CARE HOMES FOR OLDER PEOPLE
Brunswick Court 62 Stratford Road Watford Hertfordshire WD17 4JB Lead Inspector
Alison Butler Key Unannounced Inspection 29th October 2007 10:00 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.V353958.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. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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 BUPA Care Homes (AKW) Ltd Mrs Patsy Ann Maxwell 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.V353958.R01.S.doc Version 5.2 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. 30th January 2007 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. Information regarding the service is available n the Statement of Purpose and Service user Guide. For these and a copy of the most recent CSCI inspection report and for up to date fees contact the manager of the home. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection and spent the majority of their time observing and talking with residents, staff and the management team about living and working at the home. Care records were also examined. This report has been written from information contained in service user surveys received and also information provided by the home in their annual quality assurance self-assessment submitted to the Commission For Social Care Inspection. Since the last key inspection three random visits were made to Brunswick Court that included one being made by the specialist pharmacist inspector. This visit provided the opportunity to check on compliance with the requirements that had been made at the last two inspections. What the service does well:
The home provides a well-maintained and safe environment that meets the residents’ needs. All residents receive a pre-admission assessment to ensure their personal care needs can be met. The manager has an open door policy and staff confirmed that she is approachable and they feel she listens to issues they raise both good and bad. Some residents were complimentary about the care they received and felt that it is “an excellent home”, “good care is provided” and “staff are friendly and helpful;” these were just some of the comments received during the inspection. There is an activities plan in place that has been put together in consultation with the residents. There is a varied and balanced menu in place that meets the needs of the people living in Brunswick Court. There is a comprehensive complaints procedure in place and staff are clear on the procedure to follow in the event of an allegation of abuse being made. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
There is still some work to be carried out in the new care plan system, to enable all staff to be able to access the required information to provide the care for individuals. Additional training in continence, catheter care, diabetes and epilepsy should be provided to give all staff an insight into these areas and will then help them in providing care. Staff need to be reminded about sitting when assisting individuals to eat, using the seating that has been provided, as this gives the impression of them being rushed. The serving area in the dining room should be reviewed as a lot of notices are in situ and this does not provide a homely feel to the area. The manager should look at the staffing levels at different times of the day for example at lunchtime where a large number of individuals need assistance and
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 7 this is difficult for staff to provide individual time to them and other have to wait. The purchase of a hoist and weighing scales combined would be a good investment and would limit the number of handling procedures that need to be carried out for some individuals. The activities co-ordinator is looking to improve the lounges and this should be encouraged to provide a warmer feel to them. 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. Brunswick Court DS0000019341.V353958.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 Brunswick Court DS0000019341.V353958.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have a pre-admission assessment completed to ensure their needs can be met at the home. EVIDENCE: Individual care plans showed that prior to admission residents have preadmission assessments that are completed by a senior member of staff. The assessments include mobility, safety, communication, social and cultural needs, life plans and this forms the basis of a more detailed care plan. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New care plans are in place which indicate how staff can meet individual health and personal care needs. However, it is acknowledged that some work is still required to ensure that these are accessible for staff. Additional medication procedures have been put in place to ensure the safety of the residents. EVIDENCE: BUPA have introduced a new care planning system the staff are still adjusting to its use, those spoken to felt that it is a lot more detailed and is taking a considerable amount of time to complete but felt with practice the process will be less time consuming. A random pharmacy inspection carried out in January noted that a number of areas required attention, a record of medication is now kept to ensure a full audit trail of all medication, they have introduced an audit system for senior staff to carry out and errors are dealt with via supervision and are therefore
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 11 recorded. All records now bear the individuals name to prevent errors when filing them. Controlled drugs procedures have been tightened to ensure they follow policies and procedures and rotate stock as appropriate. Further training has been completed for the safe use of medicines. Observation of the medication showed that the member of staff discreetly gave information to a residents what they were taking their medication for, they kept the trolley in their sight and the doors were kept shut when administrating to individuals to ensure residents safety at all times. A meeting had been held with the pharmacist and they are looking to change to the monitored dosage system, which should help staff when medication is reviewed and possibly changed. A random inspection was carried out in March 2007 and the care of residents was observed, findings from this inspection was that staff appeared to be unaware of the needs of residents, some staff did not acknowledge residents when they entered the lounge in the residents home. Care plans were noted as not having enough information or direction