home. 31/10/07 31/10/07 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 recommend that medicines prescribed on a when required basis have supporting protocols detailing their exact use and all outcomes must be recorded following administration and their use reflected on regularly. It is recommended that an enhanced auditing system is installed in the home to assess individual staff competence in medicine management 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. DS0000062186.V346890.R02.S.doc Version 5.2 Page 36 2 3 OP9 OP9 Bromson Hill Nursing Home 4 OP11 5 OP15 6 OP15 7 OP31 Support should be available to residents to allow them to say goodbye, attend the funeral or acknowledge their grief following the death of a person in the home, especially those that have formed a close relationship and become friends. Plans to purchase a heated trolley for serving foods to people who live in the home should be pursued to ensure that the quality of food served is maintained and residents are able to enjoy their meal. The registered person must ensure that residents receive wholesome and nutritious food, which is properly prepared. To ensure that people who live in the home receive varied meal choices that they will enjoy. The appointed manager for the care home should forward an application to be considered for the role as Registered Manager for the home. This will ensure that people live in a home that is well managed and considers their best interests. Bromson Hill Nursing Home DS0000062186.V346890.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V346890.R02.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!