Inspection on 27/10/05 for Bryden House Nursing Home

This inspection was carried out on 27th October 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 11/05/05

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 27th October 2005 13:00 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.V261810.R01.S.doc Version 5.0 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.V261810.R01.S.doc Version 5.0 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) Ashbourne (Eton) Limited 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.V261810.R01.S.doc Version 5.0 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. 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 is owned by Ashbourne Care Homes. The home is purpose built and provides accommodation on three floors. The home is located on the outskirts of Kidderminster town. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 1pm. It took place over a period of four hours. The main focus of this inspection was to review requirements from the previous inspection. A partial tour of the home took place and a selection of care, personnel and health and safety records were examined. Not all records and registers requested were available at the time of the visit. This was partly due to the nurse in charge not knowing where the records were stored. The home is currently without a registered manager, and a manager from another home is covering part time hours to assist with managerial duties. At the time of the visit the nurse in charge was the only trained member of staff on duty. The home was busy, with the doctor visiting residents, relatives of a poorly resident were present and needed support, the practise nurse was administering the flu vaccine to residents, and the nurse was trying to cope with many telephone queries. During the course of this inspection four residents, and two members of staff were spoken to. What the service does well: All residents are assessed prior to their admission to the home, which enables staff to make an informed decision about their ability to meet each resident’s needs. Prospective residents and their representatives are encouraged to visit the home before making a decision to move in. Residents confirmed they had been assessed and were able to visit the home prior to admission. The atmosphere within the home is relaxed and welcoming. Visitors are welcome in the home at any time. The home has a committed team of staff who try hard to meet the needs and preferences of residents in their care. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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 Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 3,4 and 5 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 appropriate care to be provided. EVIDENCE: Records seen showed that residents or their representatives were able to visit the home prior to making a decision to move into the home. Residents confirmed they had visited the home prior to admission and had been given information to assist them in making their choice about the home. All residents are assessed by a registered nurse prior to their admission to the home to establish their individual needs and to determine if those needs can be met by the home. Written records are kept of assessments undertaken and this forms the basis of the residents’ care documentation. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 9 A service user guide was evident in each of the resident’s bedrooms seen Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 7, 8 and 9 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. Policies and procedures are in place for the administration of medication but shortfalls in record keeping could lead to errors in administration and therefore place residents at risk. EVIDENCE: The care plans for three residents were examined. Plans seen did not accurately reflect the current care needs of residents and the care being provided by staff. Any changes to care planning documentation had not always been signed and dated by the person responsible for implementing those changes. Care plans seen for one resident (who experiences transient ischeamic attacks), had no plan of care developed or the procedure for staff to follow in the event of an attack. A recent chest infection had not been included in the resident’s plan of care. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 11 Another resident’s care plan (who had skin damage) was reviewed, and no evaluation had been recorded as to the progress of improvement or deterioration. The last wound chart was dated 09/08/05. It is recommended that the nurses take photographs of any skin damage and maintain regular evaluation of the wound. It was also recorded that the resident’s weight had been falling, but no weight had been recorded since August 2005. A plan of care had not been included to address the weight loss or the need to monitor their weight on a regular basis. The resident also had a catheter and no plan of care had been developed. The care records for a new resident were reviewed and only basic details had been recorded on them. No risk assessments including skin pressure damage had been completed. Care plans for a resident identified at nutritional risk lacked detail and made no reference for the need to monitor their weight on a regular basis. The medication system was reviewed. A significant number of charts had amendments to the original prescriptions or new prescriptions added many of which had not been signed or countersigned by the persons responsible for making these changes. It is advised that for handwritten entries the medication chart is signed by two nurses. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 12,13 and 15 The dietary needs of residents are appropriately catered for. Residents are encouraged to make choices about what they wish to eat and where they wish to eat it. EVIDENCE: At the time of the inspection the activities organiser was off sick, and no activities were being held. Residents were either in the lounges watching television, or in their bedrooms, reading or watching television. Several residents were enjoying visits from families and friends. Social activities had not been included into the residents’ care records. Residents confirmed that the catering staff were very accommodating to their dietary needs. Residents stated that the food was good and they were given more than adequate portion sizes. One resident did comment that the meat could be a little more tender. Meals observed were well presented and appeared appetising. Care staff maintain a daily food diary for the residents, this is considered good practise. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 16 and 17 Polices and procedures are in place in relation to adult protection issues which provide direction to staff and aim to ensure residents are safeguarded from abuse. EVIDENCE: The nurse in charge was unable to locate the complaints register at the time of the visit; she was not sure where it was kept. The home should ensure that all staff are aware of the complaints procedure and the action to follow if they receive a complaint. Written policies and procedures are in place in order to ensure the protection of residents, which includes a whistle blowing policy. Staff confirmed they had received training about abuse and were aware of the whistle blowing policy. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 19,23,24 and 26 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 Nursing Home is a purpose-built home, accommodating residents on three floors. A passenger lift allows residents to access all areas of the home. The home is looking decoratively tired in many areas, and to enhance its appearance the home would benefit from a redecoration program. Areas of the home appeared cluttered and in general need of a tidy up. The nurse in charge stated that bedrooms are redecorated as they become vacant. The carpet on the first floor by the lift is well worn and would benefit from repair or replacement. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 15 Odours were evident in some areas of the home, the inspector was advised this was from the cleaning materials used, however the odour was musty and not pleasant. At the time of the visit the home had reduced housekeeping staffing levels, with staff having to undertake both laundry and cleaning duties. The laundry provides just one washing machine and one tumble dryer. For the number of residents and the high percentage of incontinence this is considered inadequate, and should be reviewed. Staff confirmed the washing machine is temperamental, will break down resulting in washing having to be taken to another home. At the time of the visit there was a backlog of washing and ironing due to the washing machine breaking down. The inspector was informed that the sluicing facilities are being reviewed. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 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): 27 and 30 Staffing levels should be reviewed to ensure that residents’ safety is maintained. EVIDENCE: The home should review the number and deployment of staff to ensure the residents are safeguarded at all times. On the afternoon of the inspection there was just one registered nurse on duty with four care staff. This does not equate to a 1:5 ratio, which is the minimal requirement for day shifts. Given the size of the home and dependency needs of the residents, the staffing levels should be reviewed. During the visit neither of the two lounges had staff supervision, leaving the residents vulnerable. The activities organiser was off sick so no recreation was taking place. Ancilliary staffing levels were also down, and the laundry operative was off sick. Residents confirmed that staff are hardworking and work many hours. Staff spoken to felt the levels were all right and they had received appropriate training to assist them in meeting the needs of the residents. Training records showed that currently no staff had a first aid qualification, but a course was reportedly being arranged. All other mandatory training was up to date. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 17 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. Improvements are necessary to the overall management of the home to ensure positive health and safety practices are promoted and accurate records are kept. EVIDENCE: The home is without a registered manager at the moment, support is being provided part-time by a manager from another home. This results in the nurses covering additional duties, allowing them less time to focus on care duties. Given the standard of care plans and how busy the nurse was at the time of the inspection, this should be reviewed to ensure the care needs of residents are not being compromised. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 18 The owners must also ensure that the nurse-in-charge of the home has access to all records and registers at all times. The storage of records should also be reviewed care records were easily accessible on the first floor. Training for staff in safe working practices has been provided, and they confirmed they are familiar with the health and safety policy. A staff supervision program has recently commenced and records of this are being maintained. The fire extinguishers were overdue their annual service check, this should have been undertaken in July 2005. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 19 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 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 3 2 X 2 STAFFING Standard No Score 27 1 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X X 3 2 2 Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 20 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 31 Regulation 8 (1) (a) Requirement A manager must be appointed to the home, and application for registration must be made to the local office of the Commission. Staffing levels must be reviewed to ensure that residents’ safety is not compromised. The sluicing facilities for the home must be reviewed. The source of the offensive odours must be identified and eliminated. The person in charge of the home must be able to access all records and registers. All records must be stored securely. An additional washing machine must be provided. The carpet on the first floor of the home must be replaced. All handwritten entries on the medication record must be checked and signed by a second nurse. A service users guide which reflects the current service provision and includes all the information detailed in DS0000065225.V261810.R01.S.doc Timescale for action 31/12/05 2 3 4 5 6 7 8 9 27 26 26 37 37 26 19 9 18 (1) a 13 16 (2) (k) 17 (3) (b) 17 (1) b a 13 16 (2) c 13 27/10/05 31/12/05 27/10/05 27/10/05 27/10/05 31/12/05 31/12/05 27/10/05 10 1 5 31/12/05 Bryden House Nursing Home Version 5.0 Page 21 11 27 18 (1) a 12 7 15 13 8 15 14 15 16 7 7 33 15 15 24 Regulation 5 and Standard 1, must be available in the home, and copies must be given to all current and any prospective service users. A review must be carried out to assess the time spent by registered nurses on non-nursing duties and action taken to provide additional support where necessary. Care plans must take into consideration how the emotional, spiritual and social needs of each resident are to be met by the home. Appropriate risk assessments must be completed on admission or as soon after, and show evidence of regular review. The care plan must accurately reflect the residents care needs. A care plan must be completed for each service user on admission to the home A quality assurance system must be introduced in accordance with the requirements of regulation 24 and Standard 33. A greater range of activities must be provided in the absence of the activities organiser. The Statement of Purpose must be amended to reflect the company change and must include all the information detailed in Regulation 4 and Schedule 1. 27/10/05 31/12/05 27/10/05 30/11/05 27/10/05 31/07/05 17 18 12 1 12,13 5 27/10/05 31/07/05 Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 19 38 Good Practice Recommendations The home should review the homes décor, and develop and implement a program of routine upgrade. The staffing rota should denote the person responsible for first aid on each shift. Bryden House Nursing Home DS0000065225.V261810.R01.S.doc Version 5.0 Page 23 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.V261810.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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