Inspection on 03/10/06 for Brookfield House Nursing Home

This inspection was carried out on 3rd October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brookfield House Nursing Home 09/05/07

Brookfield House Nursing Home 26/05/06

Brookfield House Nursing Home 01/11/05

Brookfield House Nursing Home 20/12/04

Brookfield House Nursing Home 12/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Brookfield House Nursing Home Forton Road Newport Shropshire TF10 7JL Lead Inspector Janet Adams Key Unannounced Inspection 09:50 3rd October 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookfield House Nursing Home Address Forton Road Newport Shropshire TF10 7JL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01952 810288 01952 810029 Mrs Margaret Jones Ms. Irene Palmer Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 25 June 2001. The home may accommodate a maximum of 18 Elderly persons of whom 5 may be suffering with dementia. 26th May 2006 Date of last inspection Brief Description of the Service: Brookfield House is a nursing home situated in the market town of Newport, Shropshire. As it is close to the town centre, the home benefits from a good range of shops and other facilities, and can be easily accessed from neighbouring towns and villages via public or private transport. The original Victorian building has been extended and offers both single and double accommodation for older people, of whom 5 may have dementia related illness. A passenger lift provides access to the first floor bedrooms. However, the current layout of the home means that access to the lift is via a bedroom occupied by two residents. There are two communal lounges, which are located on the ground floor. One has dining facilities. Externally, the front of the home has a secluded well-maintained garden that provides safe and accessible areas for all service users. The proprietor makes the services known to prospective service users in Brookfield House’s Statement of Purpose and Service User Guide. This information is available in the entrance hall to the home. The current fees charged vary between £338 and £450 per week depending on the care package required. The home is owned by Mrs Margaret Jones, who has promoted Irene Palmer to be the Registered Manager for the day to day running of the home. They are supported by a team of qualified nurses, care staff, ancillary staff, a handyman, and a gardener. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and carried out by one inspector over a period of eight hours. The aim of the inspection was to follow up on the progress made since the last inspection of the home on the 26th May this year. A few weeks before the inspection was carried out, CSCI (The Commission for Social Care Inspection.) wrote to the home manager to request some necessary information to assist with the inspection. This meant that although Brookfield House knew the inspection was imminent, they were not aware of any date or time. The inspection included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, observing, talking and listening to nearly all of the 17 people living there, a few visitors, and the staff on duty at the time of the inspection. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share valid comments, which are included in the main body of the report. Three residents and six relatives also made some written comments for the inspector about the home. The Registered Manager, Irene Palmer was on duty at the time of the inspection. Everyone, including residents and staff were very welcoming and helpful throughout the day. A total of 27 out of a possible 38 National Minimum Standards for Older People were assessed on this occasion. What the service does well: At previous inspections the home has enjoyed a reputation for providing good standards of direct care, delivered competently and sensitively, with residents and relatives expressing their satisfaction with the manner in which they are treated. This inspection found that some of these care provision standards have been maintained. Relatives and residents alike were happy to share positive comments about the care and support at Brookfield House. One took time to write; ‘All of the family are very pleased and content the way mother is looked after and cared for by everyone here at Brookfield House. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A total of 15 statutory requirements made at the last inspection have not yet been fully met. As recorded at previous inspections, CSCI are becoming increasingly concerned about the location of the passenger lift which opens into a bedroom shared by two very frail residents. One of these individuals is on permanent bed rest. Although two people who lived in other parts of the home have moved out, their rooms were not offered to the persons who have their privacy and comfort challenged by the passenger lift being in their bedroom. