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Inspection on 07/06/05 for Bryher Court Nursing Home

Also see our care home review for Bryher Court Nursing Home for more information

This inspection was carried out on 7th June 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.

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

What the care home does well

The building is well maintained and there is a wide range of equipment available to meet the needs of the residents accommodated. There are good training opportunities for staff to develop their knowledge and skills. Care plans show that staff are good at meeting the physical needs of the residents accommodated. The residents spoken with talked praised the staff team for the quality of the care and support they receive and staff spoken with stated that they are well supported and that their manager is very approachable.

What has improved since the last inspection?

At the last inspection of the home some of the residents raised concern regarding a lack of activities. An activity co-ordinator now works in the home two mornings a week. In addition to this there are other activities provided and residents spoken with were happy with the range and frequency of the activities provided. Some of the residents choose to have their bedroom doors open during the day. The home has had a number of self-closing devices fitted to these doors. This means that they comply with fire safety regulations and also with the residents` wishes. Staff are now receiving regular supervision every other month. At the last inspection of the home a requirement was made that the owner, in addition to his regular visits to the home, visited the home monthly unannounced and that a report of the visit be sent to the Commission. This practise has now begun.

What the care home could do better:

Care plans are good at detailing the physical needs of the residents. However, very little emphasis is placed on assessing the social and emotional needs of residents and how they could be met. In respect of fire safety, the systems in place to ensure that emergency lights and fire alarms are tested regularly need to be improved. Staff are now receiving regular supervision. However, the record keeping in relation to supervision generally relates to staff training provided. More emphasis needs to be placed on recording information about each staff member`s progress.

