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Inspection on 12/07/05 for Brunswick House Nursing Home

Also see our care home review for Brunswick House Nursing Home for more information

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This Home has a most friendly welcoming atmosphere. The staffing team has developed good working relationships with residents living at Brunswick House. The Home provides a wide variety of social activities to suit the residents` individual preferences. Many residents commented that they enjoyed the entertainment that is arranged. The Home provides a good choice of food and members of staff carefully monitor the nutritional needs of each person to ensure that they receive the amount of food they require to maintain a healthy lifestyle. Several ladies particularly commented on the `good food at the Home`. The Home provides comfortable accommodation, which has been decorated and furnished to a good standard. Residents have the additional benefit of the attractive well-maintained gardens. The Home is to be complimented for the excellent standard of cleanliness while the building alterations are undertaken.

What has improved since the last inspection?

The Home has made improvements in the standard of recruitment and in the maintenance of records at the Home. An extensive building programme is being undertaken which, when completed, will significantly improve the standard of the environment at Brunswick House. The residents were able to confirm that they are not being inconvenienced too greatly by the work.

What the care home could do better:

The Home must make ensure that fully documented assessments are provided for each resident; these will then provide a basis for the care planning documentation. Some improvements are also required in the recording of medication processes although these are undertaken safely. Staff supervision procedures have been introduced but these need to be developed so that each member of staff gains full benefit of the meetings.

