Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic
Date: 1 1 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home
Name of care home: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN 01692405818 01692404423 brunswick_house@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brunswick House Care Home Ltd Name of registered manager (if applicable) Miss Karen Senior Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Brunswick House is a care home providing personal care and nursing care for up to seventy-five people. Brunswick House Care Home Ltd is the registered provider. The services offered within the home are described in the Statement of Purpose and Service User Guide. The Home was built in the 1980s and is located in the town of North Walsham and is close to all local amenities. Brunswick House is a large detached property on two levels and stands in its own grounds with an extensive parking area. It is divided into three units: Grant Hadley, the first floor of Brunswick and the ground floor of Brunswick. Each unit provides nursing and residential care. The home also has a day centre in the grounds and some people living at the home attend the centre. The owners have Care Homes for Older People
Page 4 of 26 care home 75 Over 65 0 75 10 0 Brief description of the care home changed the use of some rooms and they intend to accommodate only 70 people and use 6 double rooms and 63 single rooms, most of which have some en suite arrangements but not all have full en-suite toilets and showers or baths. There are three lifts within the home. The weekly fees for the home are presented in information about the home given to residents. CSCI inspection reports are available at the home or can be obtained from the CSCI website. Care Homes for Older People Page 5 of 26 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection of the service. We followed the service through regular notifications that the home was sending, notifying us of events that affected residents. This inspection included a site visit on 11/02/09 and lasted for 6 hours during which three residents were case tracked. A further 5 residents spoke to the inspector. One of the residents was with her husband who just visited her and both gave their opinion about the service. Four staff members were spoken to. The manager and the administrator,also a corporate finance officer for the whole organisation, provided a lot Care Homes for Older People
Page 6 of 26 of information about how the home was run and explained their actions regarding the previous inspections requirements. Some documents and records and residents and staff files and were also checked. A tour of the home provided direct information about the environment. Care process was observed in one of the units and interactions between staff and residents provided evidence used in this report. An AQAA, Annual Quality Assurance Assessment filled in by the manager provided information also used in this report. A recent complaint was invesigated by an independent social worker who reported back and the outcome of her investigation was also used for this inspection, as it was relative to some care processes. We checked the homes quality assurance survey and comments from residents were used to better describe the service. What the care home does well: What has improved since the last inspection? With the new manager in post, there were big changes in the home. One that affected both staff and residents related to the new way of working. The new manager introduced a rota that ensured that all care staff worked in all units. This principle helped staff get to know all residents. The new induction programme now ensured that staff completed all necessary training during their induction. The mentoring of new staff by the experienced carers was extended to junior staff with skills and experience and raised staff motivation and better outcomes for residents. The new training matrix now ensured that staff regularly attended training. Instalation of self closing devices on the doors had begun, 6 were instaled, and the administartor explained that the whole home would be covered within 6 months. The smoking area was relocated to the room where non smokers were not affected by the smoke. An air conditioning device was installed as well as a more sensitive smoke detector. The home started recording the temperature in the medication storage room, bought a new medication fridge and arranged for collection of extra medication on a regular basis. Newly obtained anti-pressure sore mattresses were obtained. Care Homes for Older People Page 8 of 26 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provided sufficient information and in various formats to people so that they could choose the home with confidence. The home exceeded these standards. The initial assessment ensured that both the home and the prospective resident knew whether the residents needs would be met. Evidence: The home arranged for everyone in it to see information about the service in their displayed statement of purpose, service users guide, quality assurance report and last inspection report. The statement of purpose was regularly reviewed and updated. The guide was available in different formats and different languages, including Braille. The home was working on producing information about the services in audio and video format. The home exceeded the minimum standard. Files checked showed that initial assessments were carried out thoroughly, ensuring that all relevant details were recorded and used to create care plans. The manager
Care Homes for Older People Page 11 of 26 Evidence: showed what was added to these documents: marital status, nationality and contact details of their relatives at night time, among other changed boxes to record all relevant details of potential residents. The improvements made and used under new principles in assessments and determination if assessed needs could be met exceeded minimum standards. All three checked files showed that residents needs were met. A resident and her husband who visited her stated: Yes, they are great. They look after me very well. I can now stand on my own, and her husband added: She is so happy now, she made huge progress here, thanks to them. Care Homes for Older People Page 12 of 26 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New care plans and system of work recently introduced ensured better care for residents and better staffs knowledge of residents. Evidence: Three users files were checked. They were all created from the initial assessment, but one newer file used the new format for assessment and contained well transferred information from the assessment to the care plan. Detailed risk assessments were also part of the plan and there was a clear link between plans and risk assessments. Service users spoken to confirmed that they were fully aware of their care plans. Review sheets showed that these documents were reviewed monthly. A resident spoken to confirmed: I know my care plan. They always call me when they review my care plan. All three care plans checked were up to date and signed by residents. Keeping residents files in each unit and having a short summary of the plan helped staff respond much better to each individuals needs. Residents health care needs were well documented. The manager stated in their self
