Inspection on 25/01/06 for Brownhills Nursing Home

This inspection was carried out on 25th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brownhills Nursing Home 23/11/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Brown Hills Nursing Home 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS Lead Inspector Mrs Mandy Beck Announced Inspection 25th January 2006 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 Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 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. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brown Hills Nursing Home Address 29-31 Hednesford Rd Brownhills West Midlands WS8 7LS 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) 01543 374114 Kidderminster Care Ltd Dawn Lindsay Whitehouse Care Home 38 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (38), of places Physical disability (38), Physical disability over 65 years of age (38), Terminally ill (6), Terminally ill over 65 years of age (6) Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29th September 2006 Brief Description of the Service: Brownhills Nursing Home is located in a pleasant residential area on the outskirts of Brownhills, not far from Chase Water Country Park. The home is accessible by public transport. A shop and day club for the elderly are close by. The home is registered to provide nursing care to a maximum of 38 people. The external appearance is attractive but unusual. It was transformed some 15 years ago from a nightclub to its present form. It has good size car park at the front and a generous size, attractive garden to the rear. The home has a high proportion of double bedrooms, three of them have ensuite facilities. There are only six single bedrooms within the home. There is a large lounge with a clearly defined dining area on the ground floor and a smaller lounge with dining area on the first floor. There are assisted bathing and toilet facilities throughout the home. The ground and first floor are accessed by passenger lift Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection which took place between 09:30 and 16:30 hours. This was the second of the homes statutory inspections this year. The judgements made throughout this report are based on information supplied from the pre inspection questionnaire, comment cards received from both residents and relatives. Residents individual files were seen for case tracking purposes and staff files were inspected to assess the homes recruitment and selection processes. A tour of the premises was also completed, other time spent during the day involved talking to staff and residents to gain their views of life at Brownhills Nursing home. The home’s progress in meeting the requirements from previous inspections was also monitored. The registered owner and manager were present throughout the whole process. What the service does well: What has improved since the last inspection? The home has taken positive action the meet most of the requirements from the last inspection. There is evidence of redecoration throughout the home, lounges, dining rooms and corridors have all been decorated and new flooring has been laid throughout most of the home. Residents commented “I think it’s Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 6 much more homely now, it’s relaxing and I’ve got a new chair”, “it’s been noisy but I think it’s been worth it” The registered manager has taken active steps to greatly improve the quality assurance system the home has in place. The registered owner has purchased new equipment to replace worn out items such as the hostess trolley and six new height adjustable beds for service users comfort. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 Residents can be assured that their needs will be met when they move into the home, following a thorough assessment. This is confirmed in writing to residents and each resident has a written contract/statement of terms. EVIDENCE: Residents files were examined and terms and conditions were seen for all residents and detailed all relevant information, these had been signed by the residents or their representative demonstrating they have understood the contents. Each resident has their needs assessed prior to admission and the manager provides them with a letter informing them that the home is able to meet their needs. The assessment is thorough and covers all activities of daily living. It is pre printed this gives a framework to the assessment so that all aspects of health and personal care needs can be recorded. Residents are involved within this process and demonstrate this by signing their assessments. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Every resident has an individual plan of care and they can be assured that their health needs will be met. Medication policies protect the residents and medications are administered safely. Residents do feel that they are treated with respect and that their privacy is upheld. EVIDENCE: Each resident has an individual care plan which details all of there assessed needs, the care plans reflect all aspects of health, personal and social care. There is evidence that the care plans are reviewed at least on a monthly basis and that residents are involved in the process where possible. This is demonstrated by residents signing their individual care plans. There are risk assessments for pressure sore risk development, falls, moving and handling and nutritional screening. These were seen in all residents files chosen generally they were all completed but in one residents file the pressure sore risk assessment had not be signed, dated or reviewed. There is a nutritional screening tool for all residents but staff must take measures to ensure that all identified risks have an appropriate management plan. One Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 10 resident’s screening indicated that they were at risk with a score of 12 but there was no evidence of a management plan to demonstrate how this risk was going to be reduced or managed. The home actively records each resident choice of meals on a daily basis but it needs to develop a more in depth system of recording exactly what each resident eats so that they have an accurate record