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Inspection on 28/09/07 for Brownscombe House Nursing And Residential Home

Also see our care home review for Brownscombe House Nursing And Residential Home for more information

This inspection was carried out on 28th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a Statement of Purpose and Service Users Guide that give prospective residents the information required to enable them to make an informed choice about where they live. Residents confirmed that they were visited by the Manager prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident`s preferences. Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents` finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The comments received from residents and families regarding the care received included: `Staff efficient and polite ` `there has to be a bit of give and take on both sides`. `She receives excellent nursing care and care workers are kind, considerate and supportive of her every need`. There is a robust recruitment process in place to protect the residents.

What has improved since the last inspection?

The programme of refurbishment continues. The recruitment process is robust and the documentation was available for inspection. Appropriate consultation was taken regarding the storage and labelling of food and smoking at the kitchen door. The corridors were free from obstruction ensuring the safety of the residents and staff.

What the care home could do better:

The pre-admission documentation does not give enough detail at present to ensure that the home has the necessary facilities and skills to meet the needs of the prospective resident. The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Shortfalls were found in the care plan documentation and risk assessments. The home staff need to ensure that the individual care plans reflect the residents identified needs and provide guidance for staff to follow. In particular, nutrition, pressure damage, communication, falls and medication. The equipment in use to prevent pressure damage needs to be used as directed and in full working order to be effective. From direct observation and from talking to staff, residents and relatives, the current staffing levels are not sufficient to meet the identified needs and impact on residents choices and preferences.Staffing levels and skill mix need to be assessed against the specific needs of the residents living in the home. Whilst the home have visiting entertainers there are no in house activities provided to provide mental stimulation and interest. Resident`s feedback was that `I am bored` `activities, I have never been to any`. Areas of maintenance that need to be prioritised were identified. The Manager confirmed that these will be actioned.