CARE HOMES FOR OLDER PEOPLE Brunswick House Nursing Home 119 Reservoir Road Gloucester GL4 6SX Lead Inspector Eleanor Fox Unannounced 12 July 2005, 09:15 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brunswick House Nursing Home Address 119 Reservoir Road Gloucester GL4 6SX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01452 523903 01452 312033 Buckland Care Ltd Mrs Susan Gough Care Home with Nursing 34 Category(ies) of OP old age (34) registration, with number DE(E) Dementia - over 65 (6) of places Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: To accommondate one named service user under the age of 65 years. Date of last inspection 24/01/05 Brief Description of the Service: Brunswick House is a large Victorian property, which has been sympathetically converted to provide accommodation for 34 elderly ladies who require nursing care. The Home is situated in an attractive residential area on the outskirts of Gloucester. It is owned and managed by Buckland Care Ltd., a Dorset-based care provider. Bedrooms are provided on three floors accessed by a shaft lift; two chair lifts have also been installed on the shorter staircases. The Home comprises 24 single rooms, two with en suite facilities, and 5 double rooms. Some significant refurbishment continues to be undertaken throughout the property and an extension is also being built to provide accommodation for elderly ladies suffering from dementia related illnesses. A large lounge/dining room is available on the ground floor with further comfortable seating areas provided in the Caplow Wing and on the first floor. The service users have the benefit of a large attractive garden, which is easily accessible and may be enjoyed in warm weather. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of 5.75 hours. It consisted of a tour of the Home; inspection of a selection of written care records; recruitment files and other available documents; plus discussions with the Manager, and members of staff working at Brunswick House. The inspector also had the opportunity to talk to four of the residents and to three relatives during her visit. It was an extremely hot day but the majority of the Home was comfortably cool, as fans had been provided at strategic points throughout the property. What the service does well: What has improved since the last inspection? The Home has made improvements in the standard of recruitment and in the maintenance of records at the Home. An extensive building programme is being undertaken which, when completed, will significantly improve the standard of the environment at Brunswick House. The residents were able to confirm that they are not being inconvenienced too greatly by the work. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 6 Although there is provision of comprehensive literature about the Home, a thorough assessment process must be developed so that prospective residents are enabled to make an informed decision regarding their admission and be given the assurance that their needs will be met. EVIDENCE: The Home provides each service user or their advocate with a detailed contract outlining the terms and conditions for admission to the Home. Full details are also provided of the levels of any ‘RNCC’ financial contribution to which the resident may be entitled. Copies of the information supplied are also kept in the residents’ personal files. Although the Manager confirmed that full assessments are undertaken of each person who wishes to be admitted to Brunswick House, there were no completed copies of this documentation available. The only written assessment for one lady who had been resident in the Home for 7 days, was the assessment provided by social services. Although carers had been given verbal guidance in her particular care needs, there was inadequate documented detail in her records. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 9 Intermediate care is not provided in this Home. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 and 10 The care planning systems in place adequately provide the staff with the information they require to care for all the residents’ needs. However, medication systems require improvement to ensure that residents are not put at any risk of potential errors. Care is delivered in a manner that preserves the residents privacy and upholds their dignity. EVIDENCE: The Home continues to act as a ‘pilot’ for recently developed care planning documentation. Although this provides a very clear picture of each person’s general condition plus any changes, members of staff at the Home confirmed that completion of the documentation is most time consuming and often provides repetitive information. Nevertheless all relevant areas of the resident’s care needs are addressed; these are reviewed and updated appropriately. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 11 On the whole, medications including controlled drugs, are ordered, stored and administered correctly. However, handwritten additions to the drug administration sheets are not always signed by the person making the entry, nor countersigned by another person to signify agreement with the record. One drug was prescribed, “as directed”. There was no written guidance anywhere to guide staff in the correct administration of this medication. Members of staff spoke to residents in a friendly but respectful manner. Every resident who spoke to the inspector, was most complimentary about the staff, confirming that they were “kind and helpful”; “wonderful – every single one”; and “they will do anything for you, nothing is too much trouble”. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Opportunities are provided for varied and stimulating activities and social contacts, as desired. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: Two carers have now been given responsibility for arranging activities in the home; they have already attended some formal training in the processes. A full and varied programme has been arranged to suit the interests of the ladies living in the home. One lady commented that she enjoyed, “ a good sing song”; another lady liked to try word puzzles, a carer was assisting her to complete one. The residents also like the shows, which are arranged in the home for their entertainment. A number of friends and relatives called in at the Home during the day. Each was most positive about the care given to the residents and appreciative of the way in which they were addressed by the staff. One lady confirmed that she is always notified of any changes in her Mother’s condition. She said, “I look on the staff as my friends.” Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 13 The cook has prepared a varied and nutritious selection of menus based on residents’ particular preferences. Alternatives are provided when requested. The majority of the ladies ate their mid-day meal together in the dining area; every effort was made to ensure that they enjoyed their food in cool surroundings and that they were given the opportunity to eat the meal in an unhurried fashion. The recently refurbished kitchen was clean and well organised. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 A satisfactory complaints system enables service users and their families to feel assured that their views would be listened to and acted upon. Residents’ legal rights are protected. EVIDENCE: The Home has a written Complaints Procedure, which is readily available to residents, their visitors and members of staff working at Brunswick House. The processes are explained in the Home’s Statement of Purpose and are also outlined in the Information folder, which is kept in the front hall. There have been no formal complaints in recent months. Residents have been included on the Electoral Register; some of the ladies chose to submit a postal vote at the recent Election. Information on obtaining Advocacy Support is advertised in the Home. None of the current residents have required this facility. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 and 26 The current provision of extended and improved accommodation is ensuring that the residents will have the benefit of a high standard of accommodation. EVIDENCE: In addition to the construction of the new accommodation the whole home is being electrically rewired at the present time. Work is also continuing to provide improved bathing facilities on the first floor. The enclosed garden was particularly attractive on this occasion; it is equipped with sturdy furniture so that residents may sit outside if they wish. There is a good focus on ensuring that appropriate health and safety measures are in place in all areas of the home. Water temperatures are checked every month and certification dated 21.6.05 provided to confirm that water is stored in both tanks at a temperature of at least 60 degrees centigrade to prevent risks from Legionella. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 16 Despite the ongoing building work, the whole property was commendably clean and free of any offensive odours. Laundry is addressed correctly; the equipment is to be replaced towards the end of the year. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Skill mix and staffing numbers are adequate to meet the needs of the residents living in the Home. Recruitment processes must be improved to ensure the protection of residents living at Brunswick House. EVIDENCE: There were thirty-three ladies living in the Home; it was anticipated that the remaining vacancy would be filled shortly. In the morning, the Manager, a nurse and six carers were in the Home to look after the people living there; the seventh carer was unwell. One nurse and five carers were due to be on duty in the evening; with a nurse and two carers working at Brunswick House overnight. Each of the residents who were spoken to felt that they were receiving good care at the Home. Inspection of the personnel records showed that careful recruitment procedures are normally followed when employing new members of staff. On most occasions, all the required employment checks are undertaken before the member of staff joins the team. In one case, however, no reference had been requested from the previous employer. This issue is now being addressed. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36, 37 and 38 Although some improvements are required in staff development and record keeping, there are robust management systems in place to ensure that the financial interests, and the health, safety and welfare of the ladies using the service are safeguarded. EVIDENCE: The registered Manager is an experienced trained nurse who is currently completing the Registered Manager’s Award. She has also undertaken recent training to ensure she keeps updated to address all areas of her role. The Manager receives management support from a committed Deputy and the nursing team. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 19 Although the Home does not look after the personal monies of any of the residents at the current time, there are procedures and suitable secure storage in the Home to provide these facilities, when required. Each person’s situation in relation to power of attorney status is documented in the records. Observation of the records and discussion with members of staff shows that there has been limited formal supervision in the Home in 2005. Action is now being taken to ensure that the processes are conducted at least 6 times a year. The majority of records are maintained and stored correctly. There were still no photographs provided for some of the residents. There are records in the Home to show that all necessary maintenance is undertaken in a timely fashion. Members of staff have received training in Fire Safety, Manual Handling, First Aid, Food Hygiene and Health and Safety. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x 3 4 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 x x x 3 2 2 3 Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 3 9 Regulation Requirement Timescale for action By 31.8.05 By 31.7.05 3. 4. 9 29 5. 6. 36 37 Regulation The care needs of each resident 14 (1a) must be fully assessed prior to admission to the home. Regulation All handwritten additions in the 13(2) drug administration records must be signed by the person making the record Regulation There must be clear directions 13(2) for the administration of all medications Regulation A reference relating to the 19 and applicants last period of Schedule employment must be obtained 2.3 for each prospective employee Regulation Supervision processes must be 18(2) fully implemented at the Home Schedule A recent photograph must be 2 provided for each resident (Timescale 31.3.05 not met) By 31.7.05 By 31.8.05 By 30.9.05 By 31.8.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 3 Good Practice Recommendations It is strongly recommended that written evidence of the Manager’s initial assessment of the prospective user be D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 22 Brunswick House Nursing Home maintained on file to assist with the development of the service user’s care needs assessment on admission to Brunswick House. Brunswick House Nursing Home D51_D03_s58304_Brunswick House_v233511_120705_Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL4 6SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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