Inspection on 04/01/06 for Brundall Nursing Home

This inspection was carried out on 4th January 2006.

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

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

Other inspections for this house

Brundall Nursing Home 03/11/08

Brundall Nursing Home 11/07/07

Brundall Nursing Home 31/01/07

Brundall Nursing Home 27/06/06

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 Unannounced Inspection 4th January 2006 11:00 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.V278090.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brundall Nursing Home Address 4 Blofield Road Brundall Norwich Norfolk NR13 5NN 01603 714703 01603 716652 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) Ashbourne (Eton) Limited Mrs. Ann Gaul Care Home 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.V278090.R01.S.doc Version 5.1 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 10th August 2005 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. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6.5 hours. Opportunity was taken to tour the premises, look at care records and policies, and communicate with many of the forty-six service users, visiting relatives and staff members in addition to the manager. The home makes comment cards available to service users and relatives all year round, consequently two comment cards had been received from service users since the last inspection of the home, and three from relatives. These were largely complementary about the service provided. What the service does well: What has improved since the last inspection? What they could do better: It is hoped that the further planned refurbishment of the Norfolk House dining area will provide pleasing surroundings for service users to dine in. At the time of the inspection the repair and appearance of this area was still poor, and the repeated failure to meet the required National Minimum Standard must be addressed. Other environmental issues for improvement include the provision Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 6 of adequate furniture for some service users bedrooms, and the procedure for safely dealing with dirty laundry and bed linen. The staffing levels or deployment in Norfolk House is compromising the standards of care for service users with dementia. There has been a failure to meet the required National Minimum Standard for the numbers and skill mix of the staff at the home for the last five inspections. This must be remedied as a matter of urgency. Systems for management and monitoring practice, particularly in relation to the home’s providing choice and control for service users (see Standard 14), for ensuring staffing levels and deployment meet the needs of service users (see Standard 27), for enabling staff to affect the way in which the service is delivered, and other matters associated with the home’s environment need to be considered more closely. 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. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4, & 6 The home provides clear information that would assist service users in making an informed choice as to the home’s ability to meet their needs. EVIDENCE: The home has produced documentation including a Statement of Purpose and Service User Guide that are provided to service users and are available within the home, including reception areas. The home has clear written information available to prospective service users, which would provide them with a good understanding of the home’s capacity to meet individual need, including needs arising from dementia. The home does not provide intermediate care. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 11 The care planning system is clear and in the majority of instances adequately provides staff with the information they need to meet the health and care needs of service users. EVIDENCE: A sample of service user care plans was reviewed. These set out care requirements in reasonable detail, paying particular attention to the prevention of falls, and were evidently reviewed on a regular basis. There was some evidence of the involvement of service users and relatives in the construction and review of care plans and ‘life stories’ for service users with dementia. Evidence of difficulty in managing two service users continence needs was found, with the care plan for one of these service users indicating there was not a problem with continence. Care plans refer to the involvement of a variety of community health professionals. Service users confirmed access to, among others, the G.P, chiropodist and district nurse as required. Visiting professionals were seen at the time of the inspection. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 10 The home has evidently provided palliative care to service users at the home, and have an appropriate policy to support staff in the care of service users who are dying. Care plans sampled included appropriate reference to the wishes of service users in the event of their death. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 The availability of activities appropriate to the needs of service users is improved. Service users are, with some exceptions, able to exercise choice and control over their lives. Menus in the home offer choice and variety. EVIDENCE: The appointment of a dedicated activities coordinator for service users with dementia has been made since the last inspection. The coordinator described a range of activities both planned and implemented including dance, cold cooking, quizzes, making decorations and carpet bowls. At the time of the inspection a hand massage activity was taking place. Service users spoken to indicated that their visitors were made welcome at the home at any time of their choosing, and that they usually saw visitors in the privacy of their own rooms, however, they also stated that a cup of tea is not offered to their visitors. Staff and relatives confirmed this. Anecdotal evidence was provided suggesting a lack of choice and control for some service users who may wish to rise from their beds later in the morning on occasion. The matter was brought specifically to the attention of the manager at the inspection. It is evident that service users are entitled to bring and to keep personal possessions at the home. Several visitors to the home were present at the Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 12 time of the inspection. The home (where necessary) has promoted the use of independent advocates for service users. Service users gave a good response as to the quality of the food available at the home. A number of service users indicating that there is choice available at the home. The meals seen at the time of the inspection looked reasonable. Some improvements to the dining area in Norfolk House are noted, and it is hoped that the further planned refurbishment of this area will provide pleasing surroundings for service users to dine in. At the time of the inspection the repair and appearance of this area was poor. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The arrangements for protecting service users legal rights are satisfactory. EVIDENCE: Service users are able to take part in the political process, voting by postal ballot. The home facilitates access to available advocacy services where necessary. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25, 26 Service users live in a comfortable and reasonably well-maintained environment. However, further improvements to the interior are required to lift the appearance of parts of the home. The manager and proprietor must take urgent steps to ensure there is no repeat of the recent failure to meet National Minimum Standards. EVIDENCE: The home appears safe, well maintained and suitable to meet the needs of service users, with evidence of recent improvement to the interior and exterior of the home. The issues associated with the poor repair and appearance of the Norfolk House dining area referred to already in this report (and in previous inspection reports) have not yet been addressed. This is despite failure to meet the relevant National Minimum Standard at the last three inspections of the home. At the time of the inspection a representative of the proprietor was assessing the area for refurbishment. Service users spoken to stated that their bedrooms were comfortable and that they had their own possessions around them. However, it was noted that in Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 15 some bedrooms there were no chairs for service users or their visitors to use, a missing chest of drawers and bedside cabinet was also noted in a shared room. The home appeared largely clean and hygienic, though bathroom areas remain used as areas for storing dirty linen and laundry despite a recommendation made at the last inspection. Consequently access to bathroom areas is impeded, and one bathroom on the ground floor was odorous. Bedrooms are naturally and individually ventilated. All bedrooms and communal areas have natural light with artificial lighting supplementing the available natural light where necessary. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 A committed staff group provided care to service users and maintain positive relationships with their relatives. Staffing levels or deployment did not meet the needs of service users in Norfolk House at the time of the inspection. This represents a failure to meet the required Standard in the last five inspections of the home, and must be remedied as a matter of urgency. EVIDENCE: There were seven members of care staff and two registered nurses on duty at the time of the inspection supporting forty-six service users living at the home, providing a staffing level above the minimum standard required. Each of the care staff in the Norfolk House part of the home had received appropriate training in dementia awareness. It is evident from staff spoken to that there is access to induction training and a full range of mandatory training. Both service users and relatives spoken to were complementary about the work undertaken by care staff at the home, acknowledging their hard work and commitment. It was evident that the three care staff rostered to work in Norfolk House during the morning often amounted to two due to the taking of rest breaks, lunch breaks for those working double shifts, and as a result of answering the frequent telephone calls in the unit’s office. As a consequence of this, or of the way in which staff are deployed, staff were stretched in meeting the needs of their twenty service users, a visiting G.P and visiting relatives who had a query about their relative. Further evidence of difficulty was seen in unmade beds (after lunchtime) preventing some service Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 17 users taking bed rest, and some service users looking slightly unkempt in appearance. There has been a failure to meet the relevant National Minimum Standard at the last five inspections of the home. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 38 Service users would benefit from more open and transparent processes for managing the home. The financial interests of service users are safeguarded by the home. EVIDENCE: There was limited evidence of a benefit to service users from the leadership and management approach of the home. Staff meetings are not held on a planned or regular basis to communicate a clear sense of direction and leadership, and aside from the forum that supervision provides there are no evident means to encourage staff to be innovative or creative. Residents meetings do not take place at the home. The possibility of establishing a ‘residents committee’ had been discussed at the last inspection, however this forum will not be taken forward either. The manager continues to offer her monthly meetings or ‘surgeries’ where relatives can meet and speak with her. However, the home falls short of providing evidence of a systematic Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 19 cycle of measuring the quality of the service and reflecting aims and outcomes for service users. Financial records were reviewed and found to be satisfactory. Service users financial interests are safeguarded by the home. The health, safety and welfare of service users are largely ensured, though compromised by the storage of dirty laundry and linen in communal bathroom areas. Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 20 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 X 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 X 2 X X X X 2 3 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X 3 X X 2 Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 21 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 2 Standard OP8 OP14 Regulation 13(1)(b) 12 (2&3) Requirement The registered person must seek professional advice about the promotion of continence. The registered person must ensure that the home is conducted so as to promote service users personal autonomy and choice. The registered person must ensure that premises in Norfolk House are kept in a good state of repair. This Requirement Is Repeated For The Third Time The registered person must ensure each service user has suitable furniture and storage facilities. The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks. The registered person must ensure that staff are working in such numbers as are appropriate for the health and welfare of service users. DS0000065308.V278090.R01.S.doc Timescale for action 04/01/06 04/01/06 3 OP19 23(2)(b) 28/02/06 4 OP24 16(2)(c) 04/01/06 5 OP26 13(4)(a) 04/01/06 6 OP27 18(1)(a) 04/01/06 Brundall Nursing Home Version 5.1 Page 22 7 OP32 24(1)(a&b ) The registered person must develop a systematic cycle of planning action and review reflecting aims and outcomes for service users. 31/03/06 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 Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brundall Nursing Home DS0000065308.V278090.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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