Inspection on 23/10/09 for Bronte Park

This inspection was carried out on 23rd October 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 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 16/02/2010.

Random inspection report Care homes for older people Name: Address: Bronte Park Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE two star good service 18/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Stephen Marsh Date: 2 3 1 0 2 0 0 9 Information about the care home Name of care home: Address: Bronte Park Bridgehouse Lane Haworth Keighley West Yorkshire BD22 8QE 01535643268 01535647468 theheathersbrad@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Glenn Jones Type of registration: Number of places registered: Conditions of registration: Category(ies) : Bronte Regency Healthcare Ltd care home 28 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 28 The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Dementia Code DE Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 2 of 11 1 8 0 6 2 0 0 9 Brief description of the care home up to the home. There is parking to the front of the property. The rear gardens are accessible to the people who live at the home and steps have been taken to make this 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 new shaft lift. Some of the bedrooms have en suite facilities. There is a lounge and separate dining room on the ground floor as well as a separate smoking room. There are three bathrooms, one shower room and seven toilets in the home. Care Homes for Older People Page 3 of 11 What we found: We carried out a key inspection of this service on the 18 June 2009 and no requirements were made at that time. This unannounced visit was made by a Local Area Manager and an Inspector between 16:30hrs and 19:00hrs. The visit was made because of concerns raised by other healthcare professionals about the standard of health care being provided at the home. During the visit we looked in some detail at the care plans and supporting documentation completed for three people, specifically in relation to the concerns that had been raised.We also talked to staff, management and visiting healthcare professionals and observed staff as they carried out their duties. At the end of the visit we gave feedback to the manager, operations manager and registered provider. In one persons records we saw that since admission they had been visited twice weekly by the district nursing service to dress a leg ulcer. Information provided by the district nurses shows during this time they had worked with the staff at the home and given them training on moving and handling, wound care and nutrition. However, recently they had observed that the person had other wounds/sores which could not be explained. They also told us that at least three staff were standing the person although the person had always been non weight bearing. Staff should therefore not have been attempting to do this. On the day of the visit the district nurses had arrived to change the dressing on the leg ulcer and found further wounds and a bruise to the persons neck. They also found a dressing on the sacral area which none of the staff on duty knew about. On further examination they found that the person had developed grade three pressure sores on their sacrum. The Tissue Viability Nurse was asked to visit and advise about the best course of action and treatment. On arrival the Tissue Viability Nurse was concerned about the lack of documentation relating to pressure area care including an up to date care plan. The district nurses confirmed that they had visited the person twice that day, the first time leaving at about 12:30pm. On returning to the home late afternoon they had found the person to be in the same position in bed with the air mattress switched off and deflated. Neither the qualified nurse on duty or the operations manager could give a satisfactory explanation as to why this had occurred. We looked at their care plan and saw that no plan had been put in place for pressure area care to their sacral area until after they had been seen by the Tissue Viability Nurse on the 23 October 2009. However, as the night report completed on the 20 October 2009 clearly shows that staff were concerned about the area breaking down, a care plan should have been put in place immediately and advice sought. Information provided in the daily notes also showed that the person was on a diet supplement. However, the current Medication Administration Record (MAR) sheet could not be found and therefore it was not possible to determine if this was being given as prescribed. In addition, we could find no evidence in the care plans completed to indicate Care Homes for Older People Page 4 of 11 that they had been prescribed a diet supplement. During the course of the visit we had the opportunity to speak to the GP who had been asked to visit the person and she confirmed that they were terminally ill and too poorly to be transferred to hospital. The GP confirmed that while she had seen the bruising on the persons neck she could not say how this could have happened. For another person we found that although the care plan clearly showed that staff had to monitor their weight there was a four month gap in the weight chart during which time they had lost a significant amount of weight. Daily records show that the GP had been involved in the persons care since March 2009 and a blood tests done in June 2009 showed that they were anaemic. Further blood tests were due to be carried out a month later however it was not clear if this had been done. On the 21 September 2009 the person was seen by a GP for loss of appetite and was diagnosed with oral thrush. Medication was prescribed. On the 25 September 2009 the person was again seen by a GP for loss of appetite and on this visit it was noted that they were also severely constipated. Suppositories were prescribed and medication records show that they were given on the 26, 27 and 28 September 2009 but no results were recorded in the daily notes. On the 29 September 2009 the person was again seen by a GP and admitted to hospital due to changes in blood results which showed changes in renal function. We looked at the bowel monitoring chart for this person and saw that the last time they had their bowels open was on the 23 September 2009. Between the 1 