Inspection on 09/06/05 for Brook House Nursing Home

This inspection was carried out on 9th June 2005.

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

Brook House Nursing Home 07/07/09

Brook House Nursing Home 13/12/08

Brook House Nursing Home 18/09/07

Brook House Nursing Home 28/09/06

Brook House Nursing Home 01/03/06

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Brook House Nursing Home Ltd 28 The Green Wooburn Green Bucks HP10 0EJ Lead Inspector Guy Horwood Announced 09 & 17 June 2005 09:30 a.m. 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. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Brook House Nursing Home Ltd Address 28 The Green, Wooburn Green, Bucks, HP10 0EJ 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) 01628 528228 Centurion Health Care Ltd Mrs Anne Hurst Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Elderly Physically Frail. 2 Admission of a specific Service User: That from the 16th June 2004, the home’s registration is varied to enable the care of a 48 year old Service User, as identified through discussion with the Commission. This variation will cease at the end of the Service User’s stay. Requirements and Recommendations Mr & Mrs Akhtar have agreed to address all of the requirements and recommendations detailed within the Announced Inspection report of the 27th October 2004 within the agreed timescales. 3 Date of last inspection 17 February 2005 Brief Description of the Service: Brook House is a care home providing care with nursing for up to 35 elderly people. The home is situated in the village of Wooburn Green, with several small shops located nearby. The home consists of an older building, which has been renovated, and extensions that have been added in 1980 and 1997. Of the home’s 31 bedrooms, 27 are single and 4 are shared, with 14 of the single bedrooms in the modern extensions possessing en-suite facilities. An additional 6 bathrooms and 6 toilets are provided. The home has 2 through-floor lifts to allow Service Users access to all levels of the home, and mechanical hoists are provided to enable the safe moving and handling of Service Users. Toilets and bathrooms have grab rails, and some disabled bathing facilities are provided. The home has three lounge areas, one of which also provides a dining area. This dining area can seat approximately 15 Service Users. A registered nurse is required to be on the premises 24 hours a day, and a team of carers, caterers, laundry and housekeeping staff are employed. Access to allied health care professionals is possible either by direct contact or through referral by the Service Users’ General Practitioners, who can be contacted by staff. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the announced inspection of Brook House Nursing Care Home, which was carried out over 2 days on the 9th and 17th of June 2005. The lead inspector was Mr Guy Horwood who was accompanied by Miss Chris Schwarz, (Inspector). The inspection consisted of meeting with the responsible individual, (Mrs Ferida Akhtar), residents and staff. Records and documents pertaining to the provision of care and the running of the home were seen, and a tour of the building took place. The inspection findings were discussed with Mrs Akhtar at the conclusion of the visit. Thanks are expressed to the staff for their co-operation and assistance throughout the course of the inspection, and the residents for their time and for allowing the inspectors into their home. What the service does well: What has improved since the last inspection? Staff commented that since the arrival of the new providers, “things were improving for the better” at Brook House Nursing Home. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 6 The banister on the stairs to the second floor had been secured. The door to the loft space was secure, and the loft space had been cleared of flammable items. Mattresses identified as stained and unhygienic had been replaced. More appropriate mattresses have been ordered and are awaiting delivery. Meal provision has been reviewed, with the inclusion of a variety of snacks, drinks and fresh fruit throughout the day. The cooker has received a deep clean. Staff were not seen to enter the kitchen in gloves and aprons worn in the provision of personal care. All staff involved in the process of preparing and handling food have received food hygiene training. Food is prepared fresh for residents. The kitchen door, a fire door, has been repaired to ensure it closes to its stops. Action has been taken to investigate and address allegations of staff misconduct, and thus to instil the ethos that the home is to be run in the best interests of the residents. Residents are able to undertake social activities together such as dominoes and cards; a piano is utilised by residents; newspapers are delivered for residents; telephones are accessible to residents. Cupboards holding cleaning chemicals were locked, and domestic staff have received training in moving and handling and C.O.S.H.H. What they could do better: Care plans directing staff as to how they will attend to residents needs, need to be consistent in their completion, content and review. Care plans need to provide detail as to how specific medical care needs are to be met and monitored, for example diabetes, falls, angina. Care staff could be enabled to record details of care provision within care plans under the supervision of nursing staff. Where residents are noted to have lost significant amounts of weight, staff need to be prompt in reviewing care provision and seeking advice from relevant sources, for example community dieticians. Medication records need to be accurate and up to