Inspection on 04/01/06 for Brunswick House Nursing Home

This inspection was carried out on 4th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/11/06

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 Eleanor Fox Unannounced Inspection 4th January 2006 09:30 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.V276707.R01.S.doc Version 5.1 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.V276707.R01.S.doc Version 5.1 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 (6), Old age, registration, with number not falling within any other category (34) of places Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user under the age of 65 years. This condition will be removed when the service user reaches the age of 65 or is no longer accommodated at the home. Date of last inspection 3rd August 2005 Brief Description of the Service: Brunswick House is a large Victorian property, which has been sympathetically converted and extended to provide accommodation for 44 elderly ladies who either require nursing care or who suffer from dementia and require personal care. A ten bedded extension to the property has recently been completed and is now fully occupied. 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 34 single rooms, twelve with en suite facilities, and 5 double rooms. 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. Homely communal accommodation is also provided in the new extension. The service users have the benefit of a small private internal garden, which is easily accessible and may be enjoyed in good weather. Improved parking facilities are also now provided at the home. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 4.5 hours. During the day she talked to twelve of the residents, read their care records, visited their bedrooms and observed some of the care they were receiving. She also spoke to three visitors who were in the home that day. The inspector had conversations with six members of staff, and looked at a selection of recruitment records and other documents. The recently completed extension to the home is now fully utilised and the inspector spoke to staff working in this area and residents accommodated there. Some of their comments are reflected in this report. Finally, the inspector had the opportunity to speak to the Registered Manager, her Deputy and the recently appointed Activities Coordinator, all of whom were most cooperative in providing information as requested. What the service does well: What has improved since the last inspection? Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 6 Since the last inspection, the new extension has been completed, providing residents with additional comfortable accommodation, furnished to meet their particular care needs. Improvements have also been made in the standard of record keeping in care documentation and medicine administration. 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 DS0000058304.V276707.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 the following standard(s): A thorough assessment process plus a visit to the establishment gives prospective residents and/or their advocates the assurance that their needs will be met at this Home. EVIDENCE: Since the last inspection, the new extension has opened and there have been ten additional residents admitted to the Home very recently. Observation of a selection of their records revealed that full assessments had been undertaken of these ladies and records completed, which outlined the findings. Although the written documentation could reflect more detailed information about each person, they do address the required criteria. Discussion with a nurse who had been responsible for the admission of one of these ladies showed that she had had clear knowledge of this lady’s particular care needs prior to her arrival and had been able to make appropriate preparations for her care. The daughter of one prospective resident has been in contact with the Commission for Social Care Inspection to compliment the staff at the Home for Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 9 their welcoming manner and helpful attitude when she came to visit the Home prior to her Mother’s admission. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 the following standard(s): The care planning and medication administration systems in place address the residents’ care needs appropriately and also ensure that the people living at the Home are not put at any risk of potential error. Residents receive attentive care in the final days of their lives 7,8,9 and 11 EVIDENCE: The Home continues to act as a ‘pilot’ for the care planning documentation in use at the current time. This is about to be reviewed and adapted to reflect observations identified by the staff. The documentation continues to provide a clear and very thorough record of each person’s particular care needs and the attention given to each lady. Records seen on this occasion revealed that specialist support and advice has been provided for one resident who has special healthcare needs. Members of staff have received specific training in the care of this person. Other healthcare needs are addressed as appropriate. All are recorded clearly in the care files. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 11 Medication administration requirements identified at the previous inspection were checked on this visit. Written records are now maintained correctly at the Home. There was one person who was seriously ill on this occasion. The inspector saw in her records and in other case files, which had been selected as part of a case tracking exercise, that the service user’s/advocate’s wishes about arrangements following death are clearly documented. The inspector saw that this person was receiving full and appropriate personal care. She appeared relaxed, comfortable and pain free. The lady’s relatives were kept fully informed of her deteriorating condition. Medical assistance was requested and provided as required. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 the following standard(s): 14 The Home’s positive approach to residents being able to make choices and carrying out their personal preferences is reflected in the behaviour of the residents and the staff. EVIDENCE: As far as possible residents appear to be encouraged to exercise choice on how they will live their lives. This was strongly confirmed by one person, who commented that, “The staff have got to know me and let me do what I can”. She still greatly valued her independence and appreciated being able to exercise control over her life. Advice on sourcing advocacy is displayed on the notice board in the Home. This has been required recently for one resident. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 13 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): 18 The implementation of the Home’s robust policies and procedures gives residents and their families the assurances that they may expect to live in a safe and protected environment. EVIDENCE: The majority of staff employed at the Home have attended recent training in recognising all forms of abuse. Certificates of attendance are filed in their personnel records. In addition, Brunswick House has clearly detailed policies on Abuse and Whistle Blowing. A recent incident at the Home was reported to the Manager and appropriate prompt action taken to address the issue. Members of staff who were questioned confirmed that they would have no hesitation in approaching senior staff if they had any concerns about any matters concerning the residents or the Home. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 14 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 and 24 Continued environmental improvements ensure that the residents live in homely and safe clean accommodation. EVIDENCE: The new extension is now fully completed and each of the en suite bedrooms is in use. This area has been decorated in strong attractive colours and those recently admitted residents who spoke to the inspector were most appreciative of the facilities provided. Grab rails are to be fitted on the short corridors on each floor of the new unit. It is envisaged that the residents suffering from dementia who require personal care will eventually be accommodated on the ground floor of the existing home, which is more appropriately designed to meet their particular needs. Some areas of the original property need minor decorative attention but on the whole, this is in reasonable condition. However, the carpets in Room 17 and Room 10 were uneven and could pose a risk to anyone walking around in the rooms. There was no cushion on the seat of the armchair in Room 18 and no Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 15 shade on the overhead light. The Manager agreed to address these issues. Nevertheless, residents’ rooms are generally comfortable and furnished to meet each person’s needs. As on previous visits, the entire Home was clean and there was no evidence of seriously offensive odours in any area. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 16 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): 29 and 30 Residents receive care from a stable competent workforce but improved recruitment practice would help to ensure that residents are fully protected. EVIDENCE: Discussion with staff and observation of all the available records relating to employees who have joined the staffing team since the last inspection, shows that acceptable recruitment processes are followed on most occasions. All the required criminal record screening is normally undertaken before the member of staff joins the team but information about their full employment history plus the reasons for any gaps in employment is not yet obtained in every case; there are also no records of the interview processes on file. The Manager has been reminded that no members of staff may commence duties at the home, even under supervision, unless the POVA (Protection of Vulnerable Adults) screening has been completed. There was only one written reference for one person and no references were available in the home for two members of staff who had been recruited corporately. These are now being obtained. Only very limited medical information is requested from each applicant; it is strongly recommended that these processes are developed further to ensure that each new employee is fit to undertake the duties required of them. Full records are maintained of all the training undertaken in the Home. These indicated that most of the staff had attended the required mandatory training Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 17 and, where any gaps had been identified, arrangements were being made to address the issue. Additional training needs are also addressed as required. The majority of care staff now have an understanding of the special needs of residents suffering from dementia related illnesses. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 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, 33, 36 and 37 The consistent implementation of robust management systems and improved staff supervision would ensure that the health, safety and welfare of the residents would be safeguarded. EVIDENCE: The Registered Manager, a qualified nurse with considerable experience in the care of the elderly, is progressing well with her studies to achieve the Registered Manager’s Award. She continues to be well supported by the nursing team; her deputy has just completed ‘Person centred care for people with dementia’ and is awaiting her results. There are a number of auditing processes undertaken at the Home. In July, Residents’ satisfaction with meals provided, complaints, accidents and general quality of the provision of care is all monitored on a regular basis. A quality improvement report has not been provided for the Home in the last twelve months, as is required. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 19 Observation of a random selection of records and discussions with staff show that only a very limited number of supervision meetings have been undertaken throughout the past year. Nevertheless, it was confirmed that now the building work has been completed, the Manager would focus on ensuring that these important processes are fully implemented at the Home. The majority of records seen on this occasion were maintained correctly and stored securely. It was confirmed that residents might have access to their records if they wish. However, there were no photographs provided for all the residents that have been admitted in the last two months. There is a need to employ agency and relief staff and the photographs are required to assist identification. Although Standard 38 was not inspected on this occasion, it is recommended that only liquid soap should be provided in the staff toilet to promote good infection control. Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x 2 x x STAFFING Standard No Score 27 x 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 1 2 x Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 21 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 2 3 4 Standard OP24 OP29 OP33 OP36 Regulation 23(2) 19 24(2) 18(2) Requirement The maintenance and decorative requirements identified in the text must be addressed Staff employed in the Home must be subject to full recruitment processes A quality improvement report must be provided for the Home Supervision processes must be fully implemented at the Home (Time scale 30/9/05 not fully met) A recent photograph must be provided for each resident (Timescale 31.8.05 not met) Timescale for action 31/03/06 31/01/06 31/03/06 31/03/06 5 OP37 Sc. 2 31/03/06 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 OP29 Good Practice Recommendations It is recommended that increased medical information should be requested from applicants to ensure that they are fit to undertake the work required DS0000058304.V276707.R01.S.doc Version 5.1 Page 22 Brunswick House Nursing Home 2 OP38 It is recommended that only liquid soap should be provided in the staff toilet to promote good infection control Brunswick House Nursing Home DS0000058304.V276707.R01.S.doc Version 5.1 Page 23 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. 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