Inspection on 11/05/05 for Bryden House Nursing Home

This inspection was carried out on 11th May 2005.

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

Bryden House Nursing Home 21/01/10

Bryden House Nursing Home 16/02/09

Bryden House Nursing Home 15/01/08

Bryden House Nursing Home 09/01/07

Bryden House Nursing Home 27/10/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bryden House Nursing Home Marlpool Lane Franche Kidderminster Worcestershire DY11 5DA Lead Inspector Chris Potter Unannounced Inspection 11th May 2006 10:00 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 Bryden House Nursing Home DS0000065225.V293473.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. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Bryden House Nursing Home Address Marlpool Lane Franche Kidderminster Worcestershire DY11 5DA 01562 755888 01562 755887 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) Southern Cross Healthcare Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (30) Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate a maximum of 6 people aged 55-65 years in either of the above categories. 27th October 2005 Date of last inspection Brief Description of the Service: Bryden House Nursing Home is registered to provide care for up to 30 older people who may have physical and sensory disabilities or may experience mental health problems. The home is also able to accommodate up to 6 resident’s aged 55 - 64 years. The home fees range between £430.00 to £702.00. Southern Cross Healthcare owns the home. The home provides accommodation on three floors, is located on the outskirts of Kidderminster town, and provides parking for visitors. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of two days and was undertaken by two regulation inspectors from the Worcester office of the Commission for Social Care Inspection (CSCI). The inspection lasted a total of 20 hours’ inspection time. The last inspection at Bryden House took place in October 2005. Additional visits were undertaken following a serious complaint received by the Commission about the service - resulting in an immediate requirement notice being issued. This was an unannounced inspection to assess the progress made in relation to the requirements from these two previous inspections. Since the October inspection, the home has had a change of ownership from Ashbourne to Southern Cross. The inspectors were concerned with the lack of progress noted from the inspection of the 27th of October 2005. Many of the previously issued statutory requirements had not been addressed. Ashbourne had forwarded an action plan to the CSCI in response to the inspection report, which stated that action had been taken to meet the (relevant) standards. In addition to the previous inspection a serious complaint was received in January 2006, about the care of a former resident. This complaint was investigated under the adult protection team with police involvement. The investigation is still ongoing from that complaint, but initial findings indicate that the home failed to meet the resident’s care needs appropriately. The CSCI issued immediate requirement notices to prevent similar issues arising. The CSCI have been in regular contact with the responsible individual and operational manager representing Southern Cross Healthcare. Further action plans have been provided in their response as to how the requirements are being addressed. Given the concerns raised from this inspection visit, the failure of the home to address previous requirements, and the complaint investigation findings, the CSCI issued immediate requirement notices and this may result in enforcement action being taken. A manager has been appointed since the last inspection and, with the (limited) resources available, is trying to improve the standards within the home. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 6 Following this inspection, a Regulation Manager from CSCI made an unannounced visit to the home on the 16th of May 2006. At this visit it was established that the home was complying with the immediate requirement notices, and written information has been received from Southern Cross to confirm this. What the service does well: What has improved since the last inspection? What they could do better: Given the reassurances made following the previous inspection and visits, the inspectors were concerned with the lack of progress in meeting the requirements fully from the last inspection. Immediate requirement notices were issued; 1. To ensure the health and welfare of the residents, 2. To elevate staffing levels in order for the nurses to complete the residents’ care documentation to reflect their needs appropriately, Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 7 3. To improve staff training to ensure nursing and care staff are clinically up to date, - with specific reference to infection control and diet and nutrition. 4. To implement an effective staff supervision program for all staff, and 5. To improve the social and recreational activities and opportunities for all residents within the home. Given the size and layout of the home, and the number and dependency of the residents, it is required that the home review their staffing levels. At the time of the inspection, the home was not meeting the minimal requirement of a 1:5 staff to resident ratio. The home would benefit from a redecoration program. Generally, the home appears tired and fatigued. The double-glazing panels on the majority of windows had condensation in-between, suggesting that the sealed units were broken. The home must record all complaints received - both verbal and written, and provide details of the action taken to investigate the complaint – including the outcome/s from the complaint investigation. Residents must be given a choice of meals available and provided, and their preference to the portion size provided to them must be ascertained and respected. 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. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 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 Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 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 and 5 The quality outcome in this area is adequate. This judgement has been made using available evidence including visits to this service. Residents’ individual needs are assessed prior to them moving into the home in order to establish the home’s ability to meet those needs, and to help ensure appropriate care is provided. EVIDENCE: Six residents’ care files were examined during the visit to the home. For the most recent admissions the proposed manager had undertaken and completed a pre-admission assessment. The pre-admission documentation has changed since the last inspection and the document is more comprehensive in terms of information contained therein. A copy of the Service User’s Guide and the Statement of Purpose were available within each resident’s bedroom. The proposed manager advised the inspectors that these documents are in the process of being updated to reflect recent developments and change of ownership. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 10 A resident recently admitted to the home confirmed that they had been provided with the appropriate information to assist them in making their choice. They also stated that a friend had recommended the home to them. The resident confirmed they were pleased with their bedroom, and that staff were on hand to assist when required. The home must ensure that residents are only admitted within the homes category of registration – particularly as the home is accommodating a high percentage of residents with a significant level of confusion. In relation to staff competencies, the nurse’s must receive training to ensure that their clinical practice is up to date and reflects current good practise. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality outcome for this area is poor. This judgement has been made using available evidence including visits to this service. Appropriate systems are in place for care planning and health care screening but, by failing to keep records up to date, there is no assurance that the health and social care needs of residents will be appropriately met. EVIDENCE: A random selection of seven residents’ care files was examined during the inspection of the home. An immediate requirement was issued for the care documentation to be improved to demonstrate accurately each resident’s care needs fully. Given the home was issued with an immediate requirement notice in January 2006 to improve the care documentation, the CSCI are considering enforcement action. The new owners have provided the home with new care documentation for all the residents. The nurses are trying to complete the new documentation and Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 12 are working additional hours to undertake this. Given only one registered nurse covers the day shift, with their other duties, they have little time to develop accurate and appropriate care documentation for the residents. The care files lack description on how the care needs are to be provided. The nurses spoken to confirmed their shifts as busy, and confirmed that the provision of an additional nurse would assist in further developing the care documentation and allow more supervision of the care staff. The current documents show no consultation with the resident or their relatives. One care plan failed to evidence that moving and handling, nutritional, continence or falls risk assessments had been completed on admission to the home. All the relevant care needs had not been included into a care plan. Accurate recording of actual events, with times and staff signatures was poor, so it was difficult to evidence what date a certain dressing had been recommended for a resident to commence. The documentation fails to state what type of air mattress was being used for the resident, and in some instances, when the mattress had been provided. The care documentation was reviewed for a resident who had recently died. The care documentation failed to record how the care needs of the resident and their family had been provided by the home. A resident admitted to the home was in the process of receiving treatment for a malignant illness. The care documentation failed to identify the physical, psychological and spiritual needs of the resident. Some care files evidenced that the risk assessments were not being reviewed monthly. An entry in the care documentation relating to an injury observed on a resident failed to record how the injury had occurred, or if an investigation into the incident had been undertaken. The suitability of residents’ seating was discussed. A resident was sat in an armchair and had suffered skin damage to their arm from the chair. This would indicate that the chair was inappropriate for this resident’s use. The accuracy of some recorded data was discussed regarding one resident. It appeared that the measurement of an injury had been recorded inaccurately, but no one had addressed this error. The data captured on assessments was, at times inaccurate or confusing. One resident had been assessed as being “alert/sociable” on one assessment format, but on another assessment, the resident was categorised as “muddled” (a term which is considered to be demeaning). This contradiction of information helps to generate confusion when nurses have to develop a plan of care to meet the assessed needs of people residing within the home. The Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 13 manager designate stated that the resident was, in actual fact, diagnosed with vascular dementia, and was, at times, challenging the service’s ability to effectively meet the resident’s needs – the resident’s care file contained entries that cited the person as being “confused” and “wandering”. No plan of care had been developed or implemented to address the needs of an individual who possesses short-term memory impairment. Care plans developed were, on many occasions, vague and failed to comprehensively instruct staff about the interventions necessary to meet the assessed needs of people. One care plan for “nutrition” simply instructed staff to; “Encourage to have any snacks or drinks in between meal times. Offer assistance if required with eating and drinking”. The quality of the care documentation ensured that staff were unable to meet the person’s needs in a consistent and professional manner. Another resident experienced incontinence. The care plan was bereft of any relevant information or instruction. It simply cited; “Offer toilet two hourly. Ensure that (resident) has a drink every two hours. Check pad two hourly change as necessary”. At this point, it is pertinent to highlight the fact that care staff, when interviewed, confirmed that they did not have the opportunity to read care plans, and when asked about specific