Care Homes for Older People Page 13 of 26 Evidence: assessment, AQAA: Prevention of pressure sores-this shows we have given very high standards of care to the residents. One of the checked files stated: preferred to keep her private chiropodist, also showed that residents could express choice regarding their healthcare arrangements. Medication and records for 4 residents were checked and all were in good order. New arrangaments for storing and monitoring stored medication reduced the risk of exposure to higher temperatures and reduced the amount of stock medication held in the home. Risk assessments for those self administering medication, as seen in two cases of inhalers, were in place. Controlled drugs and records were also inspected and found to be in good order with strict controlling procedures that protected both staff and residents. In general the home promoted privacy and dignity and residents spoken to stated that they felt respected. However, the home would need to either record appropriately or arrange other means of showing respect to residents that wanted their bedroom doors open during the day. The manager was aware of the need to address this issue, as well as to expand the risk assessment of the resident who was allowed to smoke in her room. A new check list for staff to ensure they do not forget certain elements of care when leaving residents in their rooms was designed. This list contained 27 check points and included among other issues: check the time on residents watches, ask where they would like to sit, report any potential bruises or marks, check if they want to use perfumes/aftershave and open windows if they want. All checked files contained signed wishes in case of death. Palliative care was recently added to staff training. The AQAA also stated: We have a last wishes card, this tells us what the person prefers at the end of life care. We have details of care of the dying for different cultures. Care Homes for Older People Page 14 of 26 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were involved in planning their daily life and activities and were listened to, and their suggestions were followed through. Evidence: Residents files contained entries about their likes and dislikes and preferences regarding daily life. A user spoke to the manager during the tour of the home and said: I walked around this morning, without staff, I enjoyed it. I am all right. Thanks for letting me do what I like and looking after me so well. An activity co-oridinator spent quality time with residents. He was seen organising activities for 5 users in the lounge and two hours later he was seen with another resident in his room helping him with a digital TV box. Two residents stated that he was with them in between these times. He spoke to us, showing how well he knew residents, their wishes, preferences and expectations. A resident stated: I love bingo. I won last night. I also love going on outings. They took me to Great Yarmouth and I am planning to go to the War Museum. As a day centre was on site, some residents used that as an advantage to increase their activity and attended the day centre. The Princes Trust and The Brunswick Gardening Team tidied the garden.
Care Homes for Older People Page 15 of 26 Evidence: All those spoken to stated that the food was very good. Kitchen staff reported that all equipment was working in the kitchen and that all was well organised. The menu, produced in picture format, provided the information about the variety of food. Residents spoken to stated that they could choose any alternative if they did not like anything from the menu. Care Homes for Older People Page 16 of 26 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clearly displayed and appropriately followed complaints procedure reassured residents that they could complain with confidence and that they were protected by the appropriate protection measures in place. Evidence: The manager reported that the home had received 15 complaints in the last year. Five of these were upheld. However, the number of complaints seemed high as even questions of improving something were recorded as complaints. All complaints were responded to within the time scale of 28 days. There were 3 referrals to the Protection of Vulnerable Adults register. One of these was referred to a visitor. Although there were no inclusions on the register, the home protected residents, like in this case, when the visits were supervised after the investigation. No staff were added to the register and the latest referral was at the investigating stage at the time of the site visit. Care Homes for Older People Page 17 of 26 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A nice and pleasant environment appropriately divided into units helped residents feel relaxed and at home. Evidence: The location of the home in a quiet residential area of North Walsham, but with good access to the city of Norwich by public transport was appropriate for its purpose. In addition the home had their own minibus that was used for outings, but also to bring in potential residents who did not have other means of transport to get in. All double rooms apart from one, were used as a single, as residents wanted. The majority of comments from residents and their relatives were positive and confirmed that the home was kept clean. A relative commented: This care home is quite old, but it is a comfortable, well cared for and clean place. The manager reviewed and updated infection control measures and policies. Division into units helped maintain a home free from infections. The manager reported in their self assessment, AQAA: We continue to decorate the home in a timely fashion with minimal disturbance to residents. We have moved the smoking area to another adapted location for safety and for the health of residents. There were plans for changing the nurses office in the downstairs Brunswick area into a clinic/medication room. This would improve conditions for nurses to work with residents in a larger, safer place.
