Inspection on 31/01/07 for Brundall Nursing Home

This inspection was carried out on 31st January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 11/07/07

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 Key Unannounced 31st January 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.V329411.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.V329411.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.V329411.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 27th June 2006 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 30 single rooms and 9 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 £325 - £490. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection compromised an unannounced visit to the home that took place over 9.5 hours on 31st January 2007, and is the second key inspection at the service within the last eight months. Following the last key inspection the Commission and the Proprietor’s agreed to suspend further placement to the home due to concerns about staffing levels at the home, the healthcare offered to service users, the management and supervision of nursing and care staff, and parts of the environment to service users with dementia. The suspension of placements was lifted following immediate and satisfactory improvements undertaken by the proprietor’s last year. 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, visiting relatives, nursing and care staff and the manager. The inspection report reflects regulatory activity since the last inspection and evidence from inspection of Key Standards. The manager provided comprehensive pre-inspection information to the Commission prior to the inspection. This included 10 comment cards from service users, relatives and visiting GP’s, which gave broadly favourable comments about the service provided by the home. What the service does well: • • • • • There is good information about the service available to prospective service users. There is good feedback from service users as to the quality of the care they receive. There are regular visitors to the home who say that they are made welcome when they visit. It was clear from discussion with and observation of staff that there is considerable knowledge, experience and commitment within the overall staff group. The standard of meals at the home is good and service users individual preferences are catered for Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? • • • There is evidence of improved care and nursing care at the home since the last key inspection, when the home did not have a manager in post. There is evidence of improved activities to service users throughout the home, though this should be improved by achieving a better understanding of service user social interests. There are improvements to the quality of the accommodation and the standard of décor. The replacement of carpets, attention to general tidiness and other planned maintenance will provide further improvement. There are staff working in such numbers as are appropriate for the health and welfare of service users. There is evidence of improved care and nursing care at the home since the last inspection, when the home did not have a manager in post. Arrangements are in place to provide all staff with formal supervision of their practice. • • • What they could do better: The Company need to ensure that they recruit and retain a manager who is able to carry on the improvements noted at this inspection so the service offered is able to meet the wide range of needs of the service users accommodated. • New service users are admitted on the basis of a full assessment, though these lack social and personal information. • Managers at the service need to be clearer about who they can accommodate at the home and where within the home they may be accommodated. • An improvement to medication storage and administration practices is required. • The quality of service at mealtime should be improved. • There are insufficient numbers of dementia trained and NVQ trained staff despite requirements made at the last inspection. • There is no satisfactory or systematic approach to quality assurance to measure the home’s success in achieving satisfactory outcomes for its service users. • A clear management plan for the home did not appear to have been established for the forthcoming weeks other than the deputy manager managing in a supernumerary capacity. It is hoped more robust arrangements would be made before the manager’s departure, particularly given the concerns about quality of care following the departure of the previous manager. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 7 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.V329411.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.V329411.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, 3, 6 Quality in this outcome area is adequate. There is good information about the service available to prospective services users, though this could be improved to make it more accessible. New service users are admitted on the basis of a full assessment, though assessments lack social information. Managers at the service need to be clearer about who they can accommodate at the home and where they may be accommodated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection report and Statement of Purpose was available in the reception area of the home alongside other information about the home and its services. The Statement of Purpose (and its service users guide) have been updated recently. Both are large documents that contain a lot of information. In discussions with service users none could remember what information they had been offered prior to admission to the home. There is a new brochure for the home, which had been issued the month of the inspection visit. All enquirers are provided with a brochure either on request or Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 10 when visiting the home. It may, therefore, be useful for the service to summarise the Statement of Purpose and service user guide information so that loose-leaf copy can be included in the brochure information. Sample service user files reviewed provided evidence of initial assessments of prospective service users and details relating to their care needs. Management at the home stated that this information forms the basis for the plan