Inspection on 09/08/07 for Brookholme Croft Nursing Home

This inspection was carried out on 9th August 2007.

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

The inspector 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

Brookholme Croft Nursing Home 22/10/08

Brookholme Croft Nursing Home 21/06/06

Brookholme Croft Nursing Home 06/02/06

Brookholme Croft Nursing Home 25/01/05

Brookholme Croft Nursing Home 30/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Brookholme Croft Nursing Home Off Challands Way Hasland Chesterfield Derbyshire S41 0EU Lead Inspector Susan Richards Unannounced Inspection 9th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brookholme Croft Nursing Home DS0000002045.V340674.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. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brookholme Croft Nursing Home Address Off Challands Way Hasland Chesterfield Derbyshire S41 0EU 01246 230006 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) brookholmecroft@yahoo.co.uk Dr A P M Matthews Mrs A Matthews Angela Alice McInnes Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That a named service user named on the Notice of Proposal may be accommodated at the home under the category of DE(E) - not transferable to any othe r service user. 21st June 2006 Date of last inspection Brief Description of the Service: Brookholme Croft is a purpose built care home, which opened in 1996. The home provides nursing and personal care and support for up to 40 older persons. It is situated at the head of a residential close and is located in the village of Hasland, within close proximity of Chesterfield town centre. There is wheelchair access throughout the home, which is suitably adapted and equipped to assist those with physical disabilities/mobility problems and with an emergency call system in all private and communal areas. There is level access to a well-kept garden to the rear of the building, with car parking spaces to the front of the home. Single room accommodation is provided for all residents. Nine of which, have en-suite toilet and wash hand basin facilities. There is an option for those who choose to share a room, as there are two sets of rooms which link via interconnecting doors. These doors are kept locked when the rooms are used as single accommodation. There is a choice of communal bathrooms and toilets, which are suitably located and equipped and a range and choice of lounge and dining rooms on each floor. The registered manager is a registered general nurse, who is supported by a team of nursing, care and hotel services staff, including a part time activities co-ordinator and a physiotherapist The home’s stated aims are to provide a friendly, safe and pleasant environment, together with high standards of care and support, delivered by a dedicated and professional staff team, who will promote individual’s rights to privacy, dignity and choice. A copy of the most recent inspection report is openly displayed in the entrance to the home and nursing office located there. The current scale of charges is as follows: Personal care only - £367.95 - £369.40 Nursing care - £451.20 - £510.20 The above fees are effective as from 09/04/07. Information detailing the range of fees and what they cover are included in the home’s service guide/brochure. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account all of the information we hold about this service within the last twelve months. This includes the last key inspection report of 21 June 2006, information provided in our pre-inspection questionnaire completed by the home and twelve survey returns from people who use the service. At this inspection there were thirty-eight people accommodated, including seventeen who receive nursing care. We used case tracking as part of our methodology. This involves the random sampling of four people, whose care and service provision was more closely examined. We spoke with people about the care and services they receive and with their representatives as available and looked at their written care plans and associated health/care records and also inspected their private and communal accommodation. We also spoke with staff and external management about the arrangements for their recruitment, induction, training, deployment and supervision and examined related records and observed some of their interactions and approaches with others. We spoke with the manager about her role, responsibilities and training, about the arrangements for quality assurance and monitoring in the home, including consultation with people and also for ensuring safe working practises. What the service does well: People continue to live in a safe and comfortable home, which overall suits their needs. Their needs are properly assessed and their health care needs are effectively met. People can usually access key information about the home, before they choose to live there. The provision and organisation of activities and meals satisfies the majority of people. There is written information about how to complain, which is openly displayed in the home in the main entrance area. The home is reasonably well managed and run. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 & 3. (NMS 6 – the home does not provide for intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are properly assessed and they can access key information about the home, before they choose to live there. EVIDENCE: At our last key inspection of the home we judged that residents are provided with information about the home in suitable formats and do not move into the home without having their individual needs assessed and being assured that these would be met. For the purposes of this inspection, we looked at the information provided in our pre-inspection questionnaire about the home, which included details about fees charged and what they cover and also how this is provided for people. All Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 9 information is available in large print to assist people who may have sight difficulties, but not audio-tape for those who may be blind. Information provided by the home advised that there are no people accommodated with diverse cultural and/or religious needs, but that they would strive to provide information in suitable languages as necessary. We received twelve survey returns completed by people who use the service. All said they have received a contract and enough information about the home before they moved in to help them decide if it was the right place for them. At our visit we spoke with people case tracked about the arrangements for their admission, including information they were given about the home and its services and whether