date, and should support the health, welfare and safety of residents. The kitchen remains a hot and uncomfortable work area. Although staff were not entering the kitchen in gloves and aprons donned for the provision of personal care, they were noted as not always changing these items between attending to different residents. Within the home there remains a number of areas in urgent need of decorating, repair, refurbishment, replacement and maintenance. The new Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 7 providers have previously expressed their intention to address these issues, and further reinforced this intent at the time of inspection. It was disappointing to note minimal improvement in the environment at the time of inspection. Whereas it is recognised that the new providers only acquired the home on the 29th March 2005, it is necessary that evidence of their commitment to the improvement of the environment becomes apparent in the near future in order to avoid any enforcement action being taken by the Commission for Social Care Inspection. It is anticipated that the new providers will maintain good communications with the Commission, and that they will forward details of any current or planned undertakings to address issues pertaining to the environment. Procedures pertaining to staff recruitment are poor and do not comply with the Care Homes Regulations 2001. As a consequence of this residents are placed at risk of harm. Despite the fitting of acoustic hold open devices to the majority of doors within the home, staff were noted to prop fire doors open and thus to place people within the home at risk in the event of a fire. Window restrictors were not fitted in all rooms above the ground floor. A fragile and insubstantial stair gate is fitted to the top of stairs to the second floor. Aerosols were noted to have been left in direct sunlight on windowsills. Through the undertaking of quality assurance involving residents, their representatives and visiting healthcare professionals, the providers could ascertain what the home is perceived to do well and could do better in order to establish a business plan. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 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 standard(s) 1,2 Residents and prospective residents are provided with information about the service, thus enabling them to make an informed choice as to their admission to the home. EVIDENCE: The new providers have drawn up a new Statement of Purpose and Service Users Guide for potential and current residents. They have also revised the Terms and Conditions of residency. The information within these documents is as required under the Care Homes Regulations 2001. Copies of these documents have been provided to the Commission for Social Care Inspection and are held on file. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 10 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) 7,8,9 Care plans are not consistent in their content, are not detailed as to specific health care needs, and are not subject to regular review. As a result they do not provide the information needed to satisfactorily meet resident’s health care needs. There are errors in medication practice, which could put residents at risk. Residents are given the opportunity to self medicate within a risk assessment framework to facilitate choice and safety. EVIDENCE: A random selection of care plans were chosen and viewed by the inspectors. These care plans were found to provide a brief over view of residents and their basic personal care needs, however they did not always address individuals specific healthcare needs such as diabetes and falls. Care plans were not consistent in their content or level of completion. Examples are listed below: • In some instances tissue viability assessments had been completed on admission, but no evidence was present to show who had completed these assessments or when they had been undertaken. Care plans directed staff to review tissue viability assessments on a monthly basis, H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 11 Brook House Nursing Home Ltd however there was no evidence that staff had been undertaking this process of review in all cases. • Where risk had been identified within a care plan, specific risk assessments had not been drawn up in all cases, e.g. with regards to falls, pressure ulcers and insulin dependent diabetes. Some care plans were noted to hold risk assessments pertaining to the use of wheelchairs, cot sides and bath hoists. Specific healthcare needs were not detailed within care plans, for example: - A diabetic who’s dietary care plan held no mention of their condition or care needs other than “eats a diabetic diet”; - No information in a care plan about a resident’s heart condition liable to cause them to “faint”; - No direction as to the assistance required with personal care by a resident who had suffered from a stroke; - No information as to action required for a resident subject to episodes of angina. Where staff had sent samples or swabs for testing, records of the results were absent and no information as to the resulting changes to care needs were noted within records. Records evidencing the practice of turning residents cared for in bed over long periods of time were not available for all such residents. • • • During the inspection residents care needs were discussed with staff members. Through these discussions staff were able to demonstrate a much better knowledge of residents and their personal care, health and social needs than was recorded within the related care plans. Due to this lack of detail contained within care plans, it would appear that