CARE HOMES FOR OLDER PEOPLE Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL Lead Inspector Debbie Calveley Unannounced Inspection 28th September 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brownscombe House Nursing And Residential Home DS0000017596.V349537.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. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brownscombe House Nursing And Residential Home Hindhead Road Haslemere Surrey GU27 3PL Address 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) 01428 643528 01428 643616 Mr L K Hasham Mrs Elizabeth Jane McAllister Care Home 36 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (36), of places Sensory Impairment over 65 years of age (1) Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 25 beds may be used for the provision of nursing care for elderly people from the age of 60 years One (1) named service user within the category SI/E (Sensory Impairment - over 65 years of age) may be accommodated. 9th January 2007 Date of last inspection Brief Description of the Service: Brownscombe House is a care home registered to provide nursing care for up to 36 older people, over 60 years of age. The home is owned and run by Care Homes of Distinction who also run similar establishments in Surrey. Brownscombe House is a large building in Haslemere that provides accommodation over three floors, which can be accessed by a lift. There is ample parking available to the front of the house. Fees charged as from 1 April 2007 range from £575 to £755, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Brownscombe House will be referred to as ‘residents’. This unannounced inspection was carried out over 7.5 hours on the 28 September 2007. There were thirty- five residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment has not been received at the point of writing this report. What the service does well: There is a Statement of Purpose and Service Users Guide that give prospective residents the information required to enable them to make an informed choice about where they live. Residents confirmed that they were visited by the Manager prior to admission to the home and two stated they had been invited to visit the home to see if they liked it enough to live there. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents’ finances. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 6 Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. The comments received from residents and families regarding the care received included: ‘Staff efficient and polite ’ ‘there has to be a bit of give and take on both sides’. ‘She receives excellent nursing care and care workers are kind, considerate and supportive of her every need’. There is a robust recruitment process in place to protect the residents. What has improved since the last inspection? What they could do better: The pre-admission documentation does not give enough detail at present to ensure that the home has the necessary facilities and skills to meet the needs of the prospective resident. The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Shortfalls were found in the care plan documentation and risk assessments. The home staff need to ensure that the individual care plans reflect the residents identified needs and provide guidance for staff to follow. In particular, nutrition, pressure damage, communication, falls and medication. The equipment in use to prevent pressure damage needs to be used as directed and in full working order to be effective. From direct observation and from talking to staff, residents and relatives, the current staffing levels are not sufficient to meet the identified needs and impact on residents choices and preferences. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 7 Staffing levels and skill mix need to be assessed against the specific needs of the residents living in the home. Whilst the home have visiting entertainers there are no in house activities provided to provide mental stimulation and interest. Resident’s feedback was that ‘I am bored’ ‘activities, I have never been to any’. Areas of maintenance that need to be prioritised were identified. The Manager confirmed that these will be actioned. 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. Brownscombe House Nursing And Residential Home DS0000017596.V349537.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 Brownscombe House Nursing And Residential Home DS0000017596.V349537.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, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not ensuring their needs can be met. EVIDENCE: The Statement of Purpose and Service Users Guide, contain clear information about the home and the services it provides. Copies of these are available on request, it was discussed that all residents would benefit from a copy of their own. It was confirmed whilst talking to residents that the contract arrangements were clear and understood. There is a copy of the terms and conditions of residency included in the Service Users Guide. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 10 A review of the care documentation confirmed that pre-admission assessments are completed by the Manager or the Head of Care. The format of the pre-admission document is in a tick box format. Five admissions to the home were selected for viewing, including the recent ‘Nip In’ admission and the records relating to the admission procedures followed were reviewed. The five assessments viewed did not contain all the information required to ensure that new admissions to the home were suitable and that the home have the staff and environment to meet their care needs. The prospective residents are seen either in their home or hospital before admission and the Manager confirmed that wherever possible the family or representatives are involved. A recommendation of good practice is that all the people involved in the assessment are documented. It was however noted that the home does not confirm in writing having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the Manager who was advised that this should be completed in writing in accordance with the required documentation. The Manager was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and ensures that the Registered Nurses and carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged. The Manager confirmed that selffunding residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Brownscombe House Nursing And Residential Home DS0000017596.V349537.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): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. Residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to five residents was reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated, however it was noted that not all the plans of care highlighted all the needs of residents. For example, one resident who has communication problems did not have any guidance in the documentation to facilitate this vital need. Another did not provide guidance for staff to deal with pain and pain control. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 12 It was also found that social histories and social care plans are not completed on all residents. Risk assessments for health needs are included in the care planning format used by the home, and whilst those risk assessments were found to be completed, not all were fully completed and followed through with an appropriate plan of action when identified as required. It was also noted that the use of risk assessments was very limited; for example the use of call bells are not documented and the use of pressure relieving mattresses and their settings were not in place. Those risk assessments completed for nutritional screening, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. The daily records for personal care and bowel movements were not completed accurately. The clinical room is also the staff office; it is kept locked at all times with a keypad lock. There is a small clinical fridge and temperatures of the room and fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Staff were observed when administering medicines and they were seen to be working safely. Medication Administration Charts (MAR) were found in the main to be competently completed. However, some gaps were identified, and some medication was noted to be out of stock for five days. Also staff need to sign and date verbal changes and completion of medication courses to provide a clear audit trail, and all residents need a photograph on the MAR for identification purposes, and these should be dated and reviewed regularly. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs. However staff were seen entering bedrooms without knocking during the inspection. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lifestyle experienced by residents at this time does not always match their expectations, choice or preferences. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: The care plans still need to be developed in respect of the activities and social histories. It is acknowledged by the Manager that at present the activities are not at the full potential. There is a carer who is taking responsibility for coordinating activities but as yet this has not really taken off. The future plans for activities need to be based on the resident’s choices and preferences. Residents would also benefit from trips out. There are outside entertainers that visit the home regularly for musical sessions and an exercise class specifically for seniors. Feedback from residents included ‘don’t know of any activities’ ‘enjoy the singers, do get bored’ ‘plenty to keep me occupied’. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 14 Residents’ rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. Residents were seen to have their choices respected throughout the day with decisions being responded to. It was not possible to assess residents’ preferences when getting up as residents said ‘I have to get up when staff are ready’ ‘The morning is never easy’ ‘ it’s a relaxed environment’ ‘more staff needed’. Resident’s religious requests are asked on admission to home and Holy Communion is held regularly, visits from local churches are arranged and residents can be supported to attend the local services if they should choose to go. The workforce is multi cultural and receives training in meeting the diverse needs of the residents and ensuring that the social aspect of care is person centred. Visitors spoken to were all happy with the visiting arrangements and how staff who were said to be ‘very welcoming’ received them. The mid day meal was observed and the meals are served from a hot trolley in the main dining area. It was confirmed that residents had a choice at lunchtime, which included a vegetarian choice. Those residents saying they did not like the main choice were seen to have alternatives provided that they did want. Menus are used and circulated the day prior to or on the day the meals are provided, however records are not kept on what food is eaten by each resident and it would benefit the residents if this was introduced to help staff identify appetite traits early. All feedback about the food was complimentary and comments included ‘good food’ ‘I have choices in the meals and the meals are good’ ‘no complaints about the food’. The dining areas used are pleasant and well furnished with natural light. The chef’s post has yet to be filled, but the agency chef has worked full time since January 2007, and has a good knowledge of the residents’ likes and dislikes. Environmental Health inspected the kitchen in July 2007. Staff were seen to be following good practice when serving and distributing the meals. Residents needing assistance were being offered support discretely, however some residents were being fed luke warm food, due to the high amount of residents needing assistance. The service of meals needs to be reviewed to ensure that all residents receive hot food. The meals provided looked appetising and were served in a manner that ensured it looked attractive. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 15 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): 16 and 18. People who use this service experience good quality outcomes in this area. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The complaints policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has not received any written complaints since the last inspection, however as discussed all verbal complaints need to be documented with an outcome and action. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents benefit from having an environment, which provides a choice of comfortable communal space and residents and their families are enabled and encouraged to personalise their rooms. Whilst a refurbishment plan is in place, the maintenance of the premises needs attention. EVIDENCE: Brownscombe House Care Home offers accommodation and communal rooms for 36 residents over three floors. The lower ground floor, the ground floor and a mezzanine level with a number of small corridors. All areas are accessible via shaft lifts. One corridor in particular is very narrow and staff confirmed that it is difficult to manoeuvre wheelchairs and hoist, the home need to ensure that this part of the home is used for the more ambulant residents. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 17 The Manager confirmed that the home is following an improvement programme that will benefit the residents and visitors to the home and provide a welcoming and comfortable environment. The tour of the home evidenced that considerable work has been done and is ongoing. Some areas of maintenance that were found to be in need of attention were discussed and will be prioritised. These included a broken window in a resident’s bedroom, a radiator guard hanging off in a toilet and a toilet seat missing. There is a maintenance person who now works four days a week in the home, the Manager confirmed that there is a maintenance book that staff list any work to be done. However staff are not using the book to identify work to be done. The communal areas are also attractive and allow for different uses ensuring residents have choice and how they spend their time. The flooring in the conservatory is unsafe and a potential trip hazard. The Manager confirmed that this is due for replacement, however it needs to be made safe in the interim period. There are adequate communal bathrooms and shower rooms in the home, with specialist equipment to ensure all residents can have a bath or shower. A wooden chair was noted in the shower facility. Specialised equipment is available throughout the home to promote independence. During the inspection it was noted that staff were using lifting and supporting equipment appropriately. Call bells are provided in all areas, however not all residents had access to a call bell and there was no care plan or risk assessment in place for those that cannot use this facility to call for assistance. As mentioned previously the airflow mattresses were set incorrectly and one was malfunctioning, and the walking frames in use were not specific to the residents and were all varying heights. Advice is to be sought from specialists. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. The laundry facility remains unchanged and the laundry floor has not yet been replaced from the last inspection and therefore the requirement remains outstanding. Polices and procedures for infection control are in place and are updated regularly. Training in controlling infection is provided for staff and there are policies and procedures for staff to follow. However there are areas of good practice that need to be addressed and these include: ensuring that medical equipment and laundry equipment are not kept in the sluice areas, sluice areas are to be kept Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 18 clear and ready for use, all bins need to have lids and commodes for individual use. The appropriate use of aprons and gloves by staff was also discussed during the inspection. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 19 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 and 30. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles, the staffing levels were insufficient to meet the needs of the residents at this time. EVIDENCE: From direct observation on the day of the inspection the staffing levels were seen to be insufficient to meet the needs of the residents. The morning was busy and as was highlighted at the last key inspection, residents were still being washed and dressed just as lunch was served. Records for the residents that were frail and on continuous bed rest did not evidence that they had been attended to since the evening before. The staff members confirmed that residents are still being washed up until lunchtime and that they were always very busy ‘we need more staff to do our jobs to the standard we want’. There is little reference in care plans to residents’ preferred time of getting up and of going to bed. Again from direct observation the nurse in charge did not get the opportunity to assist in personal care as she was receiving medication from the pharmacy and busy with paperwork. The layout of the building over three floors, from direct observation and conversations with the staff team indicates that the staffing numbers need to be reviewed and the numbers increased to ensure there are sufficient staff to meet the needs and dependency levels of residents. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 20 National Vocational Qualification (NVQ) training takes place for staff, but the home does employ overseas trained nurses who are working as carers, and are considered to be equivalent to the NVQ 2. A selection of staff recruitment files was viewed and demonstrated that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Records Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. Staff spoken with said that training opportunities at the home are good and they are well supported by the senior staff and the Manager. Staff and the training list seen confirmed that compulsory training such as manual handling, adult protection, first aid and fire safety are being undertaken. The home is supported by a training co-ordinator who is employed by the group to provide the training required. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 21 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 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the home is managed in an open and friendly manner with suitable quality monitoring systems, the residents’ safety and health needs are not being appropriately promoted and protected. EVIDENCE: The Manager has been in post for six years and has the necessary skills and qualifications to run the home. She is due to complete the Registered Managers Award in the near future. The staff spoken with said that they felt supported by the management structure of the home. Residents were aware of whom the Manager is and of her role in the home. Relatives and visitors state that the Manager maintains a visible presence in the home and that they can approach the management team at any time. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 22 The quality assurance systems in the home include questionnaires sent out to residents and relatives on a six monthly basis. The formal quality assurance and quality monitoring systems have enabled the management to objectively evaluate the service and ensure it is run in the residents’ best interests. The quality assurance results are audited and action taken to address any suggestions of improvement. Resident meetings take place monthly and are recorded formally. The relative support group is to recommence in the near future. It was confirmed by the Manager that some residents keep small amounts of money with the home for safekeeping. These accounts were viewed along with the receipts and evidenced a clear audit trail. Staff supervision was discussed and staff supervision is conducted two monthly and documented. Staff spoken with confirmed that they receive supervision and found it beneficial. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. A first aid box is kept in the clinical room, this is to be regularly checked, but the records were behind and it would be more beneficial if the first aid box was more accessible and not locked in a room. All staff receive first aid training. The accident book was viewed and it was not being used correctly, and from the amount of falls recorded, an audit needs to be introduced as a means of prevention of further falls and linked to the individual residents care plans. As mentioned previously the equipment in use to prevent pressure damage and equipment to promote the independence of the residents needs to be used appropriately and correctly, call bells need to be accessible and the floor in the conservatory be repaired to prevent trips and falls. Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 23 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 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14(1) (d) Requirement That a comprehensive preadmission assessment is completed on all prospective service users to ensure that the home can meet the identified needs. That registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the care plans accurately reflect the needs of the service users in respect of their health, social and behavioural needs. That service users and/or their representatives are consulted regarding the formation of the care plans. Nutritional assessments are to be completed in full for all residents and linked to the care plan and that an accurate record of nutrition is kept. Schedule 3. That suitable risk assessments are completed in all areas of risk and cover the use of bedrails, DS0000017596.V349537.R01.S.doc Timescale for action 01/11/07 2. OP7 15(1)(2) 12 01/11/07 3. OP8 12 (1)(a) 01/11/07 Brownscombe House Nursing And Residential Home Version 5.2 Page 25 continence and risk of falls to promote resident safety. That the records pertaining to pressure damage are accurate and up to date. That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. That the registered person ensures medication practices in the home are safe. That gaps in the medication administration charts are identified and investigated. • That verbal medication changes are signed and dated. • That all service users have a photograph for identification purposes and that these are signed, dated and updated regularly. That activities are provided to suit service users expectations, preferences and capabilities. That service users are supported and enabled to attend activities. That a programme of activities is more formally devised based on service users choices. That service users choices are listened to and their preferences documented. That the registered person ensures that the frail service users that require assistance are supported in a discreet and unhurried way with hot food. DS0000017596.V349537.R01.S.doc 4. OP9 13 (1) 01/11/07 • 5. OP12 16 (2) (m) (n) 01/11/07 6. OP15 12 (1) 01/11/07 Brownscombe House Nursing And Residential Home Version 5.2 Page 26 7. OP19 23 (2) (b) That the registered person ensures that the home is safe and well maintained. • 01/11/07 8. OP22 OP38 The conservatory floor is repaired. • That the laundry floor is repaired. • That the broken window is replaced. 16 (2) (c) That the registered person ensures that all service users have access to a call bell facility or an alternative system devised for all bedrooms and communal areas. That all pressure mattresses are set correctly according to the manufacturers guidance and in working order. That the walking frames used are specific to the individual service users needs. The registered persons must ensure that suitable arrangements are in place to prevent toxic conditions and the spread of infection at the care home. • 01/11/07 9. OP26 OP38 13(1) 01/11/07 10. OP27 18(1)(a) The use of gloves and aprons. • Medical equipment and laundry equipment are not kept in the sluice areas. • Sluice areas are to be kept clear and ready for use, • All bins need to have lids. • Commodes to be used for individual use. • That the floor in the laundry area is impermeable. The registered persons must 01/11/07 ensure that at all times suitably DS0000017596.V349537.R01.S.doc Version 5.2 Page 27 Brownscombe House Nursing And Residential Home 11. OP38 13(4)(c) qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. A review must take place of the current staffing levels with a view to increasing the numbers to ensure the needs and dependency levels of service users are met. (Timescale of 09/02/07 not met) The registered persons must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. That all accidents recorded have an appropriate action plan devised to prevent reoccurrence of accidents as required under Regulation 17 Schedule 3 and 4. That first aid boxes are accessible for use and checked regularly. 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brownscombe House Nursing And Residential Home DS0000017596.V349537.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House, 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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. 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