their needs were discussed and agreed with them before their admission. We also looked at the information they were given during our visit to the home and examined the recorded needs assessment information for each of them. People spoken with said they were provided with sufficient information about the home and its services before their admission, or in some instances, the representative who arranged their admission on their behalf. However, two people whose relatives had arranged their admission said it would be useful to have copies of the home’s guide/brochure in their own rooms, which they could refer to as they chose. A copy of the guide is available from the main office at the home. Individual’s recorded needs assessment information is comprehensive and person centred and includes some areas of choices made by people in terms of their daily living arrangements and personal support. Copies of the single assessment and care plan are in place for people who are admitted via care management arrangements and pre-admission assessment information completed by the home where those arrangements are on a private basis. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health care needs are effectively met in accordance with their riskassessed needs. EVIDENCE: At our last key inspection of this service we judged that people’s personal and health care needs were largely met and the home’s philosophy of approach successfully underpinned the promotion of residents’ rights to dignity, privacy and respect. We made two requirements with regard to record keeping in respect of medicines administration. For the purposes of this inspection, we looked the information provided in our pre-inspection questionnaire completed by the home regarding people’s needs and the arrangements for their health care and support, which helped us to Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 11 decided whose care we would look at more closely during our visit to the home. We received twelve survey returns, which asked people whether they receive the care and support they need. Four said they always did and eight said they usually did. One person made an additional comment that the home is sometimes short staffed. (See staffing section of this report). At this inspection we spoke with people about the care and support they receive, including the arrangements for their medicines management and administration and looked at the written care plans and associated health care and medicines records for each person case tracked. People said they are satisfied with their care and support. One person said, “At first I was apprehensive, but from day one of moving here I have been very happy, the care is very good.” Another said, “I am looked after well.” “They were very prompt in getting me the right medical support when I was ill recently.” People spoken with who were able to express an opinion said that most staff treated them with courtesy and respect. (See also complaints section of this report). A recent complaint made about the home, alleged poor practises with regard to continence promotion and lack of provision of incontinence supplies (see complaints section of this report). During this inspection we spoke with people about the assistance they received in relation to this, including the provision of incontinence aids and also looked at the home’s arrangements for their ordering and supply. These are satisfactory. People’s written care plans examined are formulated in accordance with their risk assessed needs and are fairly person centred and reflective of recognised guidance concerned with the care of older persons, including clinical guidance. Inputs from outside health care professional are well accounted for within individuals’ care records. At the time of the inspection a range of outside health care professionals visited people at the home. Key staff was observed to liaise effectively with them, record their visits within individual’s care files and to communicate effectively people and with other staff in respect of their health care needs. We also spoke with two visiting professionals who advised that they found the home well organised and professional in its approach and usually received good feedback from people about the home and its care provision. Requirements made at the previous inspection regarding medicines records were complied with at this inspection and the arrangements for the management and administration of people’s medicines are satisfactory and in accordance with recognised practise. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 12 People spoken with said that they had chosen for staff to retain their medicines. One person said that they used to look after their own medicines, but no longer chose to do so as the now found it too difficult. All people spoken with said that staff treated them respectfully and upheld their wishes. Of the twelve survey returns, ten said that staff always listened and acted on what they said, one said ‘not always’ and one said ‘some do, some don’t.’ People surveyed were also asked if they receive the medical support then need. All said that they always did and comments received included ‘the nurses are very good and always know when I need a doctor,’ ‘They fetch help immediately,’ and ‘These arrangements are very good.’ Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The provision and organisation of activities and meals satisfy the majority of people. EVIDENCE: At our last key inspection of this service we judged that there were excellent arrangements to enable residents to engage in occupational, social and recreational activities of their choice and in consultation with them. However, residents’ views’ regarding quality and choice of food was variable. We recommended that the manager should ensure that effective consultation with residents is maintained in respect of their satisfaction as to the food/meals provided. In our pre-inspection questionnaire completed by the home they said that people have a choice of menu, that they cater for special diets and that they Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 14 would ensure they could meet the dietary needs and wishes of any potential resident with diverse needs in accordance with their culture and religion. They also provided copies of menus, which run on a four weekly rota and reflected a balanced, nutritious and varied diet with a range of breakfast choices and specified alternatives at dinner and tea. They said that the arrangements for leisure and recreational activities had not changed since our last key inspection of the home and that they continued to employ an activities co-ordinator on a part time basis. At this inspection, we