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 7 The owner of the home has also failed to inform CSCI of the proposed plans to convert this part of the home so that the lift can be accessed without the intrusion of people’s privacy. CSCI are now considering further action to be taken to ensure this situation is improved at the earliest convenience. Other issues not fully addressed include: • The system to manage potential complaints. • Parts of the home that show signs of wear and tear in need of attention, including a double bedroom which has poor flooring and an unpleasant odour of stale urine. • Commodes seen to be in poor condition, in need of repair or replacement. • Not all radiators have safety guards installed as yet. • Information necessary for the inspection process was not available when requested – including that about the progress with the lift issues and fees the home charged. • Although staff recruitment has been identified to be improved since June 2005, the records of two new starters lacked important information. • Staff records show that all team members are lacking in up to date mandatory training. The records kept at the home do not reflect the standards of care delivery seen. Recordkeeping in care plans needs to be expanded to ensure all necessary information is kept up to date to realistically reflect the care the residents need to get. As a result of this inspection eight new statutory requirements have been made totalling 23 areas of improvement the home needs to address. One area of concern resulted in an Immediate Requirement notice being issued on the day of the inspection. A stair gate had been installed on the door of a first floor bedroom occupied by two people. The home fire risk assessment had not been updated to recognise this issue, and there was no evidence the fire officer had been consulted about using this equipment. The lack of written information about this matter meant the staff did not have appropriate guidance to keep all residents safe in the event of an emergency. Furthermore, other works identified by the Shropshire Fire and Safety officer had not been carried out, and a new agency staff member had not been shown the fire safety procedure when she came on duty on the day of the inspection. Although medication storage has now been reorganised so it is all kept safe, the set of keys containing the drug trolley keys were seen to be freely accessible on a hook located above the drug fridge in an unlocked part of the home. Please contact the provider for advice of actions taken in response to this inspection. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Processes for appropriate and thorough care needs assessment, prior to admission, assures everyone concerned that the home can meet the needs of the individual admitted. EVIDENCE: Three sets of records for residents who have been admitted to Brookfield House since the last inspection were looked at. Appropriate assessments had been carried out in enough detail to assure residents, their relatives and staff that the home could meet their needs. The records of a gentleman who came to stay at the home for short term care showed that he had been for a look round before hand, and he made the comment ‘It feels like home.’ Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. The care plan recording does not provide staff with the information they need to satisfactorily meet all service users needs to keep them safe at all times. Personal support in the home is not offered in such a way to promote and protect all service users’ dignity and privacy. EVIDENCE: During the inspection visit, the staff members on duty were seen and heard to treat residents in a polite, caring and respectful manner. Observations and discussions with eight residents confirmed they were very happy living at Brookfield House. Three comment cards returned to CSCI from other residents also confirmed that they liked living at the home, felt well cared for and that the staff treated them well. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 12 The above comments reflected information shared by four visitors spoken to and six relatives who wrote to say they were satisfied with the overall care provided. Four sets of residents’ care plans were looked at, and some improvements to details have been made to show the home team is making progress to meet necessary standards. For example, catheter care guidance clearly informs staff how to manage this aspect of a person’s care, and two of the four sets of records had the right information to outline how the individuals were to be moved and handled safely. However, daily records show the care plans themselves are lacking in necessary information to guide staff and assure the residents themselves that they will be looked after in a way to meet their medical needs and personal preferences. Care plans have not been kept up to date when people’s needs have changed, and do not have the professional record keeping expected for people receiving nursing care. For example: • Although an assessment of a person’s needs was carried out before the individual moved into the home, a care plan had not been created from it. The daily records confirmed the person was a diabetic, and that he could only have soya milk, but the nutritional risk assessment form in his records did not account for these needs. There had been no moving and handling assessment for this person, and there was no contact details or arrangements written down to confirm how the person was going to continue to attend a day centre twice a week. • • Three out of four sets of records did not give details to guide staff how to carry out residents’ oral hygiene. In the care records for a person with three pressure sores, poor record keeping meant that a care plan had not been devised to compliment the wound assessment chart seen. This meant it was not possible to get a proper professional ‘pen picture’ of