residents’ care needs, could not cite the range of needs documented within the person’s care file. It became clear, through analysing the information within care files, that nursing staff were not reading and acting upon the information available within care files. For example, one resident’s care file contained a pre-admission assessment that clearly cited the person’s preferred time of retirement to bed was 12 midnight. Night staff had recorded on one occasion; “22.00(10pm) Awake and wandering”. Nursing staff also indicated, through their recorded care entries, that the culture that was, at times, being promoted was one that failed to engage the resident/s, and take into account their preferences and wishes. For example, on one occasion, the same resident’s care file contained an entry that read; “24.00 Attempted to put to bed on several occasions but refused…eventually settled at 24.30”. There was no evidence to indicate that the person’s preference/s was or were being respected by staff. Despite care records showing that the individual experienced problems with their night-time sleep pattern, nursing staff had not developed care strategies - in the form of a care plan – to address the person’s sleep pattern Health assessments were not generating care plans in a timely fashion. There were unacceptable delays between a need being identified and a plan of care being formulated to address the need. For example, a urinalysis had been undertaken on admission, which showed a possible UTI (urinary tract infection). A care plan had not been formulated until six days after the test results had been recorded. Many acute changes in health needs were not being evidenced as being met. The resident who had developed a UTI had a care plan that simply stated staff Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 14 would; “Give antibiotics as prescribed. Encourage oral fluids. Retest urine on completion of antibiotics”. 11 days after the care plan was written, an entry had been made which simply stated; “Discontinued”. There had been no recorded evaluations of the individual’s condition within the 11-day period. Infection control was not being effectively addressed by care staff within the home – who had little understanding of the issues relating to the prevention and control of infection. Many commodes that were examined on the day of inspection were contaminated with faeces, and one bed was soiled with faecal markings and skin debris. A carer failed to appreciate, when questioned, why it was unacceptable to leave a contaminated bed ready for the resident to occupy later in the evening, and proceeded to run her unprotected hand over the contaminated areas on the bed. She then implied it was alright to do so, as she was then going to wash her hands! Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 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 and 15 The outcome for these standards was poor. This judgement has been made using available evidence including visits to this service. The opportunities for residents to partake in activities are limited by the availability of staff and are therefore in need of improvement. The dietary needs of residents who require assistance to eat or drink are not met, which leaves residents at serious risk. EVIDENCE: The activities for residents are limited by the availability of staff. On both days of the inspection residents were observed in the lounges with no staff supervision, and a television was on which not all residents could see or hear. One resident said, when interviewed, that he did not particularly like the programme that was on the television. The residents did not have the ability to change the programme. Residents confirmed that weekly bingo was being held on a Wednesday, otherwise very little activities were being implemented. Residents complained Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 16 to the inspectors that very little happens in the afternoons. Residents’ social, recreational, occupational and leisure needs were not being addressed by the home. Staff were busy attempting to meet the basic physical health needs of residents, and confirmed that they do not have the time to engage residents in conversation. When interviewed, a resident said that he would like to watch war films, and would like to go to the pub. When asked if he liked being in the home, the resident simply laughed. He then proceeded to say that he was lonely, and did not get the chance to talk with other people. The residents who were in the lounge with him had poor communication abilities, and were unable to engage in conversation due to their physical and psychiatric healthcare problems. The provision of food at mealtimes was poor. Care staff was not addressing residents’ physical health limitations. One resident was asleep in her bedroom. She had been provided with a beaker of thick vegetable soup. The soup had been left with her, and was cold. The resident awoke, and informed the inspectors that she could not eat the soup as it was too thick, and the vegetable pieces got stuck in her throat. She then explained that she preferred tomato soup. Although some residents appeared to be appreciative of the food, many residents spoken to expressed their opinion that the food supplied, and the choice provided was not to their liking. When asked if they were given a choice, one resident replied, “Not really”, and another resident said that they don’t really fancy the main meal provided at the time of inspection. All residents had been provided with blackcurrant juice at lunchtime. One resident expressed his preference for orange juice. Residents’ preferences were not being sought or respected. Other residents’ opinions about the food included; “food is terrible”, “no choice offered”,” the food is alright”. Generally, comments were received from residents about being provided with too much food of poor quality, and how they would prefer a smaller portion of good quality. A relative also stated that the food was variable, and that the portion size was too large for her relative. Menus were not readily available for residents to peruse, and the menu that was available for the catering staff did not demonstrate flexibility or choice. Residents confirmed that weekly bingo was arranged on a Wednesday; otherwise very little activities were being implemented. A resident stated that the Bingo sessions were enjoyable, and they enjoyed a laugh with the activities co-ordinator. Another resident stated that no activities had been offered and she felt lonely. The residents care documentation failed to demonstrate adequately the social care needs of the residents. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 17 Residents who were able to express their wishes stated that they had a choice about what time they get up and go to bed. Some residents stated this was dependant on which members of staff were on duty. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 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 and 18 The outcome for these standards is poor. This judgement has been made using available evidence including visits to this service. There is a complaints procedure in place to fully safeguard the residents. However, the complaints procedure must be adhered to. EVIDENCE: Since the last inspection two complaints have been reported to the CSCI. The one complaint was investigated under Worcestershire’s multi-agency adult protection protocol, and remains open. The second complaint was investigated by the home, and the provider failed to respond within their timescales. The complainant was dissatisfied with the outcome and the delay in receiving information about the complaint. The inspectors were advised that the home had received no further complaints. This is questioned, given the number of complaints received in respect of the food. A relative advised the inspector they had recently complained about the laundry, and this had been sorted. Some care documents made reference to concerns being raised that had not been recorded in the complaints register. The home must review their recording of complaints and ensure all staff are aware of the procedure to follow. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 19 Staff confirmed they had received training about abuse and were aware of the whistle blowing policy. A member of staff has been suspended following an allegation of abuse. The home delayed taking appropriate action and referring to the adult protection team. The outcome of this allegation is not known at this time. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25 and 26 The outcome of these standards is adequate. This judgement has been made using available evidence including visits to this service. There has been some progress since the last inspection to improve the standard of the environment. Further refurbishment and improvements are now necessary to ensure residents have a clean and safe place to live in. EVIDENCE: Bryden House Nursing Home accommodates residents on three floors. A passenger lift allows residents to access all areas of the home. The home is looking decoratively fatigued in many areas, and to enhance its appearance the home would benefit from a redecoration program being developed and implemented. Since the last inspection, the home has recarpeted the corridors and stairs around the lift areas; this has improved the appearance of this area. However, a global redecoration program has not yet commenced. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 21 The home has recently converted a bathroom into an office area to assist with the storage and security of confidential records and registers. An additional washing machine has been purchased to assist with the management and organisation of the laundry. During the inspection, commodes were observed badly stained; the poor infection control of these was discussed with the manager to address with the care staff. In one bedroom a bed had been made using a soiled bottom sheet (see the section on “Health and Personal Care” (above)), the rationale for this poor practice could not be explained. The inspectors observed one domestic cleaning the entire home and, given the size of the home and the number of incontinent residents, the inspectors questioned the amount of hours allocated for domestic duties. Only 94 hours are allocated for domestic and laundry cover. This means that for two days, just one domestic is responsible for cleaning the entire home. Given the limited resources, the home was clean and the management of odours was commended. Few residents were sitting in the lounges or dining rooms; the majority of residents were in their bedrooms throughout the times of the inspection. Some resident’s bedrooms seen were personalised with items such as pictures, photographs and furniture. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 22 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 and 30 The outcome from these areas is poor. This judgement has been made using available evidence including visits to this service. Staffing levels must be reviewed to ensure that residents’ safety is maintained. The recruitment procedure must be followed to ensure the protection of the residents. EVIDENCE: Further to the last inspection and the follow up requirements, the inspectors were concerned with the lack of progress in ensuring the residents’ care needs are clearly identified in the care documentation. The home is staffing with one registered nurse for the day shifts, which gives the nurse no time for transferring the information onto the new care documentation. On both days the nurse working the floor was busy, and one stated that the home was “hectic”. The home is currently working with one registered nurse plus four care staff on the early shift and one registered nurse plus three care staff on the late shift. This is below the minimal requirement of a 1:5 ratio. An immediate requirement notice was issued on the day of the inspection to increase the staffing levels with additional registered nurse and carer cover. The registered nurses also stated that an additional nurse and carer would assist them in performing their duties. Since the last inspection, the home has had a high turnover of staff, but comments received from staff implied that the home is settling down and the Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 23 atmosphere is improving. Absence through sickness was noted on the duty rotas. Comments received from some residents and a relative stated that there was not enough staff on duty. A random selection of new staff files was reviewed during the inspection. The need to ensure all gaps in the employment history are accounted for was explained. Copies of the CRB (Criminal Records Bureau) checks were not available at the home, however records cited that the CRB had been obtained and the “POVA (Protection of Vulnerable Adults) first” procedure had been completed. Training records showed that some staff were completing a first aid qualification - this was a requirement from the last inspection. Clinical training for the trained staff was being reviewed. Care staff confirmed they had not received nutritional training and there were major gaps regarding training that had not been provided in response to the clinical care needs and conditions of residents living within the home. All other mandatory training was up to date at the time of the inspection. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 24 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): 31,32,36,37 and 38 The outcome for these standards is poor. This judgement has been made using available evidence including visits to this service. Improvements are necessary for the overall management of the home, to ensure positive health and safety practices are promoted and accurate records are kept. Supervision of staff must improve to safeguard residents and staff. EVIDENCE: Since the last inspection the home has appointed a manager-designate. The CSCI is in the process of going through their registration procedure. The manager commenced at the home at a very difficult time, and a serious Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 25 complaint was made about the care practises at the home directed at the registered nurses, and implicating poor record keeping. The manager-designate is committed to improving the standards and is working in excess of her appointed hours to do this. Feedback received from staff and residents was positive in that the manager-designate was approachable and always available to discuss issues. Given the outstanding issues it may be necessary to appoint a deputy manager to assist and support the manager-designate. From the complaint, the CSCI were reassured that the registered nurses had been disciplined and put on a weekly supervision program. However no record of the disciplinary or the weekly supervision sessions could be located on the registered nurses’ personal records. It was reported that their had been a high staff turnover since the last inspection. The inspectors requested the exit interviews for those staff, but the manager had been unable to undertake these within the time allocated. The home must ensure all records and registers are up to date. The residents’ care records, complaint register, patient register and staff supervision records were not up to date at the time of the inspection. Maintenance records were available and up to date, insurance certificates were displayed. Quality assurance and quality monitoring is being developed, with questionnaires being sent to relatives. A relatives’ meeting was organised to allow relatives to air their views and opinions. A copy of the minutes is available. The manager-designate also holds sessions twice a week to meet with relatives. One meeting is held in an evening to be more flexible for those relatives having to work. The home is undertaking regular audits of the food, cleaning, accidents, and complaints. Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 26 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 3 3 3 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 2 3 2 3 3 3 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 1 1 3 Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 27 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 OP7 Regulation 15 Requirement All care plans must be reviewed at least monthly, or as changes to the residents’ care needs are identified. Remains outstanding from last inspection. Timescale for action 08/06/06 2. OP8 13 The home must ensure that risk 08/06/06 assessments are up to date, reflect the residents’ current care needs, and show evidence of regular review and updating. Remains outstanding from last inspection. 3. OP7 15 Care plans must take into 08/06/06 consideration how the emotional, spiritual and social needs of each resident are to be met by the home. Remains outstanding from last inspection. 4. OP27 18 The staff skill mix must be reviewed to ensure registered nurses have adequate time to maintain their professional duties, and record this appropriately. Remains outstanding from last inspection. 12/05/06 5. OP4 18 (1) a The registered provider must DS0000065225.V293473.R01.S.doc 12/05/06 Page 28 Bryden House Nursing Home Version 5.1 6 7 OP8 OP8 12,13 17 (1)a 8 9 OP10 OP12 12 (4)a 16 10 OP14 12 11 OP15 16 (2) i 12 OP16 22 13 OP19 23 14 15 OP36 OP29 18 18 ensure that collectively staff have the skills and experience to provide the level of care required by the residents. Resident’s care needs must be met by the home. The home must ensure that nutritional screening takes place and that suitable records are maintained of diet and fluid intake as specified within the care plan. The home must ensure that residents are afforded respect, privacy and dignity at all times. Action must be taken to ensure that residents’ social, recreational and occupational care needs are identified and met. Residents choices and preferences must be sought, respected and upheld as far as is practicable. The home must ensure that all residents receive an appropriate, varied, appealing, wholesome and nutritious diet in line with individual requirements, and as detailed within an agreed care plan. The home must ensure that they record all complaints, and investigate in accordance with their own complaints procedure. The registered persons must supply the CSCI with a refurbishment programme, which includes carpeting and décor. Staff must receive formal supervision at least six times each year. The registered provider must ensure that any gaps in the employment history are fully explained. The CRB disclosure is available for the first inspection DS0000065225.V293473.R01.S.doc 12/05/06 08/06/06 12/05/06 12/05/06 12/05/06 12/05/06 12/05/06 16/06/06 16/06/06 12/06/06 Bryden House Nursing Home Version 5.1 Page 29 16 17 OP37 OP22 Schedule 3 13 18 OP37 37 following recruitment. The home must ensure all records in schedule 3 are available and up to date. The registered provider must provide equipment suitable to the needs of the residents, specifically chairs. The home must notify the CSCI as soon as possible following a significant event within the home. 12/05/06 16/06/06 12/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Bryden House Nursing Home DS0000065225.V293473.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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