to staff, some risk assessments did not state how a risk could be minimised or any direction on managing them. New care plans have been introduced since the last inspection and staff say they provide a more focused approach to the care that individuals require and prompt them where further information may need to be gathered from families etc. Acknowledging that the care plan system is new, staff must remember that information should be provided in easy to read format for example to ‘monitor pyrexia’ as for some staff English is not their first language and this was not understood. The information needs to be easily available to all staff to ensure they can read what care and action is required to meet individual needs, as only very brief information is available to them easily as the main care plans are locked in a cupboard and although it can be accessed, a key has to be sort from a senior member of the team. The staff have difficulty in weighing some of the residents with reduced mobility. There is not a hoist and weighing machine in one, which would eliminate the need for residents being handled twice as the tasks can be completed in one manoeuvre. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A varied activities programme is in place for the residents to choose from. There is a full and varied menu available that meets residents’ needs. However, staff do not always support residents appropriately during meal times in a way that provides respect and upholds their dignity. EVIDENCE: There is an activities co-ordinator employed who has put an activities plan in place, which was put together in consultation with the residents and following a survey. There is a policy in place allowing visiting to the home at any reasonable time and in consultation with individuals. The activities co-ordinator is looking at the lounges to see if they can be better utilised and create different features in them for example a quiet area for reading, puzzles and possibly an aquarium. They are also looking to put together small groups of tables so residents can sit and have a chat or a game etc rather than them all sitting around the room in one line.
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 13 At the random inspection in March 2007 staff were observed during the serving of lunch, staff were seen standing and they were being fed at speed. Some meals were served to the residents but as they needed assistance it was left in front of them for over twenty minutes and then the temperature was not checked to see if it was still acceptable to the individual. At this inspection some staff were seen not to communicate with residents when assisting them to feed and they were still seen to be standing although perching stools had been purchased for the staff to enable them to sit comfortably whilst assisting resident to eat. These were suitable for those in high reclining chairs, which would prevent staff having to stand. One of these stools had still not had the packing removed from the frame and was not being used during the lunch time period. One member of staff was seen assisting two residents to eat at the same time. There was some very nice interaction happening between staff and residents where they were being asked what they would like to eat. One resident who chooses to stay in their wheelchair whilst eating their lunch said that they were uncomfortable as a cushion was required, but they did not want to ask for one, as previously staff have provided one that is to big to go behind them and made them feel most uncomfortable. This information was fed back to the manager who stated that they would address the issue with the individual person. Staff did not respond to the fact that residents had the sun shining in their eyes whilst sat in the dining area and it took a relative to get up from their chair to close the curtains to make it more comfortable for the residents. The menus are on display throughout the home although some residents find them difficult to read and some people are taken into the dining room in wheelchairs and are therefore unable to read the menus unless they ask, but this can be difficult due to time constraints. Residents also mentioned that although they choose their menu in advance they couldn’t always remember what they had chosen and are unable to see the menu as they are not accessible if you are unable to walk and they have to rely on staff to remind them what they have chosen, which is not always done. This was discussed with the manager who said they would look at alternative ways to display the menus, which would enable residents to see what is being offered. The chef offers fruit smoothies that have been introduced to increase daily fruit intake. There is a Night Bite system that ensures light snacks are available 24 hours a day. Work has commenced on a sensory garden and some additional funding has been received to allow further work to be done. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives can be assured that there is a comprehensive complaints policy in place. Training is provided to staff to ensure residents are protected from abuse. EVIDENCE: The complaints policy is available in the reception area of the home. A record is held of complaints made; this also shows the action taken and the outcome. A complaint was made to the home in June and the organisation has carried out a thorough investigation of the issues raised. A full investigation report was seen at this visit and it listed areas for improvement where it was necessary. Policies and procedures are in place to deal with allegations of abuse or neglect. Training is provided to all staff on dealing with allegations of neglect and abuse. Staff spoken to were aware of the action to take if an allegation of neglect or abuse was made to them. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and comfortable, well furnished and maintained and this provides a pleasant environment for people who live or work in Brunswick Court. EVIDENCE: A tour of the home was conducted and showed that it was clean and well maintained and no unpleasant odours were detected during this inspection. A discussion took place with the manager and activities co-ordinator of various ways in decorating and furnishing lounges that would benefit the residents. The serving area in the dining rooms has posters that are not all relevant and they look untidy. Weekly inspection take place and where areas are identified as needing improvement and individuals are spoken to during their supervision to ensure they meet a good standard at all times.