Care Homes for Older People Page 18 of 26 Evidence: Previous requirements related to fire protection were responded to by the installation of the self closing devices, 6 doors were already fitted with this equipment and the administrator stated that all doors would be completed within 6 months. Although the manager wanted to have a designated storage area, the fire exits were now free as the equipment was temporarily stored in unused bedroom and one of the unused bathroom. A tour of the home showed that the homely environment was maintained and residents liked the opportunity to bring in pieces of their own furniture. Infection control measures were in place and the manager was proud to state that their measures contributed to elimination of MRSA bacteria. The laundry room was seen in the shed just outside the back door and was appropriately equipped for the size of the home. Care Homes for Older People Page 19 of 26 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefited from being cared for by a dedicated, experienced and stable staff team, who were appropriately checked during the recruitment process and well trained to their job. However the size of the home required a deputy manager post. Evidence: The manager reported in their self assessment, AQAA: All care staff have done or are due to do all mandatory training. All staff have gained NVQ 2 and 3s and all new starters will commence their NVQ in the near future. The manager has completed RMA (Registered Managers Award). The administrator was in the process of sorting all staff files in consistent order. Three staff files were checked and two newly compiled were in order. All three contained all necessary documents, such as CRB and POVA disclosure, references, registration details of nurses on NMC (Nursing and Midwifery Council) , interview notes and contracts. The staff rota was checked and showed that some staff opted to work long shifts, normally joined morning and afternoon shifts. The rota was written with the staff members first name. The manager would need either to include staffs surname or to make the list of staff full names in front of the rota folder, to enable better identification of staff. The manager had recently started engaging agency staff to cover shifts that local bank staff could not fill. The manager reported that she was engaging
Care Homes for Older People Page 20 of 26 Evidence: agency staff despite the owners dissatisfaction with this extra expenditure. The administrator covered during the managers absence when she was on two weeks holiday. The manager was still contacted during that time, almost daily, for advice. This showed the great need for a post of Deputy manager to be introduced. The manager statement: I am on call 24 hours every day, in 365 days. The new, improved training programme already showed positive results and the training matrix showed that all staff were closely monitored regarding their training. One of the checked files of the new care worker, as well as other two files, showed that recruitment procedure was appropriately conducted. All comments received from residents and their relatives praised staff for their good work. The manager also stated in the AQAA that 20 staff out of 36 held NVQ qualifications, showing how the home exceeded this standard. Care Homes for Older People Page 21 of 26 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A new, skilled and experienced manager conducted the home in the way that ensured progress, that was also seen in quality assurance survey responses and during the site visit and from comments received from satisfied residents. They were protected by safe working practices. Evidence: The home presented their evidence in their self assessment under what can be improved, which stated: To continue with what we are already doing. More thought is given to the annual development plan for the future to ensure that what is identified is achievable within 12 months. This statement and the site visit showed that the manager was aware of the need for further improvements and directed the pathway for these improvements in the future. The manager completed her RMA. Changing the way the staff worked by allocating them to work in all units periodically and to get to know all residents positively affected the ethos of the home. When this
Care Homes for Older People Page 22 of 26 Evidence: was discussed with 4 staff, they stated that it had not been easy to change, but now the improvements can already be seen. Quality assurance reviews and surveys provided information on what and how needed to change. In cases where the home kept residents money, the records and auditing process ensured that residents were protected. Three records were checked and found to be accurate. Residents that wanted to hold some money with them were allowed to do so. The manager admitted that supervision was not completely up to date, but the plan and training booked for more senior staff to become supervisors was already in place. The plan was seen, as it was displayed in the office. The home ensured that they had all policies and procedures to ensure the home operated in a safe way and ensured protection for residents. Records of contacts with Environmental Health and Fire Department showed the homes determination to comply with the legislations. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 26 18 The home must have a 30/04/2009 deputy manager to ensure the smooth running of the home, protection of residents and support for staff at all times, even when the manager is off, as this position is necessary for the size and nature of the home. This would ensure that residents are all the time served by appropriate staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!
