Inspection on 11/07/07 for Brundall Nursing Home

This inspection was carried out on 11th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Brundall Nursing Home 03/11/08

Brundall Nursing Home 31/01/07

Brundall Nursing Home 27/06/06

Brundall Nursing Home 04/01/06

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

CARE HOMES FOR OLDER PEOPLE Brundall Nursing Home 4 Blofield Road Brundall Norwich Norfolk NR13 5NN Lead Inspector Mr Jerry Crehan & Mrs Hilda Stephenson Unannounced Inspection 11th July 2007 09:00 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 Brundall Nursing Home DS0000065308.V345869.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. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brundall Nursing Home Address 4 Blofield Road Brundall Norwich Norfolk NR13 5NN 01603 714703 01603 716652 brundall@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Position Vacant Care Home with Nursing 48 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (28) of places Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Twenty eight (28) Service Users who are elderly may be accommodated. Twenty (20) Service Users who are elderly and have dementia may be accommodated. One (1) Service User (who is named in the Commission`s records) who is currently under 65 may be accommodated. Total number not to exceed 48. Date of last inspection 31st January 2007 Brief Description of the Service: Brundall is a care home providing residential or nursing care for up to 28 older people and care for up to 20 older people who may have a diagnosis of dementia (a total of 48 service users). The home is situated in the village of Brundall a few miles to the east of Norwich. The home is a large detached building that has been extended. It is divided into two main wings, Verne House and Norfolk House. The latter caters for service users who have a diagnosis of dementia. The accommodation is located on both ground and first floors. There are single and shared rooms. There are garden and patio areas to the rear of the home. There are local shops, pubs and other amenities within the immediate vicinity of the home. Brundall is one of several homes in Norfolk owned by the proprietors. The range of weekly fees for the home is £347 - £551. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. This report gives a brief overview of the service and current judgements for each outcome group. Before the inspection the new Manager of the service completed a lengthy questionnaire about the service. Five comment cards were received from service users. Records held by the Commission and previous inspection reports were checked. This key inspection compromised an unannounced visit to the home that took place over 7.5 hours on 26th June 2007. Two inspectors, one of whom inspected nursing and residential care arrangements, the other who inspected the arrangements for dementia care, carried out the inspection. Opportunity was taken to tour the premises, look at care records and policies, and communicate with the home’s service users, several nursing and care staff, the administrator and the Manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. Brundall is one of several homes in Norfolk owned by the Proprietors. What the service does well: • • • • • There is good information about the service available to prospective service users. People who use services receive good nursing, health and personal care that is based on their individual needs. The principles of respect and choice for people as individuals are put into practice by a committed nursing and care staff team. Service users care plans showed that the relatives are involved with their content and development in monthly reviews and at other occasions. Care staff play a part in supporting service users activities, interests and therefore their emotional wellbeing. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 6 • The standard of meals at the home is good and service users individual preferences are catered for. What has improved since the last inspection? • • • Care is taken to ensure that individual care plans reflect service users social needs taking their life history into account. Social and recreational activities meet individual’s expectations throughout the home, and provide a link with the community. The home is commended for providing a more flexible approach to where and when meals can be taken, and the provision of food throughout the day for service users. Previously cluttered lounge areas have been opened up providing easier access for service users and staff, and helping to provide more suitable areas for service users. The Management and senior staff approach at the home is positive and inclusive with a variety of new and innovative ideas to improve the way in which care is delivered, the homes accommodation and supporting service users interests. • • What they could do better: • • Medication practices at the home should be improved to support and safeguard the health of people who use the service. Training and refresher training for staff in the protection of vulnerable adults is needed to help in protecting people who use the service from possible abuse. There should be night staffing provision in ‘Verne House’ including a Nurse and at least two care staff to meet the needs of people who use the service. Training for staff at the home in providing dementia care, in first aid and NVQ training must be provided to improve outcomes for people who use the service. DS0000065308.V345869.R01.S.doc Version 5.2 Page 7 • • Brundall Nursing Home • Disruption resulting from changes in Management has meant that a requirement from the last inspection of the home has not been met. This is the continued absence of a planned system of quality audit where the views about the service have been sought and evaluated. 