September and 12 September 2009 there was no bowel movement recorded. There was no reference to elimination in the assessment of needs or care plan and no entries in the daily reports relating to this matter. We looked at the care records and and found it difficult to determine if this person had developed a pressure sore as the care plan referred to a sore on their heel but the daily records suggested that this is now healed. There was a reference in the care records about a wound dressing but it was not clear where this was. We spoke to the qualified nurse on duty and she thought that the person may have had a pressure sore on their heel which had healed. The assessment records for another person diagnosed with dementia identified that they were at risk of weight loss due to a poor diet intake. We looked at the weight chart and it showed that between the 1 June 2009 and the 14 July 2009 they had lost 12.5kgs. There was no further entries on the chart until the 26 September 2009 when it showed that the person had gained 9.9Kgs. We looked at the daily records for this person and found that they had been seen by a GP on the 22 October 2009 and prescribed Movicol sachets. We therefore looked at the bowel chart, which showed only three entries on the 23 September and the 2 & 3 of October 2009. There was no reference to elimination in the assessment of needs or care plan and no entries in the daily reports relating to this matter. Generally the care plans and supporting documentation we looked at were disorganised with information difficult to find or unclear. It is therefore apparent that staff are not able to use the care plans as working documents, which may lead to people not receiving the Care Homes for Older People Page 5 of 11 level of care and support they require. This matter must therefore be addressed so that peoples health and safety is not compromised. We looked at the staff rota and noted that it did not show the surnames of qualified staff or their nursing qualification. We recommended to the manager that these details are in future recorded on the rota so that people can clearly identify who is providing their care and support and their professional qualification. The home must also make sure that the skill mix within the qualified nursing staff team on day and night duty is such that they are able meet peoples physical and mental health care needs. Currently only Registered Mental Nurses (RMN) work on day duty, while the qualified nurses on night duty are Registered General Nurses (RGN). This may lead to peoples health care being compromised, as on the day of the visit the qualified nurse on duty (RMN) confirmed that she had not updated her wound care training for between two and three years. During the visit we observed that the standard of cleanliness in the dining room was poor and generally it was not a pleasant area for people to eat their meals. There was also a strong smell of cigarette smoke, as the smoke room used by people living at the home is located adjacent to the dining room. We found the ventilation in the smoke room to be poor even though the windows were open. The room is also in urgent need of refurbishing as it does not provide a clean and comfortable environment for people. We looked at the duty rota for domestic staff and found that only one part time domestic assistant is employed at the home Monday - Friday between 08:30hrs and 13:15hrs. In addition, the rota showed that the domestic assistant was on leave on the day of the visit and all the following week. Domestic hours must therefore be reviewed to make sure that sufficient staff are employed to keep the home clean, tidy and free from offensive odours at all times. What the care home does well: What they could do better: Care plans and supporting documentation must be completed, updated and maintained in good order so that the information provided gives clear guidance to staff on how peoples needs are to be met. This will make sure that people receive the level of care and support they require. The care records must include details of peoples health care needs and treatment. As a minimum this must include risk assessments and care plans relating to nutrition, pressure area care, moving and handling, communication and continence as well as any other special needs. This will make sure that peoples health care needs are met. The skill mix within the qualified nursing staff team on day and night duty must be reviewed to make sure that they are able to meet peoples physical and mental health care needs.This will make sure that peoples health care is not compromised. Care Homes for Older People Page 6 of 11 Domestic hours must be reviewed to make sure that sufficient staff are employed to keep the home clean, tidy and free from offensive odours at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans and supporting 14/12/2009 documentation must be completed, updated and maintained in good order, so that the information provided gives clear guidance to staff on how peoples needs are to be met. This will make sure that people receive the level of care and support they require. 2 8 17 The care records must 14/12/2009 include details of peoples health care needs and treatment. As a minimum this must include risk assessments and care plans relating to nutrition, pressure area care, moving and handling, communication and continence as well as any other special needs. These records must be accurate and up to date. This will make sure that peoples health care needs are met. Care Homes for Older People Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 27 18 The skill mix within the 14/12/2009 qualified nursing staff team on day and night duty must be reviewed so that they are able meet peoples physical and mental health needs. This will make sure that peoples health care is not compromised. 4 27 18 Domestic hours must be reviewed. To make sure that there are sufficient domestic assistants employed to keep the home clean, tidy and free from offensive odours at all times. 14/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 27 The full name and qualification of all qualified nurses should be recorded on the rota so that people can clearly identify who is providing their care and support. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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