the management, size and depth of these wounds. Upon visiting the person in her bedroom it was seen she was on permanent bed rest. The bed itself did not have the appropriate pressure-relieving mattress expected to be provided for such a frail individual. Despite the daily records confirming further deterioration of her pressure areas in a very short period of time. Record keeping did not show whether this matter had been investigated further to make sure the individual had the right care equipment to manage the pressure sores. This matter was discussed with the registered manager to be dealt with as a matter of urgency. A recent care plan audit carried out by one of the home’s nurses identified similar shortfalls, and also confirmed that residents and their representatives need to be more involved in this important process. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 13 The way the home manages its medication systems has improved, and all medication was seen to be stored appropriately on this occasion. However, the practice of hanging the drug keys on a hook above the drug fridge in an area of the home, which is unlocked means that the security and safekeeping of the medications remains challenged. The way the home disposes of the medications it no longer needs requires further action. It is recommended that the disposal of medication records are improved to make sure the date they are collected from the home is recorded and witnessed appropriately. The aforementioned medication issues were also discussed in depth with the registered manager to ensure these systems could be improved as a priority. CSCI continue to have concerns about the individual privacy and dignity arrangements for two of the people living at the home. • The only place for the passenger lift to open on the first floor of the home is in their bedroom. • One of the residents is on permanent bed rest and is expected to remain so for the rest of her life. In the last inspection report it was recorded: ‘Priority must be given to ensure maximum privacy for these people’. ‘Consideration of care arrangements including ‘end of life care’ needs to be reorganised in order to ensure maximum privacy as well as achieving ground floor access for the other four people who regularly use the lift.’ Although two beds suitable to care for these people have become available elsewhere in the home since the last inspection, the two service users remain in a situation which compromises their privacy and dignity. This reflects that both persons’ individual needs were not treated with the equality and fairness expected. Two statutory requirements made for Mrs Jones, the owner of the home to permanently address this situation have not been met. No formal communication about this matter has been made since the last inspection action plan was submitted by the owner stating that the above arrangement ‘Continued subject to agreement’ and was ‘Being looked into’. Although the inspection was expected, there was little evidence available on the day of the inspection for the registered Manager to share with the inspector to show what measures the owner had taken in order to rectify this matter. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 14 As discussed at the end of the inspection, advice has been taken from CSCI senior management, and the issues is being dealt with in line with the Commission guidance. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a variety of opportunities to participate in activities to meet their needs and preferences. Residents have many opportunities for community/family contact, which enables them to make a choice about who they see and when and where they see them. Dietary needs of residents are very well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Observations on the inspection day showed that the staff encourage and welcome residents to make choices about their daily lifestyle. Improvements to recordkeeping shows that people are encouraged to join in pastimes to match their needs and tastes. The Registered Manager is currently exploring options to make sure residents on complete bed rest have meaningful activities. She has arranged for an aroma therapist to come to the home to offer 1:1 hand massages etc. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 16 It was positive to hear of the team’s efforts to build a resident’s confidence up to feel comfortable to get out and about in a wheelchair. The staff have been encouraging the person to go into the garden to practise how to ‘self propel’ the wheelchair to promote his independence. One person who makes a lot of knitted toys for charity is to be recognised in the local press for her hard work in the near future. Another lady was proudly wearing a shawl her fellow resident had made her. The home continues to have long established links with the local community of Newport. Two people attend local day centres; another has a weekly visit to a hospice. The staff team were seen to meet and greet a stream of visitors with a welcoming rapport, and involve them in their relative’s preferred daily activities. It was positive to see residents being encouraged and supported to spend quality time with their relatives; some regularly visit their family in their homes. The home has a four-week menu, which is regularly changed to make sure residents get a balanced diet, in line with their choice and seasonal availability of foodstuffs. Discussion with residents confirmed their appreciation of the quality, quantity and choice of food provided. They commented that the food, which was already good, is now even better, since the new cook started at the home seven weeks ago. A group discussion with residents confirmed they agreed that the lunch had been ‘beautiful’, and they appreciated the homemade cakes and puddings they were regularly offered. It is positive all residents are offered the same variety of foodstuffs despite their medical conditions. One lady who has diabetes said she is ‘not deprived’ of the nice puddings the rest of the residents get as the cook uses sugar free ingredients. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Service users do not have access to a complaints procedure that offers assurance to residents and their representatives to be confident their views will be listened to and acted upon. Management procedures at Brookfield House need further action to fully demonstrate resident’s well being is safeguarded at all times. EVIDENCE: CSCI have not received any complaints about this home since the last inspection. Neither has Brookfield house. All six relatives who made written comments about Brookfield house also confirmed they have not had to make a complaint. The registered manager has made an effort to improve the complaints policy and procedures at the home, and has now set up a complaints logbook, which will meet all necessary legislation when required. It was also reported that the home are now following a different policy for handling complaints. This was seen on display in the entrance hall. Upon reading this policy it was observed that the advice it gave to potential Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 18 complainants was out of date – it referred to involving social services if the home is dual registered. This is no longer the procedure to make complaints about ‘registered homes.’ This was discussed with the registered manager. The local multi agency adult protection policy was seen to be freely accessible for all staff, although there was no evidence to show they knew about it. Examination of training records for this matter confirmed that staff are being nominated for adult protection training. So far three out of the 19 care staff have received training for this matter, and another three staff were attending in the near future. Some of the findings during the tour of the home shows the home has not taken appropriate actions to ensure residents’ well being is safeguarded all the time. Risk assessments for some people as well as equipment needs to be improved and acted upon before this standard can be seen to be met. For instance, the use of a stair gate on the bedroom door of two service users’ bedroom is also considered to be a form of restraint as well as having an impact on other health and safety arrangements. These are recorded in other sections of this report. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The majority of accommodation at Brookfield House provides a clean, comfortable environment for residents to live in. However, there are still areas within the home which have required improvement for some time, and have a negative impact on the privacy and dignity of some residents. EVIDENCE: Brookfield House has well tended gardens, which are accessible and appropriate in design to meet the needs of most residents. Many parts of the home been maintained to a satisfactory standard, with furnishings and fittings that create a comfortable and ‘homely’ atmosphere. Residents are encouraged to bring their own possessions into the home. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 20 Five residents spoken to made comment they were happy with their personal accommodation, and observations on the home tour confirmed the home is adequately equipped to safely care for most of them. Several improvements have been made to the environment since the last inspection, including the installation of the sluicing disinfector, new toilet flooring, a radiator guard and the replacement of valves to the hot water supply in communal bathrooms. All of these works has resulted in the home being a safer place to live. Some other areas identified for improvement at the last inspection have not been carried out yet. For instance: • A double bedroom with its adjoining toilet had an offensive odour of stale urine. The carpet poses a trip risk as it is not laid flat to the floor. It was seen that the toilet area of this room was also carpeted, and a commode in this room had worn paintwork near the seat. • The plans to relocate the lift so that it doe not open out into the bedroom of two very frail service users have not been actioned. As recorded earlier, this is an increasing concern as one of the residents is very frail and cared for in bed all of the time. A CSCI Regulation Manager attended the home at the end of the last inspection to look at this and discuss the issue with the manager. Proposals how this is to be improved have not been submitted to CSCI as a matter of priority as requested. In addition to the above issues, observations made on the tour confirmed further important improvements, which need to be carried out. • A stair gate was seen to have been installed on a bedroom door occupied by two residents. It was reported to be used at night to prevent one of the people who live in the room from wandering out