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. Brundall Nursing Home DS0000065308.V345869.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 Brundall Nursing Home DS0000065308.V345869.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): Standard 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people to use the service have their needs assessed, and access to all of the information they need about the service they may choose. EVIDENCE: The home has a well-designed assessment pro-forma (pre-admission assessment) used by the Manager when collecting information to ascertain the level of support required by prospective service users. There is evidence of assessment for new service users seen in their files. All prospective service users are invited to the home with their relatives. Assessment information in individual care files provided evidence of the involvement of service users in their own assessment and admission process. The manager or other senior staff will show people around and provide information about the service and facilities. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 10 The Manager indicated that she would be reviewing the home’s brochure and other pre-admission information, to make more of a focus of the services on offer at the home. The home’s service users observed during the inspection visit appeared appropriately placed. Brundall Nursing Home DS0000065308.V345869.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): Standard 7, 8, 9, 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services receive good health and personal care that is based on their individual needs, however some medication practices do not fully safeguard the health and welfare of people who use the service. The principles of respect and choice for people as individuals are put into practice. EVIDENCE: A sample of service user care files containing individual care plans were reviewed. All the care plans were well detailed regarding the service users personal, physical, social and mental health care needs. A helpful ‘pen picture’ of the service user is available to care staff at the front of each care file. These contain brief information such as the service users preferred name, their diagnosis, mobility, preferred routine, preferences about care, food likes and dislikes. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 12 A life history of the individuals past life to enable the care staff to care for the service user as a whole person and understand their current needs was also in place, this was usually obtained from family although in some cases the service user themselves were able to assist the nurse with the past details. The Nurse on duty, Team Leader (or Senior Carer) would compile the care plan when a service user is admitted and continue to care for that persons needs becoming their named Nurse, reviewing their care needs on a monthly basis. Two of the service users who were spoken to confirmed that their Nurse met up with them to discuss any changing needs. Care plans showed evidence that service users or relatives are involved at the beginning of their stays at the home and in subsequent care reviews. There are also weekly progress reports for every service user completed by Senior Carers or Nursing staff. These are useful summaries of service users progress as they report on health and on the service users state of mind and general wellbeing. A service users care plan showed evidence of MRSA and the Nurse had adequate infection control procedures in place with regular monitoring of the person’s condition. Another care plan showed that the relatives were involved with a service user’s monthly reviews, due to their communication difficulties and included a relative’s communication record in place, which is good practice. Evidence of specialist services such as chiropody, hearing, dental and psychiatric services were regularly sought for those who required these. The dentist was visiting some service users at the home at the time of the inspection visit. The home has specialist pressure area equipment in use and has good clinical procedures in place, with evidence that Nurses regularly update their knowledge on pressure area care. The Manager in consultation with the G.P has introduced a weekly ‘surgery’ at the home where the home will contact the local health surgery in advance of the G.P’s visit with the details of any service users with a need to be seen during their visit to the home. The Manager explained that the G.P is still available to visit the home at any other time should a service user require. The trained Nurse on duty administers all medication on the ‘Verne House’ side of the home and the lunchtime round was partially observed. The medication records were checked for several service users and were found to be accurate. Senior carers administer medicines within the ‘Norfolk House’ unit. While checking the medicines it was noted that a prescribed liquid medicine was stored in the medication trolley though was evidently not being administered. The service users Medication Administration Record (MAR) did not refer to this medication, and staff confirmed the service user no longer needed the medication. The Manager must audit medicines to ensure medicines no longer required are not left in medication trolleys where they may be administered in error (See Requirement 1). Newly prescribed medication for a service user had been received into the home the afternoon before the inspection visit. It had been correctly recorded Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 13 as received into the home, but the prescribed nightly dose not administered (See Requirement 2). Service users confirmed that the staff at the home uphold their privacy and dignity at all times, assisting them back to their rooms or the quiet lounge if they require a quiet area. Several service users stated that they prefer to spend time in their own room and this was respected by the home. One service user uses an advocate to assist them with shopping. Brundall Nursing Home DS0000065308.V345869.