spoke with people about their daily lives and routines in the home, including the arrangements for activities and leisure and meals. We also observed serving and assistance for people at lunchtime. We asked people surveyed whether activities are arranged by the home that they can take part it and if they liked the meals served at the home. Of the people surveyed, ten said activities were always organised and two said sometimes. People spoken with said that regular activities and entertainments were organised and that they chose whether to engage in these. Information regarding activities is provided within the service guide and also in the reception area of the home. One person visited their church on a weekly basis and a visiting Church of England minister visits the home on a monthly basis. Links the Catholic Church, is also established with visits arranged for people as they wish. All said that visiting to the home was open. People spoken with said that they usually liked their meals and they confirmed that there was a range of breakfast choice, with a specified alternative at lunch and teatime. They said they were able to eat where they choose, some preferring the privacy of their own rooms for some or all meals. Eight people surveyed said they usually liked the meals at the home, two said they sometimes did and two said they always did. Supporting comments were not provided. Regular residents meetings are held and the minutes of the most recent ones were seen, which provide ongoing consultation with people in respect of meals provision. The most recent meeting meetings recorded that people who attended were more satisfied with the quality and quantity of food provided and previous minutes recorded their views regarding suggested menu changes and follow up. Lunches were served to people in two dining rooms and for some in their own rooms. We spoke to two people who stayed in their own rooms for lunch who confirmed this is their stated preference. Tables were well set. One person was observed as assisted by a staff member, who stood over them whilst feeding that person. This was raised with the manager during the inspection. Details of the daily menu were visibly displayed in the dining room. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 15 Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of people know how to complain, although some are not best informed with regard to the home’s complaints procedure. The registered persons have acted in a manner, which is in people’s best interests following allegations of poor and abusive practise by some staff towards some people who live at the home. EVIDENCE: At our last key inspection of this service we judged that residents knew how to complain and that these were effectively dealt with in accordance with the home’s complaints procedure. We also judged that there were suitable systems and procedures in place to promote the protection of residents from abuse and staff understood their responsibilities in relation to these. In our quality assurance questionnaire completed by the home they provided information regarding the number of complaints they had received. They said they have received two complaints over the last twelve months. One of these was fully substantiated and one partially substantiated. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 17 At our inspection we looked at the home’s record of these complaints, which included details of their investigations, outcomes and action taken. One of the complaints made alleged a lack of care and poor staff attitude/lack of respect. This was investigated by the home and partially substantiated. The action taken by the home is recorded, which included staff disciplinary action. The second complaint concerned an alleged lack of communication regarding an outbreak of infection. This was substantiated and further action taken is clearly documented by the home. The Commission has received one complaint about the home. This included some allegations relating to poor and unsafe practise, lack of cleanliness and equipment, carpets needing replacement, bullying of staff and residents, including racism towards one staff member, lack of promotion of dignity and respect towards resident including a lack of choice, insufficient staffing levels, poor communication with regard to an outbreak of infection, lack of choice for meals, lack of proper training and induction for staff and lack of confidentiality with regard to staff sickness and absences. This was passed to the registered provider to investigate through the home’s complaints procedures. This complaint also included specific allegations about the care of two named residents and the poor attitude and abusive care practises of some staff towards those persons. These were referred to social services via recognised safeguarding adults procedures for investigation. The registered provider has investigated the complaint referred to them and provided the Commission with a detailed written response regarding their findings and areas of proposed action. Some areas of this complaint are substantiated or partially substantiated – these included staffing levels (see staffing section of this report), poor communication regarding an outbreak of infection, confidentiality with regard to staff sickness and absences. The action taken by the registered persons was discussed at this inspection and is satisfactory in principle. Allegations investigated by social services were not substantiated, although there are matters arising from their investigations with regard to staffing levels not always being sufficient. However, the registered provider has also investigated concerns reported directly to them since completing our preinspection questionnaire, regarding a staff member’s attitude towards a named resident. These were partially upheld. Written details of their investigation and action taken are included in their complaint response to us, which is satisfactory in principle. Out of the twelve survey returns, nine said they always know who to speak to if they are not happy and three said they usually do and eleven people said they knew how to make a complaint, with one person indicating they were unsure. A copy of the home’s complaints procedure is openly displayed in the Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 18 home. People spoken with said they would discuss any concerns or complaints they may have with the manager, although some did not know who the manager was and were not provided with their own copy of the home’s complaints procedure. During this visit, we inspected the relevant national minimum standards for older persons relevant to the areas identified in the complaint. These are referred to under the relevant sections of this report. We also spoke with people case tracked and they confirmed they knew who they would speak with, if they needed to raise any concerns or to complain, although they were not familiar with the home’s actual complaints procedure. Since the last complaint further training has been provided for staff with regard to recognising abuse and safeguarding adults procedures. We spoke with staff about their roles and responsibilities with regard to safeguarding vulnerable adults, including procedures to follow in the event of any suspicion or allegation of abuse of any person. All spoken with are conversant with these. Brookholme Croft Nursing Home DS0000002045.V340674.