particularly for those residents identified as being at risk. Residents spoken to indicated that staff treat them with respect and in a manner they find respectful. “the girls are lovely they always smile and are very friendly”. “I can’t complain about anything they help me in the shower” Another resident commented “I’ve had a new bed it’s comfortable and I sleep much better”. Staff were observed talking to residents and it was evident that these were positive interactions for residents. There was evidence to show that residents are reviewed on a regular basis by a range of health care professionals, doctors, dentist, chiropody, community psychiatric nurses and opticians. The home continues to use quilts are a method of pressure relief and has the support from the tissue viability service for this practice, the home has a low incidence of pressure sores. All charts pertaining to residents health care were found to be completed in full these included blood sugar monitoring, bowel charts, turn charts and personal care delivery. Comments from residents and relatives included “since going into the home she is no longer depressed and has a smile for everyone”, “if I’m ill the doctor comes to see me the matron sees to this” None of the residents administer their own medication. The home has robust policies and procedures in place to ensure that residents interests are safeguarded. Qualified nurses administer all medication, some minor shortfalls were observed. There is evidence that medicines are being over ordered and this has lead to a build up of stock. The opening date of all medicines and “calogen” needs to be recorded. Nursing staff must ensure that all gaps or omissions recorded on Medication Administration Record charts can be accounted for. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection EVIDENCE: Although none of the above standards were assessed during this inspection, outstanding requirements were looked at, one requirement remains outstanding all others had been met in full. Each resident now has an individual record of social activity, individual preference and activity charts are now completed. Menus include four meal options and each residents choice is recorded, the manager still needs to introduce the food consumption charts for those residents identified as being at risk. Residents were spoken to about their choice of size of plate they have at meal times and it was observed that residents now have a choice of dinner sized or tea sized plate for every meal. “I was asked but I like the little plates you get enough food on them” Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents can be confident that all of their complaints will be listened to and acted upon. Residents are protected from abuse. EVIDENCE: Information from comment cards returned indicated that not all residents or relatives are clear about how to make a complaint and this should be explored by the manager. There is currently no complaints log this is because the home has received no complaints during the last twelve months. The complaints procedure and policy need to be updated to ensure that it meets the minimum standards. This will give clarity to residents and other interested parties should they wish to make a complaint. The home has policy guidance on protection of vulnerable adults and a whistleblowing policy. The manager and deputy matron have recently completed their abuse training, this training should now be arranged for all staff to ensure that all aspects of abuse can be recognised and appropriate action is taken. The home has an appropriate financial policy and stores residents monies safely. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The environment is being redecorated throughout and is clean and hygienic for residents to live in EVIDENCE: There have been major improvements within the home since the last inspection. The lounges and dining areas have been tastefully redecorated and new flooring has been laid. Residents commented “it’s been noisy but they have done a good job”, “it’s lovely but it did need doing and I have had a new chair” “the tables are really posh”. In addition to the decorating the residents have benefited from new chairs to replace the worn out ones with more chairs on order. There has also been a delivery of six new height adjustable beds, residents were very impressed with these new changes “I’ve got a new bed it’s really comfortable I get a good nights sleep”. The glass partitions and fluorescent lighting remain but are now not as evident because the eye is drawn to the décor and furnishings. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 14 The kitchen has had new flooring as required, the windows have been repaired and all required catches/handles are in place. The flooring outside the laundry area has been addressed and is now even and the whole area has now been re-carpeted. The cracks in the laundry walls have been filled and are ready for painting. The home has recently been visited by an Occupational Therapist who undertook an assessment of the premises and the facilities within it, the report addresses the suitability of bathing and toilet facilities around the home some recommendations have been made and the registered owner and manager are considering them. One double bedroom is currently being adjusted so that an additional storage room can be provided for wheelchairs to reduce the trip hazard they could present for service users. The bathroom on the first floor appears gloomy even when the light is on. The manager should consider ways in which to improve the lighting and eliminate the gloomy feel of the room. There are still some stained and worn carpets in resident’s bedrooms that need replacing and repairs to damaged beds needs to be addressed (room 19). Liquid soap and paper towels were seen in bathrooms and toilets. Hand wash signs were on display in many area. Staff have access to gloves and aprons to reduce the risk of cross infection from resident to resident. Care should be taken not to leave individual residents toiletries in communal bathrooms and continence products should not be stored in toilets or bathrooms as each resident has their own individual supply for individual use. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,30 Staff are given appropriate training and induction ensuring that they have the knowledge and skills to meet the needs of residents they care for. EVIDENCE: The home currently has fifteen of it’s care staff with an NVQ level 2 qualification this exceeds to 50 minimum ratio required by the national minimum standards. All newly appointed staff are registered on TOPSS induction training programme. Staff files were seen and all relevant documentation was present, this included POVA/CRB disclosures and a job description. The manager must however ensure that all gaps in employment history are explored and the reasons documented. Staff commented that they are “kept up to date we do training every year”, “I’ve done my NVQ 2 and all the yearly training like health and safety”. Certificates were seen in each employees files for all training completed in the last year Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 The home is generally run in the best interests of residents, who can be assured that their financial interests are safeguarded. The health and safety of residents is promoted. EVIDENCE: The manager has developed the home’s quality assurance systems and should be commended on the hard work that this has involved. Systems are now in place for an annual review based upon the cycle of planning – action – review, this will help to develop the service in the best interests of the residents. Questionnaires developed to obtain residents points of view are objective and based around the national minimum standards, what the manager needs to do now is to further develop the system so that views of relatives, and stakeholders in the community can be obtained. The results of which should be published for all interested parties to read. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 17 The home is not responsible for managing any resident’s money but they do hold small amounts of personal allowance for two residents. Their monies are held in a secure location and all receipts and records of transactions were satisfactorily completed. Residents can have confidence that their monies are being well looked after. Evidence seen in residents files of risk assessments for the use of foot plates on wheelchairs this was a requirement from the last inspection and has now been met. Additionally the home has purchased a new hostess trolley to replace the old one this helps keep food warm whilst it is being served to the residents. the passenger lift has recently been serviced and confirmation of this was seen by the inspector, some recommendations were made as a result of the service and the registered owner is considering them. The home has improved it’s storage of COSHH items and has provided a folder with all relevant manufacturers data where these products are stored. The fire officer has recently completed an inspection of the premises and the home has taken steps to meet the requirements highlighted by the fire officer. Staff have received a recent fire safety training day with another planned for April. Those residents who have requested that their bedroom doors remain open have had suitable automatic door closures installed. All wardrobes have been secured to the walls to prevent residents from moving furniture and placing themselves at risk. Suitable locks have now been fixed to sluice doors to prevent unwanted access and reduce risk to residents. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 18 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 3 3 3 X X 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 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 19 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 OP19 Regulation 23(2)(d) Requirement The registered person and manager must ensure that the external rendering is painted (previous timescale not met 01/12/05) The registered person and manager must ensure that individual food consumption charts detail what residents have eaten throughout the day. (previous timescale not met 14/10/05) The registered manager must ensure that all risk assessments are kept up to date, are signed and reviewed and this is documented. All risks identified must have an identified management plan The registered manager must ensure that there are no gaps MAR charts and all omissions are accounted for. The opening date must be recorded on all medicines this includes Calogen Timescale for action 30/04/06 2 OP15 17(2) sch 4 (13) 01/03/06 3 OP7 17(3)(a) 01/03/06 4 OP9 13(2) 01/03/06 Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 20 5 OP16 22 Medicines no being used should be disposed of to avoid overstocking of medication The registered manager must 01/03/06 ensure that the complaints policy includes all the required information in standard 16 6 7 OP18 OP19 Ensure that once the new policy is completed that all residents and their relatives receive a copy 13(6) The registered person and 01/07/06 manager must arrange training for all staff on Adult Abuse 23(2)(b)(c The registered person and 01/04/06 (d16(2)(c) manager must provide the CSCI with a programme for the continued maintenance and redecoration of the premises. This will include dates for the staged replacement of bedroom carpets. And Decoration of remaining bedrooms The registered manager must ensure that all gaps in employment history for prospective employees are accounted for and the reasons are documented The registered manager needs to build upon the existing system of quality assurance by Seeking stakeholders views Publish the findings for all interested parties 8 OP29 19 01/03/06 9 OP33 24 01/05/06 Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP8 OP8 OP26 OP9 Good Practice Recommendations The manager should explore other methods of monitoring those residents weights who find it difficult to use conventional scales The registered manager should give consideration to the introduction of individual bed rail risk assessments Residents toiletries should be kept in their own rooms not in communal areas The registered manager should consider purchasing a destruction kit for controlled drugs. Brown Hills Nursing Home DS0000064827.V273168.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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