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): Standards 12, 13, 14, 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services have access to a good diet that is well prepared and can be taken in a choice of surroundings. Social and recreational activities meet individual’s expectations and provide a link with the community. EVIDENCE: The activities on offer at the home are publicised for service users in both Norfolk House and Verne House. There is a dedicated activities coordinator employed to arrange and provide a range of recreational options for service users throughout the home. The home has records of activities participated in by service users, their particular interests and preferences. The home’s activities programme is developing and becoming more varied. The programme includes day trips to local attractions, including garden centres, nurseries, pubs and other local attractions. There are two such trips planned for July. Activities on offer at the home include quizzes, games, gentle exercises (seen taking place at the time of the inspection visit), taste and smell sessions, and reminiscence. The Norfolk House side of the home has recently developed a reminiscence room for any/all service users who would wish to Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 15 use it. The room is a quiet area containing objects of interest from the past to stimulate discussion about past family life and experience and local history. ‘PAT’ dogs visit the home, musical and other entertainment is ‘bought in’ to the home periodically, and service users can commission a massage therapist if they wish. It was evident that the welfare of service users, through providing individual attention to their interests, is not solely the responsibility of the activities coordinator. Care staff can and do access activity resources including the reminiscence room referred to, and care staff were observed taking time to provide service users with individual attention. An example of this was seen with a service user who had the attention of a carer to themselves to have their hair done. It was clear that they had enjoyed the carer’s attention, felt valued, and pleased with the way they looked. The home publishes a monthly newsletter that includes information about day trips and other plans for activities. The Manager stated that she has funding to make garden areas at the home more accessible to service users, and hopes to include sensory areas and other areas of interest to service users with dementia. Discussion with service users and observation during the visit to the home provided evidence that the home supports their contact with relatives and friends, and that it enables service users to bring and keep their own possessions with them. The rooms seen on the day of the inspection visit were well furnished and equipped to suit the service users daily lifestyle and reflect their personal choices and preferences. Many bedrooms have been redecorated to a good standard. Advocates are in place for service users who require someone to represent their interests. The lunch menu on the day of the inspection visit was pork casserole or cheese and onion slice with broccoli, carrots, potatoes and gravy, followed by fruit salad and ice cream. Meals looked appealing and were evidently enjoyed by service users who were complimentary about their lunch. Dining areas were varied, some service users prefer to take their meals in their own bedrooms and they are supported to do this. Others take meals in more communal settings, which are varied throughout the home and give service users choice. Fluids were available throughout the home for service users. There were jugs of water and squash in bedrooms and in communal areas also. Service users in Norfolk House now have access to a toaster where they may assist in making toast and crumpets in the mornings or at suppertime. Four out of five comment cards from service users indicate that they usually like the meals at the home. One comment card indicated that they would like more fresh vegetables. The home is commended for providing a more flexible approach to meals and the provision of food throughout the day. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 16 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): Standards 16 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an effective complaints procedure. People who use the services are protected from abuse though further staff training must be provided. EVIDENCE: The home has a detailed complaints procedure and information on how to make complaints is detailed in the service users guide, which is made available to service users and their relatives. There has been one substantiated complaint recorded by the home since its last inspection, which was satisfactorily dealt with by the Manager. The Manager stated that she had established a ‘Relatives Surgery’ that takes place monthly when she is available all day for any problems or queries. She feels this and her ‘open door’ approach have been one of the reasons complaints have been at a minimum. Comment cards and feedback from service users indicate that they know how to make a complaint should they need to or wish to. Each of the staff spoken with were clear about the action they would take if concerned about the possibility of abuse taking place at the home and were confident that they could deal with this appropriately. They were equally aware of the home’s ‘Whistle-blowing’ procedure for the reporting of concerns. Some staff have received training in the protection of vulnerable adults, though many have not. This training needs to be undertaken for these staff and refreshed for others (See Requirement 3). Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at the home has improved significantly. It is safe, well maintained and used to support the needs of people who use the service. EVIDENCE: A tour of the building and inspection of maintenance records demonstrated that the home is well maintained and meets service user needs in a homely and comfortable way. The home’s grounds and gardens are well established, attractive but proving difficult to maintain. It is hoped that funding the Manager has secured to develop garden areas will help with this. Accommodation for service users is well decorated and furnished. Doors to service users private accommodation is lockable and there are lockable facilities within each bedroom for money and valuables. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 18 The home’s environment has continued to be improved, with many changes to the way in which space is used and some redecoration. There is a reduction in the number of shared bedrooms with a view to improving the standard of accommodation and a reduced overall occupancy at the home. Previously cluttered lounge areas have been opened up providing easier access for service users and staff, and helping to provide more discreet and distinct areas for service users within larger communal areas. As indicated already in this report there is a greater choice of places to dine. A reminiscence room has been developed, and there is somewhere for visiting relatives to stay or have a rest if they need. Carpets have been replaced in Norfolk House corridor and lounge, greatly improving the general environment in these areas. The Administrator’s office has been moved to the front of the home where she and the Manager spend time and are more ‘visible’ for visitors to the home. The Manager is commended for her efforts to improve the home’s appearance and accommodation. The Manager stated that additional security arrangements are currently being considered for the home. This may mean additional security at the home’s entrance with a coded keypad (or other system) entry and exit. The laundry was clean, tidy and safe, with good systems to keep clean and dirty linen apart. Hoists and other equipment were safely stored, equipment servicing up to date and the home is clean and tidy. Brundall Nursing Home DS0000065308.V345869.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): Standards 27, 28, 29, 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not provided the specialist care they are assessed as needing. Staff in the home are experienced, dedicated and hard working, but not suitably skilled or trained to fully meet the needs of people who use the service. EVIDENCE: There were 35 service users accommodated at the time of the inspection visit. There were sufficient staff on duty to fulfil their roles, and to provide good care on both Norfolk House and Verne House units during this inspection visit. However, the duty rota showed that not enough care staff were caring for those requiring nursing care in Verne House at night. The rota indicated the provision of one Nurse and one carer for up to twenty-four service users (twenty at the time of the inspection visit). There should be provision for service users including a Nurse and at least two care staff. The home is required to increase staff numbers in line with recommended guidelines (See Requirement 4). Safe recruitment procedures are followed with the Manager obtaining the required references and CRB checks before employing new staff. An induction programme was in place for new staff to follow although not all staff had undertaken this in the past. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 20 Sample staff training records were reviewed, with the majority having undertaken mandatory training in the past some required to be updated. There is a lack of dementia training, first aid training and adult protection training (See Complaints and Protection section of this report) for staff. Care staff should be assisted by the provision of suitable specialist training in providing care to people with dementia. The Manager must ensure that staff caring for service users with dementia needs undergo the training (See Requirement 5). At present it would be difficult for the manager to ensure that there is always at least one staff member on duty with a current qualification in First Aid. The home must have adequate numbers of staff who have first aid training (See Requirement 6) The home falls below the recommended numbers of staff who have undertaken the NVQ 2 training and it is recommended that the manager encourage care staff to undertake this training and update their skills (See Recommendation 1). The home is divided into two units with the Norfolk unit managed by a Team Leader to care for service users with dementia needs. The Verne unit is managed by a trained nurse supported by care staff to care for service users with nursing and residential needs. Both units are run well with good leadership and an experienced staff group who are clear about who they should report to. The Manager and acting Deputy Manager take it in turns to provide emergency cover when not on duty at the home. Brundall Nursing Home DS0000065308.V345869.