CARE HOMES FOR OLDER PEOPLE
Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN Lead Inspector
Don Traylen Unannounced Inspection 24th January 2008 10:45 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 House Nursing and Residential Home DS0000068355.V358525.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 House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Brunswick House Nursing and Residential Home Address 81 Bacton Road North Walsham Norfolk NR28 0DN 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) 01692 405818 01692 404423 brunswick_house@hotmail.com www.brunswick-house.co.uk Brunswick House Care Home Ltd Position Vacant Care Home 75 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (75) of places Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th January 2007 Brief Description of the Service: 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 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. There has not been a registered manager since April 2006. The weekly fees for the home range from £325 to £575. CSCI inspection reports are available at the home or can be obtained from the CSCI website. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission for Social Care Inspection carried out this inspection that started at 10.45 am and finished at 5pm. The home completed an Annual Quality Assurance Assessment and 28 survey forms from people using the service and their relatives were completed and returned to the Commission. The majority of comments were positive, although many of the survey forms had been completed by care workers on behalf of people living at the home. There was no acting manager at the home at the time of the inspection. The organisation’s Head of Administration was present throughout the inspection and provided information and documentation that was asked for. The care plans and admission arrangements for two people were tracked. Medication administration records and the storage and management of medication were assessed. Staff recruitment and staff training arrangement and records were read, as were the home’s policies and procedures. The arrangements and the documents used for guidance to protect vulnerable people were inspected to determine whether people are adequately safeguarded. Three care workers were consulted for their experiences. A number of people living at the home were spoken to at various times throughout the inspection for their views and experiences of living at the home. What the service does well:
Care staff were friendly and were attentive to people. The result of this was an atmosphere that was conducive to providing good care. There was evidence that staff provided good care and this was seen in the interactions between care workers and people being given care and in their records and care plans. During the inspection eight people said they were satisfied with their care and stated care workers treated them respectfully and kindly. Nobody said they were dissatisfied with their care, or with any aspect of the home. The internal environment was clean and hygienic and the owners have developed a plan to keep the home maintained and have planned to make a range of environmental improvements. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection?
The home has been re-structured and changed from operating two units to three, which are each headed by a nurse-manager. The same care workers are usually deployed in each of the units with the intention of providing some continuity and consistency of care. The administration and management and storage of medication are conducted separately in the three units. An acting manager has been in post for approximately seven months and has overseen a number of improvements to the home that include: care planning and the organisation of care and care teams; staff training; the management of medication and employing an activities co-ordinator who has planned an interesting selection of activities for people to become involved in should they choose. A new extension has been built and is a dedicated surgery for the weekly visiting GP. This facility is a very clean and well-equipped small surgery where the visiting GP can be consulted in private. A few ‘hospital’ beds with specialised mattress have been purchased for people who are spending a significant amount of time in bed or who are cared for in their bed. New hoists have also been acquired. Redecoration of the three dining rooms and the three lounges has been completed. Many of the bedrooms had been redecorated. There has been a decision to reduce the homes accommodation to approximately 70 people, rather than the 75 people it is registered to provide for. The owners and the acting manager considered that the use of some of the larger rooms were not suitable for use as double rooms and will be used only as single rooms. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request.
Brunswick House Nursing and Residential Home DS0000068355.V358525.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 House Nursing and Residential Home DS0000068355.V358525.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): 1,3,6 Quality in this outcome area is good. People are assured they are adequately assessed prior to moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A colourful and well-presented Statement of Purpose and a Service User Guide were available for people who are interested in the home. There was no indication of the range of fees charged by the home in their Service User guide. There were references to the registered providers and the proprietors as individuals, despite the fact that the registered provider is “Brunswick House Care Home Limited”. The two documents must be reviewed for their accuracy. The admission assessments and information for two people were read and found to be satisfactorily informative. PCT Care Managers’ assessment information had been received prior to admission and the home had made their assessment of the person’s needs.
Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 10 The last report stated, “When assessment of prospective new service users are made the needs of all service users and the number of staff needed to meet these needs will need to be carefully monitored.” This observation still applies as the home have a mixture of nursing and residential care that is not separated and the night time staffing levels are greatly reduced from the daytime staffing levels. Intermediate care is not provided by the home. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 11 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. Care is planned and given in a respectful manner, but people are not always assured their care plan is always written or recorded in full. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for two people with high dependency needs were read. One female was confined to bed and the other person was cared for in bed and from a chair during some of the daytime. It was noted that he was not seated in a specialist pressure-relieving chair when we spoke to him and his wife at lunchtime. It is recommended that the home consult with a community nurse regarding the seating and any specialist equipment that might be needed by this person. A few ‘hospital’ beds with specialised airflow mattress have been purchased to help alleviate any pressure for people who are spending a significant amount of time in bed. New hoists have also been purchased by the home. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 12 The care plan for the gentleman referred to above did refer to his personal hygiene needs, but did not adequately explain or make clear his personal hygiene circumstances and needs. There was no written instruction or description of when or how this care would be provided. There were no records of the times he was hoisted from bed into a chair or the duration he was seated in a chair. There was a record of the time he had been ‘turned’ whilst in bed to relieve any pressure on his skin, although these were irregular and did not show if checks had been made at any other times. His fluid intake chart and food intake charts had been regularly maintained by care workers nurses and his wife. The care provide for another person who was confined to bed did not state the frequency of the turns to relieve any pressure build up on her skin. A ‘turn chart’ had been maintained and include the times and record of turns but they were irregular and there was no written instructions of the frequency that should be kept to check or provide this care. Her personal care had been sometimes been recorded as “all personal care given”, but it was impossible to know what had been given. On the day of inspection at 4.30pm when the care plan was read there were no records entered in her notes since 9.30 am. Overall, the care plans were adequate and did plan to address needs but did not always describe the care, or the circumstances clearly. For instance, notes that were written in one person’s plan stated, “deterioration”, but did not explain what this meant, or if care had remained the same, or had altered. There were daily evaluations and care plan evaluations recorded but there was an overall lack of descriptive actions for some important aspects of care. Staff were observed to communicate and approach people in a way that promoted privacy and respected dignity. This was evidence gathered from observations of staff assisting people during the inspection. Several people were asked if they were treated with respect and all said they were. One written comment received was, “the staff are very willing and helpful…. They respond very quickly to any requests we may have”. Another person had written, “When I ask I get the care and all the help I need”. The medication room on one unit was recorded at 30C. This was above the recommended storage temperature of 25C for medication. There were excess stocks of creams and liquid medication. One cream was dated November 2007 whilst the majority of creams were dated December 2007. Although these medicines had not been opened they had been stored for over one month and some for two months at temperatures too warm for their recommended storage. The administration and records for medication had been accurately maintained in the Medication Administration Record (MAR) charts and stocks were checked and found to be accurate. The home’s medication policy included ‘PRN’ prescribed medication and stated the medical advice and reason for administering should be recorded.
Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 13 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 good. People enjoy a lifestyle that meets their assumptions and expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eight people stated they were satisfied with life at the home and were happy living there. Nobody reported they were dissatisfied with their care. They all agreed that their care was, as they liked. It was clear that family contacts are kept. During the day there were nine relatives or friends that visited people at the home. One person who was visiting her husband said that she visited every day at lunchtime and usually stays for approximately two hours. There was a relaxed atmosphere and a feeling that people were enjoying the spaciousness of the building and could be alone or private in small groups or become involved in organised activities, as they chose. The activities co-ordinator who is employed for five days each week has arranged trips out and has supplied many photographs and reminders in a book of these events. He organises daily activities and small group interests. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 14 A balanced and nutritious looking and plentiful meal was eaten at midday. Special diabetic and soft food is prepared for a number of people. The cook knew and kept a list of each person’s dietary needs and preferences. The kitchen was staffed by a cook and three assistants and seen to be very clean and tidy. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 15 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. People living at the home are generally protected from abuse by the home’s policy and procedures, although they would be better protected if staff were enabled to individually report a suspicion of abuse to the lead authority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and maintains a complaints logbook. The complaints policy was on display in at least four different parts of the home. The home has appropriately reported suspicions of abuse. An information file about adult protection had been collated and included the PCT policy and procedures and contacts for where to report concerns and allegations and information about the POVA First team. The home’s policy regarding abuse was appropriate. Staff were not provided with, and were not sure of where to locate any contacts of where they should report an allegation or suspicion of abuse, should they ever need. This was discussed with the Head of Administration. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 16 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 adequate. People are assured of a warm and friendly environment but are not assured the home has adequately responded to the no smoking legislation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and tidy and well decorated internally. Three dining rooms and three lounges and many of the individual rooms had been redecorated and re-carpeted. One person had written, “ When picking my home a contributing factor was the cleanliness”. The Head of Administration explained that more internal redecoration is planned. The home has prepared a fairly extensive written programme for improvement that is realistic and based on improving the internal environment first and then attending to the external decorative state. Plans to re-site and rebuild the laundry on a new level have been drawn up by an architect.
Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 17 Two lifting hoists were stored in corridors directly in front of fire extinguishers and caused an obstacle near to a doorway because they were too wide to be safely stored in the corridor. This was pointed out to the Head of Administration during a tour of the building. One bathroom was fitted with an old and worn Parker bath that is due to be replaced in the near future. A tour of the building revealed that there may not be sufficient numbers of functioning bathrooms or shower rooms for 70 people living at the home. Bedrooms had not been fitted with self-closing doors. It is recommended that the home consult with the Fire safety officer regarding this matter. The smoking area used by people living at the home was located within the building, between the conservatory and the corridor within the communal walkway for accessing the conservatory. This was an unsatisfactory arrangement. There was no protection from smoke fumes and these fumes would be contained within the home and appeared that they could possibly activate the fire alarm. The home is constructed internally on many different levels and mezzanine floors. This potentially may present physical and mental challenges to people who have impaired memory, orientation or recognition. The home has recently increased their service to include 10 persons with dementia related needs and should keep in mind the potential environmental impact of the home on their functioning. Overall however, this is an improving situation with many bedromms having been redecorated and recarpeted since the change of ownership. Work has also been carried out to open up a new bathroom close to Rooms 29 and 30. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 18 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 adequate. People living at the home are not assured staff receive appropriate training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Extra staff are employed for assisting with bathing between the hours of 9am – 1pm. One nurse as manager and three care workers are employed on each unit during the daytime. The staffing levels are much lower at night time when one nurse and four care workers are employed. This may not be an adequate staffing arrangement between 8pm and 7 am because the home can provide care for up to 75 people. Two care workers said they not sure of what or if any training had been planned for them in the future. One nurse felt that training in Dementia care and Parkinson’s Disease were needed by staff, especially as the home is registered to provide care to people with dementia related needs. There was a notice on the staff notice room about some training dates and three staff said they expected any training provided to be made known to them through being posted onto this board in the staff room. It seemed that the acting manager had personally provided and arranged much of the induction training within the past seven or eight months. Care workers stated that the acting manager had provided induction training for new staff. The induction records were not available for inspection, but the induction programme was seen and was based
Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 19 on the Skill for Care Standards. The acting manager is a certified Moving and Handling trainer. Training in the Mental Capacity Act and Adult Protection had been provide by the Local Authority to some care workers and it was stated by three care workers that the acting manager had also provided some of this training to staff. Fourteen care workers were actively undertaking NVQ level 3 awards in Care. Eight staff had started an NVQ level 2 awards and the acting manager had started the Registered Managers Award and the Head Administrator has started the Institute of Management Accountants award. A training matrix revealed that most of the recorded training was at induction level and had been provided by the acting manager. Any further training had not been provided and future training had not been planned. A training folder was read and this was just a collection of training organisations, their courses and contact details. The home are not making adequate arrangements to train more staff in further topics of care and have relied upon Induction training and the NVQ level 2 and 3 awards rather than provide further or additional training in a range of topics related to the provision of nursing and residential dementia care. A number of oversees care workers had been employed and some of these were nurse qualified in India and were being assisted to do an English for Student with Overseas Language (ESOL) course to improve their use of English language. Many of these nurses were undertaking NVQ level 3 awards in Care. Two files containing the recruited records for two staff revealed that both people started employment prior to a full CRB disclosure and after a POVA First check had been obtained. There was no record of their supervision whilst awaiting their POVA first disclosure and no ongoing records of any supervision. Both person’s files contained a record of them being inducted to the home through a BVS training video process with a book to record their progress. This book was not available to assess. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 20 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): 31,33,38, Quality in this outcome area is adequate. People living at the home are not assured of consistent and good management and that staff are supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was without a manager or acting manager on the day of inspection. The acting manager who had worked at the home for approximately seven months was on sick leave and the organisation had arranged for somebody to become the stand-in temporary manager. However, this person was not working at the home on the day of inspection. The unit nurse-managers managed much of the functioning of the home and the Head Administrator, by default, had taken on some of the work of the acting manager. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 21 The home’s record keeping for training and induction arrangements did not provide satisfactory evidence of a well-managed service or that the interests of people living at the home are appropriately promoted. Regulation 37 reports have be appropriately sent to the CSCI and kept by the home. Annual fire safety test certificates were in place and the weekly and monthly checks of fire alarms and fire drills and the testing of emergency lighting were recorded. Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 22 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x N/A x x 3 Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 23 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 OP8 Regulation 23(2)(n) Requirement Timescale for action 01/05/08 2. OP9 13(2) People who need to remain seated, or lying in bed, must be provided with the appropriate equipment designed to relieve pressure areas so they are not at risk of developing pressure sores. Medication must be safely stored 01/04/08 and managed: • All medication must be stored at an appropriate temperature so that people are assured of safely managed and administered medication so that people are assured their medication is safe to use. All excess, or extra medication outside of the safe to use by period, must be disposed of or returned to a pharmacist so that people are not at risk. 01/03/08 • 3. OP19 23(5) • Consultation and advice must be sought from the Environmental Health Officer in relation to the
DS0000068355.V358525.R01.S.doc Brunswick House Nursing and Residential Home Version 5.2 Page 24 4. OP19 13(4) 5. OP19 23(4) 6. OP30 18(1)(c) 7. OP30 18(1)(c) 8. OP36 18(2) smoking area arrangements that have been decided by the home to ensure that people are not put at risk. Hoists must be stored where they are not obstacles, or prevent access to any fire equipment so that nobody in the home is put at risk. The fire Safety Officer must be consulted regarding the lack of any self-closing devices for bedroom doors to ensure that people are not put at risk. A structured Induction training based on the Skills for Care Induction Standards must be evidenced for each person receiving induction and be recorded to show the competencies they have attained so that people are not at risk of inadequate care from inadequately trained care staff. Further training must be provided and must be recorded so there is evidence that staff have been provided with appropriate training so they are able to meet the diverse needs of people living at the home. Staff must receive regular and appropriate supervision and this includes all new staff employed prior to a satisfactory CRB disclosure being received must not work alone, or without working alongside a named person responsible for their supervision to ensure people are protected from risks. 01/03/08 01/05/08 01/05/08 01/05/08 01/05/08 Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 25 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. 3. 4. 5. 6. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and the Service User guide should be reviewed and provide an accurate statement of the registered provider and of he fees charged. It is recommended that the temperature of each of the rooms used to store medication be monitored to ensure medicines are stored at or below 25C at all times. It is recommended that medicines no longer in use or surplus to requirements be promptly removed for disposal. All staff should have easy and immediate access to the contact details should they need to make a referral regarding an allegation or suspicion of abuse. Attention to repainting and decorating the worn and peeling paintwork on the exterior woodwork should be planned and carried out. The interior area around the lower parts of doors and doorframes and corridors that have been scuffed and dented by wheelchairs should be repainted and protected from further damage. The night time staffing levels should be reviewed so that people are assured there are always adequate staff in the home to meet their needs. OP9 OP9 OP18 OP19 OP19 7. OP27 Brunswick House Nursing and Residential Home DS0000068355.V358525.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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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