Inspection on 23/06/05 for Bronte Park

This inspection was carried out on 23rd June 2005.

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

The inspector 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 13/06/06

Bronte Park 05/10/05

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 BD22 8QE Lead Inspector Gillian Sangster Unannounced 23 June 2005 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 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 J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bronte Park Address Bridgehouse Lane Haworth Keighley BD22 8QE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01535 643268 Bronte Regency Healthcare Ltd Care home with nursing 28 Category(ies) of Dementia - over 65 (28) registration, with number Old age (28) of places Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14/02/05 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 J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection between 9.15am and 3.30pm. The manager and provider were present during the inspection and for the feedback at the end. We spent time talking to residents and visitors and observing practice. We also spoke with staff and management. We looked at records including recruitment files, duty rotas, residents’ care records, staff training records and accident reports. Many of the requirements included in the last inspection report dated 14 February 2005 have not been dealt with. The home is failing to meet a number of the standards. What the service does well: What has improved since the last inspection? What they could do better: The home must provide written information about the home, such as a statement of purpose and service user guide, to allow residents to make an informed choice about moving in. Residents must be given a statement of terms and conditions when moving in so that they know their rights of occupancy. The home must recruit more permanent staff to provide a stable staff team, which will give residents continuity of care. The manager must make sure that Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 6 all recruitment checks are completed before any person starts work in the home. Staffing levels must be increased to allow staff sufficient time to meet all the needs of the residents and ensure that they have a good quality of life. All new staff must receive thorough induction training when starting work at the home to ensure that they have the skills and knowledge to meet the needs of the residents. Staff must be given the opportunity to undertake NVQ training. Residents must have an up-to-date care plan and risk assessments so that staff are informed about the action they need to take to meet individual needs. The home must provide a range of frequent and suitable activities for the residents including opportunities to go out of the home. The home must also provide safe and secure outside space, which the residents can easily access. Residents must have access to a telephone that they can use in private. The provider must look at providing additional communal space for the residents and separate staff facilities. The standard of cleanliness through the home must be improved. A machine to clean the carpets must be kept at the home to allow staff to maintain a good standard of cleanliness. 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 J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 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 standard(s) 1,2,3 and 6. Residents are not provided with the written information they need to help them make an informed choice about the home. Residents are not provided with contracts and therefore are not informed of their rights of occupancy. Prospective residents’ needs are assessed before admission to ensure that they can be met. EVIDENCE: The manager said that she has no written information about the home to give to prospective residents or their relatives. The statement of purpose and service user guide, which give details about the home, remain in draft form. There is no brochure. Statements of terms and conditions for residents have not been given out. The manager visits and assesses all prospective residents before admission. Assessment forms seen provided detailed information of the individual’s needs. The home does not provide intermediate care. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 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 standard(s) 7 and 10. Care plans are very poor with insufficient information recorded to inform and guide staff in meeting individual needs. The residents’ privacy and respect is compromised by aspects of the environment. EVIDENCE: Care records for five residents were inspected. Two residents had no care plans and the others had not been evaluated since April 2004. One resident had no risk assessments recorded despite a number of risks identified in the pre-admission assessment. Other risk assessments contained insufficient information and had not been updated for several months. Some records were unsigned and undated. There has been no improvement in the care plans since the last inspection. Senior staff acknowledged that the care records are very poor but said that with the current low staffing levels they have no time to review or update them. The manager has produced a new care plan format which appears comprehensive but has not been implemented. As discussed with the manager and provider the care records require urgent attention in order to safeguard residents and ensure consistency in meeting their needs. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 10 Generally staff were seen to treat residents with respect and carried out personal care tasks in a way that maintained the privacy of the individual. However there were several areas that showed a lack of regard for the respect and privacy of the residents. There is no separate telephone for residents to make or receive calls in private and residents have to request to use the office telephone for any calls. This is not acceptable and either a pay phone or separate telephone must be provided for the residents’ use. One resident at risk of falling was positioned in a reclining chair in a way that compromised her dignity and comfort. Another resident had been re-admitted to a room where building work had been carried out. The room was unprepared with no curtains at the window, no light shade, the mirror above the sink was propped against the wall and the sink was heavily stained. This showed a lack of respect for the resident. No locks were fitted to the doors of two toilets and one bathroom, this compromises the residents’ privacy. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 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 standard(s) 12 and 15. Activity provision is poor and there are few opportunities for residents to go out which restricts the residents’ quality of life. Residents enjoy the meals. EVIDENCE: The home has no activity co-ordinator. The manager encourages care staff to spend time with the residents and said that recently there had been a flower arranging session with one resident. A physiotherapist visits once a week and does music and movement with a group of residents. The hairdresser visits weekly. Local clergy visit to give communion each month. Activity records showed that activities occur infrequently. As staffing levels are low and affected by constant change, activities take a low priority in the home. During discussions with relatives they said that although there had been an improvement since the new manager was employed more could be done regarding activities. Discussions were held with the provider about the garden which is in a lovely setting. This could be used daily by residents if it was made safe and was easy accessible from the building. The importance of providing suitable and fulfilling social care for residents, including opportunities for them to go out independently and on organised trips, has been discussed with the provider at the last four inspections. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 12 The home has employed a new cook since the last inspection. This is a good improvement as previously care staff had to undertake many of the cooking duties. Lunch was a sociable occasion with staff providing assistance discreetly to those who needed help. Residents appeared to enjoy the meal. The manager said that menus are currently under review. The dining room is not large enough for all the residents and this means that some have to eat their meals in the lounge. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 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 standard(s) 18. Adult protection procedures are in place. But all staff must be fully aware and understand the different types of abuse to ensure that residents are protected. EVIDENCE: The manager advised that the majority of the staff have attended adult protection training with the local adult protection team. One of the care staff said that no one had spoken to her about adult protection and was unclear about what to do if she witnessed a staff member shouting at a resident. In contrast one of the senior staff showed a good understanding of adult protection and the procedures for reporting any allegations. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 21, 23, 24 and 26. The design and layout of the home does not help the residents to easily find their way around. Some bedrooms are personalised and comfortable but an equal number are bare with few personal effects. Residents would have more freedom if they could access safe and secure garden areas. The standard of cleanliness is poor. EVIDENCE: All parts of the home were seen. Work is required to make the home more accessible and suitable for the client group. No adaptations have been made in order to help the people with dementia communicate and cope with daily life. There are no visual cues such as photographs or drawings to represent toilets or bathrooms or different colours on doors to aid identification. The manner in which a home is furnished and decorated can help to reduce confusion and improve orientation. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 15 There is one large lounge and a small corner with three armchairs in the dining room. The residents who live at the home have specialist needs because of their dementia. They would benefit from having the choice to sit somewhere quieter other than the main lounge where the television is usually on or the dining room which is used by staff for their breaks. It was apparent during the visit that many of the residents prefer to be on the move. Keypad locks are fitted to the external doors and residents walking down the corridor from the lounge can see the lovely gardens outside but cannot access them. The layout of communal space, corridors and easy access to the outside play an important part in meeting the needs of this client group. All of these matters have been discussed at length with the provider at previous inspections. The bathrooms and toilets need refurbishing, as they are cold and uninviting. The two toilets next to the dining room need urgent attention as they are very shabby. Some of the bedrooms in the old part of the home are large and spacious. In one bedroom urgent attention was needed as part of the ceiling had collapsed. In another bedroom the pipe work leading from one vanity unit was rusting and required attention. Some bedrooms were warm and inviting with many of the resident’s own possessions displayed. Those residents who were able to voice an opinion said they were comfortable in their rooms. The standard of some commodes was poor as much of the woodwork was worn making it difficult to keep them clean and hygienic. Paper towels and liquid soap were available in bathrooms and toilets as required. The standard of cleanliness throughout the home was poor due to a lack of attention to certain areas. The floor covering in many of the bathrooms and toilets was ingrained with dirt around the edges. The carpets in two rooms needed cleaning and there was a strong malodour. The back of the bath chair needed thorough cleaning. Under one bed was a collection of debris which had obviously been there for some time. Some of the linoleum was ill fitted and compromises infection control measures. The home has to share a carpet cleaning machine with the provider’s other home in Halifax and therefore carpets cannot always be cleaned immediately. This is unacceptable as there should be sufficient cleaning equipment provided in the home to ensure that it is kept clean at all times. The chair lift near the shower room was not working. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Staffing levels are low which means that the staff have little opportunity to spend quality time with the residents. There are still gaps in the recruitment process potentially putting residents at risk from unsuitable staff. Induction training for staff is poor. EVIDENCE: The home needs to strengthen its staff team by looking at ways in which it can recruit and retain staff. There has been a significant turnover of staff since the last inspection and agency staff are being used to cover many of the shifts. There are still vacancies for three full time and one part time care staff. More nursing staff are needed so that there is sufficient cover for holidays and any sickness. Staffing is at a minimum level and must be increased to give staff time to meet the needs of the residents. Although physical care needs are being met the quality of life for residents could be improved. More staff would mean that they could spend time with residents doing activities, going out for walks, sitting talking about the news and many other things that may enrich their lives. Recruitment files for four overseas staff were seen. These showed that there are still gaps in the recruitment process as some records such as references and contracts were not available for some staff. These staff had brought police checks form their country of origin which is acceptable as the home is their first place of employment in this country. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 17 New staff are given a basic induction on their first day of working in the home. This does not meet the required standard and therefore puts the residents at risk of being cared for by staff who have not been adequately trained. The manager said that moving and handling and fire safety training updates are due for all staff. The operations manager provides this training. The majority of the staff have completed training in food hygiene and some are attending a wound management course. The manager said that she has tried unsuccessfully to access NVQ training for the staff. Only one of the care staff is currently taking NVQ training. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 and 36. The manager is unable to carry out her responsibilities fully due to low staffing levels and poor support from the providers. Residents’ money is properly accounted for. Staff do not receive formal supervision. EVIDENCE: The manager has been in post for seven months and inherited many of the problems identified in this report. During this time she has tried hard to make improvements to bring the home up to the required standard. She provides strong leadership and support for staff by working alongside them and promoting good practice. However because of the high turnover of staff and low staffing levels she has had to spend most of her time working as part of the staff team. This has left her with little time to address the many issues identified in this report. There is no administrative support provided at the home. It is difficult to see how the manager can make the improvements that she is capable of making unless staffing levels are increased, which would Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 19 allow her to be totally supernumerary. The providers are aware of these difficulties and yet have done little to resolve them. Four residents’ personal allowances are held by the home for safe keeping. Transactions were well recorded and receipts are kept. Some residents have accumulated large amounts of money. This should be kept in a bank account in the resident’s name where it can gain interest. There is no formal supervision system in place for staff. Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 x 2 2 x 1 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 x x x 2 1 x x Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 21 yes 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 op1 Regulation 4&5 Requirement The registered person must provide a final copy of the statement of purpose and Service User Guide and must forward copies to the Commission. The registered person must ensure that all service users are provided with a statement of terms and conditions at the point of moving into the home. The registered person must ensure that all service users have an up-to-date care plan and risk assessments. The plan must be reviewed monthly or more frequently if needs change. The registered person must make arrangements for the service users to be able to access suitable telephone facilities and for them to be able to use these facilities in private. The regsitered person must provide suitable door locks on the toilet and bathroom doors. The registered provider must record the personal history and social interests of each service user and use this information in consultation with the service Timescale for action 31/08/08 2. op2 5 31/08/05 3. op7 15 1/09/05 4. op10 16 31/08/05 5. 6. op10 op12 16 16 31/08/05 31/08/05 Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 22 7. 8. 9. op19 op19 op20 23 23 23 10. op26 23 11. 12. op22 op27 23 18 13. op29 19 14. op30 19 15. op30 19 user to draw up a programme of activities. The registered provider must ensure that there are sufficient trained staff who have dedicated time to provide the activities. The registered provider must provide service users with the opportunities to go out of the home either on organised trips or individual outings. The registered person must make the garden safe and accessible to the service users. The registered person must complete the maintenance works identified in the report. The registered person must provide proposals for alternative communal space for service users and separate facilities for staff. The registered person must ensure that the home is kept clean and hygienic at all times and must provide sufficient cleaning equipment for staff. The registered person must ensure that the chair lift is working. The registered person must increase the staffing levels and strengthened the staff team by further recruitment of staff. The registered person must ensure that all recruitment checks as detailed in schedule 2 and 4 are in place for all staff before they start work. The registered provider must ensure that 50 of the care staff are trained to NVQ level 2 or equivalent by 2005. The registered person must ensure that all new staff receive induction training that meets NTO specifications. J52 S50797 Bronte Park V233384 230605 Stage 4.doc 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 31/08/05 Bronte Park Version 1.30 Page 23 16. op33 25 17. op36 18 The registered provider must 31/10/05 develop and implement a quality assurance system and annual development plan for the home. The registered provider must 31/10/05 develop and implement a programme of formal supervision for care staff at least six times a year. 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 provider should assess each service user in relation to nutritional needs and the risk of falling and record the assessment. The registered provider should discuss and record with service users and/or their relatives their preferences and wishes regarding dying and death. The home should develop a policy/procedure for staff in dealing with dying and death. The registered person should arrange for an occupational therapist or other suitably qulaified specialist to under take an assessment of the environment. The registered person should make arrangements for service users personal money to be kept in their own bank account. 3. 4. op22 op35 Bronte Park J52 S50797 Bronte Park V233384 230605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley 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. 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