should staff, who were unfamiliar with the residents, be charged with their care, (for example agency care staff), the residents would not be guaranteed the same level of care provided by regular staff employed at the home. Daily report sheets are completed at the end of each shift, and record care provided to individual residents. Entries are made in the daily report sheet by trained nurses, who receive details as to the care afforded to each resident from care staff verbally or on pieces of paper. The deputy manager expressed that they have been looking into care staff writing directly into the daily report sheets, and it is recommended that this practice commences with suitable support, supervision and monitoring for care staff. Daily report sheets contained details of visits by healthcare professionals and General Practitioner visits, as well as records of wound care review and Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 12 dressings. Separate documents recording these details would be more user friendly. Details are held in care plans as to resident’s family and life histories, social interests and hobbies. These were detailed to varying standards in the different care plans viewed. Records were present to show that all residents were weighed on a 3 monthly basis. This weighing had been undertaken consistently in most cases. Through viewing weight records it was noted that some residents had lost significant amounts of weight. There were no individual action plans noted to address this issue of weight loss. Where residents had been noted as losing weight, the frequency of weighing these residents had not increased. The case file of a diabetic resident was viewed, and the records pertaining to the testing of blood sugar levels were requested. These records were unable to be located. Other care records did confirm regular review of this resident’s diabetes by his General Practitioner. The monitoring of blood pressure and temperature is not performed on a regular basis for all residents due to the discomfort associated with these procedures. The home has been pro-active in seeking alternative methods for this monitoring of residents observations through the use of alternative devices. The home has equipment for the provision of specific healthcare needs. This includes pressure relieving devices, moving and handling equipment, weighing scales and nutritional supplements. Medication administration record, (MAR), charts were viewed. Evidence of General Practitioner review of medication was noted in some instances. All charts were noted as being handwritten, in the majority of cases by the homes manager. Copies of original prescriptions were available upon request to confirm handwritten instructions. In some instances the person entering handwritten instructions had not signed the chart to identify them selves. Where residents had chosen to self-administer medication, risk assessments had been conducted as to their ability and records were present to show that the resident’s General Practitioner had been consulted. Gaps were noted in several medication administration charts indicating that medication had not been given as prescribed. Where medication had not been given there was a failure to record reasons for these omissions. Scraps of paper were attached to some charts directing staff as to changes to medication administration or as “reminders”. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 13 Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 14 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) 15 The dietary needs of residents are well catered for, with a balanced and varied selection of food available that meets with resident’s tastes and choices. EVIDENCE: The home recently appointed a suitably experienced cook, who commenced in post the week of the inspection. The home employs relief and “supper cooks” to cover weekends and prepare and serve evening meals. The cook was spoken with and demonstrated changes she had instigated and issues she planned to address. The cook stated that she needed to update hazard analysis and food handling and hygiene training. It was recommended that training relevant to catering for elderly residents also be undertaken, and that contact with local community NHS dieticians be established. Changes to the menu were evident, including the provision of snacks and fresh fruit for residents. Records of fridge, freezer and meal temperatures were complete and up to date. Recognition of specialist diets was evident. Staff were no longer entering the kitchen in aprons used when providing care. The cooker had received a deep clean. Food was appropriately covered and stored. Lunch was sampled, which was home made, very tasty, well cooked and well presented. Residents spoken with expressed that meals were pleasant and some confirmed having met with the new cook. Residents either take their Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 15 meals together at tables in the dining room, or at individual tables in the lounge. Where soft diets were provided, these were served as separate portions and offered separate tastes and textures of food. Throughout the day hot and cold drinks were offered to residents on a regular basis. Supplementary drinks were noted to be available where required. The refurbishment of the kitchen was discussed with the cook and registered provider, with the timescale for this issue to be addressed now re-confirmed as the 26th of October 2006. The kitchen remains a very hot and stuffy work area, and it is anticipated that dialogue between the cook and provider will provide a temporary solution to improve the work environment until such time as the kitchen is refurbished. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 16 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 The homes recruitment practices are not robust and therefore fail to protect residents. EVIDENCE: The Commission for Social Care Inspection is currently in receipt of one complaint with regards to Brook House Nursing Home. This complaint is in the process of being dealt with through liaison with the homes providers. Concerns as to the behaviour of a small number of staff members identified at previous inspections has led to the provider conducting an investigation as per relevant adult protection procedures. This has led to further disciplinary action being taken. The relevance of referral for inclusion on the PoVA register was discussed and will be followed up at future inspections. Staff recruitment procedures were looked at, (Detailed under National Minimum Standards 29), with concerns as to the recruitment procedure being followed at the home expressed. The relevance and requirements of regulations pertaining to recruitment procedures were discussed with Mrs Akhtar, and an immediate requirement was served that staff recruitment comply with Regulation 19 and Schedule 2 of the Care Homes Regulations 2001. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 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 standard(s) 19,20,21,22,23,24,25,26. At the time of this inspection the home had been under new ownership for 10 weeks. Within this time there has been no significant change for the better to the environment. In some areas this poses a risk to the health and safety of people within the building. EVIDENCE: At inspections conducted under the previous provider, (owner), and within the past 8 months, a number of concerns were raised with regards to the condition and maintenance of the environment. These concerns included issues pertaining to the health, safety and welfare of residents, staff and visitors to the home. The current providers, as a condition of their registration, agreed to address all of the issues listed within these previous inspection reports within agreed timescales. A tour of the premises was undertaken. The lounges and communal areas are decorated in a homely style. There are three sitting areas, two of which are currently in use. These areas are furnished with a variety of furniture, which is Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 18 arranged satisfactorily. The dining room is pleasantly arranged but does not provide sufficient space for all residents to dine together. Some residents eat in the main lounge with individual tables placed in front of them. This may lead to some residents being seated in the same position for long periods. Residents were observed playing dominoes, reading newspapers and one resident entertained by playing the piano in the dining room. A number of carpets, as identified in previous inspections, remain stained, unhygienic and unpleasant. In several areas the linoleum flooring beneath carpet tiles is stained and unhygienic. The condition of these carpets does little to assist attempts to provide a “homely” environment. Requirements for the replacement of carpets have been agreed with the new providers, who stated that they wish to undertake this action alongside extensive redecoration throughout the home. The timescale for the replacement of carpets has been previously agreed as the 26th October 2005. This situation will be monitored closely. Mattresses identified at previous inspections as “old, unhygienic and stained” have been replaced with new mattresses. Although these replacement mattresses have been identified as not suitable for use within the home, steps have been taken by the registered persons to replace them with more appropriate mattresses. This issue will be reviewed at future inspections. The bed base in room 9 was noted as worn and in need of replacing. The registered persons are reminded that all beds need to be height adjustable, (National Minimum Standard 24.3). This issue will be reviewed at future inspections. Lighting within bedrooms has previously been commented on as not of a homely design, although lighting is of a domestic style in communal areas. A call bell system is in place within the home, and when tested staff attended promptly. In some instances call bells were out of reach of residents. In some bedrooms accommodating two residents, wardrobes are shared. Furnishings were noted in some areas as old and worn and in need of replacement. The flooring and bath in the bathroom next to room 26 were stained, worn and in need of replacing; the bathroom next to room 16 requires updating and decorating; the flooring in the bathroom next to room 20 needs replacement. The laundry is situated next to the kitchen with an adjoining door. This was closed at the time of the visit. Laundry staff were spoken with and washing was under control. No protective garments or alginate washing bags were evident for use by laundry and/or care staff, and antibacterial hand wash had run out. No alcohol hand rub is provided for use in the laundry room. Care staff rinse out soiled linen despite the alleged provision of alginate bags and Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 19 the presence of a washing machine with a sluicing facility. Boxes of communal “net knickers” were present in the laundry, which were unnamed and had been repeatedly washed. Linen cupboards appeared orderly and the contents well laundered, although one cupboard was found to contain an unnecessarily large amount of clothing from “previous” residents. Within sluice rooms a container of decanted white powder was found and no alginate bags were discovered. Carpet tiles were found in the sluice. These appeared to have been scrubbed. Gloves and aprons were present in the sluice. The home produces little clinical waste due to possessing a macerator. A contract is in place for the disposal of clinical waste. Clinical waste is stored in a redundant “salt bin”, and not within an appropriate, lockable clinical waste skip/bin. The access door to the roof space was locked. The roof space had been cleared of a lot of clutter including flammable and toxic chemicals, although a lot of redundant items and equipment remained. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 20 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) 29 The homes recruitment practices are not robust and therefore fail to protect residents. EVIDENCE: The provider is in the process of recruiting new staff following some success in advertising locally. When this recruitment has been completed Mrs Akhtar is intending to review staff hours and rotas to ensure that staff are deployed effectively in order to meet residents care needs. The current manager is to leave in July 2005. Mrs Akhtar has commenced in seeking a replacement. A selection of staff files were viewed, which included recently employed nurses and care staff. A variety of documents and employment checks required by Regulation 19 and schedule 2 of the Care Homes Regulations 2001 were absent from these files. Absent details included: • • • • • • Job application forms, Proof of identification, Criminal Record Bureau checks, PoVA First checks, References, Evidence of work permits where required. The recruitment file of a qualified nurse on duty on the day of inspection was viewed. This file held no evidence of references, no proof of identity, no copy of the relevant work permit, no application form, no PoVA check and a Criminal Record Bureau check from a previous employer. The provider, Mrs Akhtar, Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 21 was advised that this staff member could not continue to work at the home until all of the information required by regulation had been obtained. Records were viewed pertaining to the unacceptable behaviour and limited disciplinary action taken against a long serving member of staff. This case was discussed with Mrs Akhtar, and a course of action advised. In some cases staff had commenced in employment before PoVA and Criminal Record Bureau checks had been obtained, or with Criminal Record Bureau checks from other organisations. The requirements of Regulation 19 and Schedule 2 of the Care Homes Regulations 2001 were discussed with Mrs Akhtar. Recommendations were made to Mrs Akhtar with regards to improving existing staff records. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 22 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) 31,33,37,38 Quality Assurance procedures are not undertaken within the home, thus the views of residents, their representatives, visiting healthcare professionals and other visitors to the home are not taken into consideration with regards to the operation of the home. Staff do not adhere to policies, procedures and practices pertaining to health and safety, potentially placing those within the building at risk of harm. Housekeeping staff have undergone relevant training. As a result they are aware of their responsibilities and actions with regards to health and safety and the potential to place persons within the home at risk. EVIDENCE: The current manager, Mrs Anne Hurst, is registered under the Care Standards Act 2000. Mrs Hurst is due to retire from her post in July 2005, and the provider is currently seeking to recruit a replacement. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 23 Mrs Akhtar is in the process of reviewing and amending the homes existing policies and procedures. For this reason Mrs Akhtar has met with the managers of other homes and is considering external sources such as The Registered Nursing Homes Association for this purpose. No process of quality assurance has taken place since the new providers acquired the home, and it is recommended that a survey amongst residents and their relatives, attending General Practitioners, community Nurses and other professional contacts be undertaken to ascertain their experiences of the home in order to try and identify areas of good practice to expand upon and any areas requiring remedial attention. Mrs Akhtar is also required to conduct visits as directed under Regulation 26 of the Care Homes Regulations 2001, and examples of such visits and reports will be forwarded to Mrs Akhtar by the Commission for Social Care Inspection. The fire door at the top of the main stairs failed to close to its stops due to a broken closure device. Cleaning staff were noted to prop doors open with equipment and then to leave the vicinity. Doors were noted as held open with chairs. The majority of bedrooms, and some communal areas, have been fitted with acoustic hold-open devices. Fire doors marked as “keep closed” or “keep locked” were open in some instances. Several windows above the ground floor of the home are not fitted with window restrictors. A fragile and insubstantial stair gate is located at the top of the stairs to the second floor. It was pleasing to note that cleaning cupboards were secure and that they held orderly C.O.S.H.H. files for easy reference. Domestic staff confirmed that they have received training with regards to moving and handling and C.O.S.H.H. Aerosols were noted on windowsills in direct sunlight. Care staff were noted failing to remove gloves and aprons after providing personal care and prior to entering communal areas. Staff are reminded as to this poor practice with regards to infection control, and this issue will be monitored at future inspections. Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 1 2 1 2 3 1 2 1 STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 2 x 1 x x x x 2 Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 25 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 29 Regulation 19 and Schedule 2 Requirement An immediate requirement was served to the effect that new staff are not to commence employment at the home until all of the information required under regulation 19 and schedule 2 of the Care Homes Regulations 2001 has been obtained. This includes Criminal Record Bureau and PoVA checks, and relevant and appropriate references. Immediate requirement served: Window restrictors are to be fitted on all windows above the ground floor, and are to be maintained in good working order. Regular maintenance checks are to be made to window restrictors, with records maintained of this action. Immediate requirement served: Fire doors are not to be held open other than by approved hold open devices. Regular checks and maintenance of fire doors throughout the home must be undertaken. Immediate requirement served: The broken door closure on the Timescale for action 17.06.05 2. 38 13(4)(a) and (c) 18.06.05 3. 38 13(4)(a) and (c) 13(4)(a) and (c), 23(4) 13(4)(a) and (c), 23(4) 13(4)(a) and (c), 01.10.05 4. 38 17.06.05 5. 6. 38 38 17.06.05 20.06.05 Page 26 Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 23(4) 7. 8. 38 9 13(4)(a) and (c), 23(4) 13(2) 9. 9 13(2) 10. 9 13(2) 11. 7 15 and 12(1) 12. 8 12(1) 13. 19 -26 23 14. 15. 24 22 23(2)(c) and (n) 23(2) 16. 24 23(2)(m) fire door at the top of the main stairs must to be repaired. Fire doors marked as to be kept closed or locked, must be kept closed or locked. Instructions entered on to medication administration charts must be signed by the staff member entering such details. Reasons must be entered into medication administration charts for omissions of prescribed medicines. There must not be gaps in medication administration record charts where regular prescribed medication is to be given. Careplans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Residents care plans must be kept under regular review. Where concerns are noted as to residents weight loss, action must be implemented without delay to address and monitor this issue. All environmental issues identified at the announced inspection of the 27th October 2004, and unannounced inspection of the 17th February 2005, and described within the subsequent reports of those inspections, is to be attended to within the timescales stipulated. The bedbase in room 9 is to be replaced with one which is height adjustable. Residents must have the means to summons assistance at all times. Call bells must be within reach of residents. Individual wardrobes are to be provided for all residents. 17.06.05 01.10.05 17.06.05 17.06.05 01.10.05 01.10.05 Various. 01.01.06 01.10.05 01.01.06 Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 27 17. 24 23(2) 18. 19. 20. 21. 21 21 21 26 and 38 23(2)(b) and (c) 23(2)(b) and (c) 23(2)(b) and (c) 23(2)(c) 22. 10, 26 and 38 13(3) and 12(4)(a) 23. 24. 25. 38 26 and 38 33 13(4)(a) and (c) 13(3) 26 A programme for the replacement of old, tired and worn furnishings is to be established, with records kept to evidence the progress of this programme. Flooring is to be replaced in the bathrooms next to room 20 and 26 The bath is to be replaced in the bathroom next to room 26. The bathroom next to room 16 is to be redecorated. Laundry staff are to be provided with protective garments; antibacterial handwash; alcohol hand rub; alginate bags. Clothing is to be for individual use. Residents are to have their own underwear. Net Knickers are not to be used communally. Chemicals must remain in their original containers, and must not be decanted. An appropriate and secure container for clinical waste is to be obtained. The providers must undertake monthly, unannounced visits as described under Regulation 26 of the Care Homes Regulations 2001. 01.10.05 01.01.06 01.01.06 01.01.06 01.10.05 17.06.05 01.10.05 01.11.05 01.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 29 Good Practice Recommendations It is strongly recommended that all existing staff provide an up to date c.v., evidence as to qualifications held, and a list of training undertaken, for inclusion in their recruitment file. It is recommended that the cook undertake training H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 28 2. 15 Brook House Nursing Home Ltd 3. 4. 5. 37 7 7/8 6. 7. 8. 33 relevant to catering for elderly residents, and that contact with local community NHS dieticians be established. It is recommended that revised policies and procedures are forwarded to CSCI for scrutiny. It is recommended that care staff enter details of care provided into daily report sheets under the supervision / monitoring of trained nurses. It is recommended that records of visits by healthcare professionals, (G.Ps, District nurses, Tissue Viability Nurses etc), are maintained on a sheet to the daily reports notes. It is strongly recommended that the providers undertake a quality assurance survey of residents, their representatives and visiting healthcare professionals Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 29 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, HP19 8JR 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 Brook House Nursing Home Ltd H53_H02_S62534_Brook House Nursing Home_V221319_09170605_Stage 4_GH_ces.doc Version 1.20 Page 30 - 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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