CARE HOMES FOR OLDER PEOPLE
Bromson Hill Nursing Home Ashorne Warwick Warwickshire CV35 9AD Lead Inspector
Jackie Howe Announced Inspection 7th February 2006 09:15 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.V274682.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 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 Alpha Health Care Limited Mrs Judith Mary Corless 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.V274682.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Bromson Hill is a converted manor house, which has been extended to provide accommodation for 34 elderly service users who may require nursing care. The home is situated in the Warwickshire countryside close to Ashorne village. The mainly single accommodation is provided on two floors with access via passenger lifts or stairs. The homes décor and furnishings are to a high standard and are domestic and homely. The home has established and well maintained gardens, which are accessible to all residents including those who may require wheelchair access. Alpha Health Care Ltd is the current owner having acquired this home in November 2004. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place between 09.15 and 17.30 and was announced. This was the second inspection of the inspection year 2005/06 and was undertaken with the new manager who has been in post a few days and the outgoing manager. The inspection included a partial tour of the home, speaking with staff and residents, accessing records and procedures, reading care plans and observing care practices. Prior to the inspection residents and their relatives/ visitors completed comments cards and comments from these have been used in this report. During the inspection a total of ten residents, seven staff and one visitor were spoken with. What the service does well:
Bromson Hill is an impressive building and the home is well maintained. The furnishings are of a good standard and fixtures and fittings are appropriate to the age of the home. The residents are able to enjoy ‘magnificent views’ across the countryside. Lounge and dining areas are comfortable, and there is a pleasant atmosphere. Residents speak positively about the care provided, the attitude of the staff, the food, activities provided and the facilities and garden. ‘ If you have got to be old, this is the place to be.’ The staff produce a monthly newsletter, which informs residents in the home, what is taking place in the form of activities and outings, news about residents in the home and announces birthdays being celebrated. Care planning and health care assessments are of a good standard and contain risk assessments and guidance to staff to minimise risk and provide a good level of care to residents. Residents spoken with said that they are able to exercise control over their life style by choosing how to spend their days. The home has been able to maintain a stable workforce, and many of the staff spoken with had worked there for a number of years and demonstrated loyalty to the home and its residents.
Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Whilst these standards were not fully assessed, residents spoken with confirmed that they had made an informed choice about moving into the home, and were pleased with the decision to live there. One resident said that she had come up from Dorset on the recommendation of a friend, and another said that whilst she had not been able to visit herself, that her daughter had chosen the home for her. ‘My daughter could not have chosen a nicer home.’ Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 There is a clear, consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service user needs. The residents’ health care needs are clearly identified and regularly reviewed in the individual plans, to guide staff and ensure care needs are met. EVIDENCE: Care plan systems have been developed within the home and significant improvements have been made in reviewing and updating resident’s needs. During the inspection four care plans were read and there was good evidence of the assessment of risk and staff transferring this into individual plans of care so that care staff are aware of the actions they need to take to meet individual need. The home undertakes regular dependency ratings to review changing needs. Photographs were seen on individual plans, and a copy of social/ life story information collected by the activities organiser.
Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 10 Some care plans were signed by the resident, or their representative, but one resident spoken with was unaware that she had a care plan, and said that she had not had any involvement with it. Health care assessments are completed in great detail. Local residents are able to keep their own GP, optician and dentist if they choose to do so; otherwise the home ensures provision from visiting practitioners. The home’s nursing staff provides nursing care. Two of the staff are trained in promoting continence and are able to meet these needs. Exercise for those who choose to join in, is available via the activities programme. Nutritional screening of all residents is undertaken and actions taken as required. Residents spoken with confirmed that they were weighed regularly. Equipment is available within the home to assist with the promotion of tissue viability. Staff expressed some concern that some of the equipment was inadequate with increased frailty of residents, especially the provision of pressure revealing mattresses. Beds available in the home cannot be raised up and down by care staff, which they find to be a problem when giving care. They acknowledged that there were systems in place to request new equipment, but said that on occasions this was not always available in sufficient time scales. The home has three hoists to assist with manual handling. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 The activities and opportunities to maintain community links, provided by the home, meet service users’ expectations, interests and needs. Work undertaken by staff to achieve this outcome must be recognised as a strength in the home’s performance. Service users are enabled to make choices and exercise control over daily living routines. EVIDENCE: Residents spoke enthusiastically about the activities they are able to take part in, and of the activities organiser. Trips to the Leamington Spa centre, and to the local village to see the pantomime, were enjoyed by all who attended. Some residents are planning a ‘market garden’ and discussed the types of vegetables they are planning to grow. Local schools visit to sing Christmas carols, a visiting masseur gives ‘holistic massage’ and a neighbour brings the parish newsletter for those who may be interested. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 12 Residents are able to meet their visitors in rooms other than their bedroom, and the home upholds a policy that residents receive only who they wish to see. A relative visiting her mother confirmed that she was made to feel welcome in the home and was able to visit whenever she chose to do so. There is not currently anyone in the home using an advocate, but information is available should they choose to do so. Residents confirmed that they were given choices in regard to their lifestyle. ‘I get up when I want and go to bed when I want and I have my own room with my bits and pieces around me’. The inspector joined the residents at the lunch table, and the food provided was seen to be of good quality with plenty of variety and choice. Residents spoke highly of the food joking that they were fed too well and were putting on weight. One resident who is on a special diet, confirmed that this was available. ‘They are very good with my diet, and they know what I can’t eat’. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a complaints policy and procedure for residents and their representatives to access, and records are kept of complaints made. Policies and procedures and opportunities for staff to attend training concerning the protection of vulnerable people are inadequate, putting residents at risk. EVIDENCE: The home has a complaints procedure, which is on display and a copy is given to residents on admission. The home has developed its own system so that a record is kept of complaints made and in some cases of responses made to complaints. The recording system currently does not show where complaints have been upheld, and there is insufficient detail of what actions have been taken to resolve complaints, or what responses have been made to complainants. The home does not currently undertake an audit of complaints made. Two residents spoken with have complained that there is a terrible noise in their room when the laundry is in use. Staff have responded by trying to minimise use of the laundry between 11pm and 7.30 am but this is still causing the residents some concerns. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 14 Information is available to staff in the form of a pamphlet, and information from social services about elder abuse. Induction booklets for new staff show that the potential for abuse in elderly people is addressed as a topic for discussion but not developed upon in the form of training. Training records show that very few staff have received formal training in recognising and responding to abuse and adult protection issues, and this puts residents at risk. The home does not currently have a copy of the DoH ‘no secrets’ document. Staff are aware of some of the home’s policies and procedures. The whistle blowing policy is displayed on the wall in the staff office. Staff were unaware of a policy to preclude staff involvement in assisting in the making of, or benefiting from service user’s wills. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The home is very clean and comfortable. Generally the premises are well maintained resulting in a suitable living environment for residents. The gardens are well maintained and accessible, so the residents can take pleasure in these areas. EVIDENCE: The home is an old building and was seen to be internally in a good state of repair. The home employs someone to concentrate on the maintenance of the building and another for the garden areas. Recently the ceiling in the lounge experienced a serious leak from pipes above resulting in large parts of it falling on to the dining table. As this happened during the night, residents were not put at risk. Repairs have been made to the ceiling but this emphasises the need for regular checks and risk assessments to be completed and regularly reviewed on the maintenance of the building.
Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 16 The home as an older building has a number of staircases, which can be used by residents. Risk assessments on these staircases must be regularly reviewed to ensure that the abilities of the changing resident group are reflected. The gate at the bottom of the staircase up to the manager’s office should be removed, as it is causing a hazard to staff coming through carrying objects and hot fluids and could cause harm. The resident who was assessed to be at risk from the staircase is no longer in the home. Two residents complained that their room could be warmer, and the noise from the laundry should be given due concern. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Current staffing levels are not always sufficient to appropriately offer care to residents given the layout of the building, and dependency levels within the home. Recruitment policies and procedures ensure the support and protection of the residents. Systems for the management and opportunities for staff training and development are unsatisfactory and have the potential to affect the standard of care provided. EVIDENCE: The home on the day of the inspection had 4 empty beds and therefore the staffing ratio was being calculated on the care needs of 30 residents. The staffing rota showed 1 RGN and 3 carers were on duty for the evening shift, which is insufficient based on the dependency needs of the residents in the home, a significant number of whom need 2 carers to provide their care and to move them using the hoist. A projected rota was being completed by the assistant manager, which showed a number of shifts where staffing levels were far below the required standards. It was hoped that new staff may be employed by this time, or staff could be persuaded to work some overtime. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 18 Staff spoken with expressed serious concerns about working with lower staffing levels. One said staff were ‘rushed off their feet’, another said that on a recent occasion they had not got enough staff to sit with someone who receiving terminal care. Staff used words such as ‘disheartened’ and felt they were not able to do the job they were trained to do. The home has been going through a period of change with the change of owner 1 year ago and the recent resignation of the manager. Staff expressed loyalty to the home and to the residents in their care but their low morale and level of anxiety was of concern. Recruitment procedures are now of the required standard and records accessed showed that staff are only confirmed in employment following receipt of CRB checks having been undertaken. The home does not currently involve volunteers in the home. Records showed that training undertaken by staff over the past year has been minimal. Staff confirmed that they had not received training in a number of mandatory areas, as they had to wait for a training course to be available, and often when it was available, it was at a location too far away to access. The assistant manager is a manual handling trainer and she has ensured all care staff receive training in this area, kitchen/ domestic staff however have not received training in moving inanimate objects. None of the staff spoken with had received training in COSHH, apart from what was covered in the NVQ. Training courses are provided for staff as and if they come up, and are not available as a response to the needs of the home or its residents. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36. 38 The home uses quality assurance systems to ensure the home is run in the best interests of the residents. Staff are supervised to ensure that they have the support, skills, practises and knowledge to meet residents care needs. Training opportunities to equip staff with the skills to maintain safe working practices in this home are inadequate putting the health and safety and welfare of residents potentially at risk. EVIDENCE: The manager has undertaken annual quality assurance surveys the results of which are collated and a report is produced and shared with residents and their relatives. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 20 The home also has a suggestions box where staff, residents or visitors can make anonymous suggestions, which are discussed at residents meetings. The manager does not currently produce an annual development plan or objectives for the home in response to these audits. The manager has introduced a programme of supervision for staff. Staff spoken with confirmed that they had met with a supervisor and records accessed showed that this had taken place at regular intervals. The current system of supervision should be developed to focus on positives as well as ‘problems’ in performance and include a process to identify training needs for staff. Nurses said that they felt happy to mentor and supervise staff, but felt concerned that they may lack the skills required in formally supervising challenging staff. Records show that the majority of staff have been unable to access appropriate training to ensure that they have the skills required to keep themselves and others safe. Some staff had never received training in Health and Safety, and none of those spoken to had received training in Control of Substances Hazardous to Health (COSHH), apart from what was covered during the NVQ. Training received by staff within the last year is far below the required standards. Generally systems within the home to maintain a safe environment are well managed. An audit of falls by residents is undertaken monthly, and the only patterns noted have been in relation to particular residents and increased frailty. Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x x 3 x 2 Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? 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 OP18 Regulation 13 Requirement The registered manager must ensure that all staff receive appropriate training in recognising and reporting signs of abuse. The registered manager must ensure that there are always sufficient staff on duty with the relevant skills, to meet the dependency and needs of the residents in the home. The registered manager must ensure that all staff are given suitable assistance and opportunity to attend training appropriate to their job role The registered manager must ensure that the home makes provision for the health and welfare of its residents by ensuring staff attend appropriate training including, health and safety, risk assessment, COSHH, infection control, first aid and basic food hygiene, with evidence of such training available for inspection. The Registered Provider must ensure that regular building surveys and risk assessments are completed.
DS0000062186.V274682.R01.S.doc Timescale for action 01/05/06 2. OP27 18 01/03/06 3. OP30 12, 18 01/05/06 4. OP38 12, 13 01/06/06 5 OP38 12, 13 01/06/06 Bromson Hill Nursing Home Version 5.1 Page 23 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 OP16 Good Practice Recommendations The registered manager should undertake a regular audit of complaints received and record detail of the outcomes of investigations, to identify if complaints have been substantiated. The registered manager should obtain a copy of the DoH ‘No secrets’ document to support the home’s documentation and procedures for recognising and responding to abuse. The gate stopping access to the office staircase should be removed, and a risk assessment completed. Nursing staff undertaking supervision should be given training opportunities to equip them with the appropriate skills required to undertake the role. Current documentation used for undertaking supervision should be developed more to focus on positive as well as negative outcomes for staff, and identify training and development needs to assist with planning training for the home. 2 OP18 3 4 5 OP19 OP36 OP36 Bromson Hill Nursing Home DS0000062186.V274682.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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