of care. Those files seen demonstrated good assessment of health and personal care needs. However, information is lacking as to who the person is, what they are like, what interests they have. It is recommended that assessment skills of staff are reviewed to ensure that the assessment (that forms the basis for the plan of care) takes account of social and emotional care requirements. (See recommendations). Some of the discussion with management centred on the home’s registration status as there is some confusion about where to accommodate residents with differing needs within the home so that they can have meaningful choices of association. Confusion concerned service users with a confirmed diagnosis such as nursing or nursing (dementia) residential care (dementia). There was evidence of this in relation to a newly accommodated service user with complex care and health needs, who was wrongly accommodated in the dementia care side of the home. (See recommendations). The home does not provide intermediate care. Respite care can be offered and staff will work to a planned programme of care as agreed with the service user; which will promote some self caring aspects of independence for those returning to their own homes and independent living. Brundall Nursing Home DS0000065308.V329411.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, 10 Quality in this outcome area is adequate. There are improvements to care planning and to nursing care at the home. There is good feedback from service users as to the quality of the care they receive. An improvement to medication storage and administration practices is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans are generated from the initial assessment of need and completed as soon as possible after admission. From files seen there is evidence of service user/ family / representative involvement and contribution from any relevant source that helps to provide a good overview of needs. Each of the sample files seen were well maintained and up to date. Each one had a review date and contained generic and individual risk assessments. The daily reports are brief and record the care pattern for the day in practical and physical terms relating to health aspects and treatments. The reporting does not detail information relating to mood or sense of well being which would Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 12 give a more personal record of daily care and service user welfare. (See Requirement 1) Service users requiring nursing care have a range of nursing needs and are dependent on the staff for all their care including help with mobility and intimate care. Eight service users need close supervision with their meals or need full assistance with eating. The information in the files records the health care support offered. The home has special mattresses/beds and necessary equipment to manage and monitor wound care. One service user is receiving dressing care for pressure wounds developed in hospital. The service user is nursed in bed and there is a programme in place for regular turning and positioning to reduce constant pressure. The management of the home have tried to access advice from the tissue viability nursing staff at the Norfolk & Norwich Hospital with regard to any new treatments or innovations regarding wound care without success. Training in wound care management has been delivered since the home’s last inspection, and further training is planned. Service users who have had mobility problems recently have (and are) being encouraged to improve their mobility by exercise and a daily pattern of movement. These service users said they are improving slowly and can weight bear for longer periods and walk a little further (with support and walking aids). Nutritional screening is in place .If any service user shows signs of weight loss or poor appetite a record is maintained so that other dietary options can be looked at or can be referred to nursing staff. Medication storage, records and medication were reviewed at this inspection. Medication is safely stored in locked metal trolleys designed for the purpose, which can be fixed to the wall when not in use. There is a small fridge for storing some medication the temperature of which is recorded daily. However, on the day of the inspection the fridge temperature gauge was not working. The morning medication round was not completed until 11am, mainly due to the way in which the medication is given (by the individual on duty). Some nursing staff manage to dispense in less time though this appears to generate a greater number of refusals. The medication for most service users does not set a specific prescribed time of day (other than am midday and pm) for administration. In some cases, like the late risers who like to lie in occasionally the medication is being given at a later time. Good practice is in place as service users are being offered a service to meet own requirements. However, this practice needs to be reviewed and recorded in the care plan of each person where medication is given at a later time throughout the day, and agreed with the GP. (See Requirement 2) There is a monitored dose system in use and the medication for the service users seen on the nursing side of the home corresponded to the MAR sheets. Medication records and storage indicate that prescribed medication is available to service users. The medication trolley on the dementia side of the home contains paracetamol medication for service user that is no longer prescribed, and should consequently be removed from the trolley. Chlorphenamine 4mg tablets for a service user are not indicated on their Medication Administration Record (MAR chart) as prescribed, but are stored in the trolley. Staff confirmed Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 13 that this is currently prescribed medication. It therefore needs an appropriate entry on the MAR chart to ensure its correct administration. Paracetamol medication prescribed for a service user from MAR chart records has evidently not been administered. Staff confirm that this medication has not been required by the service user. However, the medication is not prescribed as to be administered when required. Discussion with the GP was advised at the time of the inspection. (See Requirement 3) Good returns process in place in order that