CARE HOMES FOR OLDER PEOPLE
Brunswick Court 62 Stratford Road Watford Herts WD17 4JB Lead Inspector
Yoke-Lan Jackson Unannounced 18 and 19 May 2005 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 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 I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Brunswick Court Address 62 Stratford Road, Watford, Herts, WD17 4JB Telephone number Fax number Email 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 BUPA Care Homes Ltd CRH Care Home 91 Category(ies) of OP-31, PD-15, PD(E)-91, TI(E)-4 registration, with number of places Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 15 people with physical disability between 50 and 65 years of age. 2. This home may accommodate 2 service users between 50 and 65 years of age, for palliatice care. 3. This home may accommodate 16 older people who require personal care. Date of last inspection 8 November 2004 Brief Description of the Service: Brunswick Court, purposed-built as a Nursing and Residential Care Home, is provided by BUPA Care Homes Ltd. It is situated in a residential area within easy reach of the town centre of Watford. The Watford Junction rail station and the main bus route are within walking distance of the home. The M1 and M25 Motorways are a short drive away. The home has a number of car parking spaces in the front of the building and in the basement car park. The front entrance leads to a large reception area that is isolated from the rest of the building by means of security locks. The administrative offices are all on the ground floor. The kitchen, laundry and staff room are in the basement. The ensuite bedrooms are large in size and they are on three floors that are served by lifts. The bedrooms on the ground floor are allocated to service users requiring nursing care. Brunswick Court has ample communal spaces on every floor, including a dinning room and two lounges. The garden is located mainly to the side and back of the building. The courtyard has a landscaped woodland area with comfortable seats.All the rooms and the garden are accessible to wheelchairs. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first inspection (Unannounced) during the year 2005. The inspection took two days. The home manager (newly appointed) and the deputy manager were present. There were 74 service users and 9 vacancies. There was a mixture of positive and negative feedback from service users and their relatives. Many of the service users had commented that the staff were usually helpful and caring. One service user commented “The personal care is good; the food is good but I wish they woudn’t rush me.” Another said that “…sometimes the food given is cold….. Staff take no notice when you tell them.” There was evidence of some inconsistency in the performance of services and a few areas of non-compliance with the National Minimum Standards. These were reflected in several negative comments received from the service users and two past written complaints from relatives and evidenced in the documents that were examined during the inspection. (Please see below for details of the inspection findings). What the service does well: What has improved since the last inspection?
Since the last inspection, a new home manager has been appointed. She had been in post two months preceding this inspection. Since her appointment, the new manager has been involved in the investigation of two outstanding written complaints. As a result, she has revised local policies and procedures and implemented them to ensure that the standard of care and services in Brunswick Court will continue to improve.
Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 6 One of the volunteers arranging activities has been employed as a part-time activity co-ordinator. The storage facilities for medicines have been re-organised to ensure compliance with legislation in regard to storage of medicines. The nurses had completed their refresher course in the Administration and Handling of Medication. (See previous Inspection and Pharmacy Inspection Reports). The Laundry Procedure has been revised to ensure that all clothing are returned to their rightful owner. Recent investigations have revealed that personal items of clothing have been misplaced or lost and the property lists have gone missing. A copy of the Laundry Procedure/Action Plan was submitted to the Commission (CSCI). (Please see Statutory Requirements and Statutory Recommendations). 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 I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 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 standard(s) 3, 4, 5. The manager ensures that the home will only admit service users whose needs can be met. Opportunities are given to prospective service users and their relatives to view the home before making the decision to move in. However, in the case of admission under the Continuing Care System, this is not always possible. EVIDENCE: The new manager has begun the process of ensuring that all pre-admission assessment forms have the signature of the prospective service user (or their next of kin) at the point of admission. Random checks of the pre-admission assessment forms revealed that not all the relevant forms have the signature of all the relevant parties involved or the date when these forms were signed. New corporate protocols regarding admission, care input and discharge have been implemented in the home.
Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10. The management does not currently ensure that service users are treated with respect and that their dignity is preserved at all times. This includes ensuring that service users’ wishes and feelings are taken into account and that they wear their own clothes at all times. Not all care plans and risk management forms, are appropriately signed by the respective service user (or representative) and dated the same day. Verbal concerns raised by service users or their relatives are not written in the daily report file or be seen to be taken seriously. The manager ensures that all medicines are handled in accordance with relevant legislation and Guidelines from the Royal Pharmaceutical Society. EVIDENCE: The majority of the service users spoken with were positive about the personal care given. A relative commented “I am satisfied with the care given. If not I will find another home……”. The care plans examined have details of the healthcare needs as well as the personal and social needs of the respective service users. Some care plans
Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 10 were signed and dated by the assessor, the service user or the relative. However, a conversation with one relative (on the day of the inspection) revealed that the plan of care that was drawn up previously and agreed by the service user and the relative was not signed by the relative until the day of this inspection. An examination of the named file confirmed the signature but it was not dated. A management study of two investigative outcomes revealed that lost or misplaced clothing was not mentioned in the daily report file for the individuals concerned. This was despite staff members being aware of the problem at this time. Communication books have however, been introduced and these are maintained and checked by management twice daily. Recent study of the case files revealed that any lost or misplaced clothing was not mentioned in the daily report file of the individual case file, even though members of staff were aware of the problem at the time. In addition, concerns raised by the relevant relatives were not written down in the daily report file. There was no indication of any action taken by managers or staff members. It was evident that service users have been given clothing, including socks that belong to someone else. Relatives have expressed their disappointment over the fact that when issues were raised, certain members of staff made comments such as “It will turn up; you worry too much”. Management has taken these concerns seriously and as a result of this, new laundry procedures have been introduced, which on request have been documented onto an action plan received by the Commission. (A copy of the Laundry Procedure/Action Plan was submitted to the Commission (CSCI) following the inspection). One service user expressed her wish to be consulted before things are moved around in her bedroom. The inspection revealed that the medicines for external use were not stored separately from those for internal use on the ground floor. Other objects were also found in the same cupboard. The situation was rectified on the second day of the inspection when an additional storage cupboard was installed on the ground floor. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 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 standard(s) 12, 13, 14, 15. The service users were given choices and preferences in the daily activities offered. They are encouraged to maintain links with family and friends. The service users received a varied and wholesome diet but mealtimes can be hurried. EVIDENCE: The routine of daily living and the activities made available are varied. A coach trip to Southend was arranged for 19th May 2005. All the service users were given the choice to participate in the outing. One service user said that she was not too keen to make the long journey and changed her mind about going. A member of staff had reassured her that she was allowed to change her mind. Although meals are wholesome, mealtimes can be hurried. One service user commented “The food is good but I wish they wouldn’t rush me”. Another said that “… sometimes the food given is cold. Staff take no notice when you tell them…”. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16, 17, 18. A system is in place to safeguard the service users from abuse, neglect and self-harm. EVIDENCE: The home has a copy of the Hertfordshire Vulnerable Adult Policy and Procedure. The members of staff are aware of the Whistle Blowing Policy. The home is not involved in the financial affairs of the service users. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19, 20, 21, 23, 24, 25, 26. Brunswick Court has ample community spaces for the service users to use including the courtyard. The premises are generally well maintained. The en-suite bedrooms are clean and comfortable. The manager currently does not ensure that all doors are held open with appropriate hold-open door devices, placing all occupants of the building at risk. (See Statutory requirements). EVIDENCE: There is an ongoing maintenance programme. The bedrooms examined have personal items on display that reflect the individual lifestyle of the respective service users. The service users spoken to are very pleased with the bedroom facilities. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 14 On the day of the inspection many bedroom doors were held open with manual wooden wedges. The manager has agreed to install automatic hold-open devices to all the bedroom doors that are held open by wedges. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) ,27, 28, 29, 30. The recruitment process is in accordance with current legislation, including police checks and the Protection of Vulnerable Adult (POVA) checks. The home manager ensures that all members of staff receive relevant training and refresher courses to meet the assessed and changing needs of the service users. EVIDENCE: A system is now in place to ensure that all staff rotate their duties on the three floors to ensure that important services are maintained in a consistent way throughout the home. An activity volunteer has recently joined the staff as a part-time activity coordinator. The home is under a new manager and the members of staff are adjusting to the change, but further training to enhance communication skills is required. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, 37, 38, It is too early to assess the impact on the standard of management and administration. However, the changes made so far seemed favourable. EVIDENCE: The home is under a new manager who has been in post since 7th March 2005. The process for registration (for the home manager) with the Commission for Social Care Inspection (CSCI) has yet to commence. The new manager is aware that a number of BUPA corporate policies and procedures have not been followed, in particular, the BUPA Policy that all service failures affecting service users be discussed with the families and a resolution agreed upon. She has identified areas of concern and has proposed for implementation the new admission and discharge checklist policies and the new Laundry Procedures and Action Plan and the Best Practice Guidelines for Respite Admissions. She has introduced communication books that are to be monitored and checked by management twice daily. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 17 The Laundry Procedure has been revised to ensure that all clothing are returned to their rightful owner. Recent investigations have revealed that personal items of clothing have been misplaced or lost and the property lists have gone missing. A copy of the Laundry Procedure/Action Plan was submitted to the Commission (CSCI). (Please see the section on Health and Personal Care, Statutory Requirements and Statutory Recommendations). Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x 3 3 2 3 Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 19 No 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 7.6 Regulation 15 Requirement All care plans (including review) must be drawn up with the involvement of the service users, recorded in a style accessible to the service users; agreed and signed by the service user whenever capable and/or representative (if any). All service users must wear their own clothes at all times Mealtimes must be unhurried with service users being given sufficient time to eat. The manager must ensure that all doors are held open with systems approved by the Fire Authority. Records required by regulation for the protection of service users, ( including daily records) are maintained, accurate and up to date. Timescale for action 18/05/05 Henceforth 2. 3. 4. 10.3 15.9 19.1 38 37 12 (4)(a) 12(3) 23(4)(c) (i) 17(1)(a) Schedule 3(j) 18/05/05 Henceforth 18/05/05 henceforth By 18th june 2005 18/05/05 Henceforth 5. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 20 No. 1. Refer to Standard 30 Good Practice Recommendations It is recommended that all staff have refresher training in regard to Communication Skills, Customer Service and Report-Writing. Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts 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. Extracts may not be used or reproduced without the express permission of CSCI Brunswick Court I52 s19341 Brunswick Court v229404 180505 Stage 4.doc Version 1.30 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