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People continue to live in a safe and comfortable home, which suits their needs. EVIDENCE: At our last key inspection of this service, we judged that people live in a safe and well-maintained environment, which meets their needs and is homely and comfortable. In our pre-inspection questionnaire completed by the home they said there have been no changes to the premises since the previous inspection. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 20 At this inspection we spoke with people about their satisfaction with their environment and inspected the private and communal areas they used. We also asked people by written survey whether the home is fresh and clean. All people spoken with said they were satisfied with their environment. Eight people surveyed said the home is always fresh and clean, three said it usually is and one said it sometimes is. Comments received, include, I spend a lot of time in my room, it is always clean and tidy and I enjoy being in it,” “cleanliness is top priority here, the cleaners work hard to keep the home fresh and clean,” A recent complaint made about the home, included alleged lack of cleanliness and hygiene and cleaning equipment. At this inspection, areas seen were clean, tidy and comfortable and reasonably decorated, furnished and equipped. People’s bedrooms were personalised in accordance with their own choices. The registered manager advised of imminent plans for the extension and upgrading of the home, to include areas of renewal to existing fabric. Cleaning equipment was available and stored safely. Staff spoken with confirmed they are always provided with sufficient and suitable equipment to promote good infection control. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Record keeping with regard to staff recruitment, induction and training is improved and is satisfactory. However, the arrangements for staff deployment are not always effectively managed, which may not be in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that although residents’ care and support needs were met by staff, the home’s record keeping in respect of staff recruitment, induction and training did not evidence this. We made three requirements in our report of that inspection and said that a copy of two references obtained for each staff member for the purposes of their recruitment must be kept and that a record of induction and training must be provided for each staff member and be properly maintained. In our pre-inspection questionnaire completed by the home, they provided us with information about staff employed, recruitment information and staff turnover and training, including NVQ training status for care staff. They also told us that there are thirty-eight people accommodated at the home, with Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 22 seventeen who receive nursing care. They said that twelve of those people have high dependency needs, twenty-six have medium needs and two have low dependency needs. They did not provide details of staff hours as requested in that questionnaire. They said that eight staff are first level nurses and that they employ twentyfour care staff and nine hotel services staff who work varying hours. That ten care staff have achieved an NVQ level 2 or above (45 ), with ten staff holding a current first aid certificate. They said that staff training, which had taken place during the past twelve months included NVQ training (levels 2 and 3), fire and moving and handling training, recognising and alerting other to suspected abuse, dementia care, optical awareness and induction training for new staff starters in accordance with skills for care standards. They also said that future training planned included optical awareness, hearing awareness, food hygiene updates and further first aid training and that further staff are now enrolled to commence NVQ training. A recent complaint made about the home included an allegation of lack of proper training and induction for staff. (See complaints section of this report). At this inspection we discussed the arrangements for the recruitment, induction, training and deployment of staff with them and with the manager and examined associated records, including staff rotas and the personal records of four of the most recent staff starters. We also spoke with people about staff availability and asked people surveyed if staff is available when they need them. Overall these were satisfactory, however matters arising from a recent complaint investigation via safeguarding adults procedures, comments received from people, including those surveyed and examination of duty rotas indicate that staffing levels are not always sufficient. This was discussed with the manager who advised that although some general consideration is given to resident dependency levels with regard to determining staffing, that this is not formally calculated by use of an evidence based individual dependency assessment tool and that the residential forum is not used to calculate a guide to care staffing levels. Additionally, rolling rotas, were not always amended to reflect staffing changes. Occasions were noted where staff were taken off the original rolling rota, for example due to sickness and/or to take annual leave, leaving insufficient, such as one registered nurse and four care for up to thirtyeight residents. The manager advised that a recent review of agency arrangements was undertaken, enabling staff at evenings and weekends to access agency in times of staff shortages. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36, 37 & 38. Quality in this outcome area is adequate. This judgment has been made using available evidence, including a site visit to the home. The home continues to be generally well managed and run, which for the most part is in people’s best interests. However, a considered review of management methodology applied to determine staffs’ deployment and their continuous supervision, may better assist in promoting consistency of good practise in terms of their attitudes and approaches towards people. EVIDENCE: At our last inspection of this service we judged that positive measures were introduced to promote people’s rights and best interests by increased formal Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 24 consultation with them. And that the home is generally well managed and run, although some inconsistencies and omissions of record keeping, procedures and practise, did not always serve to underpin the safeguarding of people’s rights and best interests. We said that there must be a safe system for moving and handling residents – in that a review of sling sizes available for use with the hoist must be undertaken and equipment provided in accordance with individual needs. We also said that the registered manager should ensure that the system for individual staff supervision is effectively rolled out to all staff and undertaken in a timely manner. In our pre-inspection questionnaire some information was given about how key management responsibilities are allocated in the home and about admissions to the home, deaths and the number of residents admissions to hospital accident and emergency unit. Satisfactory details of the arrangements for the maintenance of equipment in the home are also provided. A recent complaint made about the home alleged a lack of leadership by the registered manager, lack of management confidentiality with regard to staff sickness and absence and poor moving and handling practises by some staff. (See complaints section of this report). At this inspection we spoke with the registered manager about her role and responsibilities, the management of the home, training undertaken by her in the previous twelve months and also the arrangements for consultation with people for the purposes of quality assurance and monitoring. We spoke with people accommodated about how they are consulted and examined the arrangements for the management and handling of people’s monies via those people case tracked. We also spoke with staff about the arrangements for ensuring safe working practises and examined related training records. The registered manager advised that there had been a recent review of management responsibilities with external management responsible for particular focus on staff induction and training. The home has Investor’s in People award, which is due for review in September of this year. The manager advised of a recent satisfaction survey questionnaire aimed at residents and their relatives, although a low return response was reported. The manager has monthly meetings with people accommodated who wish to attend, together with periodic relatives meetings, the most recent being June 2006. Minutes of those meetings were seen, with the most recent focus on consultation with people about meals and menus, activities and laundry Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 25 arrangements. Information and updates about the home and its services are also included in those meetings and people’s requests are noted. People spoken with were not aware of any formal consultation by way of satisfaction questionnaires, although are aware of the provision of residents’ meetings. We received positive comments with regard to those meetings, such as, “ We have meetings once a month and Matron takes notes and always listens to what we say,” “Matron is easy to talk to and always tries to do what we ask.” The arrangements for the management and handling of people’s monies are satisfactory and in accordance with their wishes and capacities. Staff spoken with is conversant with their responsibilities and those of others and said they are reasonably well supported and supervised, although felt at times that staffing levels had an impact on their support and supervision. They also confirmed they receive regular training with regard to safe working practises, including within their induction and advised that an additional hoist is purchased and that there is sufficient and suitable moving and handling equipment provided to assist them in their duties for people’s care. A number of records, which are required to be kept in the home were inspected and are referred to under the relevant sections of this report. These included the home’s statement of purpose and service guide/brochure, individual’s health care records and care plans, including medicines records, staff records (recruitment, induction, training and deployment/staff rotas), complaints records, records relating to residents monies held in safekeeping by the home, accident records, menus and the visitors record. These were well maintained, with the exception of staff duty rotas, which were not always amended as necessary to reflect changes due to sickness and absence (see Staffing section of this report). Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 2 3 Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP27 Regulation 18(1)(a) Requirement At all times there must be (suitably qualified, competent and experienced) persons working at the care home in such numbers as are appropriate for the health and welfare of service users. Timescale for action 09/09/07 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. 3. 4. Refer to Standard OP1 OP1 OP15 OP16 Good Practice Recommendations A copy of the home’s service guide/brochure should be routinely provided in their own rooms for ease of access and reference. Details should be provided in the home’s service guide/brochure regarding the availability of information about the home in alternative formats/languages. It should be ensured that staff assistance, which is provided for people in their eating and drinking, is always done in a discreet and sensitive manner. A copy of the home’s complaints procedure should be provided for each person. (This may be as contained in DS0000002045.V340674.R01.S.doc Version 5.2 Page 28 Brookholme Croft Nursing Home 5. OP27 6. OP36 the home’s service guide/brochure). Recognised formal assessment tools should be introduced which assist in the determination of staffing levels, (such as individual dependency assessment and the residential forum staffing tools), to ensure staff deployment arrangements are always in the best interests of people who live and work at the home. Management planning of the arrangements for staff deployment and skill mix should aim to consistently promote their continuous supervision and best practise towards the people they care for. Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Brookholme Croft Nursing Home DS0000002045.V340674.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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