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): Standards 31, 32, 33, 35, 37, 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is competent to run the home. However, quality assurance systems should be further developed to measure success in meeting the aims and objectives of the home, and the Manager is not registered. EVIDENCE: The Manager has been the acting manager since Febraury 2007 and was formally appointed to the post in June 2007 having previously been Deputy Manager at the home for a year. She is a qualified Registered General Nurse, and now has approximately eighteen months management experience in nursing and residential care settings. She has recently embarked on the Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 22 Registered Managers Award training, and is continuing to update other professional and nursing qualifications. The Manager must submit an application to register with the Commission (See Requirement 7). The Manager is well thought of by staff who appear motivated by her approach. They indicate that she is caring, approachable, and open to their ideas. It is recommended that the position of Deputy Manager is soon filled to provide continuity for staff and service users, and support for the Manager (See Recommendation 2). It is clear that the Manager has created and open and inclusive style of management, and has implemented significant changes in a relatively short period of time. However, outcomes for service users reported here are significantly improved on recent inspections of the service. General staff meetings take place lead by the Manager – minutes of these were seen. There are also kitchen meetings, health and safety meetings and senior team meetings. There are several other processes at the home for monitoring the quality of the service it provides. The Manager and the Proprietor carry out quality audits covering a range of topics, and they send monthly monitoring reports to the Commission. The Manager has carried out satisfaction surveys in questionnaires sent to relatives of service users, with the aim of using the information to improve services. Though it is not clear how these have been used to inform any development or improvements to the service offered by the home, and results have not been published or provided to the Commission. The change in the management at the home has hampered the implementation of a satisfactory and systematic approach to quality assurance (See Requirement 8). Relatives or appointees manage service user financial affairs. Financial records reviewed were satisfactory and are evidently audited periodically for the protection of service users and staff. The confidentiality and privacy of service users is supported at the home, and has improved with some of the recent environmental changes that have taken place. Brundall Nursing Home DS0000065308.V345869.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 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X 3 2 Brundall Nursing Home DS0000065308.V345869.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 OP9 Regulation 13.2 13.4 Requirement Timescale for action 11/07/07 2. OP9 3. OP18 4. OP27 5. OP30 People who use the service must have medicines administered by staff who follow safe procedures. This is to protect people’s health and welfare. 13.2 People who use the service must 13.4 have medicines administered in line with prescribed instructions at all times and this can be demonstrated by the home’s record-keeping practices. This is to protect their health and welfare. 13.6 All staff must receive refresher training on adult protection issues, which helps to protect people who use the service. 18.1(a) There should be staffing provision for service users in ‘Verne House’ including a Nurse and at least two care staff at night. This is to meet the needs of people using the service. 18.1(c)(1) The Manager must ensure that staff receive training in dementia care. This will help to ensure that the mental health needs of people using the service are met. DS0000065308.V345869.R01.S.doc 11/07/07 31/08/07 31/07/07 31/08/07 Brundall Nursing Home Version 5.2 Page 25 6. OP30 13.4 7. OP31 9 8. OP33 24.2 There must be at least one first aid trained person in the home at all times, to help ensure that people who use the service receive appropriate treatment in an accident. The service must have a registered Manager that meets the requirements of the Care Standards. The Manager must ensure that the views of people who use and are associated with the service are sought and included when making decisions that effect outcomes for people living at the home. This Requirement Is Repeated 30/09/07 30/11/07 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP28 OP31 Good Practice Recommendations It is recommended that all care staff are supported to undertake NVQ 2 (or above) training to update their skills. It is recommended that the position of Deputy Manager is soon filled to provide continuity for staff and service users, and support for the Manager. Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Brundall Nursing Home DS0000065308.V345869.R01.S.doc Version 5.2 Page 27 - 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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