downstairs. The fire service had not been consulted about this, nor had the home fire safety risk assessment been updated to include what the responsibilities of the team were with regard to this equipment being used in the event of a fire or an emergency evacuation. An Immediate Requirement notice was issued for this on the inspection day in order for an urgent review of the home’s ‘safe working systems’ to make sure residents were being safeguarded at all times. In addition, when the gate was held open for daytime access, it protruded into the doorway of an adjacent bathroom posing an injury risk. Work had not been completed as requested following the fire and safety inspection in October 2005.The inspection report for this visit reported that the works to provide an additional door to a fire escape route had to • Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 21 be carried out by March 2006. This report also confirmed CSCI inspection findings that the residents’ bedroom doors were being wedged open. • • Two other commodes were seen being used which were in need of repair or replacement. An additional stair gate in place to protect residents from descending another set of stairs did not offer appropriate protection should a person fall against it or tumble under it. The way it had been positioned meant the gap underneath the gate was too large and posed a hazard. Professional health and safety advice needs to be sought to confirm appropriate installation, and an appropriate risk assessment carried out for this matter. In April 2006, the home had its first infection control audit by the Health Protection Agency infection control nurse. Findings at this inspection confirmed the home was well on its way to meeting all of the recommendations made. One main issue of concern is the lack of foot operated pedal bins for the disposal of contaminated waste and for hand washing facilities. The home was seen to be using a ‘Sangenic’ disposal system for pads. This again is a hand-operated piece of equipment. It is recommended advice be sought from the infection control nurse about using this equipment. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 The quality outcome in this area is poor. This judgement has been made using available evidence including a visit to this service. Lack of necessary detail in staff records shows that systems to manage recruitment are not robust, potentially placing service users at risk. Recent lack of training provision, monitoring and supervision of staff does not ensure that service users are in safe hands. This does not demonstrate good employment practice, and does not protect vulnerable service users in the home. EVIDENCE: Examination of the rotas for two weeks before the inspection as well as the forthcoming fortnight shows the home is adequately staffed. Some housekeeping and catering staff are employed, although it is the responsibility of the care team to do the home laundry. All feedback from relatives confirmed they thought there was sufficient staff on duty. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 23 Some shifts were seen to be covered by agency staff, however staff confirmed that this was not happening as often as it had been. It is positive that 50 of its carers are NVQ qualified. All residents and relatives spoken to were full of praise about the staff. Written comments from residents and relatives all confirmed that the staff were helpful and kind and ‘Always let them know what was going on’ Examination of the recruitment records for two new staff members showed that there had been some improvements to this process. A new application form is now used and it covers applicant’s health status. It is of concern that the home management continues to let people start work before all necessary vetting procedures have been carried out. As a result: • The duty rotas and new starters’ records showed that one nurse had started working at the home before a ‘first check’ of the vulnerable adult list or CRB clearance had been obtained. Although this person shadowed another nurse for two shifts, no information was written down about it. • The references for a new starter due to start at the home did not clearly identify whether one was from the most current employer for the person. Similar shortfalls were seen at inspections in June 2005 and May 2006 when it was written: ‘Newly recruited bank staff must have the necessary checks in place as required by the standards and legislation.’ Although none of the staff are up to date with the necessary training they need, for food hygiene, moving and handling, and fire safety it was reported to be in hand to be carried out within a short timescale. The new registered manager has been working hard to set up appropriate training for the staff team to get them up to date with mandatory training as well as training relating to the medical conditions of residents living at the home.Other courses booked for staff includes risk assessment, palliative care, dementia awareness, medication in care, and urine catheter management. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 & 38 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The new Registered Manager has an understanding of the areas in which the Home needs to improve and, since the previous Inspection, has developed plans to address most areas of concern. In some areas action already implemented has started to bring about change. Record keeping in the home is variable in quality so that service user’s rights and best interests are not safeguarded. EVIDENCE: Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 25 Since the last inspection, the day to day management of the home has been taken over by Ms Irene Palmer, a Registered Nurse who was successful in attaining her NVQ Level 4 in care and the Registered Managers Award in May this year. She was successful in her application to be registered as manager of Brookfields with CSCI in September 2006. As yet, Ms Palmer has not yet had a formal job description or change to her terms and conditions of employment since accepting this responsibility, although Mrs Jones the owner and former manager of the home will remain actively involved with the home to manage the financial issues of Brookfield House. Observations during the inspection confirm that Ms Palmer has embraced this challenge and is already working hard to ensure the home meets all standards. Several new systems are in the process of being launched, including cleaning schedules recommended by the infection control nurse specialist. A new ‘Quality Audit’ folder has already been set up, to review many parts of the service the home provides. As recorded earlier, it is of note that the home has already carried out its own care plan audit. A Staff meeting was held within a month of Irene taking up her post in order to launch forthcoming plans for the home. It is of note the home team are in support of their new manager and have welcomed her into her new role. Meetings for residents and relatives have been planned for October, as it is Irene’s intention to ensure everyone can be involved as much as they would like to be in the way the home can be run. The way the home manages residents’ monies was seen to be satisfactory. Care records of one person randomly looked at to review this matter clearly showed this matter was being managed appropriately. As recorded earlier in this report, there are still some actions which need to be carried out as priority in order to maximises the safety of the staff and residents at all times. For instance: • Only half of the 4 sets of care records looked at in depth had the right risk assessment information for the safe management of bedrails. • Following separate discussions with three staff members including a new employee sent from an agency on the morning of the inspection it was clear that people are not made aware of fire safety arrangements as part of their working day. The new starter was not aware of the home fire evacuation drill, and the experienced staff member was not aware the person should have been informed of this. The home does not use any specific form to use as evidence to show how new starters are introduced to the home. This lack of information in staff records means the home cannot show how well it monitors new starter’s health and safety. This was discussed with the registered manager during the inspection. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 26 • • Examination of the fire risk assessment for the home showed that it was not dated to show it was relevant to the current state of the building. COSHH data sheets were not available for all chemicals seen in day-today use. Discussion with the registered manager confirmed that some necessary information required to fully carry out the inspection was not available when requested. This included information about the current fees the home charges, and the relevant paperwork for the lift conversion. Although the homeowner was aware the inspection was imminent, this information was not made available for the Registered Manager. It is positive to see that accident monitoring in the home looks set for improvement. When the paperwork associated with a resident who recently fell in the grounds of the home was looked at, it was seen that the records showed the matter had been acted upon appropriately to make sure it did not happen again. Ms Palmer has devised a new accident audit system to monitor such events. It was reported to be almost ready for use, once the nurses who are in charge of the home have been informed about it. Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 2 3 X 1 2 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 2 2 Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Risk assessments for all equipment used for residents must have the necessary details so staff knows how to use it appropriately and effectively, including stair gates. (Previous timescales of 10/08/06 not met) Care plans must be reviewed with the involvement of the resident or a representative on his /her behalf, and kept up to date so that they meet the current preferences and needs of the individuals. (Previous timescales of 10/08/06 not met) Care plans must show details that resident’s health needs are monitored, as they should be, And any necessary equipment is provided to maximise resident comfort, including appropriate pressure relieving mattresses for residents with pressure sores. (Previous timescales of 10/08/06 not met) Security arrangements for the medication keys must be DS0000022238.V312490.R01.S.doc Timescale for action 30/11/06 2 OP7 15 30/11/06 3 OP8 12 30/11/06 4 OP9 13 (2) 10/11/06 Brookfield House Nursing Home Version 5.2 Page 29 reviewed to make sure there is no unauthorised access to medication storage facilities 5 OP16 22 (1)(2) The home’s complaint procedure