Inspection on 06/02/07 for Brookview Nursing Home

This inspection was carried out on 6th February 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 26/09/07

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 Key Unannounced Inspection 6th February 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 Brookview Nursing Home DS0000002046.V327974.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.V327974.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.V327974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th October 2006 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. There is a choice of communal bathing, shower and toilet facilities suitably located. There two separate lounge areas and one combined lounge/dining room. A number of aids and adaptations are provided to assist service users 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 service users are provided with care and support from a team of nursing, care and hotel services staff, led by the registered manager who has external management support. Fees charged per week are in accordance with agreed terms and conditions between the home and individual resident. They detail local authority purchasing contracts where individuals are funded via these or where privately funded they are in accordance with a written contract agreed between the home and individual resident. Fees charge are as follows:Residential clients (personal care only) - As at 26.04.06 fees range from £289.70 to £369.70 per week. Fees are banded and determined in accordance with individuals assessed needs/levels of care and individual accommodation. Nursing residents per week - As at 26.04.06 fees range from £409.40 to £509.40. These fees are current as at the time of the inspection. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the third key inspection of this service for the inspection year 2006-07. Following the last key inspection in October 2006 we wrote separately to the registered provider about the serious concerns we had about the service with regard to specified Care Homes Regulations 2001, which had been persistently breached. We told the provider what they must do and asked them to provide an improvement plan telling us how they were going to make the necessary changes to comply with the regulations and to improve outcomes for people who use their service. They have also provided us with weekly management update reports in conjunction with their improvement plan and we have undertaken a number of unannounced random visits to the home, together with this inspection. At this inspection there were 46 service users accommodated, including 21 receiving nursing care. Case tracking was used as part of the methodology. This involves the random sampling of a number of service users (4), whose care and service provision is examined more closely. This included discussions with them and also their representatives and staff about their care, the examination of their care plans and associated care records and inspection of their private and communal accommodation. What the service does well: What has improved since the last inspection? Service users and their representatives have increased confidence that that home is now better able to meet individual’s assessed needs. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 6 There is an increased sense of management accountability for service users health and personal care resulting in their health and welfare being better promoted and protected. The organisation of activities and meals and mealtimes has improved considerably. There are satisfactory arrangements in place and a more suitable approach to the acknowledgement, management and handling of complaints. There are substantial improvements to the management and staffing of the home, with service users best interests and safety and welfare being better promoted. Good progress has been made in all areas where improvements were required in accordance with the home’s improvement plan and previous inspection report requirements, with the exception of some aspects of staff training, for which the home has a timely written programme to ensure this is complied with. What they could do better: Ensure that the improvements made in terms of the management and staffing of the home continue in a timely manner, via its quality assurance and monitoring systems, which are proactively based on seeking the views of service users, their representatives and outside stakeholders. Continue to develop and sustain a track record of clinical accountability and appoint a suitable registered manager. Ensure the prompt and effective re-establishment of suitable adaptations and equipment in the two bathrooms with missing hoists and provide suitable orientation signing within the environment. Ensure that action is always progressed within agreed timescales to implement requirements made in CSCI inspection reports. Please contact the provider for advice of actions taken in response to this Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 7 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.V327974.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.V327974.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): NMS 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their representatives have greater confidence that the home is better able to meet individuals’ assessed needs. EVIDENCE: At the last key inspection of this service (October 2006) a requirement was made with regard to records of service users health and personal risk assessed care needs, which were not always being kept under review and amended where necessary. During this inspection case tracking was undertaken in respect of four service users accommodated. Each of these had satisfactory, up to date and comprehensive needs assessment information recorded, including that relating to identified areas of risk (including falls, nutrition, pressure ulcer, use of Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 10 equipment and moving and handling) although an up to date list of individuals current medicines were not always maintained within their needs assessment information in accordance with their individual medicines administration record sheets. A revised individual needs assessment and care planning documentation format was being introduced, with a total of ten service users transferred onto the new documentation, including two of those service users case tracked. Discussions were held with service users as able and also some of their representatives. All said that significant improvements had been made in respect of the arrangements for their daily living routines and choices and all felt that their needs were now being better (and adequately) met in consultation with them. The home does not provide for intermediate care. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 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. Overall, service users personal and health care needs are adequately met and accounted for and their health and welfare better promoted and protected. EVIDENCE: At previous inspections of this service during 2006 (January and October) requirements were made in respect of service users care plans, which did not always detail how their needs were to be met, were not always kept under review or revised where necessary in accordance with identified risks. Advice provided by Social Services and Derby County Primary Health care team in October and November 2006 via care reviews undertaken in the home for all funded service users, also detailed that service users’ care plans/health records were not being properly maintained and were unsatisfactory. Following the inspection in October 2006, as required by the Commission, the home provided Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 12 an improvement plan, which included details of how these were to be addressed by them. During this inspection the care plans of service users case tracked were examined. These were reflective of their documented risk assessed needs and had recent reviews recorded. Care interventions were clearly recorded in respect of their personal and health care needs, and were in accordance with guidelines concerned with the care of older persons, including that relating to risk of falls. However care plans were not signed as agreed by those service users who would be able to do so/or their representatives. Discussions were held with staff about the care of those service users case tracked and they were conversant with their needs and required care interventions, including equipment. Equipment provided in the private accommodation of service users case tracked as observed (pressure relieving mattresses and cushions, bedrails and mobility aids were in accordance with their written care plans. The health care needs and arrangements for service users to access outside health care professionals and for the purposes of routine and specialist healthcare screening were generally well accounted for and records were maintained in respect of these. However, staff is not always recording daily health records, including service users weights on the same record format. This appeared as seemingly deficits of recording. The need to record consistently on one agreed document to avoid confusion and misinformation was discussed with the acting manager who agreed to rectify this. At the inspection of this service in October 2007 three requirements were made in respect of service users medicines. These were complied with at this inspection. A report of the most recent visit from the local pharmacy supplier (21 January 2007) was provided. This detailed a number of recommendations in respect of equipment (which the pharmacy will supply to the home), and also with regard to the recording of medicines received, handwritten administration instructions, ordering and returns. During this inspection, the medicines administration record (MAR) sheets of those service users case tracked were examined and the arrangements for their storage were examined. These were satisfactory, with the exception that the hand written instructions on the MAR sheets of two of those service users were not signed by the staff member writing them or countersigned by a witnessing staff member. This was however, rectified by registered nurse responsible during this inspection. With the exception of one service user, who maintained their own inhaler, staff administered their medicines in accordance with their capacities and choices. However, the home’s medicines policy had been revised to include a more comprehensive assessment policy in respect of any service user who may wish to retain their medicines. The manager had instigated monthly medicines audits in order to monitor medicines practises in the home. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 13 At the previous key inspection of this service in October 2006, there were significant and numerous concerns from service users and their representatives relating to the poor organisation of care delivery and staffing of the home. At that time these severely compromised staff’s ability to adequately promote service users dignity and personal choice in respect of the arrangements for their health and personal care. Observations and discussions with service users and their relatives/representatives and also staff during monitoring visits conducted since that inspection and also at this inspection have evidenced clear improvements in this area. Service users and their relatives/representatives have however, always maintained that staff treat them with respect and uphold their right to privacy. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation and provision of activities and meals has improved considerably to the benefit of service users. EVIDENCE: At the key inspection of this service in April 2006 it was identified that the organisation of activities and occupation for service users was minimal. By second key inspection in October 2006 a part-time activities co-ordinator was employed, who had made considerable progress and improvements in relation to activities organisation for service users, both within and outside the home. However, feedback from service users at that time indicated that improvements were needed in terms of providing additional assistance to enable those who were more physically dependant the option of engaging in activities, which remained so at this inspection. Staff spoken with agreed with this and felt additional dedicated activities hours/an additional activities Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 15 assistant would be of benefit, given the dependencies of service users and their care needs. Details of entertainments and social activities were posted on the service users notice board and a variety of in house activities were organised, including board and card games, sing-alongs and crafts. Some service users attended outside lunch clubs and one service user case tracked regularly attended her local church service with support from the home. The local church minister