Inspection on 13/06/06 for Bronte Park

This inspection was carried out on 13th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bronte Park 23/10/09

Bronte Park 12/06/09

Bronte Park 18/06/08

Bronte Park 07/11/07

Bronte Park 24/01/07

Bronte Park 05/10/05

Bronte Park 23/06/05

Bronte Park 14/02/05

Bronte Park 07/10/04

Bronte Park 29/04/04

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

CARE HOMES FOR OLDER PEOPLE Bronte Park Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE Lead Inspector Frances Shillito Unannounced Inspection 13th June 2006 10:30 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 Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 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. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bronte Park Address Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE 01535 643268 01535 647468 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) Bronte Regency Healthcare Ltd Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: Bronte Park is a detached, converted property situated in the village of Haworth and is registered to provide nursing care for older people with dementia. The home is close to local amenities and public transport routes, although there is a long driveway leading up to the home. There is parking to the front of the property. Rear gardens are accessible to the residents but do not provide a secure area. A side entrance provides disabled access into the property. The main house is a listed building with an extension to the rear of the property. The accommodation is on two floors with access between floors via a chair lift. There are twenty-one bedrooms, fourteen singles and seven doubles. None of the bedrooms have en suite facilities. There is a lounge and separate dining room on the ground floor. There are three communal bathrooms, a separate shower room and seven toilets in the home. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission for Social Care Inspection (CSCI) is now inspecting services at a frequency which has been determined by the risk assessment of a service. Information is gathered from a variety of sources, including a site visit. This evidence is used to inform the inspection process. This is the first key inspection of Bronte Park, with another planned to take place before the end of March 2007. Further site visits will take place as part of random inspections. These will be scheduled in line with the Commission’s action plan for Bronte Park. This is to make sure that the home is meeting the National Minimum Standards and is run in line with the Care Home Regulations 2001. This key inspection is a major evaluation of the quality of a service and any risk it might present. It focuses on the outcomes for people using the service. All the core National Minimum Standards are assessed and this forms the evidence of the outcomes for people using the service. The visit was unannounced. Two inspectors were present and the visit started at 10.30am and finished at approximately 3.30pm. Feedback was given at the close of the visit. Before the site visit took place, evidence gathered about the home was reviewed. This included looking at the number of reported incidents and the action plan submitted following the previous inspection, as well as reports from other agencies. This information was used to plan the site visit. During the inspection, three case files were seen, other records were looked at, and care staff were observed carrying out their work. Residents, staff, visitors and the deputy manager were spoken with during the visit. From April 1st 2006 fees are charged within a range of £375 - £390, plus the funded nursing care element. What the service does well: Pre-admission assessments and care plans are person centred and identify needs as well as strengths. People can make informed decisions about moving into the home with the written information available to them and a planned visit to the service. Staff work in partnership with a range of other professionals, to offer good care to residents. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 6 Staff work well as a team and are supportive to the residents. Staff find their inductions useful and they benefit from the ongoing support of a mentor. The home has exceeded it’s target for staff achieving National Vocational Qualifications (NVQ’s). What has improved since the last inspection? What they could do better: The manager needs to ensure that medications are disposed of appropriately and promptly, as part of the recently implemented medication audit process. The home would benefit from an Activities Organiser who can co-ordinate activity provision. This would enable care staff to meet the needs of the residents more effectively. Staff rotas need to be planned in advance and to take into consideration the needs of the residents. It is suggested that four care assistants are needed on an early shift, which is the busiest time. Staff need to have training which is relevant to their work and to the needs of the residents they care for. The management of the home need to produce a detailed plan, setting out the range of maintenance works and refurbishments which are to be made to the environment. This should include clear timescales and any plans to establish separate communal facilities for residents and staff and signage around the home. This would help people with dementia to find their way around the building more easily. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 7 A user friendly guide or flow chart needs to be produced to inform staff at a glance, of what they need to do and who they need to call if they suspect abuse. Each service user should be assessed in relation to their nutritional needs. The manager should make arrangements for discussions to take place with residents and their families, with regard to their wishes in dealing with dying and death. 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. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using all available evidence, including a site visit to the service. Detailed assessments are made before a person moves into the home. People can make an informed decision about the home from what they see when they visit. EVIDENCE: The case files of three residents were seen which contained detailed preadmission assessments. These provided a clear picture of the individual’s needs and how they would be cared for in the home. There was evidence that the opinions of family members and professionals had been taken into consideration during the assessment and care planning process. Care plans provided a picture of the whole person and focused on strengths as well as needs. They were written in a way which showed clear respect for the individual. Paperwork had been sent by the hospital which contained useful information for staff on the needs of two of the residents. Case files were well organised. It was suggested that these files would benefit from a front sheet to make them easier to follow. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 10 On the day of the site visit a prospective resident was looking around the home with a relative, their social worker and a ward nurse from a local hospital. They were greeted by the deputy manager who gave them lots of information about the home and spent time with them making sure that the home would be able to meet the person’s needs. The social worker said that in their limited contact with the home, they have found the manager and the staff helpful and organised and would be happy to place people there, based on this first impression of the home. The nurse said that they had positive dealings with the home in the past and they visited a resident that they had placed there who said that they are happy and well. The home does not provide intermediate care. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using all available evidence, including a site visit to the service. Staff treat residents with dignity and their work is supported by good care planning, which helps them to meet the needs of the residents. The manager must ensure that medications are disposed of quickly and safely and that records of this are made. EVIDENCE: Three care plans were looked at. They contained clear and detailed information on how to meet the residents’ identified needs. The plans are regularly reviewed by the key worker and rewritten where necessary. It was clear that relatives are involved with the care planning process, where this is possible. The file of one resident contained a beautiful chronology of their life produced by a relative, which helps staff to gain in depth knowledge of the person they are caring for. Each file had a photograph at the front which is useful for staff. This also shows that each resident is valued as an individual, which was also confirmed by the way in which staff spoke of the residents with knowledge and respect. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 12 Records of visits by GP’s, District Nurses and other specialist healthcare staff were seen. Staff said that they work closely with these professionals and the recording on the case files confirmed this. Staff said that they encourage independence and choice. During the site visit this was reflected in the way they care for residents and there was evidence of this in the recording on the case files. One resident seen has pressure sores which are being treated and monitored by staff and recorded on his file. Staff said that the District Nurse had visited to offer advice and support and would be visiting again to make a further check. Staff said that residents are seen in the privacy of their bedrooms if they are seeing their GP or a nurse. During the site visit staff were seen knocking on the doors of residents before going into their bedrooms. Personal care is provided in private to ensure dignity. The home has a cordless telephone which residents can use to make or receive telephone calls in private. The manager is making arrangements for a staff member to have training on assessing the nutritional needs of residents. They will then be the lead worker for nutrition within the team. In the meantime staff said that they have had advice from the District Nurses, who have provided an assessment tool that may be useful to the home. The deputy manager said that there are plans for her during the week to meet with residents and their relatives to discuss and record their preferences regarding dying and death. The deputy manager said that the home has implemented a new audit process for medication in line with national guidelines. This is a process where the pharmacy delivers a month’s worth of medication to the home. Medication stocks are now counted and checked by two staff members every day. This helps identify any errors as they arise and allows action to be taken to correct the error quickly, where this is needed. Each resident’s medication record has a photograph of the resident at the front of the file. This helps to avoid errors being made. The medication cabinet and the records were seen to be in good order. A staff member was also seen administering medications. In addition the home’s Drug Policy was read. Staff said that recent problems have arisen with the disposal of medications in the home. It was evident that a large quantity of medications were stored in the upstairs office waiting to be collected by the company yet it was unclear why there had been disruptions to the disposal service. It is important that this situation is resolved without delay. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 13 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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using all available evidence, including a site visit to the service. Activity provision at the home is enjoyed by residents and some opportunities are made to link them to the community. Meals are enjoyed by residents. EVIDENCE: Case recording on the three residents’ files provided details of the daily living routines and the activities that take place within the home. This included “singalongs”; music and movement; spending time in the garden; hand massage; reading the newspaper; bingo; dominoes and outings. Arrangements are regularly made for a priest to visit the home to spend time with residents and give communion. This ensures that the religious and cultural needs of residents can be met, particularly those who can no longer make it to church because of their health and mobility needs. In addition a hairdresser visits the home on a weekly basis. Families are encouraged to visit the home and one of the residents seen has regular visits from their son and grandchildren. One visitor spoken with said that the resident they are visiting is happy at Bronte Park. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 14 Staff said that they spend individual time with people and showed good knowledge of the things that the residents like to do, which was recorded on the case files. One resident likes to dance and a staff member was seen dancing with them. However the demands on staff time for providing care means that they are not always able to provide stimulation to the residents. It is therefore suggested that the home appoints an Activities Co-ordinator to assist the staff team to provide organised meaningful activity for the residents, both at the home and within the community. A number of the residents were seen relaxing and watching television. The locality of the home is such that the residents need support to go out into the community and it is suggested that this could be achieved with small groups with similar levels of need. It was clear from looking around the home and seeing residents’ bedrooms that they are homely and decorated with personal belongings. Staff said that they encourage residents and their families to bring personal possessions into the home, to help the resident to settle in and feel comfortable and familiar in their new surroundings. During the site visit residents were seen enjoying lunch in the dinning room where there was a pleasant atmosphere. Staff were seen assisting residents who needed support to eat their meals and to freshen up afterwards. Care plans indicated that residents should have the time to eat their meals in an unrushed manner. The dinning room chairs are arranged in such a way as to make the room feel more spacious. Menus seen showed that residents are having balanced and healthy diets. Residents said that they like the food and staff ask them what they would like to eat. Residents who prefer to eat in their bedrooms were seen to have their meals served there. Snacks and drinks can be prepared for residents when this is asked for. At present there are no residents who are from black or minority ethnic communities so there are no cultural and dietary needs to be met with the current resident group. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using all available evidence, including a site visit to the service. Residents are protected by the home’s complaints and adult protection procedures. EVIDENCE: The complaints procedure was seen in the Service User Guide. The contact details of CSCI are provided so that people can share information with the Commission where a complaint has not been resolved. On the day of site visit, a prospective resident was looking around the home with his daughter, his social worker and a ward nurse at the local hospital, and they were given a copy of the guide, so will be fully aware of how to complain. The deputy manager said that all prospective residents or their relatives are given a copy of the guide. The complaints procedure was seen on notice boards within the home. It was recorded in the pre-inspection paperwork that no complaints have been received at the home in the last twelve months. Residents spoken with said that they know how to complain and who to approach if they have concerns. Adult protection procedures were seen in the staff policies and procedures manual and there was also a copy of the Local Authority Adult Protection Procedure, “No Secrets”. The training records of staff indicated that they had received in-house training on indicators for abuse and how to use the procedures. Staff spoken with confirmed this. The home does have all of the Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 16 information that they would need to follow if an allegation was made or abuse was suspected. However it was recommended that a simple flow chart or easy guide on what to do is produced, that gives a simple step by step description of what to do and who to notify. This guide should include telephone numbers of key people or agencies to contact. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 17 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): Standards 19, 20 and 26. Quality in this outcome area is adequate. This judgement has been made using all available evidence, including a site visit to the service. A clear and detailed improvement plan needs to be developed, to set out the action to be taken to complete maintenance works and refurbishments, to make the home a comfortable environment to live in. EVIDENCE: As a result of the previous site visit, maintenance works were identified for completion and this formed the basis of a requirement. During this visit there was an opportunity to assess the progress made since the visit of 18th May 2006, although it is acknowledged that there was limited time in which progress could be made. These are in the following: • • • The ceiling in the lounge on the ground floor needs to be painted. Paintwork remains damaged on the hall and stairs. The stair carpet is still worn in one area. The sash window in Room 4 is still in need of repair. DS0000050797.V293067.R01.S.doc Version 5.0 Page 18 Bronte Park • • • • • Some carpets around the home are stained and some still need replacing. The overgrown bushes outside the window in Room 6 make this room unnecessarily dark and they need cutting back. Some furniture throughout the home needs to be repaired or replaced. In particular the rough edges on the melamine vanity units in some of the rooms need to be checked and repaired where this is needed. The sash window in Room 3 needs to be repaired. Given the age of the building, it was suggested that all the sash windows are checked on an ongoing basis, to see if they are in a good state of repair and to be maintained as necessary. Flaking paint was seen in a number of areas throughout the home which require attention. There was in addition a requirement for an Improvement Plan to be drawn up by the provider, setting out their plans to meet this requirement, the timescale by which it will be met and the name of the person responsible. The provider sent a plan to the Commission and have since been asked to amend the plan to reflect the action points for this service in a clearer and more comprehensive format. It is further required that a planned programme of redecoration and refurbishment for the next twelve months should be drawn up. In addition this should incorporate signs and colours to assist the residents in finding their way around the home easily. No such plan has been set out in writing as yet. An Improvement Plan, setting out the direction of the home for the next twelve months and detailing the range of priorities discussed at the two most recent inspection visits, would be useful in ensuring that progress is made. On the day of the inspection it was positive to note that the gate was being installed and the posts were being painted, in order to make the garden more secure. Staff said that the proprietors are looking into the possibility of also developing an already secure area just outside the home. This area could be enhanced with plants and shrubs to make it a pleasant setting for the residents to spend time outdoors. There is a requirement for proposals for alternative communal space for residents and separate facilities for staff be put forward. No written proposals have been submitted and this area for development should be included in an Improvement Plan. Staff said that every effort is made to keep carpets clean and free from odours and where necessary vinyl is fitted. There are plans to fit new carpets in some of the bedrooms. The standard of hygiene and cleanliness at the home on the day of the site visit was satisfactory. However it was noted that the flaking paint throughout the building possibly makes it difficult to maintain a good standard of cleanliness. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 19 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using all available evidence, including a site visit to the service. Residents are cared for by a supportive team of staff, though rotas need to be well planned to ensure that the needs of residents can be met effectively. Recruitment procedures are followed in practice to make sure staff are vetted, but staff need to complete the training that is relevant to their job. EVIDENCE: The staff duty rotas were checked. These showed that generally on an early shift there is one qualified nurse working with four care assistants. Staff described this as the busiest shift and at times they may run the shift with only three care assistants. Staff said that at these times it is difficult to meet the residents’ needs. This was the case on the day of inspection. Usually the manager would be on duty, but was on annual leave. The deputy manager was dealing with management tasks as well as their nursing duties. This was discussed and a recommendation made that some forward planning takes place to ensure, as far as is possible, that there are always four care assistants on duty. Staff said that when needed, domestic staff who are suitably trained, can be taken off cleaning duties and deployed as care assistants. This is not an ideal approach. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 20 During the site visit, staff were observed caring for residents in a sensitive way and their approach was professional, yet personable. The relationships between staff and residents were seen to be good. Staff said that there is a good team spirit and they were seen communicating well and getting on well with each other. There has been very little staff turnover and no use of agency staff and this has helped morale and consistency of approach. Three recruitment files were checked. These all contained the necessary documentation including Criminal Records Bureau (CRB) and the protection of Vulnerable Adults (POVA) checks; two references; completed application forms; interview check lists; job descriptions and contracts. These checks demonstrate that any new employee is properly vetted and checked. At the point of taking up work, any new employee has an induction and the staff files contained evidence of this. Staff spoken with described what had happened, what was included in the induction and how they had been mentored by a senior member of staff. The home has achieved and exceeded targets that have been set in National Minimum Standards, for care staff to have National Vocational Qualifications (or an equivalent). The operations manager who was present during the inspection confirmed that all care staff would be following new Skills for Care training programmes that combine National Standards for induction and foundation training and the staff spoken with were at different stages of this. The newly appointed manager has conducted a training needs analysis and has highlighted gaps in training that need to be addressed. The minutes of the first staff meeting held showed an emphasis and commitment to ensure that staff complete mandatory training. Discussions with staff and evidence from requests in their personal supervision sessions, show that there is a need for care staff to undertake more specialist training. The specialist categories of the home and the specific needs of some individuals require training to be arranged in dementia, mental health and stroke awareness. All staff need to have fire safety training. It was agreed that now the training needs have been identified, a six month period would be realistic for this to be completed. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 21 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): Standards 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using all available evidence, including a site visit to the service. The manager must make an application to become a registered manager as soon as possible. The administration of residents’ monies needs to be improved. An annual plan needs to be drawn up for the home. EVIDENCE: A new manager has recently been appointed. An application for his formal registration with CSCI must be made without delay. He is an experienced nurse with previous management experience. Although having only worked at the home for a week, better office organisation was already noted. Staff spoken with said that they felt he is ‘positive’, he ‘listens’, ‘gets things sorted out’, ‘is on the ball’ and ‘active and involved’. Clearly these are good early signs. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 22 A staff meeting has been held and the deputy manager said that the manager intends to hold further regular meetings with qualified staff, care staff and domestic staff, so that agendas for meetings can be focused. The minutes of the first meeting were available and it was clear to any reader what the priorities were. There are established systems of auditing and monitoring aspects of quality at the home and some of these were checked. Although not available at the time of the site visit, these include satisfaction surveys given to relatives and visiting professionals. It is required by regulation, that part of quality assurance is an annual development plan for the home. At the last random inspection a development / improvement plan was required and this was provided within the timescale set. It did not however, cover all of the regulatory issues identified in the last inspection report. A new plan, specific to Bronte Park must be submitted that covers all of the regulatory issues raised in this report. The plan is vital in demonstrating that the providers are organised and serious about making improvements and is the tool that the Commission uses to monitor progress. A formal staff supervision system has been established that is in its infancy. However from the discussions with staff there are encouraging signs that staff are valuing these sessions and using them properly to identify training needs. This should continue. In order to check that residents’ financial interests are safeguarded, the records and systems for holding and accounting for any money