must be further developed to be robust and reflect current legislation. (Previous timescales of 10/08/06 not met) The registered manager must ensure all necessary evidence is recorded in staff and service user records to maximise resident safety and well being. This includes • Staff training for vulnerable adults • Resident assessment and care recordkeeping. All parts of the home must be kept safe. Residents’ bedroom doors must not be wedged open Stair gates must only be installed and used in line with Fire and Health and Safety Executive legislation after appropriate risk assessment. (Immediate requirement notice issued on day of inspection.) All commodes and equipment used to promote continence must be kept clean and in good repair. (Previous timescales of 10/08/06 not met) The ‘double occupancy’ room, containing the shaft lift door, is to be retained as ‘single occupancy,’ should residency change and is subject to direct agreement with CSCI and following appropriate ‘risk assessment’. This arrangement is to remain in place subject to/and pending the lift DS0000022238.V312490.R01.S.doc 30/11/06 6 OP18 13 (6) 30/12/06 7 8 OP19 OP19 13 (4) 23(4)(b) 23(5) 13(4) 30/11/06 30/11/06 9 OP21 16(1) 23 (2)(j) 30/11/06 10 OP23 12(4)(a) 30/12/06 Brookfield House Nursing Home Version 5.2 Page 30 11 OP23 12 (4) (a) 12 OP23 16 (1) 23 (2)(f) 13 OP25 23 (2)(p) replacement. (Previous timescales of 31/03/06 not met) Priority must be given to move 30/11/06 the two female service users out of the bedroom, which occupies the lift at the earliest opportunity, in consultation with all interested parties. The next female bed that becomes vacant in the home must be used to address this issue. The registered provider must 30/11/06 provide plans to convert the passenger lift arrangements to ensure it does not need access from resident’s bedrooms. (Previous timescales of 10/08/06 not met.) All radiators and heaters must be 30/11/06 guarded, including the radiator in the dining room/lounge (Ongoing timescale requirement made 26/11/03.) All parts of the home including 30/11/06 residents bedrooms and communal bathrooms must be kept clean, in good repair and free from offensive odours. (Previous timescales of 10/07/06 not met) The home must implement an 30/11/06 action plan to implement changes to infection control management in the home in line with the report of the Health protection Agency audit on 05/04/06, including the provision of foot operated pedal bins in all ‘high risk’ areas. (Previous timescales of 10/09/06 not met) The registered manager must 30/11/06 provide required evidence of having taken steps to recruit suitable people to work with DS0000022238.V312490.R01.S.doc Version 5.2 Page 31 14 OP26 16 (2) (c, j) 23 (2)(b, d) 15 OP26 13 (3) 16 OP29 19(4) Brookfield House Nursing Home 17 OP30 18(1) (c) 13(5) vulnerable adults. (Previous timescales of 10/07/06 not met) All staff training records must contain necessary information to evidence all staff including agency staff are introduced to safe working practices at Brookfield House, including fire safety and emergency arrangements. All staff training records must contain necessary information to evidence mandatory training, including hoist training has taken place. (Previous timescales of 10/08/06 not met) All records must be available for inspection at all times. (Previous timescales of 10/08/06 not met) ALL Bedrail risk assessments must be reviewed and updated so that records can confirm they are installed maintained and checked in line with Medical Hazards Reporting Agency guidelines and the Health and Safety Executive Guidance. (Previous timescales of 10/08/06 not met) 30/11/06 18 OP30 18(1) (c) 13(5) 30/11/06 19 OP37 17, Schedule3 ,4 13 (4)(6) 30/11/06 20 OP38 30/11/06 21 OP38 23(4) 22 OP38 23(4) 30/11/06 The registered persons must ensure the home fully complies with the recommendations of the inspection of the premises by Shropshire Fire and Safety Service. The required works to the internal fire escape identified to be completed by the fire safety officer before 27th March 2006 must be completed with out delay. The home fire risk assessment 30/11/06 must show it is up to date and relevant to the current fire safety DS0000022238.V312490.R01.S.doc Version 5.2 Page 32 Brookfield House Nursing Home 23 OP38 13 (4),(6) arrangements at Brookfield House. All chemicals used in the home must have written guidance for their use in line with COSHH regulations. 30/11/06 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 OP7 OP9 Good Practice Recommendations It is recommended when printed information is part of a person’s care plan, that it is named and dated to identify this. It is recommended that the disposal of medication records are improved to make sure the date they are collected from the home is recorded and witnessed in the drugs for disposal book. 12 (4)(a) Privacy and end of life care arrangements for residents currently occupying the bedroom where the lift is must be prioritised, including the ground floor access for other residents during such times. It is recommended advice be sought from the infection control nurse about using a ‘Sangenic’ pad disposal system. 3 OP10 4 OP26 Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Brookfield House Nursing Home DS0000022238.V312490.R01.S.doc Version 5.2 Page 34 - 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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