Inspection on 26/09/07 for Brookview Nursing Home

This inspection was carried out on 26th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brookview Nursing Home 06/02/07

Brookview Nursing Home 18/10/06

Brookview Nursing Home 26/04/06

Brookview Nursing Home 23/01/06

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 Susan Richards Unannounced Inspection 09:30 26 September 2007 th 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.V341609.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. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 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 Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2007 Brief Description of the Service: Brookview Care Home provides nursing and personal care for older persons. The home provides 54 single bedrooms, 44 of which have en suites. There are three double bedrooms, one having and en suite facility. Communal bathing, shower and toilet facilities suitably located around the home. There is one large lounge and two smaller lounge areas, one being a quiet lounge and one combined large dining/small lounge area. There are a range of aids and adaptations provided to assist people who may have physical disabilities, including an emergency call system and a shaft lift giving access throughout the home. Level/ramped access is provided to garden areas, with seating provided. Visiting to the home is open and people are provided with care and support from a team of nursing, care and hotel services staff. There is currently no registered manager for the home. The range of fees charged per week per person is as follows: £359.30 to £420 per week. This does not include the free nursing care fee as determined by the local PCT, which is paid by them directly to the home. There are additional charges for dry cleaning & labelling of clothing, hair dressing via private outside service at the home, private chiropody, personal toiletries and private transport. Brookview Nursing Home DS0000002046.V341609.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 the information we hold about this service. This includes our previous key inspection report of 06 February 2007 and information provided in our annual quality assurance questionnaire completed by the home. We received four out of twenty survey returns from people who use the service. At this inspection there were forty-nine people accommodated at the home, including nineteen who receive nursing care. We used case tracking as part of our methodology. This involved 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 looked at their written care plans and associated health/care records and also inspected their private and communal accommodation. We also have taken into account information received from social services concerned with individuals, for whose placements at the home are secured by way of their funding arrangements. We also spoke with staff and management about the arrangements for their recruitment, induction, training, deployment and supervision. Examined related records and observed some of staffs’ interactions and approaches with others. In the absence of a registered manager we liaised with the regional manager, who currently provides acting management cover at the home, about the management and monitoring arrangements for the home. What the service does well: People live in a home, which is clean and comfortable, decorated and furnished to a high standard. There are effective admission and need assessment arrangements in place tailored to the individual. People’s health care needs is reasonably well accounted for and their rights to respect and dignity is usually well promoted. Activities are regularly organised at the home and meals provided are nutritious. Individual complaints made are taken seriously and acted upon by the home. People are protected from a staff team, who are properly recruited, inducted and for the most part reasonably well trained. People’s health, safety and welfare is reasonably well accounted for. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ensure that approaches to the organisation and delivery of care and support for people are consistent and accord with their expectations. Develop staff practise in relation to infection control and dementia care approaches. Ensure that medicines recording and administration practises are consistently in accordance with recognised guidance. Further develop systems and approaches to care, aimed at maximising peoples’ rights to exercise autonomy and choice in respect of their daily lives. Ensure more prompt/timely attention to the maintenance and repair of equipment at the home and ensure bathrooms are not used as general storage areas in order to better assure people’s choice and safety. Provide a more suitable location for the recently appointed staff office accessed via the residents’ lounge in order to better promote people’s privacy. The registered persons should listen to staffs’ expressed views as to the conduct of the home and take action, as necessary to improve service outcomes for people. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 7 Ensure the views of people who use the service are regularly obtained by a reliable formal method and used to inform service development and improvement and that the results of any surveys are shared with people. Develop a quality benchmark for the completion of staff employment application form, which forms part of its selection criteria for interview. Ensure that the person that continues to manage the home submits an application for registration to the Commission. Review the arrangements for staff communication and handover from one shift to another to ensure that staff is provided with the key information they need to enable them to effectively understand and comply with their roles and responsibilities for the benefit of the people they care and support. 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. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. (NMS 6 was not assessed, as the home does not provide intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are effective admission and needs assessment arrangements in place for people. EVIDENCE: At our last key inspection of this service we judged that people who use the service have greater confidence that the home is better able to meet individuals’ assessed needs. We judged the quality outcome in this area to be adequate. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 10 We made a recommendation from that visit that people’s recorded needs assessment information should include a record of their current medication usage. In our annual quality assurance questionnaire completed by the home, they say that they have a clear and updated statement of purpose detailing the care and service provision offered by the home. That all planned admissions to the home have a pre admission assesment with multi disiplinary involvement, trial visits and day visits are offered. They say they have improved over the last 12 months by reviewing their statement of purpose/service guide and introducing welcome packs. They feel they could do better by providing key service information for people in alternative formats and aim to make this improvement over the next 12 months. At this inspection there are no people accommodated from diverse religious or cultural backgrounds, all being British white of christian based religion. We spoke with people about the arrangements for their admission to the home, including information provided for them about it servcies and whether their needs are discussed and agreed with them. We also looked at the home’s service guide. We examined the recorded needs assessment information for those people case tracked and we asked some people by way of our written survey if they received a contract and whether they received enough information about the home before they moved in so they were able to decide if it was the right place for them. We also asked people whether they feel they receive the care and support they need. People spoken with said they may have received some written information about the home, although were not sure and felt that the routine placing of a copy of the home’s service guide may benefit. However,all said that they or their representative had received a copy of their contract. People also confirmed that their needs are discussed with them before their admission to the home, or for some via their representative as they chose. The small number of surveys returned from people said they had received a contract and enough information about the home before deciding to live there, except one person who was an emergency admission. The latter did not state a to whether they were provided with that information since. The service guide provided at our visit, detailed sufficient and suitable information about the home. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 11 People’s recorded needs assessment information was generally well recorded and included details of their preferences and choices with regard to their care support daily living routines. Overall responses as to whether people feel they receive the care and support they need was variable. Many felt that on the whole this is satisfactory. However, some said that this was not consistent, with comments ranging from ‘usually’ to ‘sometimes.’ (See also staffing and management sections of this report). As far the could be observed and from the feedback gained from people on the day of our inspection visit, people case tracked received the care and support they needed, although with the exception of one area relating to dementia care, which is detailed under the Healthcare and Staffing sections of this report. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health care needs are reasonably well accounted for and their rights to respect and dignity are usually well are promoted. However, approaches to the organisation and delivery of care and support for people can be inconsistent and do not always accord with their expectations. EVIDENCE: At our last key inspection of this service we judged that overall, peoples’ personal and health care needs are adequately met and accounted for and their health and welfare better promoted and protected. We judged the quality outcome in this area to be adequate. We made a requirement that items identified in the supplying pharmacist report of 21 January 2007 must be achieved to ensure the correct arrangements for the ordering, recording and disposal/return of medicines in Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 13 the home. We also made two recommendations that care plans should be agreed and signed by the people wherever capable (or their representative) and should be accessible to them. And that staff should be clear and consistent as to which format they use to record service users daily health records (and including weights) in order to avoid confusion and omissions. In our annual quality assurance questionnaire completed by the home they say that all aspects of the care, which people require are recorded in their care plans, including that relating to their risk assessed needs and that people’s privacy and dignity are respected. They say they have improved standards in the recording people’s care plans ensuring that they are reviewed in a timely manner and also their medicines arrangements by way of policy review, staff training and management monitoring systems. They feel they could do better by developing recognised ‘End of Life’ care approaches and increasing people’s involvement in obtaining life experience information for each person, which they feel would improve the care planning process and their approach to that level of care. They aim to achieve this over the next twelve months and also to improve by developing their methods for consultation with people and their representatives about their care. At this inspection we spoke with people about the arrangements for their personal and healthcare, including staffs’ approaches with them and we examined the care plans for those people case tracked. We spoke with staff about the arrangements for and organisation of people’s care delivery. We also asked some people by way of our written survey whether staff listen and act on what they say and whether they receive the medical support they need. The majority of people spoken with said that they felt the care and support they receive is overall good and said that staff is usually available when they need them. However, all said that sometimes there are staff shortages, which they believe are due to ‘people not turning up’ and said that on these occasions that this can impact on the quality of the care they receive. Most people said that staff listen and act on what they say and that they receive the medical care they need. However, two people (including one surveyed) said that staff listen do not always act on what they say or ‘follow through.’ Some people also felt that some shifts are less well organised than others. (See also staffing section of this report). Key comments are also received from staff relating to staffing arrangements at the home and the organisation and quality of care delivery. These are referred to under the Staffing and management sections of this report. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 14 Most people said that staff treat them with respect and maintain their dignity and privacy. Although one felt that some staff can be indifferent in their attitudes. At our visit, staff were observed to treat people with respect. Overall people’ written care plans examined are fomulated in acordance with their risk assessed needs, include some details as to their personal preferences and wishes and for the most part are reflective of recognised guidance concerned with the care of older people. There is also evidence that they are regularly reviewed. However, for two people with dementia/short term memory problems, their care plans did not reflect best knowledge and practice with regard to recognised care interventions, which may assist in terms of their wandering and confusion. People did not have a written daily living plan as agreed with them detailing their preferred daily living routines and known choices. (See also Social Care and Activities section of this report). The daily health care monitoring records for people case tracked were completed satisfactorily. Inputs from outside health care professionals are accounted for within people’s care records and all people said that these arrangements are satisfactory, although one person was less satisfied, relating to their view that some staff did not always ‘follow through’ on what they say. We also looked at the arrangements for the management and administration of people’s medicines. There is clear policy guidance for staff in respect of these, including for people who may wish to retain and administer their own medicines. The latter had recently been developed with a recorded risk assessment to be introduced in respect of these. The requirement we made in respect of medicines at our last inspection is complied with and overall the arrangements for the management and adminstration of people’s medicines are satisfactory. However, gaps of recording for the administration of prescribed medicines were occasionally evident and there was some occasional practise of sharing common medicines where people are prescribed the same. This was discussed with the person responsible and assurances given by them and management that this practise would cease immediately. Brookview Nursing Home DS0000002046.V341609.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Whilst a range of activities are provided and people usually receive a satisfactory diet, people’s rights to autonomy and choice are not always best promoted or accounted for in terms of their daily living arrangements. EVIDENCE: At our last key inspection of this service we judged that the organisation and provision of activities and meals was improved considerably to the benefit of service users. We said that the quality outcome in this area was adequate. We made one recommendation that consideration should be given to providing additional dedicated staff hours for activities. In our annual quality assurance questionnaire completed by the home, they say that they have a dedicated activities co ordinator and a programme of regular activities provision, including crafts and regular outings aimed at maintaining Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 16 community links for people. They also say that they have good support from some relatives, who regularly volunteer to assist with various activities. They say they have improved over the last twelve months by developing their planned activities programme with social events to include the local community. They feel they could do better by increasing evening social events, making outings available to more people and by holding themed restaurant evenings, which they aim to do over the next twelve months. At this inspection visit we spoke with people about their daily living arrangements, including the organisation and access to activities and meals and we observed the same. We also spoke with staff about the arrangements and support for these and we asked people by way of our written survey if activities are arranged by the home, which they can take part in and if they like the meals at the home. People said that activities are arranged on a regular basis. Some felt that activities are aimed at those who are most independent and able and one felt that the availability and organisation of these could be improved. Some people spoken with were not aware of recent trips out. One person case tracked particularly enjoyed painting sessions and had some of their work displayed. They also said they enjoyed the monthly church service and Holy communion, which they can attend at the home. Some said that they would like access to library books or reading materials, including large print or talking newspapersfor those with sight difficulties, which are not available at the home. There is an activities notice board, which details activities, events and entertainments. These included painting, crafts, manicures and hand massage, coffee mornings, pat dog, board games and quizzes. Photographs are displayed of various events, including bulb planting, reminiscence day and the autumn fayre held at the home. Trips out during the summer have included Chatsworth, Bakewell and Ladybower. There are also a variety of entertainers who come into the home, including on the day of our inspection when an organist played during the afternoon. Hand massages and manicures were also available during the morning of our visit. Some people said that trips out were limited to a few or often the same people, which was thought may be due to a lack of time/staff availability to support the activities co-ordinator. One recent trip was able to accommodate three wheelchair users. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 17 Although aspects of people’s known daily living preferences and routines are recorded, together with some instances of their involvement in activities, people do not have a person centred written care plan in respect of these. People’s wishes, capacities and arrangements for the handling of their financial affairs also not recorded. People are able to bring personal posessions, including items of furniture into the home. People said that they usually like the meals at the home, that there are menus, although available in small print only and that there is usually an alternatve choice provided. However, some said that at tea time recently there was not always enough of each item, which restricted their choice of food. People who choose to stay in their own rooms in the evening said that they are not always offered an evening drink there and felt that this depended which staff are on duty. Three people said that mid morning and mid afternoon drinks are occasionally missed or sometimes very late if there are staff shortages or staff are busy. At our visit drinks were served at key times and people’s fluid and dietary charts seen were properly completed. We observed lunches and the tea time meal served and the assistance provided for people. Overall, these were well organised and people observed received the assistance and support they needed. Some people ate in their own rooms with individual staff assistance. Breakfasts were completed by 10.45 am, although lunches were served at 12.40 pm, finishing at around 13.30 hrs with afternoon tea at 16.30 pm. Some people felt these to be close together, although all said they received sufficient food, which they usually enjoyed. Staff put on music at lunchtime in the dining room on both days of our visit, people dining were not consulted about their preferences for this, the second day being loud pop music. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 18 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): NMS 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For the most part, individual complaints made are taken seriously by the home and acted upon. However, further address of key themes emerging from these may further benefit the people who live at the home. EVIDENCE: At our last key inspection of this service we judged that the arrangements for the management and handling of complaints, if effectively continued should better promote the people’s protection. We said that the quality outcome in this area was adequate. In our annual quality assurance questionnaire completed by the home, they say that they have a suitable complaints procedure displayed and that people are confident to voice any concerns they may have. That they ensure correct procedures are followed concerning complaints and allegations. They say they have improved over the last twelve months – by ensuring that the majority of staff attend training with regard to recognising, preventing and reporting of abuse and that improvements have been made in the recording, Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 19 investigation and management of complaint handling together with communications between the home and external agencies. They feel they could do better by providing staff training in dealing with challenging behaviour, which they aim to meet over the next twelve months and by ensuring that newer staff who have not done so, attend training with regard to recognising, preventing and reporting of abuse. They also say they have received eight complaints since our last key inspection of this service in February 2007, which are investigated and recorded. These include two where areas of concern were raised via individual care reviews. At this inspection we discussed complaints made about the home with the regional manager and examined records kept in respect of these. Two of these alleged insufficient and reduced staffing levels at the home, including one, which also alleged poor hygiene care for a resident. The remaining five concerned specified areas of poor care practise, including alleged lack of fluid intake, lack of equipment, poor hygiene care, poor communications, including staff handover systems and lack of follow up relating to medical/health care needs. One of these was made directly to social services as the funding authority for a particular person, who then carried out a number of visits to the home at various times. There has also been one area of concern investigated via social services joint agency safeguarding adults’ procedures, passed to the home for their internal investigation. This was partially upheld and satisfactory action was taken by the home in respect of this. We also received one complaint about alleged reductions in staffing levels at the home, which is included in the above. Allegations of insufficient/reduced staffing levels at the home were not fully upheld. However, management advised that that there have been problems with short notice illness from staff, which sometimes have been impossible to cover at such short notice, although agency are used wherever possible. Management also advised us regarding application of their disciplinary procedures with some staff due to their conduct in relation to the home’s sickness and absence procedures. The two areas of complaint relating to a lack of equipment are substantiated and resolved. Three of the complaints relating to the alleged poor care practises are partially substantiated by the home and two are not substantiated. The detail of the action, which is taken by the home, is also recorded. One is currently being Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 20 looked at with the complainant via the formal care review process and is not concluded. The feedback we have received from social services in relation to their visits to the home and also their care reviews advises are overall satisfied with planned staffing levels at the home and the home’s response with regard to staffing deficits as resulting from short notice absence by staff. They also advise us that many residents and relatives are satisfied with the care they are receiving, and that some praise the home. However, the feedback we have received from them about their visits to the home, indicates their considered view that leadership and organisation is not always consistent or strong when senior management are not present, which can result in variable outcomes for people who use the service. The evidence we have obtained from our inspection, which