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 16 The lounge/dining areas have had the flooring replaced and staff stated that they are much easier to keep clean and look better. There are policies and procedures in place for the control of the spread of infection. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect the residents. EVIDENCE: Residents spoken to during the inspection were on the whole positive about the care they received. One stated that “the carers are very busy, they don’t have time to come and chat with me” another said, “they are very kind and it’s a nice place”. Staff were seen to very busy and task led due to time constraints, this gave very little time to have some social interaction with them. The manager should look at redistributing or increasing the staff numbers on the top floor as the majority of the residents require 2 carers to support their personal care needs. There is a training co-ordinator in place and this has improved the staff induction and training programme. A training matrix is in place and training is on a rolling programme. Training for carers is not provided in diabetes, epilepsy, continence and catheter care which would help staff to understand the care they are providing to the individuals. There has been a high turnover in staff and a high use of agency but this has since settled with a new management team and training co-ordinator in place and there has been little if no use of agency in the past few months.
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 18 Recruitment files for recently recruited staff were examined and found to include the required checks to provide confidence and reassurance to people living in the home that unsuitable people will not be employed to care for them. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 19 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team at Brunswick Court work together to provide an effective and efficient management and administration of the home, which benefits all those who live and work there. EVIDENCE: The manager was registered with the Commission in May 2007. She has an open door policy and this was confirmed through discussions with staff that felt that she is approachable and listens to them. There are various meetings held within the home for staff, relatives and residents that provide a way of allowing people to discuss any issues or concerns they have. BUPA review their policies and procedure manuals and
Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 20 these are updated as and when required. They carry out an annual satisfaction survey and the findings of this are made available to interested parties. Residents are encouraged where possible to manage their finances. Requirements made at the last inspection have been met with the exception of all residents requiring a care plan that contains up to date information and an easy reference to staff. This has been partially met and the manger assures us that this will soon be completed as they have introduced a new format. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 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 3 X 3 X 3 X X 3 Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All service users must have a current and up to date care plan, which is an easy reference for staff so that care can be provided to meet individual peoples needs. The requirement is repeated but has been partially met. The timescale has been extended as an audit of care plans continues. Timescale for action 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP8 OP10 Good Practice Recommendations Consideration should be given to the purchase of a hoist and weighing scales to minimise the moving and handling of individuals. Staff should receive further training covering continence, catheter care, diabetes, dignity and epilepsy this would provide them a better understanding when providing care and support to individuals.
DS0000019341.V353958.R01.S.doc Version 5.2 Page 23 Brunswick Court 3 4 OP27 OP15 Consideration should be given to increase numbers of staff at certain times of the day to meet the needs of individuals. For example lunchtime & suppertime. The residents should be assisted when eating to eat in a dignified manner by staff interacting with them and sitting down when providing assistance. Brunswick Court DS0000019341.V353958.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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