Inspection on 14/11/05 for Brunswick Court

This inspection was carried out on 14th November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Brunswick Court 21/10/08

Brunswick Court 29/10/07

Brunswick Court 10/11/06

Brunswick Court 17/05/06

Brunswick Court 18/05/05

Brunswick Court 08/11/04

Brunswick Court 01/07/04

Brunswick Court 23/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Brunswick Court 62 Stratford Road Watford Hertfordshire WD17 4JB Lead Inspector June Humphreys Unannounced Inspection 14th November 2005 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 Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 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. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Brunswick Court Address 62 Stratford Road Watford Hertfordshire WD17 4JB 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) 01923 218333 01923 212109 cooperdupa.com BUPA Care Homes Limited Care Home 91 Category(ies) of Old age, not falling within any other category registration, with number (91), Physical disability (15), Physical disability of places over 65 years of age (91), Terminally ill over 65 years of age (4) Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 15 people with physical disability between 50 and 65 years of age. This home may accommodate 2 Services Users between 50 and 65 years of age, for Palliative Care. This home may accommodate 16 older people who require personal care. The home may admit one (named) terminally ill service user who is under 65 years of age. 18th May 2005 Date of last inspection Brief Description of the Service: Brunswick Court is a purposed built residential and nursing home. It is managed by BUPA care homes Ltd. It is situated in a residential area within easy reach of Watford town centre. The Watford Junction rail station and the main bus route are within walking distance, as is motorway access via the M1, and M25. The home has ample parking at the front of the property, and in the basement area located at the rear of the building. The front entrance leads to a large reception area, which allows access to the main building by means of security locks. Security within the building is good. The administrative offices are located on the ground floor. The kitchen, laundry and staff room are in the basement. The en-suite bedrooms are large in size and are located on three floors with access via a lift. The bedrooms on the ground floor are allocated to service users requiring nursing care. Brunswick Court offers ample communal spaces on every floor, including a dinning room and two lounges. The garden is located at the side and rear of the building. The courtyard area has a landscaped woodland area with easy access for wheelchair users. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was second unannounced inspection during this year (2005). Two inspectors carried out the inspection over one day. The manager was newly appointed at the last inspection and there have been many positive changes since the last inspection. Brunswick Court is a large care home, but despite its size, it manages to provide a good standard of care to people with varied, complex needs. The requirements and recommendations made at the last inspection were all met, which demonstrates a commitment to continued improvement. This is particularly evident in the manager’s diligents to improved communication between staff and carers. What the service does well: What has improved since the last inspection? The communication processes within the home appear to have improved. Complaints are dealt with in an expedient and caring manner. Assessments and care plans are now signed and complete. A new chef has been appointed, and is consulting with service users on the menus. Service users spoke positively of this, one person stating, “I am enjoying the change”. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 6 The manager is also working to increase and improve activities within the home. This includes outside tutors/instructors i.e. the new exercise to music class. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 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 Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 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): 1,3 and 6 Adequate, and update information is provided relating to admission to the home. Full assessments are carried out, and extra information is provided in an easy useable format for service users receiving respite or intermediate care. EVIDENCE: The inspectors randomly selected care plans of eight service users. The assessment plans seen were now signed and the information is used to develop a plan of care on admission. The care plans incorporated all aspects of care and support required; physical, mental health, (including behaviour management) nutrition, and when necessary dealing with falls, and pressure sores. The inspector listened to a staff member working with a service user providing basic care. The carer was patient and supportive, explaining what they were doing and encouraging the person to be as independent as possible. The service user described the carer has a “life saver”. They appeared to have a good relationship and the carer was aware of the service users specific needs, set out in the care plan. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 9 The care plan of a service user who was receiving intermediate care was viewed. The manager had worked diligently with professionals outside of the home to develop a multi- disciplinary risk assessment; increasing the safety of the environment for the person. Continued deterotion of the persons mental, and physical health, meant that a return home would not be safe. The manager worked hard to allow the person to remain in the home, explaining how she wanted to provide consistency of care in what was a difficult and challenging situation. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 10 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 and 11 Several care plans of service users who had been resident in the home for a period of more three months were examined. In the majority of cases these appeared up to date, and good examples of working documents; including appropriate risk assessments. However one concern was raised, relating to the need to regularly review. The manager has agreed to investigate and feedback. Several care plans did include information regarding service users wishes regarding death and dieing; and whilst acknowledged, that this is a sensitive area to address, this must be explored as far as possible and noted in all care plans. EVIDENCE: The service provision is on three floors. Each floor operates its own individual manager (nurse) in charge. The care plan format is used across the service, and those viewed by the inspectors showed that much work had been carried out since the previous inspection. Completion of the forms, and higher levels of consistency was apparent. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 11 This good work must be part of working practices across all floors, ensuring that all service users risk assessments are regularly up dated, to address changing needs. An example of importance, was a service user who discussed his experience, and concern in relation to staff’s response when using the pull bell system. His deteriorating condition requires an immediate response, and although inspectors tested call bells and response was good, a need for staff guidance as part of review, should be an integral part of the risk assessment. The service accommodates service users with varied, complex needs, including people suffering from terminal illness. It is therefore imperative that as part of the admissions process the wishes regarding funeral plans are discussed and reflected in individual care plans. This work has begun, but is incomplete. The management and handling of service users clothing was of concern at the previous inspection. Complaints had been received both from service users and relatives. The manager was aware of this, and had developed an action plan to try to overcome this. The inspectors enquired on ‘how this was going’? The manager explained that she had personally investigated the concerns as part of the complaints procedure, and felt it had been resolved. Respite users laundry is now handled separately and she has introduced weekly meetings with all domestic services (laundry, maintance, and the chef). Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 12 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): 12,13 and 15. The manager has a real interest in providing a wide range of different activities within the home. The programme is being developed and extended. Service users commented on how much they enjoyed the new programme and there appeared to be greater participation. A new chef has been appointed, and he has consulted with service users about the new menus. EVIDENCE: Service users were observed participating in an exercise to music programme. The activity was very much gaged to the level and ability of the participates. It was encouraging to watch service users laughing and joking; there was a real ‘group feeling’ in the room. Relatives can visit service users at anytime, and several relatives were seen in the home at the time of inspection. Service users spoken to said that the food provided was good. Many chose to eat in their rooms. The chef had started to consult with service users on likes and dislikes, and was eager to change and adapt menus according to feedback Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 13 received. Fish and chips from the local take away had been requested and this request was going to be tried. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 A satisfactory complaints procedure is in place. The manager has properly investigated all complaints since the previous inspection in May 2005. EVIDENCE: The manager has implemented monthly carers meetings. She is keen to provide opportunities to talk to service users and relatives about the quality of care the home is providing. This is a new development, and outcomes cannot be evaluated at this stage. On the day of the inspection the deputy manager had met with several relatives to discuss concerns relating to their relatives care plan. The inspectors observed her providing feedback to the senior nurse and carer about the necessary changes that were required to improve the person’s care. Four complaints have been received since the last inspection. The inspectors examined the complaints book and were able to confirm that the complaints had been investigated, and now complete. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 15 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): 19,20 and 26 The building is purpose built and provides a comfortable, and pleasant environment for service users. There is good access to all areas of the home, and garden, which are maintained to a satisfactory standard. EVIDENCE: There was no apparent concern with the communal areas inspected. All seen to be clean, tidy and well maintained. The kitchen equally had good food hygiene practices in place. The toilet and bathing facilities provide a range of equipment to allow individual needs to be met. This can make the facilities appear cluttered. All equipment appeared in good working order and had been tested earlier in the year. There was concern raised in relation to toilet seats on all floors. They appeared to be discoloured on the top, and stained underneath. It is possible that this relates to the cleaning products that are being used, which needs to be checked. A programme of repair and replacement is in operation in the home, and this needs to be incorporated in the manitance plan. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 16 There were no concerns raised on the day of inspection relating to health and safety. Fire extinguishers had been checked in September 2005, and the requirement with regard to doors not being wedged, and the fitting of automatic closing devices to bedrooms had been fully met. A service user interviewed confirmed that these were working satisfactory. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 17 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): 27,28,29,30 The service users living in the home have a range of complex needs, the work is therefore challenging and demanding. The manager is introducing new systems to ensure staff are supported to provide an effective service. The procedures for the recruitment of staff are robust and offer protection to people who live in the home. EVIDENCE: As part of the inspection process staff rotas were examined, and found to be adequate. The level of staffing is four carers and two registered nurses on each shift during the day, and one registered nurse and two carers at night. Service users interviewed generally stated positive things about the staff ”even when there busy they always offer to help.” One person did however say that the period from getting up, to having breakfast had started to take a long time, and that because of this he often missed the activities being offered. This was discussed with the manager, and she has agreed to look at allocation of staff during peak periods. All the members of staff spoken to during the inspection were enthusiastic about their work, but what was evident was that there was a mix of staff of which some needed greater support then others. The manager is beginning to address the above by organising an ‘open surgery’ where staff of all grades can come and talk to her. She also now provides in house training on the needs of all new service users admitted to the home. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 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): 32,33,37 and 38 The manager appears keen to actively seek the views of both service users and carers. She is developing sound working practices in the home to ensure the staff employed, are involved and understand, the importance of this in relation to service delivery. EVIDENCE: The service users spoken to talked very positively about the staff that care for them. They said that their views were listened to and that they could raise any concerns if needed. Even the service user who had raised concern about the time staff took to respond said that he had his ‘favourites’, but all staff were friendly and helpful. The manager of the home has clearly worked hard to develop channels of communication in the home. This seems to have improved service provision. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 19 Meetings with carers and service users are now in place, and appear to be helpful in monitoring the quality of service provision. The manager has now been in post since March 2005, and it is important that the commission receives an application for her intention to register as manager of the home. Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X X 3 3 Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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(2)(b) Requirement The care plan and risk assessment of the service user who has a deteriorating condition should be reviewed and updated. All service users plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Service users plans must be kept under review. Equipment provided at the home for use by service users must be maintained in good working order. Review the staffing arrangements for early mornings to ensure that sufficient staff are deployed to meet the needs of the people who use the service. The manager must apply for registration with the CSCI. Timescale for action 21/11/05 2. OP7 15(2)(b) 06/12/05 3. OP19 23 (2) (c) 08/01/05 4. OP27 18(1)(a) 12/12/05 5. OP31 8 (1) (a) 08/01/05 Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 22 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 OP11 Good Practice Recommendations Care plans should contain service users’ funeral wishes Brunswick Court DS0000019341.V265869.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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