Inspection on 14/11/06 for Brunswick House Nursing Home

This inspection was carried out on 14th November 2006.

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.

Other inspections for this house

Brunswick House Nursing Home 04/01/06

Brunswick House Nursing Home 12/07/05

Brunswick House Nursing Home 24/01/05

Brunswick House Nursing Home 03/08/04

Brunswick House Nursing Home 22/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Brunswick House Nursing Home 119 Reservoir Road Gloucester Glos GL4 6SX Lead Inspector Mrs Janice Patrick Key Unannounced Inspection 11.50 14 & 15th November 2006 th 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 Home DS0000058304.V314566.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 Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brunswick House Nursing Home Address 119 Reservoir Road Gloucester Glos GL4 6SX 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) 01452 523903 01452 312033 Buckland Care Limited Mrs Susan Gough Care Home 44 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (44) of places Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 To accommodate one named service user with Dementia under the age of 65 years. To be removed when the service user either leaves the home or reaches the age of 65 years. 4th January 2006 Date of last inspection Brief Description of the Service: Brunswick House provides accommodation for older people over the age of 65 years who require personal or nursing care. It is important to note that the home is for females only. It also provides dementia care for a set number of residents, but this is only personal care only (not nursing dementia care). This group of residents are integrated into the main home. Situated in a residential area on the outskirts of Gloucester City, the bus routes are on the main road, which is approximately quarter of a mile away. There is a Church of England church on this main road and in the other direction, about the same distance, a provisions shop. The house has been extensively extended and accommodation is provided over three floors. There is a passenger lift and two chair lifts installed on the shorter staircases. There are 24 single rooms, two with en suite facilities, and 5 double rooms. At the time of this inspection a further extension of two ensuite bedrooms was being built. The home provides ample communal lounge and dining space. There is a mixture of assisted and unassisted bathrooms. An attractive courtyard garden can be viewed from a seating area within the home. The current, self-funding range of fees is £550.00 to £650.00 per week. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over two days, the first between 11.50am & 8.30pm and the second between 9.25am & 1pm. Both the Registered Manager and the Deputy Manager were available during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Also several records pertaining to the care of residents were inspected and the care of three residents was inspected in detail as part of a ‘case tracking’ exercise. Records associated with staff training and recruitment were also inspected. General health and safety systems were inspected along with how the home protects its vulnerable adults. How the home generally communicates with residents and relatives was explored. How it provides information, including financial information available was inspected. Prior to the inspection the Commission for Social Care Inspection (CSCI) sent out surveys to residents/relatives in order to ascertain their views on the services and care provided and received 14 back. The Registered Manager was also asked to complete a pre inspection questionnaire. What the service does well: What has improved since the last inspection? Completion of a major new build has taken place since the last inspection in and the home now accommodates 44 elderly ladies comfortably. The home has organised for more staff to undertake the National Vocational Qualification (NVQ) in Care, therefore enabling more staff to carry out their jobs with underpinned knowledge. The service has highlighted in particular ‘End of Life’ care as an area it wishes to improve and be able to offer an ‘excellence in care’ in. Staff have begun training in this and consideration will then be given in how the home will plan its care. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brunswick House Nursing Home DS0000058304.V314566.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 Home DS0000058304.V314566.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 & 6 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Although there is the required information for residents and visitors in the reception area it would be more helpful if it were more obvious. Arrangements are in place to provide the appropriate person with basic financial information but not everyone is receiving the information they should now have. Arrangements are in place to ensure residents’ needs are fully assessed prior to admission in order for these to be met. Residents can be reassured that their needs will be adequately met by staff who are trained to do so. The home provides opportunities for residents and their families to visit prior to admission and thereafter. This home does not offer designated rehabilitation care. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 10 EVIDENCE: There is a Statement of Purpose, Service User Guide and the home’s last inspection report (produced by the Commission for Social Care Inspection, CSCI) in a file in the main reception area. Unfortunately it was not obvious on entering the home that this wealth of information was available. The Registered Manager confirmed that a copy of the Statement of Purpose & the Service User Guide is given to visitors along with the home’s main brochure. This contains the home’s complaint procedure and a copy of the contract of residence. Examples of the home’s invoicing were seen. These were easy to read and included examples of invoicing for extras, which are clearly highlighted in the above documents. The only exception to this is, although a deduction is shown in the total amount payable to the home by those self funding for the Registered Nurse Care Contribution (RNCC) or the better known ‘free nursing’ element and this is given back to the resident/representative. The home needs to state what the RNCC figure being deducted is, either on the invoice or in a separate letter to aid transparency. This is also now a requirement irrespective of how the residents’ fees are being met, so if they are receiving funding, the RNCC amount within the funded figure must be made obvious. Possible ways of doing this without causing confusion were discussed. The Registered Manager explained that a pre admission assessment is carried out on all admissions to the home. This involves a visit to the individual wherever they are at the time, although in a few cases it may be dependant on information over the telephone and from an initial assessment of needs carried out by the Community Adult Care Directorate (formally Social Services) if the resident lives out of the county. A completed pre admission assessment form was seen for one of the resident’s who was case tracked. This had been carried out in the resident’s previous care home and had taken into account information supplied by a social worker. Staff have or in some cases are working towards having the correct skills to meet the needs of the residents. Qualified nurses have a broad skill mix including necessary experience and qualifications in the care of the elderly, dementia care and current experience in more acute nursing. Additional trainings include relevant clinical skills including the current training in palliative care, which four members of the nursing team are undertaking. The home was extremely busy on the two days of this inspection with a steady stream of visitors throughout the daytime and evening. A high proportion visit on a daily basis and if not, at least several times a week. Several were spoken to and all said they always feel welcomed and included. Several husbands said Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 11 they like to help feed their wives, as it is one thing they are still able to do for them. The home includes one visitor at mealtimes to ensure he has a cooked meal a day. This home does not provide designated rehabilitation care. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. Although the majority of residents’ care is planned, in places the written plan could be more individual to the person as they currently present and demonstrate more resident and relative involvement. Residents’ health care needs are very well met. The medication system is as safe as it can be in order to protect residents from poor practice, although the layout of the home is a challenge to maintaining this. Residents’ privacy and dignity is upheld. At the time of death residents and relatives are treated with respect and skill and their wishes acknowledged and respected. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 13 EVIDENCE: Although this outcome has been assessed as good for residents there are shortfalls in the care planning system, which require improvement. Written care plans are in place outlining in some cases how the residents’ needs are to be met, however in others the content was not specific enough, needing to be more ‘person centred’. This has been identified by the home staff who plan to change the care planning process as part of the Gold Standard ‘End of Life’ pathway, currently being worked through by some staff. One resident’s care was followed and the care documentation was inspected in detail. The care plans for this resident showed a fairly large shortfall in the recording of the care being given. However this was not reflected in the very individual and skilful care that was being provided for this resident who was dying. The content of one other resident’s care plan needed updating, as it was not relevant anymore. Another resident’s care plan for confusion and wandering was not specific to that individual. A system of auditing care plans would help the member of staff who is responsible for writing the care plan, pick up these shortfalls quickly and should be considered. The care documentation demonstrated that several external health care professionals are involved with the home in meeting the residents’ health care needs. These include the GP, members of the Mental Healthcare Team, Continuing Healthcare Nurse, Continence Advisor, Chiropodist, Optician and Dentist. The medication administration records for several residents were inspected. The privacy and dignity of residents is upheld by staff knocking on doors before entering, speaking to residents in a respectful and kind manner even when the resident is confused and repetitive. One resident was able to confirm that all of her personal care is carried out in private and in a manner that does not embarrass her. One resident was afforded privacy whilst taking a telephone call in the main office. The care of the resident who was dying was followed during this inspection. The staff were clearly very fond of her and knew her well. They were aware of her wish, which was to remain in control of the care being given to her for as long as was possible. A member of staff was observed being an advocate for this resident in one situation and liaising with other health care professionals in a knowledgeable manner in order to obtain a peaceful death for this individual. A visiting GP was able to confirm that the staff are always professional and said that they ‘know what their talking about’. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 14 Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is judged to be excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to help promote the residents’ preferences and help them make their own choices on a daily basis. Family and visitors are welcome and are seen as an integral part of the residents care. The food is liked and meets all the residents’ needs. EVIDENCE: Several residents were able to confirm that they make decisions for themselves on a daily basis. These ranged from where they spent their day, with whom they spent time with, what time they get up and go to bed, what they eat and what care they receive. Residents who are not able to make decisions for themselves so easily were observed being asked questions by the staff enabling them to make simple decisions as the day went on. The preferences of many residents were already known by the staff who made sure these were upheld. The home meets the social and recreational needs of the residents by having opening visiting. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 16 On four days a week for 4 hours there is a member of staff who organises activities. These vary from different art and craft based activities to music and movement. Reminiscence based activities are also carried out in small groups or on a one to one bases with residents who have memory problems. External entertainers are popular and the home often hosts events for fund raising such as coffee mornings, raffles and fetes. Recently the residents have been busy making Christmas cards and Christmas puddings to sell/raffle at the next coffee morning. Two residents regularly spend days at a local day centre and one resident uses dial-a-ride to visit her own relatives at home. A newsletter has been started which is distributed to residents and relatives of those who need to remind their loved ones of certain events. The home has been able to accommodate the express wish of one resident to have her dog in the home with her. Before this was decided the opinions of existing residents were sought and now all residents are very fond of ‘Ernie’. There is a Communion Service held each week within the home and alternative arrangements made for another resident who is a practicing Roman Catholic. The Registered Manager has confirmed that any resident or next of kin is welcome to read relevant care records if they so wished. There was no obvious information on advocacy for visitors or residents to read, although the Registered Manager has subsequently confirmed that this has been available for some time. The kitchen was inspected and the cook spoken with. Although the kitchen is small it is well organised and looked clean with evidence of cleaning schedules being kept. The requirements of the Food Safety Agency were being adhered to and included records of temperature probing of cooked foods and fridge & freezer temperatures. There is an alternative menu each day, although the cook was well aware of everyone’s likes and dislikes. One resident spoken to said she only prefers to eat potatoes and cheese each day. This is served, but the cook said they have tried many vegetarian dishes and all have been returned. Another resident said she loves poached eggs and was seen having these instead of meat with her vegetables. Residents confirmed that the food was nice and these sentiments were also echoed in the pre inspection surveys returned. Supper was seen being served from a trolley and there were 2 hot alternatives including sandwiches, which could be chosen from the trolley. One resident had specifically asked for an alternative to all of this, which was provided but not recorded. Residents also said that they are able to have sandwiches or cheese and biscuits later in the evening with their hot drink if they want it. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 17 Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 16 & 18 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. Residents and visitors have access to the home’s complaints procedure but this is not obvious enough for all visitors to read. The home takes the protection of its vulnerable residents seriously and is proactive when needed to be in order to stamp out any form of abuse. EVIDENCE: The home distributes the complaints procedure with its Service User Guide. It is can also be found in the folder in reception mentioned in the first outcome group in this report. The profile of this procedure should be raised and consideration should be given to placing a copy on the wall in a conspicuous position so that visitors and residents can read it. The home has reported no complaints received in the last 12 months. Qualified staff spoken to were very aware of the possibilities of abuse against elderly people, although the majority of staff in the home have not received training on this subject. One night nurse confirmed that she had discussed the subject with a group of night care assistants. Details of the ‘enhanced alerters’ training, provided by the Adult Protection Team in the county were discussed with the Registered Manager. One situation, which was reported to the Inspector by a resident at the time of this inspection, was probably a misinterpretation of events by the resident. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 19 However the Deputy Manager rightly made enquiries rather than just presume the resident was confused. The Registered Manager has had contact with the Adult Protection Team in the past when it has been necessary to take advice on adult protection processes. These situations have also been openly discussed with the CSCI at the time demonstrating that the Registered Manager takes the subject seriously. She has also made referrals to the Protection Of Vulnerable Adults (POVA) list when needed. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 20 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 the following standard(s): 19, 22, 24, 25 & 26 Quality in this outcome area is judged to be good. This judgement has been made using available evidence including a visit to this service. The environment of this home continues to improve in order to offer a safe, well-maintained, clean and comfortable place to live. Bedrooms are domestic in character with several being personalised by the resident. Arrangements are in place to ensure the right equipment is provided to help meet the residents’ health needs and promote their comfort. EVIDENCE: The home over the last two years has undergone huge changes with completion of a large extension to the front, which now offers modern, comfortable accommodation. At the time of this inspection two more bedrooms were being built and builders were breaking through one of the internal walls into the main house. On the Inspectors return on the second day this was secured with board and was not causing any hazards. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 21 It was noted that one room in particular has a totally obstructed view through its main window due to the last major extension, although a smaller second window has been installed. Residents and relatives must be made aware of this if they do not view this room for themselves prior to admission. Several bedrooms in the main house have been decorated and refurbished over the last 2 years and have been made to look welcoming. The Registered Manager explained that rooms are refurbished as and when they are vacant or if they are high on the list of priority. One of these rooms was discussed, as the carpet in the ensuite was particularly tired and unhygienic. Two more rooms discussed during this inspection need their carpets replacing. These were subject to a requirement made in the last inspection and although the home has taken remedial action they remain ill fitting. The Inspector was informed that the occupants of each room were immobile; therefore an immediate requirement was not given however, these must be replaced as a matter of priority. The home’s maintenance person was painting doorways at the time of this inspection. He works 30 hours per week and is responsible for the general upkeep of the home and for some of the basic health and safety checks of which records were seen. The home is well lit and ventilated, it was also comfortably warm and none of the residents felt cold to the touch. Specialised equipment was seen in use and generally comprised of high-low beds, electric beds and specific pressure relieving mattresses and cushions. The home also has equipment for safe moving and handling all of which is serviced appropriately. One resident was seen in bed with a bedrail in place one side of the bed. This was correctly protected with a bedrail bumper, but the side of the bed up against the wall was without a rail. This could put the resident at risk of falling between the bed and the wall and was pointed out to the Registered Manager. The laundry was not inspected on this occasion; a designated laundry assistant runs it 3 days of the week. Several members of staff have completed a distance-learning course in infection control and the home has a link with the Health Protection Agency. Care staff were observed carrying small containers of alcohol gel to use between (not instead of) hand washing. Plastic aprons were worn when serving food and kitchen staff wore appropriate protective clothing and head cover. The home also has arrangements in place for the removal of different grades of waste. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 22 Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. There are adequate staff with appropriate skills to meet the care/health needs of the residents, but the deployment of staff must ensure all residents receive enough supervision/contact from staff. Arrangements are in place to improve the number of staff trained to a nationally recognised level. Improvements to the recruitment process would further help to protect residents. Staff receive training and supervision in order to carry out the tasks they perform safely. EVIDENCE: Although this outcome has been assessed as adequate identified shortfalls in the recruitment process must not be repeated if residents are to be properly protected. The Registered Manager was asked if the home was staffed adequately as one communal area, with three residents in it was not supervised by a member of staff for the 50 minutes that the Inspector sat there. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 24 There are 9 care staff and one qualified nurse on duty in the mornings. In the afternoon there are 5 care staff and 1 qualified nurse and at night there are 4 care staff and a qualified nurse. There is an additional carer each day on duty between 6pm & 10pm, when it can get busier, evening suppers have to be served and residents want to go to bed. Also most mornings of the week there is an additional qualified nurse on duty from 9am until 1pm, although the week of this inspection she was off duty. The Registered Manager is supernumerary to these numbers. Domestic, kitchen and administrative staff support the care team. Although it is an extremely busy nursing home the Registered Manager felt confident that the above shortfall was due to a deployment problem rather than a lack of staff numbers and would look into this. Out of the fifteen pre inspection surveys received back from residents/relatives, fourteen said that staff are either ‘always’ or ‘usually’ available when they are needed. One disagreed with this. Residents spoken to during the inspection acknowledged that staff were busy but did not feel they were ever left waiting if they needed help. The home is making arrangements to improve the numbers of staff who hold the National Vocational Qualification (NVQ) in Care. At present only two staff hold this award at Level 2 with one carer nearly completed. Seven more staff have been registered to begin and are waiting for the college to initiate the course. One is to start the more advanced Level 3. Night staff are included in these numbers. The recruitment records of four staff were inspected. In one case the person had been employed with only one verbal reference and in another case only one written reference had been received. The Inspector was informed following this inspection that a second reference had been obtained for both these members of staff. The Care Home Regulations clearly state that two written references must be obtained before employment. This was highlighted following inspections in January 2006 and July 2005. One nurse employed did not have evidence in her staff file of Criminal Records Bureau clearance (CRB) having been done. The Registered Manager also confirmed that this is now within the staff member’s file. New care staff receive induction training through an external trainer and are thereafter supervised in the home by an experienced person until considered competent. Records of this training were seen. The home should give consideration to how it demonstrates that a new carer is allocated to a more experienced carer for the duration of their induction. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is judged to be adequate. This judgement has been made using available evidence including a visit to this service. The residents and staff benefit from strong leadership and an approachable Manager, who is able to communicate effectively. Arrangements are in place to seek residents’ views, but arrangements that help identify shortfalls in the service need to be more robust. The home does not keep any personal monies for safekeeping. High standards of care are maintained through good supervision of staff. The home carries out all the main health and safety checks and servicing required, however a shortfall identified to promote residents’ safety when mobilising has still not been dealt with. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 26 EVIDENCE: A proportional view has been taken and this outcome has been assessed as adequate, however the CSCI is concerned that a requirement based on promoting the health and safety of residents has not been met since the last inspection 10 months ago. Also a shortfall in basic auditing needs to be given serious consideration. The current Registered Manager has been in post for 3 years. She is a Registered Nurse who has extensive experience in the care of the elderly person and is registered with the CSCI. She demonstrates clear leadership qualities and is able to communicate effectively with her staff. She also keeps herself updated in mandatory trainings, but also in management skills. The Deputy Manager demonstrates strong clinical leadership and ensures that the care given is in the residents ‘best interest’. She brings to the team additional skills in elements of dementia care and person centred care. Meetings are held in order to communicate with all staff and ensure that the vision for the home is taken forward. The Registered Manager confirmed that resident meetings are held and minutes are kept, although these were not to hand during this inspection. A discussion was held on how the residents could be more involved in the decision making within the home and some of this will be explored. However, at present they are involved in decisions made about the food and how money raised is spent. This summer residents voted to buy furniture and cushions for the courtyard garden. The cook said she always goes out after lunch to talk and find out whether the food was enjoyed. One resident confirmed that the cook often visits her. The views of residents and relatives are sought on a daily basis via an open door policy and this was very much observed in practice, but set relative meetings have not been held. As part of the home’s quality assurance a survey was sent out to residents and relatives a year ago seeking their views formally on the catering, personal care/support, daily living, the premises and the management. The Registered Manager said that the feedback was positive, but the collated outcome was held at head office. This needs to be made available to the residents and relatives. The Registered Manager explained that she does carry out audits of the main systems in the home. She said she visually checks care plans and the medication system but no records are kept. Consideration should be given to commencing a ‘user friendly’ system, which would help identify shortfalls and record any action required with timescales. This would certainly help the home when the regulatory self-assessment process comes into place. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 27 The Registered Manager informed the Inspector that no personal monies are kept on behalf of residents. Some rooms have lockable facilities some do not. A record is kept of who holds Power of Attorney for each resident. A staff supervision system is in place with records kept for each staff member. All main health and safety checks are carried out and recorded including major systems such as the fire detection system, emergency lighting system and lifts. Specialised equipment is serviced regularly including the main utilities. The home was electrically rewired one year ago. Water tanks are also check for the risks of Legionella. The home has a fire risk assessment in place and was last inspected by the Fire Officer in March of this year. The Environmental Health Officer last visited in 2005. All hazardous substances are secured. Individual risk assessments are carried out when required. The need for grab rails along one corridor was made a requirement in the last inspection and has not been met. This must be done as a matter of priority. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 28 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 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 X 2 Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5B(b&c) Requirement The Registered Manager must, irrespective of how a residents fees are being met inform each existing resident as to whether a nursing contribution is paid in respect of nursing being provided to him/her at the home. The Registered Manager must, where practicable prepare a written care plan in consultation with the resident or their representative. The Registered Manager must ensure that residents’ care plans are kept under review. (This relates to altering care plans where an element of the content is now not relevant). The Registered Manager must ensure that a record of food provided for residents is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual residents (this is in DS0000058304.V314566.R01.S.doc Timescale for action 08/01/07 2 OP7 15(1) 08/01/07 3 OP7 15(2)(b) 08/01/07 4 OP15 17 Schedule 4 (13) 08/01/07 Brunswick House Nursing Home Version 5.2 Page 30 5 OP24 13 (4)(c) relation to alternatives provided for residents outside of the menu choice). The Registered Manager must 08/01/07 ensure that all unnecessary risks to the health or safety of residents are identified and so far as possible eliminated (this refers to the carpets in bedrooms 10 & 17 which must now be replaced by the required date or sooner if possible). This requirement has been repeated from the last inspection. The Registered Manager must make arrangements to prevent infection, toxic conditions and the spread of infection (this refers to the carpet covering in the ensuite discussed at this inspection). The Registered Manager must make proper provision for the care and, where appropriate, treatment, education and supervision of residents (this refers to the supervision of residents in the new build communal lounge). Staff employed in the Home must be subject to full recruitment processes (this refers to two written references being obtained prior to employment and a CRB clearance being obtained on all staff). This requirement has been repeated from the last inspection. The Registered Manager shall establish and maintain a system for evaluating the quality of the service provided at the care home (this refers to a recorded audit system). DS0000058304.V314566.R01.S.doc 6 OP26 13 (3) 08/01/07 7 OP27 12(1)(b) 11/12/06 8 OP29 19 11/12/06 9 OP33 24(1) 08/01/07 Brunswick House Nursing Home Version 5.2 Page 31 10 OP38 23(2)(n) The Registered Persons must ensure suitable adaptations are made, and such support, equipment and facilities, including passenger lifts, as may be required are provided, fir residents who are old, infirm or physically disabled (this relates to providing grab rails along the short corridors of the new build area. This must be completed by the stated date or earlier if possible). This requirement has been repeated from the last inspection. 01/02/07 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 OP7 Good Practice Recommendations There should be a written record kept demonstrating auditing of the care plans, presented in such a way that would also act an aid memoir for the staff responsible for those care plans and which flags up shortfalls within the care documentation. Consideration should be given to making available information on Advocacy Services. Consideration should be given to placing a copy of the complaint procedure in a conspicuous place, making it more obvious to residents, relatives and visitors. Consideration should be given to all staff receiving information based from the ‘Alerters Training’ and for senior staff to attend the ‘enhanced alerters’ training. Consideration should be given to formally demonstrating who staff on their induction training are being supervised by when on duty. Consideration should be given to holding meetings for relatives and recording the content. Consideration should be given to commencing a resident DS0000058304.V314566.R01.S.doc Version 5.2 Page 32 2 3 4 5 6 7 OP14 OP16 OP18 OP30 OP32 OP32 Brunswick House Nursing Home committee/group, which is included in decisions made during recruitment of staff. Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brunswick House Nursing Home DS0000058304.V314566.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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