Inspection on 23/01/06 for Brookview Nursing Home

This inspection was carried out on 23rd January 2006.

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

Brookview Nursing Home 26/09/07

Brookview Nursing Home 06/02/07

Brookview Nursing Home 18/10/06

Brookview Nursing Home 26/04/06

Brookview Nursing Home 05/09/05

Brookview Nursing Home 02/03/05

Brookview Nursing Home 20/10/04

Brookview Nursing Home 29/03/04

Brookview Nursing Home 07/10/03

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

CARE HOMES FOR OLDER PEOPLE Brookview Nursing Home Holmley Lane Dronfield Derbyshire S18 6HQ Lead Inspector Sue Richards Unannounced Inspection 23rd January 2006 10:00 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 Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 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. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brookview Nursing Home Address Holmley Lane Dronfield Derbyshire S18 6HQ 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) 01246 414618 01246 414657 Brookview Nursing Home Ltd Ms Sheila Bacon Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the increase in beds from 40 to 60 is phased in accordance with the completion of an agreed programmed works to the building - as detailed in the site visit report and letter dated 16.05.05. That no more than 40 service users are accommodated without prior approval of the Commission - dependant on compliance with agreed phased works. 5th September 2005 2. Date of last inspection Brief Description of the Service: Brook view Care Home provides nursing and personal care for older persons, with the number of service users to be accommodated in accordance with the stated conditions of the homes registration. The registered provider took over ownership of the home on 17 March 2003 and has invested considerably in the substantial redevelopment and upgrading of the home and its facilities. There are 54 single bedrooms, 44 of which have en suites. There are three double bedrooms, one having and en suite facility. There is a choice of communal bathing, shower and toilet facilities suitably located. There two separate lounge areas and one combined lounge/dining room. Suitable equipment is provided to assist service users who may have physical disabilities, including an emergency call system located in all areas which service users access and a shaft lift giving access to all levels of service users areas. Level and ramped access is provided to garden areas, with seating provided. Visiting to the home is open and service users are provided with care and support from a team of nursing, care and hotel services staff led by the registered manager. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was on organisation and delivery of health and personal care and support to service users. Case tracking was undertaken for three service users, which involved discussions with them and staff about their care, examination of their recorded needs assessment and care planning information and associated records and observation of the organisation of care in the home. Discussions were also held with other service users. What the service does well: What has improved since the last inspection? Completion has been achieved of Phase 2 of the redevelopment works to the home (Phase 1 was completion prior to the last inspection) to a high standard and works to refurbish and redecorate the old building are well underway. Proper processes are being undertaken in respect of staff recruitment. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 6 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. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 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 Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 4. Staff worked hard to deliver care and support to service users. However, the serious lack of staff impacted on their abilities to deliver person centred care in accordance with service users needs, lifestyle preferences and choices. EVIDENCE: Case tracking was undertaken in respect of three service users accommodated in the home. This involved examination of individual care needs assessment and care planning documentation and associated records, discussions with staff about the organisation and delivery of care and discussions with service users in accordance with their capacities. Written contracts/statements of terms and conditions were not available in the home for inspection, although the manager advised that these had been provided for service users case tracked. Service users case tracked had representatives who supported and assisted them with their financial and legal arrangements. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 9 There was a standardised approach to the formulation and recording of individual needs assessments, including the provision of assessment information for those service users admitted via care management arrangements. Overall information recorded was fairly comprehensive, although some deficits were identified where not all information had been fully recorded in accordance with that format. Areas of assessment information deficits were largely around psychological and social needs information and including individual wishes and personal instructions in relation to death and dying. There was also a standardised approach to the recorded assessment of risk, including clinical risk, although risks identified were not always followed through in terms of recorded action taken. Individual lifestyle preferences were accounted for, although mainly in respect of physical care interventions and daily living routines. At the previous inspection for this service the arrangements for staff training were found to be satisfactory. Additional information had also been provided by the registered manager, by way of the pre-inspection questionnaire regarding training undertaken during the past 12 months and training planned, which was satisfactory. During the inspection, the Inspector observed aspects of the organisation and delivery of care and support to service users. Examination of duty rotas and discussion regarding staffing provision was also undertaken with staff and service users. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Care plans were not always fully reflective of service users needs and required care interventions in relation to changes in their conditions and/or identified clinical risks and also their social and psychological needs. The arrangements for the management and administration of medicines in the home was satisfactory with the exception of the timeliness of administration for some service users, which was impacted by insufficient staffing levels. EVIDENCE: The recorded care plans were examined for those service users case tracked, these were formulated in accordance with their documented needs assessments and within a framework of risk management. They evidenced regular reviews. However, for all of the service users, areas were identified where their risk assessment reviews detailed recorded changes in their condition and level of associated risk, although their written care plans did not reflect these changes. Such areas included that relating to nutrition, continence and mental state. There was no recorded evidence of the involvement of service users or their representatives in the formulation of their Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 11 care plans. Care plans were not always in place in relation to the social needs of service users. The personal and oral hygiene needs of service users case tracked were well accounted for and records detailed their individual lifestyle preferences and routines in association with these. One of the service users, for whom there were clear indications of problems in relation to their mental state and aggression had no psychological assessment information or care plan recorded, although staff were regularly recording episodes of aggression and a referral had been made via the service users GP for specialist consultation. Service users said that they were able to access outside health care professionals for the purposes of routine healthcare screening and their records were reflective of this. Although for one service user case tracked (in receipt of personal care only) the need for referral to the district nurse for a continence assessment was recorded, but with no further information as to whether this had taken place or the outcome. The arrangements for the management and administration of medicines in the home were examined and were largely satisfactory. There were two small medicines trolleys, which although providing sufficient space for the number of service users accommodated at the time of the inspection (30), these will need review should the number of service users increase significantly. However, the administration of medicines to service users observed over breakfast and lunch times were significantly late on both occasions due to staffing constraints. Staff was observed to treat service users with respect and were mindful of their needs, although somewhat frustrated by the impact of insufficient staffing levels on their abilities to maintain service users dignity in relation to personal care giving. (See social care section of this report – meals and mealtimes). Service users spoken with praised staff but said that staffing levels were insufficient. For those service users case tracked, personal instructions and wishes were not always recorded in relation to death and dying. (There was no service user accommodated at the time of the inspection requiring special care in relation to death and dying). Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 12 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 Although the views of service users and their relatives are sought regularly via specific meetings, feedback and concerns raised by them in relation to (staffing levels) inadequate provision for social stimulation and activities and meals and mealtimes have not been acted on. EVIDENCE: The recording of service users daily living routines and preferences was variable, with more comprehensive information being recorded in respect of the personal physical care needs and with less information regarding their leisure and social activities requirements. Staff and service users described activities over the Christmas period, which were enjoyed. However, with the exception of monthly gentle exercise sessions and periodic entertainers – both from outside groups, there was little evidence of the promotion of regular activities. Service users spoken with expressed concerns regarding staffing levels in the home, particularly in relation to the serving of meals. The Inspector observed the organisation of lunch for service users, which was conducted in a calm manner with tables attractively set and service users who required received assistance with eating. Service users expressed their enjoyment of the food Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 13 served. The majority of service users needed assistance to the dining tables (and to toilets and hand washing facilities beforehand). Given the number of staff on duty, this resulted in some service users being seated at dining tables for an unacceptable time period waiting for their lunch, whilst staff assisted remaining service users to the dining room. For some service users, this caused them to remain seated at the dining table for almost one hour and forty minutes before lunch was served. Service users were verbally complaining amongst themselves as to the frequency that this occurred. There is provision for a resident/relative group who meeting regularly in the home. Minutes of these meetings are kept. Recent minutes were reflective of concerns raised within the group regarding staffing levels and the perceived effects on the arrangements for eating and drinking and activities in the home, which were felt to be unsatisfactory. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 14 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. There are satisfactory systems in place to promote the protection of service users from abuse, however, concerns raised by service users, their representatives and staff in relation to staffing levels in the home, have not been acted on. EVIDENCE: There is a complaints procedure in place for the home, which is provided in large print format, is displayed and also provided within the statement of purpose and service user guide for the home. There were no complaints recorded since the previous inspection, although clear examples were found during the inspection of the recording of concerns expressed by service users and their relatives/representatives via minutes of meetings – see also Daily Life and Social Activities section of this report. Clear policy guidance was in place in relation to adult protection and associated procedures. Staff spoken with was conversant with these and had received training updates in relation to these. Policy guidance was also provided in relation to violence and aggression, although this did not include detailed nonphysical interventions in respect of any service user. The arrangements for the management and handling of service users monies were examined and were satisfactory. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 15 A complaint is currently being investigated via Derbyshire’s joint agency adult protection procedures. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 16 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): EVIDENCE: A full inspection of the building was not undertaken on this occasion, although a number of communal areas were seen during the inspection. Since the previous inspection for this service an additional visit has taken place in order to monitor progress with the upgrading and redevelopment of the home in accordance with the providers variation application to increase the number of beds from 40 to 60. A copy of the completion certificate from the buildings control officer remains outstanding (following completion of Phase 2). The third phase of the redevelopment, which is to refurbish and redecorate the original part of the building is well underway. There is no provision for a rollator iron in the laundry – domestic type only. Staff had raised concerns during a recent staff meeting regarding the Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 17 difficulties this presents given the large amount of ironing they are presented with. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 18 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 Staffing levels in the home and including the arrangements for staff deployment were unsatisfactory and insufficient to meet the needs of service users. EVIDENCE: Comments have been made under the various sections of this report which relate to lack of sufficient staffing in the home and its impact and care and service provision. Serious concerns were raised with the registered provider separately and in writing at the time of the inspection regarding staffing levels and deployment, requiring immediate action to be taken by them. Details of staff employed, together with staff turnover, minutes of staff meetings and duty rotas were provided and examined, including the arrangements for nursing, care and hotel services staff provision and deployment. There were 30 service users accommodated with fairly high dependency needs. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 19 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): The standards in this section were not assessed on this occasion. EVIDENCE: Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 21 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 OP2 Regulation 5 Requirement Each service user must have a written contract/statement of terms and conditions with the home, a copy of which must be available for inspection. Individuals’ recorded needs assessment information must include all areas as detailed under NMS 3.3 for Older Persons. The registered person must ensure that the assessment of the service users needs is kept under review and revised at any time when it is necessary to do so having regard to any change in circumstances. The registered person must ensure that the service users care plan is available to them, kept under review and revised where necessary. The service users care plan must detail as to how their needs are to be met (particular emphasis her on their social and psychological care). The registered person must always ensure that where DS0000002046.V272006.R01.S.doc Timescale for action 28/02/05 2 OP3 14 28/02/06 3 OP3 14 28/02/06 4 OP7 15 28/02/06 4 OP7 15 28/02/06 5 OP8 13, 17 28/02/06 Brookview Nursing Home Version 5.0 Page 22 6 OP12 16 7 OP14 12 8 OP27 18 necessary, treatment and advice from other healthcare professionals are arranged and that a record is kept of this for any service user. The registered person must consult service users about their social interests and make arrangements for them to engage in social and community activities. The registered person must ensure that there is proper provision for the health and welfare of service users and that their wishes and feelings are taken into account and their dignity promoted. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (To also account for the fact that the provision of nursing and hotel services staff is additional to the residential forum guidance calculation, which is for care staff only). Immediate requirement made during inspection. 31/03/06 28/02/06 24/01/06 Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 23 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 OP26 OP18 Good Practice Recommendations A rollator iron should be provided in the laundry. The home’s written policy regarding dealing with aggression should be developed to include non physical interventions as appropriate to service users accommodated. Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Brookview Nursing Home DS0000002046.V272006.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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