emerges under the various sections of this report are also reflective of this. During our inspection visit we spoke with people and also asked people by way of our written survey if they know who to speak to if they are unhappy and whether they know ho to make a complaint. People spoken with said they knew who to speak to if unhappy and knew how to complain. People surveyed said the same except one who felt communication to be an issue, often preventing any concerns from being passed on and dealt with. A copy of the complaints procedure is displayed on the residents’ notice board and there is clear information about how to complain in the home’s service guide/brochure. The majority of staff spoken with confirmed they had undertaken training and instruction in relation to safeguarding vulnerable adults. Those who had not undertaken formal training were aware of reporting procedures to follow in the event of any suspicion or witnessing of the abuse of any person residing at the home. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 21 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 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, people live in a clean and comfortable environment, which is decorated and furnished to a good standard, although more prompt attention to the maintenance and repair of equipment at the home would better assure people’s choice and safety. EVIDENCE: At our last key inspection of this service we judged that overall people live in a safe well-maintained environment, which for the most part suits their need and is decorated and furnished to a high standard. We said that the quality outcome was good. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 22 We made one requirement and three recommendations at that inspection. That the missing fixed seat hoist to a specified bathroom be replaced in order for people to be able to use this. That suitable signing is provided at appropriate locations in the home to assist people in their orientation. That consideration is given to the possible provision of more choice of lounge space and the provision of a rollator iron in the laundry. In our annual quality assurance questionnaire completed by the home, they say that there is an excellent standard of accommodation throughout including cleanliness and that people’s own rooms are well personalised according to their wishes. They say they have improved over the last twelve months by providing better maintenance and housekeeping schedules and by their planned improvement to bathing facilities, which has commenced. They feel they could do better by improving the laundry facilities and bathing facilities and by completing bathroom upgrading and repairs, which they aim to do over the coming twelve months but ensuring that bathroom upgrading and repairs are completed shortly. At this inspection we spoke with people about their environment, asked people by way of written survey if the home is fresh and clean and inspected the private and communal areas accessed by those people case tracked. We also looked at all bathroom facilities. For the most part, people are satisfied with their environment, although are still unable to access some bathrooms due to repairs outstanding. We noted that works have commenced, as planned in accordance with grant obtained monies in order to improve bathing facilities. We discussed these with management and also agreed to extend the timescale to our previous requirement made in conjunction with these works. Areas of the home that we inspected were clean and odour free, with the exception of some wheelchairs, which would benefit from regular cleaning and one bathroom where dirty linen was left on the floor (despite the availability of an empty linen skip in the vicinity). There was also a full bag of soiled incontinence pads left open there on the floor. A number of bathrooms were cluttered and untidy, having other equipment stored therein, making access in some instances difficult. There have been no improvements made to signing at the home. A rollator iron is not provided. One of the quiet rooms is now more furnished with comfortable chairs to better accommodate people. Hot water temperatures from some bathing outlets (including a shower) were scalding hot to touch. Additionally some cold water taps emitted warm water. This was discussed with the manager and maintenance person and direction was given by the manager as to the action to be taken. There were no up to Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 23 date records of hot water temperatures as taken from bathing outlets available for inspection. The regional manager has verbally advised us since our inspection that these are made safe. Overall standards of décor and furnishings are good and people’s own rooms inspected were personalised, clean and comfortable and suitably equipped in accordance with people’s individually assessed needs. A change of use of an internal store cupboard, which opens directly into the main lounge, has occurred since our previous inspection of this service. This is now a staff working office and is contrary to plans submitted and agreed by us on registration approval. This room has no ventilation, is excessively hot in environmental temperature, requiring the door to be left open when in use and is only accessible via the residents’ lounge, which impacts on people’s privacy. Details of the most recent inspection visit from the local fire authority officer were also provided at this inspection, together with details of their planned revisit to the home in November 2007. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 24 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. People benefit from a staff team who are properly recruited, inducted and for the most part reasonably well trained, although staffing arrangements at the home do not always promote consistency and best practise in the organisation and delivery of care for people. EVIDENCE: At our last key inspection of this service we judged that there had been considerable improvements made with regard to the staffing arrangements in the home, which have improved outcomes for people, better promoting their safety and protection. We said that the quality outcome in this area was adequate. We made a requirement to ensure that persons employed to work at the home, receive training appropriate to the work they are to perform. This referred to a previously agreed improvement plan for the home in relation to staff training. As the majority of this improvement plan was achieve at that inspection, we gave an extended timescale to achieve the two areas outstanding. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 25 In our annual quality assurance questionnaire completed by the home, they say that they have a thourough recruitment procedure. That rotas are planned well in advance and staffing levels planned to ensure people’s needs are met. They say they have a high commitment to staff training and development and that regular staff meetings are held. A planned programme of staff supervision is now devised. They say they have improved over the last twelve months by – developing their approach to staff training needs analysis and planning and by the recruitment of more permanent staff resulting in the reduction of their use of agency staff. They feel they could do better by increasing their dedicated training hours provided for staff and in ensuring that staff that require, undertake infection control training. They aim to achieve these over the next twelve months along with their imminently planned recommencement of alternative NVQ training arrangements. At this inspection we spoke with people who use the service about staff availability and asked people by written survey if staff are available when they need them. We also spoke with staff about the arrangements for their recruitment, induction, training and deployment and examined related records, including staff personal records for four of the most recent staff starters. Opinions as to staff availability and staff deployment arrangements varied considerably. The majority people accommodated we spoke with or surveyed said staff are usually available, although many felt that this was sometimes affected by unplanned staff absence. Some said staff is sometimes available. Some staff felt that more care staff are required as did some relatives and one person surveyed. However, all staff expressed the view that leadership, support and organisation for staff was significantly lacking on some shifts, particulary in the absence of senior management and some experienced care staff felt that staff skill mix, (where there are more inexperienced staff on duty), particulary if coupled with perceived poor leadership did adverseley impact on the organisation and delivery of care for that shift. Staff also raised concerns about communication and a lack of handover for care staff. (See management section of this report). At this inspection visit there were forty nine people accommodated, nineteen receiving nursing care. Rotas are planned to provide one nurse and eight care staff for the morning shift, one nurse and seven care staff for the afternoon shift and one nurse and three care staff at night. Activities and hotel services Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 26 staff are additional to these. Resident dependencies were confirmed by management. Staff hours confirmed by the home in our annual quality assurance questionnaire as provided for the then 44 people accommodated equated to that recommended by the residential forum staffing tool. Staff spoken with confirmed satisfactory arrangements for their recruitment, induction and training and records examined reflected this, with the exception of two people’s application for employment forms, which were not fully completed. However, full and proper employment checks were obtained in respect of all people who personal files were examined. We also saw written confirmation from the proposed provider arrangements to re-commence NVQ training at the home. At the time of the inspection there were six people accommodated with dementia, including one person with signficant wandering and confusion. Some staff expressed concern about their ability and confidence to care for that person and discussions with them revealed a lack of training and knowledge with regard to recognised dementia care practise. This was discussed with management. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 27 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, 26 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health, safety and welfare is reasonably accounted for, although staff views, as to the conduct of the home, together with the views of people who access the service are not always effectively listened to, accounted for or acted upon by the registered persons, which may not be in the best interests of people who live there. EVIDENCE: At our last key inspection of this service we judged that the substantial improvements made with regard to the management and running of the home Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 28 were resulting in people’s best interests and safety, health and welfare being better promoted. We said that the quality outcome in this area was adequate. We made two requirements at that inspection about environmental risk assessments and the maintenance of the emergency call system. These have been complied with. In our annual quality assurance questionnaire completed by the home they say they have improved by introducing revised quality assurance and monitoring systems, including financial and systems auditing covering all aspects of the service. Also, that they have recruited an experienced home manager, who has substantial support from a well-qualified regional manager. They have also begun to review some of their policy guidance, with a number of key policies revised and updated. They feel they could do better by ensuring that all policies are revised and updated as necessary and in ensuring that those staff who have not yet done so attend suitable health and safety training. They aim to achieve these over the coming months along with ensuring continued service auditing and quality monitoring. At this inspection we spoke with people about the arrangements for the management of the home, including direction and leadership and methods for consultation with people about the home and its service aims and objectives. (The comments we have made about direction and leadership at the home made under the staffing section of this report also apply here). We looked at the arrangements for the management and handling of people’s monies via those people case tracked. We also looked at the arrangements for safe working practises, including staff training and the reporting and recording of accidents via those people case tracked. Since our previous inspection we have received written notification of the appointment of a manager for the home. At this inspection the manager was absent from the home. Interim management arrangements and support are provided from the regional manager, who is operational at the home on a full time basis in her planned absence. Staff spoken with expressed concerns about some aspects of communication at the home, including the absence of formal handovers for care staff on each shift. They said that this resulted in them not knowing key information about changes to people’s care or about new people admitted to the home. Some staff also expressed concerns about their considered view as to the lack of leadership and support by some senior staff in charge of shifts. We discussed these issues with the regional manager at this inspection. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 29 Staff said that the new manager had commenced appraisals and individual supervision sessions, which some had received, although these had not continued in her absence. We looked at the home’s quality assurance and monitoring systems discussed these with the regional manager, along with the home’s written development/action plan. We also looked at a satisfaction questionnaire recently devised and due to be circulated to people. Meetings are held with people who live at the home and their relatives and representatives and minutes of those meetings are provided. There is a comments and complaints book on reception and a suggestions box located there. Staff said that access to training was usually good and confirmed that training in safe working practises are regularly organised. Comments made under the Environment section of this report with regard to safe water temperatures and handling of dirty linen also apply here. Staff spoken with is conversant with procedures to follow in the event of an accident or untoward incident and accident records examined via case tracking are properly kept. Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 30 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X 3 2 X 2 Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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(1) Requirement Where necessary, people’s written care plans must detail clear care interventions for staff to employ, which accord with recognised dementia care practises, associated in dealing with individuals’ confusion/agitation and wandering behaviours. Gaps of recording must not be left in medicine administration record (MAR) sheets. Staff responsible must sign to indicate whether a medicine is given as prescribed, or where this is not given the recognised coded reason entered onto the MAR sheet. Medicines must only be administered to the people they are prescribed and supplied for as labelled by the supplying pharmacist. They must not be used in any circumstances, for any other person, who may be prescribed the same medicine. Assisted baths and associated equipment must be maintained in a good state of repair to be DS0000002046.V341609.R01.S.doc Timescale for action 31/12/07 2. OP9 13(2) 31/10/07 3. OP9 13(2) 31/10/07 4. OP22 23(2) 30/11/07 Brookview Nursing Home Version 5.2 Page 32 5. OP19 23(2) 6. OP25 13(4)(c) 7. OP27 21 8. OP30 18(1)(c) 8. OP31 8, CSA 2000, S(11) accessible for people to use. Works and repairs commenced are to be completed. (Original timescale 30/04/07 – extended timescale agreed). The layout of the home must meet with people’s needs and ensure their privacy. In this instance staff office space opening onto and accessed by the main lounge must be reviewed and be suitably relocated. (NMS 38 also applied here). Unnecessary risks to people’s health and safety must be identified and so far as possible be eliminated. In this instance regular checking and maintaining up to date records of hot and cold water temperatures from outlets used by service users with prompt and necessary action taken to ensure people’s safety. At all times. (OP32 also applies here).Staffs’ expressed views as to the conduct of the home with regard to its staffing arrangements and its leadership, support and organisation must be listened to and acted upon by the registered persons with the aim of ensuring improvements in the consistency of care and support for people who live at the home. Staff must be provided with dementia care training, together with infection control training for those who are outstanding this. The manager appointed to the home must submit a registration application to the Commission, or in their absence, should the regional manager continue to manage home, that person must submit an application to the Commission for their DS0000002046.V341609.R01.S.doc 31/12/07 10/10/07 30/11/07 31/12/07 31/12/07 Brookview Nursing Home Version 5.2 Page 33 registration. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations (OP12 also applies here). People should have written daily living plans in place, which account for their known daily living preferences, routines and choices as agreed with them. The conduct of the home should be aimed at maximising people’s rights to exercise personal autonomy and choice in respect of their daily lives and with consideration to recent and relevant guidance such as the Mental Capacity Act. People’s choices and arrangements for their financial affairs should be recorded within their care planning records. Bathrooms should be left tidy, clutter free and be accessible for people to use and should not be used to store other equipment. Staff employment application forms should always be fully completed. Staff handovers should be provided on each shift change to ensure that all staff are given key information necessary to assist them in their role and with their responsibilities. Formal methods of consultation with people about the home, such as satisfaction surveys should be regularly employed and the results of any such consultation surveys be shared with people and used to inform service development and improvements. 2. OP14 3. 4. 5. 6. 7. OP14 OP22 OP29 OP32 OP33 Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Brookview Nursing Home DS0000002046.V341609.R01.S.doc Version 5.2 Page 35 - 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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