medication can be audited off the premises. The home’s controlled drug book is in order and up to date with correct medication counted and checked against entry. Each of the service users seen and spoken to on the day of the visit said that the service they receive is good and the staff are caring and helpful and kind. A service user said he is spoilt by the staff but quietly enjoys it. Two other service users gave good examples of personal care and kindnesses shown to them by staff. All said they were content with the care and service they receive. Other service users were observed being cared for by staff who were acting competently and demonstrated a knowledge and understanding of individual service users needs. A service user who is relatively young did admit to being bored at times despite liking their own company most of the time. All the service users seen said that they would like more personal time on a one to one basis with staff even if it is just to talk or chat. A visitor to the home said that she is made welcome by the home, and can visit whenever she wishes. One service users room is directly next to the front door and also a visitors WC, the service user chooses to have their bedroom door open which exposes them to public view. The inspectors have asked for management to review the situation to promote both service users choice and also to provide and maintain their dignity and privacy. Brundall Nursing Home DS0000065308.V329411.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): 12, 13, 14, 15 Quality in this outcome area is adequate. There is evidence of improved activities to service users throughout the home, though this should be improved by achieving a better understanding of service user social interests. Contact with friends and relatives are supported by the home. The standard of meals at the home is good and service users individual preferences are catered for, though the quality of service at mealtime could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users seen on the day of the inspection visit were able to recall social activities that take place each day from Monday to Friday and commented on what they like to do. Their favourites are reading, group art and craft and bingo. The activities sessions are run by a designated member of staff and are mainly group sessions with some individual hand massage therapy offered by an outside therapist. It is recommended that management check that the oils used by the therapist is compatible with individual service users medication and health care status. (See recommendations) Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 15 There is a published weekly activities programme, though this does not indicate what time activities are to take place. A game of Bingo was in progress during the inspection visit. None of the service users attend local or community events or activities. There are trips out in the summer and seasonal events throughout the year. A review of personal, social interests should be undertaken so that some activities can be taken up on an individual basis with service users, and where possible outside the confines of the home. (See Requirement 4) The majority of activities for service users with dementia are led by care staff and include card games, dominoes, chair exercises, and personal grooming such as manicures and hairdressing. Staff and service users confirmed that visitors and relatives can attend the home at any time. One service user said that they have two voluntary visitors and one acts as their financial advocate, which is a very satisfactory arrangement and works well. All but one service user seen said that their family or a representative manage their finances for them and they are also happy with their current arrangement. The rooms seen on the day of the inspection visit are furnished and equipped to suit the service users daily lifestyle and reflect their personal choices and preferences. There are three main meals a day breakfast from 7-10am and lunch from 12.30pm and high tea from 5.30pm. There is also a hot drink and snacks / sandwiches served from 8pm each evening although there seemed to be some confusion as to whether this arrangement is still in place for some people. The management were asked to check this to ensure service users are offered refreshments prior to their bedtime so that they are not experiencing long periods of time without food/hot drinks. (See Recommendations) Service users are offered a choice of the main meal from usually three options each day, though in reality service users can actually have what they asked for. A service user stated that they preferred a cooked breakfast in the morning and that this was provided. On the day of the inspection the main dish served was pork casserole with vegetables and potatoes. It was well presented and looked appetising and plentiful. One service user however had egg and chips another had added roast potatoes as an extra others had varied dishes to meet their personal dietary requirements. This was followed by a choice of sweets/pudding. Service users receiving liquidised or softened foods did so with each item of food having been liquidised separately so the meal retained its colour and identity to some extent. None of the service users could recall what they had ordered for their meal as this is done 24 hours previously. However all seemed satisfied with the meal arrangements. For teatime meals service users can choose from a range of standard hot dishes or lighter meals like soup and sandwiches and jacket potatoes with filling. The management were asked to review the way the small dining room is used as a servery or distribution base for breakfast and breakfast trays, as this does not provide a pleasant setting for those service users who choose to take their breakfast in that room. (See Recommendations) Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 16 Menu boards should be completed each day or a print out of the next seven days menus should be issued to each service user or in their rooms as an aide memoire for them. The information could also include the days and times of activities too. A daily diary of foods prepared and served is maintained. A record is also kept of any noticeable difference in service users eating patterns so that they can be monitored and screened and alternative foods can be offered. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. Arrangements for protecting and responding to the concerns and complaints of service users are in place. The overall outcome cannot be measured as good without evidence of complaint investigation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One complaint received since the last inspection by CSCI was sent to the provider to investigate. There was evidence of a letter of apology to the complainant and information relating to changes in ownership and management by way of explanation to them. There is no evidence of any formal investigation and the manager did not investigate (as this was before her time in post). No record of any management action or intervention as to practice. There have been no further complaints. From comment cards and discussion with service users they indicate that they have an understanding of the home’s complaints procedure. Staff have attended ‘Protection of Vulnerable Adult’ training and refresher training courses are being planned for 2007. Discussion with care staff suggested that they were clear about their responsibility regarding the protection and safety of vulnerable people. CRB checks are carried out on all prospective staff and two relevant references are also sought to ensure that they are suitable to work with vulnerable people. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is adequate. There are improvements to the quality of the accommodation and the standard of décor. The replacement of carpets, attention to general tidiness and other planned maintenance will provide further improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home’s environment was undertaken and there is evidence in place that refurbishment and decoration of service users rooms and external work on the grounds is taking place. Apart from one room all designated double rooms are being used for single occupancy. The bed linens and some furniture have also been replaced and offer a good standard. Communal carpets are showing serious signs of wear and tear and should be replaced, particularly the lounge carpet in the dementia side of the home. (See Requirement 5) The communal sitting room/conservatory on the nursing side of the home needs to be reviewed by management and service users to look at ways in Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 19 which this room can be improved in terms of lay out and arrangement. Currently it is messy and cluttered and does not promote a pleasant ambience. (See Recommendations) A review as to the purpose of letterboxes that do not open on the doors of service users with dementia is recommended. (See Recommendations) A new roof to the conservatory area in the dementia side of the home is due to be installed before summer 2007. The current roof is not sufficiently reflective and consequently the temperature in this area cannot be moderated sufficiently. Recently installed air conditioning units should assist in providing a comfortable temperature in summer months. The home is clean and reasonably tidy, aside from cluttered area mentioned above. The home would benefit from the management applying some attention to details in respect of general good practice in tidiness and neatness/storage, especially in bathrooms. The environment would be improved by the disposal of old items and containers and dead flowers and plants, as well as a review of the number of artificial flowers and plants around the home, especially in communal rooms. There was a mild odour around the home between 9am – 10am, which quickly dissipated with none noted after that time for the rest of the day. The dementia side of the home was odour free also. Some discussion with the management took place during the visit about how soiled laundry is managed and dealt with. It was suggested that practice could be reviewed to ensure minimum exposure to air or corridors or communal space. Laundry area not visited on this occasion. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor as a consequence of training deficits. There are suitable numbers of nursing and care staff to meet the needs of service users. Service users are protected by safe recruitment practices. For this outcome area to achieve an adequate or good rating, there must be suitable numbers of staff trained in dementia care delivery and suitable numbers with NVQ 2 (or above) training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were 34 service users accommodated at the home at the time of the inspection visit, 15 of whom were living on the dementia side of the home, 19 on the nursing and residential side. There is a total staff complement of 25 carers, 6 nurses (excluding the manager) and 14 ancillary staff and 6 registered nurses. This is adequate for the numbers of service users currently accommodated. Staffing in the dementia side of the home provides 3 carers each morning and afternoon/evening shift, and two carers at night. This was reflected in rosters seen at the home and in the deployment of staff in this part of the home at the time of the inspection visit. Staffing levels on the nursing/residential unit were also satisfactory given service user numbers. Eight comment cards from service users indicate that staff are usually or always available to them. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 21 At the time of the inspection visit there were 20 of care staff working at the home with NVQ 2 or above. The manager indicated that seven care staff were registered to undertake this training. This would see the home fall just short of the 50 requirement. (See Repeated Requirement 6) Sample staff files provided evidence that service users are protected by good recruitment practices. Staff training records provided evidence of a range of relevant training other than dementia training. This is reflected in discussion with care staff. There are three care staff with specialist dementia related training. Consequently, service users do not benefit significantly from appropriately trained staff. (See Requirement 7) The manager stated that this training had been due to take place with staff but had been cancelled and re-scheduled for March 2007. A programme of supervision for all staff has now been established, and there is evidence that this is being carried out. It is recommended that training in providing staff supervision be provided to all staff required to undertake it. (See recommendations). Currently only a few staff have had access to this training, and some supervision records seen do not meet the requirement of the Standard. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 22 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, 33, 35, 36, 38 Quality in this outcome area would be adequate if the existing management arrangements were going to continue or if there had been a proper plan in place for the management of the home on her departure. The quality rating is therefore poor. There is evidence of improved care and nursing care at the home since the last inspection, when the home did not have a manager in post. There is no satisfactory or systematic approach to quality assurance. This judgement has been made using available evidence including a visit to this service. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has considerable experience within the care sector though has been in post for several months only. The manager is a trained nurse and has completed the City & Guilds Advanced Management in Care course. However, the manager was due to leave her position the week following the inspection visit. The proprietor had previously indicated that the post has been advertised. A clear management plan for the home did not appear to have been established for the interim other than the deputy manager managing in a supernumerary capacity. However, it is hoped more robust arrangements would be made before the manager’s departure. There are some processes at the home for monitoring the quality of the service it provides, including audits by the manager and proprietor, staff team (or unit) meetings and staff supervision. The manager indicated that quality assurance feedback questionnaires were sent out in November to service users and their relatives. The manager stated that these have not yet been evaluated. Nor have questionnaires been extended to ‘stakeholders’. The manager said that a residents meeting had been offered but there had been no attendees. A lack of continuity of management at the home has hampered the implementation of a satisfactory and systematic approach to quality assurance. (See Repeated Requirement 8) Relatives or appointees manage service user financial affairs. Financial records reviewed were satisfactory, corresponded with monies held at the home and are evidently audited periodically. As indicated above, there is evidence of the implementation of a programme of supervision for nursing and care staff at the home. Evidence of this was provided by the manager, in discussion with staff and through staff records. The health, safety and welfare of service users are largely met. However, medication and staff training deficits may compromise this. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered person must ensure the service users care plan indicates how service users needs in respect of health and welfare are to be met. The registered person must take steps to ensure medicine administration is reviewed ensuring medicines are safely administered at scheduled times The registered person must take steps to ensure medicines are administered in line with prescribed instructions and this can be demonstrated by the home’s record-keeping practices. The registered person must ensure that service users are consulted about their social interests, and make arrangements to enable them to engage in local, social and community activities. The registered person must ensure that premises are kept in a good state of repair. Timescale for action 28/02/07 2. OP9 13.2 13.4 28/02/07 3. OP9 13.2 13.4 28/02/07 4. OP12 16(2)(m) 30/04/07 5. OP19 23(2)(b) 31/03/07 Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 26 6. OP28 18(1)(a) 7. OP30 18(1)(c)( 1) 24(1)(a&b ) 8. OP33 The registered person must 31/05/07 ensure continued progress toward meeting a minimum ratio of 50 NVQ 2 (or above) trained staff. This Requirement Is Repeated The registered person must 16/04/07 ensure that all staff receive training appropriate to the work they are to perform. The registered person must 31/05/07 develop a systematic cycle of planning action and review reflecting aims and outcomes for service users. This Requirement Is Repeated For The Second Time RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations It is recommended that assessment skills are reviewed to ensure that the assessment (that forms the basis for the plan of care) takes account of social and emotional care requirements. It is recommended that the service managers define more clearly the service user groups they can safely accommodate and care for to ensure suitability and appropriateness of placement within the home. It is recommended that management check that the oils used by the therapist is compatible with individual service users medication and health care status. It is recommended that management check as to the availability of refreshments prior to bedtime so that service users are not experiencing long periods of time without food/hot drinks. 2 OP3 3 4 OP12 OP15 Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 27 4 OP15 5 OP15 6 7 8 OP19 OP19 OP30 It is recommended that the way the small dining room is used as a servery or distribution base for breakfast and breakfast trays is reviewed, as this does not provide a pleasant setting for those service users who choose to take their breakfast in that room. It is recommended that menu boards be completed each day or a print out of the next seven days menus should be issued to each service user or in their rooms as an aide memoire for them. The information could also include the days and times of activities too. It is recommended that there is a review of the Verne House conservatory/lounge environment as it does not promote a pleasant ambience for service users. A review as to the purpose of letterboxes that do not open on the doors of service users with dementia is recommended. It is recommended that training in providing staff supervision be provided to all staff required to undertake it. Brundall Nursing Home DS0000065308.V329411.R01.S.doc Version 5.2 Page 28 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.V329411.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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