visits regularly and provides communion in the home for those who wish to receive it. There were no service users accommodated with diverse cultural or religious needs. Visiting to the home is open and service users confirmed that they have visitors whenever they chose. Some go out to families and friends also as they choose. Service users case tracked had their own personal possessions in their own rooms and records of these were kept with their individual care records. Service users and their representatives knew about advocacy services, such as Age Concern and said that their care was discussed with them, but did not have information as to how to go about accessing their personal records, should they wish to do so. Over the year the standard of food has developed with full menu reviews and the provision of waiting staff to assist with the serving of meals. Feedback from service users throughout the year and at this inspection was that the standard of food is good with variety and choice provided by large pre-printed menus, displayed on each dining table on a daily basis. Baskets of fresh fruit are provided to dining tables and the lounge areas on a daily basis. However, at the last inspection of this service insufficient staffing arrangements severely impacted on residents’ routines, and including the arrangements for and serving of their meals and their individual food intake on a regular basis and numerous concerns were raised by service users and their representatives about this at that time. Over the course of the three monitoring visits undertaken to the home since then and at this inspection, observations were made of the organisation, serving and assistance to service users with their meals (breakfast, lunches and teas) and discussions were held with service users and their representatives and also staff about these. Good progress has been made with significant improvements made to the satisfaction of service users and meals observed were served in a timely manner to the benefit of service users. Service user dependencies remain high with some 18 plus service users requiring assistance with feeding at mealtimes. The ongoing arrangements of staff allocations for these, which were put into place in November 2006 as part of the interim management review and improvement plan for the home were discussed with care staff over the course of the monitoring visits and also at this inspection. At this inspection they expressed some concerns regarding the Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 16 recently revised allocation and management monitoring arrangements/support for care staff in relation to meals and mealtimes. These were discussed with the acting manager, who agreed to review and monitor this carefully. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. The now satisfactory arrangements for the management and handling of complaints, if effectively continued should better promote the protection of service users. EVIDENCE: Between 01 January 2006 and 30 September 2006 the home received a total of nine complaints. Two were concerned with dissatisfaction with procedures following the death of a service user and property loss/laundry. Seven were made by relatives of individual service users regarding their dissatisfaction with the standards of care and in some instances alleging a lack of care. Two of the seven were referred and investigation via Derbyshire County Council’s joint agency adult protection procedures, alleging neglect of care. All of the complaints have been either partially or substantially upheld. Action plans were provided by the home in response to the latter. In addition to the above up to the last key inspection of this service in October 2006, the Commission also received a further three complaints alleging insufficient staff levels and the personal care needs of service users not been adequately met, nor their individual choice and dignity relating to their daily living routines not being adequately promoted. The components of these were Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 18 investigated at the inspection in October 2006 and were upheld. (See also Staffing section of this report). There were also a number of thefts at the home over the year. Suitable action has been taken by the home in respect of these. At the time of the inspection, a joint review and investigation by the home and social services under local adult protection procedures in relation to falls suffered by a service user was being undertaken. The home has advised of the action they have taken in respect of this, which is satisfactory. The home has provided a written improvement plan as requested by the Commission in response to their inspection report of October 2006 and a warning letter issued to the provider following that inspection in November 2006 (See Management section of this report). This includes details of their proposed falls prevention and falls management strategy (see also Choice of Home and Healthcare sections of this report with regard to risk assessments and care plans in respect of falls for those service users case tracked). The improvement plan, which has also provided weekly management updates, is comprehensive and addressed all key areas of the complaints referred to above in relation to the management of the home, its staffing arrangements and care practises, with adequate progress to date. There have been no further known complaints made to the home or allegations or suspicions of theft made, nor to the Commission. The outcome of discussions held with service users and their relatives and representatives during the monitoring visits carried out since October 2006 and at this inspection were positive. All said that to date there were significant improvements in the staffing of the home and the organisation of care delivery and standards of care and that they felt that service users were safe and their care needs were being adequately met. The acting manager advised that she was reviewing the laundry service as a whole and intended to shortly hold an open day to provide opportunity for service users and relatives to view unclaimed laundry and clothing. The acting manager advised that a meeting was held with service users and their representatives in January 2006 during which revised complaints information was provided and past concerns openly discussed. Discussions were held with staff regarding recognising abuse and procedures to follow in the event or suspicion of the abuse of any service user. Staff is generally conversant with appropriate action to take, but not all were fully conversant with joint agency procedures. The manager advised provided a training plan during the inspection, indicating that 50 of staff required POVA/resident welfare training. This was planned by the end of March 2007 (see also Staffing section of this report). Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 19 Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 20 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, 20, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users live in a safe well-maintained environment, which for the most part suits their need and is decorated and furnished to a high standard. EVIDENCE: Inspection of the private and communal accommodation of service users case tracked was undertaken. All areas of the home were clean well lit and ventilated, overall safe and warm and provided a high standard of décor, furnishings and fabric in accordance with recognised standards. Service users and their families/representatives expressed high levels of satisfaction with the their rooms and standards of cleanliness, décor and furnishings in the home. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 21 However, during discussions a number of concerns were raised with regard to the congestion in the main lounge. Although the home provides sufficient communal space and has a main lounge and separate dining room, with a lounge area off and also a smaller quiet lounge, the majority of service users sit in the main lounge, which can and does become congested as observed during the inspection. Given the dependencies and mobility needs of many service users, this will require careful monitoring in terms of their individual safety, if the number of service users increase (currently 46) to the full capacity of 60. The quiet lounge tends to be used more for care reviews and private meetings. Additionally, some service users and their visitors felt that signage to aid orientation in the building was needed. There was a significant number of service users accommodated with varying levels of confusion. At the previous key inspection of this service, concerns were raised regarding the removal of fixed seat hoists in two bathrooms ( No 405 & 403) for repairs, which were not returned/replaced. These were not in place at this inspection. Although service users were able to access other bathrooms, for some these were a significant way from their own rooms. This was discussed with the manager who agreed to ensure these were replaced. There have also been ongoing problems with the emergency call system. At the random inspection visit in December a requirement was made to provide a copy of an up to date maintenance certificate for the emergency call system by 28 February 2007. This is not provided to date. The manager had undertaken an internal audit of the laundry and laundry systems which measured as poor. An action plan was devised in respect of this. Progress will be assessed at the next inspection of this service. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. There have been considerable improvements made with regard to the staffing arrangements in the home, which have improved outcomes for service users and better promotes their safety and protection. EVIDENCE: At the previous inspection of this service the quality outcome in this area was assessed as poor. Serious concerns were raised separately in writing with the registered provider in respect of insufficient staffing levels/skill which were impacting considerably on the arrangements for service users personal care and their health and welfare resulting in their needs not being consistently and effectively met. Following that inspection, concerns were also raised in writing with the registered provider regarding persistent breaches of regulation in respect of insufficient staffing levels, unsatisfactory arrangements for staff deployment and deficits in staff training. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 23 At the Commissions request, the registered provider forwarded an improvement plan detailing action they intended to take to make the necessary changes to comply with the regulations and improve outcomes for service users. Also as requested by the Commission, weekly management reports were also forwarded from the provider detailing progress in respect of the above. Further unannounced monitoring visits were undertaken to the home during December 2006 and January 2007 during which progress and improvements were monitored, which overall to date, are satisfactory. During this inspection the arrangements for staff recruitment, induction, training and deployment were further examined. This included discussions with the manager and staff and examination of related records, which were satisfactory. Discussions were also held with service users and their relatives and representatives. All felt that considerable improvements had been made and were generally satisfied with their care and support and continued to express that staff worked hard and that they had good relationships with them. Good progress has been made in all areas where improvements were required and with the exception of some aspects of staff training, previous requirements are adequately complied with. However, there were clear arrangements in place to ensure that outstanding training is completed by all staff and a written programme for the completion of these, including times and dates during March and April 2007 was provided during the inspection. Given the considerable work that has been undertaken to comply with regulations and improve outcomes for service users (see Management section of this report) an extended timescale is agreed to for completion of outstanding staff training as detailed on the home’s programme. A total of 51 of care staff have at least NVQ level 2 or above, with further training planned. The home continues to use agency staff, although this is being better managed and planned and there are suitable arrangements in hand in respect of the recruitment and employment of additional staff. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The substantial improvements made with regard to the management and running of the home are resulting in service users best interests and safety, health and welfare being better promoted. EVIDENCE: Previous inspections of this service during 2006 and up to the last inspection of this service have found the home to be inconsistently and often poorly managed, with a lack of effective and consistent quality assurance, management and monitoring systems resulting in the home being Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 25 inconsistently run and not in the best interests of the service users who live there. Following the inspection in October 2006 the Commission wrote to the registered provider outlining our concerns about the service, who provided a satisfactory improvement plan telling us how they were going to make the necessary changes to comply with regulations and to improve outcomes for service users. Weekly management reports with regard to the improvement plan have also been forwarded to the Commission up to this inspection, which are satisfactory. The registered manager employed at the time of the last inspection in October 2006 (from March 2006) along with the regional manager and clinical lead nurse also all left their employment at that time and suitable interim management arrangements were proposed by the registered provider and agreed by the Commission. These were maintained as agreed. At the time of this inspection a new regional manager was recently appointed, who will provide acting full time management of the home until a satisfactory appointment is made of registered manager Discussions held with staff, residents and relatives/representatives during this inspection indicated their overall increased satisfaction regarding improvements made (referred to under the relevant sections of this report) as relevant to the management and running of the home and with regard to their support and supervision. However, care staff expressed some areas of concern/reservation regarding the latter, with reference to their direct line management support and supervision, which was variable. This was discussed with the acting manager. Discussions held with the acting manager indicated her good business awareness. Clear systems that monitor practise and compliance with the home’s improvement/action plans and policies and procedures were in place with planned developments. These included the introduction of a full auditing and quality assurance and monitoring systems, review of the arrangements for the management of service users monies and staff/clinical supervision and competency monitoring strategies. Arrangements for formal group meetings with service users and their relatives/representatives had commenced with minutes recorded. Staff meetings had not been held, but were formally planned. Progress with the above will be monitored at the next inspection of this service. A number of records, which are required by law, to kept in the home, were examined during the inspection. These are referred to under the relevant sections of this report and include, service users health/care records, provider monthly reports, staff records (recruitment, deployment, induction and Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 26 training), complaints, accidents and incidents, food, visiting and maintenance records. These were generally satisfactory and suitably stored. Following the last inspection of this service, full individual care reviews were undertaken for all service users in the home via Derbyshire County Council Social Services. Concerns arising from those reviews were shared with the Commission and included issues around safe working practises, including moving and handling and clinical practises. All staff have received suitable moving and handling training since in accordance with the home’s improvement plan. There are also suitable management strategies in place as detailed above, in respect of staff clinical supervision and competency monitoring and training. Again progress will be assessed at the next inspection of this service. During inspection of the building a discussion was held with the acting manager regarding the security of the premises and service users safety in respect of the French windows in their own rooms. The manager agreed to ensure environmental risk assessments were undertaken as appropriate. Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X 2 X 3 X 2 STAFFING Standard No Score 27 3 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 3 2 Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13 Requirement Items identified in the supplying pharmacist report of 210107 must be achieved to ensure the correct arrangements for the ordering, recording and disposal/return of medicines in the home. Suitable adaptations and equipment must be provided for service users – in this instance assisted baths, which are capable of meeting the assessed needs of service users (replace missing fixed seat hoists). Suitable signing must be provided at appropriate locations in the home to assist service users orientation. The registered person must ensure that persons employed to work at the home, receive training appropriate to the work they are to perform. (Timescale extended in accordance with areas outstanding as detailed on the home’s training programme/plan). Recorded environmental risk assessments must be provided DS0000002046.V327974.R01.S.doc Timescale for action 31/03/07 2. OP22 23 30/04/07 3. OP22 23 31/05/07 4. OP30 18 30/04/07 5. OP38 13 31/03/07 Brookview Nursing Home Version 5.2 Page 29 6. OP38 13 with regard to the security and safety of individual service users whose own rooms have French windows. A copy of an up to date service 28/02/07 and maintenance certificate must be provided (forwarded to the Commission) for the emergency call system in the home. 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. Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Recorded needs assessment information should include current medication usage. Care plans should be agreed and signed by the service users wherever capable (or their representative) and should be accessible to them. 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. Consideration should be given to providing additional dedicated staff hours for activities. Consideration should be given to providing additional lounge space should service user numbers increase towards full capacity. A rollator iron should be provided in the laundry and action taken as necessary with regard to the outcome of the home’s internal audit of the laundry and laundry systems. 4. 5. 6. OP12 OP20 OP26 Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 30 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 Brookview Nursing Home DS0000002046.V327974.R01.S.doc Version 5.2 Page 31 - 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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