held for safekeeping were checked. Some smaller sums of money are kept for safe keeping securely in the home’s office. These are individually accounted for and cash is held in individual wallets. One resident’s records were checked and a reconciliation made with the cash held. There were no concerns with proper recording, receipts held and the cash balancing with the record. However, previous reports have raised that larger sums of money that are accrued should be put into individual bank accounts. The current system simply transfers money to the home’s safe. The safe key was not available, the manager being the sole key holder, so the contents could not be checked. The deputy manager said that money is held in envelopes and when money is placed in the safe, two staff signed the envelope. From the records available it appeared that some residents had significant sums of money. The operations manager said that it was difficult to open bank accounts and there were no relatives to pass the money on to. In such cases the local authority social services department should be approached so that these residents’ personal finances can be properly administered, perhaps through guardianship proceedings. This should be done without delay. The financial interests of residents must be properly safeguarded. The proprietors must also put in systems to check that their interests are safeguarded and that regular independent checks are made. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 23 The pre inspection questionnaire that provides information about the home was received by the Commission on an agreed date, some weeks following the site visit. There was documentary evidence that fire safety equipment, hoists, the stair lift, electrical installation and equipment and weekly fire alarm system checks were up to date. Accident records were checked and these were properly recorded. Audits are made to reduce the risk of accidents. It was indicated on the pre-inspection paperwork that fire training and a fire drill had taken place recently. The central heating system has been checked by an approved gas installation engineer within the last nine months. Temperature checks and water heating checks were made within three months of the site visit. An approved electrician had checked the electrical wiring three years ago and arrangements have been made for a further check. Emergency lighting was checked within two weeks of the site visit. Data sheets for the recording of hazards presented by dangerous substances within the home are being implemented over a three month period. The home has recently been inspected by Environmental Health Officers and issues have been raised that the home has been trying to address. From the verbal report of the deputy manager who was present during the last of these inspections, the officer was satisfied. A written report will be made available following meetings that were held with the owners and inspection visits, in order to establish conclusive information. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 2 X 2 Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9O Regulation 13(2) Requirement The registered person must make sure that medications are disposed of promptly and appropriately. The registered person must complete the maintenance works identified in the report. (Previous timescale of 30/11/05 and 30/06/0 not fully met). The registered person must provide a planned programme of redecoration and refurbishment for the next 12 months and this should incorporate signs and colours to assist the residents in finding their way around the home more easily. (Previous timescales of 31/12/06 and 30/06/06 not met). The registered person must make the garden secure and safe for residents. (Previous timescale of 30/11/05 and 30/06/06 not met). Timescale for action 31/07/06 2. OP19 23 31/08/06 3. OP19 23 31/08/06 Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 26 4. OP20O 23 The registered person must provide proposals for alternative communal space for residents and separate facilities for staff. (Previous timescale of 31/12/05 and 30/06/06 not met). The registered person must develop and implement a quality assurance system and annual development plan for the home. (Previous timescale of 31/01/06 and 30/06/06 not fully met). The registered person must arrange for staff to receive specialist training which is relevant to their work with residents with specialist needs. 31/08/06 5. OP33 25 30/08/06 6. OP30 18 31/12/06 7. OP31 9 8. OP35 35 (9) and (20) 9. *RQN 24 A formal application to be 31/08/06 registered with the Commission must be made by the recently appointed manager. 31/08/06 The registered person must establish and implement a system to make sure that the financial interests of residents are safeguarded and that independent checks are made. Where residents have no relatives and lack capacity, appropriate arrangements must be made to make sure their finances are handled in their best interests. The provider must produce an 31/08/06 Improvement Plan setting out their plans to meet the requirements in this report, the timescale by which it will be met and the name of the person responsible. Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 27 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 2 Refer to Standard OP8 OP11 Good Practice Recommendations The registered person should assess each resident in relation to nutritional needs and the risk of falling and record the assessment. The registered person should discuss and record with residents and/or their representative their preferences and wishes regarding death and dying. The home should develop a policy for staff in dealing with dying and death The registered person should recruit an Activities Organiser to the staff team, to develop the activity provision within the home and link the residents to the community. The registered person should produce a user friendly guide or flow chart with contact details of relevant agencies, mapping what staff need to do if abuse is suspected. The registered person should make sure that forward planning is taken into account when arranging duty rotas and that there are four care assistants on duty on an early shift, to meet the needs of the residents. The registered person should make sure that the programme of staff supervision which has been established is maintained and monitored. 3 OP12 4 5. OP18 OP27 6 OP36 Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 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 Bronte Park DS0000050797.V293067.R01.S.doc Version 5.0 Page 29 - 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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