CARE HOMES FOR OLDER PEOPLE Bryher Court 85 Filsham Road St Leonards-on-sea East Sussex TN38 0PE Lead Inspector Caroline Johnson Unannounced 7 June 2005 9:20 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bryher Court Address 85 Filsham Road St Leonards-on-sea East Sussex TN38 0PE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Paul Kevin David Barron 01424 440011 Mrs Christine Boniface Care home 45 Category(ies) of Old age, not falling within any other category registration, with number (OP) 45 of places Physcial disability (PD) 45 Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum service users to be accommodated is (45) 2. Service users should be aged 65 years or over on admission Date of last inspection 8 November 2004 Brief Description of the Service: Bryher Court is a Care Home with Nursing provision. In order to cater for peoples’ nursing and care needs the home owners’ employ registered nurses, and also care staff to support the nursing team. There are also catering, cleaning, maintenance and administration staff to ensure the residents have a good quality of life within the care home.The Care Home is situated in a residential area of St. Leonards-On-Sea. It is a large home with access for disabled people, including two internal passenger lifts to the upper floors. There are assisted baths and hoist equipment for the less mobile. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1 2005 to March 31 2006. The inspection lasted from 09.20am until 4.00pm. During the inspection there was an opportunity to meet with seven residents in private. Three members of staff were interviewed individually. A number of records were examined and plans for the care to be provided for four residents and the pre admission documentation held in respect of two recently admitted residents were seen on this occasion. A full tour of the building was not undertaken. However, the communal areas, seven bedrooms and some of the bathrooms were seen. What the service does well: What has improved since the last inspection? At the last inspection of the home some of the residents raised concern regarding a lack of activities. An activity co-ordinator now works in the home two mornings a week. In addition to this there are other activities provided and residents spoken with were happy with the range and frequency of the activities provided. Some of the residents choose to have their bedroom doors open during the day. The home has had a number of self-closing devices fitted to these doors. This means that they comply with fire safety regulations and also with the residents’ wishes. Staff are now receiving regular supervision every other month. At the last inspection of the home a requirement was made that the owner, in addition to his regular visits to the home, visited the home monthly unannounced and that a report of the visit be sent to the Commission. This practise has now begun. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 The home has a good history of carrying out assessments of prospective residents’ abilities and needs prior to making a decision about offering accommodation. EVIDENCE: There is a detailed statement of purpose in place providing information for prospective residents. However, the document gives information about the staffing levels when the home is full but it does not state the numbers of residents the home is actually registered to accommodate. In addition the document does not refer to staff members’ qualifications or training opportunities. Records were seen in respect of two residents that had been admitted to the home in recent months. The manager had visited both individuals to assess their needs prior to making a decision about whether the home could provide accommodation. The home does not cater for intermediate care. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 Care plans were up to date and provide staff with detailed advice concerning the physical needs of the residents accommodated. The home has made limited progress in addressing the requirement and recommendation made at the last inspection of the home. Once this is achieved care plans will include a more holistic picture of residents needs and how they are being met. EVIDENCE: Four care plans were examined in detail. As at the last inspection of the home, there were detailed records highlighting the physical needs of the residents accommodated. Dependency profiles are kept up to date and risk assessments are carried out as needed. Records showed that limited progress had been made in addressing the requirement made at the last inspection to include in care plans more detailed assessments of individual residents’ social and emotional needs. Records also showed limited progress in documenting within daily records how the social and emotional needs of service users were being met. There were satisfactory arrangements in place for the storage and handling of medication. Record keeping was detailed. The home has been using specialist advice and support in relation to wound management for one resident. Detailed records were kept of the specialist involvement along with details of staff involvement. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 The numbers and frequency of activities provided is appropriate to meet the needs of those accommodated. EVIDENCE: There is a member of staff employed to provide occupational therapy two mornings each week. Activities include bingo, musical bingo, discussion groups and board games designed to stimulate memory. A lay preacher visits weekly to provide a non-denominational service. There is a mobile library service provided every other week. Some of the residents choose to have newspapers delivered daily and the home arranges for newspapers to be delivered twice a week. In addition one member of staff plays the piano one afternoon a week. Seven residents were spoken with during the inspection. Some advised that they choose to be involved in the activities provided by the home others stated that they choose not to participate. One resident who has lived in the home for a number of years loves doing jigsaws. Space is provided in the lounge area for him to take part in his favourite pastime and one of his jigsaws is displayed on the wall. One member of staff advised that in addition to the structured activities the home also has coffee mornings and every other year a summer fayre is held. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 There is a detailed complaint procedure in place. However, the complaint procedure included in the staff policy and procedure manual needs some minor amendments. EVIDENCE: There is a detailed complaint procedure in place. Since the last inspection of the home there was one complaint recorded. Records showed that the complaint was unsubstantiated. The complaint procedure in the home’s policy and procedures manual needs to be updated in line with the policy on display in the home to show reference to the Commission and to dealing with complaints within a twenty-eight day timescale. The home follows East Sussex multi-agency guidelines on the protection of vulnerable adults. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,26 The home is well decorated and the environment is homely. Bedrooms seen had been personalised. Improvements need to be made in relation to the recording of the testing of fire safety equipment in the home. EVIDENCE: A full tour of the building was not undertaken as part of this inspection. However, communal areas were seen along with six bedrooms. All areas seen were clean and were well maintained. There are sufficient numbers of toilet and bathing facilities in the home. There is a wide range of equipment in place to meet the individual requirements of the residents accommodated. At the time of inspection one of the lifts was not working. The manager advised that the parts were on order. One of the residents spoken with stated that this was not causing too much inconvenience, as she was still able to get down stairs with staff support. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 13 Since the last inspection of the home a number of self-closing devices have been fitted to bedroom doors in line with residents’ wishes. The home has a fire risk assessment in place. There is also format in place for carrying out a fire safety inspection. However, this has yet to be completed. Records showed that emergency lights were last tested in April 2005. Fire alarm tests are due to be carried out weekly. However, records showed that on average, they are tested twice a month. Staff receive regular training in fire safety. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 There are good training opportunities available for all the staff working in the home. Record keeping in respect of staff recruited to work in the home is generally detailed but the home needs to ensure that they keep a copy of all the documents listed in Regulation 2 in each staff file. EVIDENCE: Ten of the twenty-four care staff employed have achieved NVQ level two or above. Some of the staff that have not completed NVQ training have completed a care skills course via distance learning. The home’s rota shows that there are satisfactory staffing arrangements in the home. When necessary to cover sickness or holidays, agency staff are used. Staff spoken with during the inspection confirmed that they had attended courses or talks within the last few months on tissue viability, infection control, food supplements, nail cutting, moving and handling and fire safety. Arrangements are being made for a chiropodist to provide training for staff in the autumn. Staff recruitment records were seen in respect of two staff members. The home had followed their procedures in making sure that application forms were completed, references had been obtained and CRBs had been carried out. The need to always ensure that a photo of each staff member and proof of their identification and qualifications is kept on file was highlighted. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,36,38 The home is well managed and staff have a clear understanding of their responsibilities. Staff are given regular opportunities to share their views on the way care is delivered in the home. Record keeping in relation to formal supervisions has improved but further progress could be made in this area. The tool used for carrying out the health and safety assessment of the building in 2001 would be a good format for formalising the regular assessments carried out on the building. EVIDENCE: The manager is a Registered General Nurse. She has taken a break from her studies to attain NVQ level four in management. However, she advised that she hopes to resume her studies in September. A staff member spoken with during the inspection described the manager as `very supportive and approachable’. Staff also stated that there are regular staff meetings. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 16 There is a suggestion box so that if a staff member is unable to attend a staff meeting, they can write down the issue to be raised and this is brought up at the meeting. This ensures that everyone is given the opportunity to share their views. At the time of inspection the manager advised that the owner had been carrying out the monthly visits as is required by Regulation 26. However, copies of the reports had not been sent Commission or to her. Prior to completing this report the Commission received copies of the monthly reports from January to May 2005. In addition a copy of the home’s business plan had also been forwarded to the Commission. The manager keeps a record of monthly supervision with staff. This generally includes updates on staff training and when particular issues have been discussed with staff on topics relevant to their role. It was agreed that records could be expanded to include reference to each staff member’s individual progress. The Manager advised that this is currently discussed regularly with staff but not recorded formally. Records seen in respect of accidents were sufficiently detailed. In addition to the individual records detailing accidents, the home keeps a chronological list of all the accidents that occur in the home. It was agreed that the timing of accidents should also be recorded on the chronological list, to check if there are particular times of day/night when accidents are more frequent. A detailed hand written health and safety assessment of the building was carried out in 2001. Staff advised that should they note any maintenance issues that require attention they record them in the maintenance book and they are addressed quickly. In addition the manager advised that the owner regularly tours the building and if issues are noted they are also recorded in the maintenance book. Certificates were seen confirming that the equipment in use in the home is serviced at regular intervals. Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 2 3 x 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 2 3 x 3 x 2 x 2 Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 18 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 16(2)(m)( n) Requirement More detailed assessments must be carried out in respect of individual service user’s social and emotional needs. (This was a requirment of the previous inspection. Timescale given was 15/1/05) Emergency lights must be tested monthly, fire alarms weekly and the homes fire safety inspection completed in line with the homes risk assessment. Records held in respect of staff recruited to work in the home must include all the documents listed in Schedule 2. The registered manager must continue to study for NVQ level four. Timescale for action 31 August 2005 2. 19 23(4)((c) (v) 31 July 2005 3. 29 19 Schedule 2 10(3) 31 July 2005 2005 4. 31 Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 19 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 1 Good Practice Recommendations The home should include in their statement of purpose details of the numbers of residents they are registered to accommodate. In addition they should include reference to staff qualifications and the training opportunities provided to staff in the home. Daily notes should make reference to how the social and emotional needs of service users are being met. Records should also show any deterioration in service users’ mental health needs. The complaint procedure in the policy and procedure manual should be updated, in line with the policy on display in the home, to include reference to the commission and to the need to deal with complaints within 28 days. Formal supervision for staff should inlcude reference to each staff members individual performance. The chronological list of accidents that occur in the home should include the time of each accident. The home should produce a format for carrying out their regular assessments of the building in respect of health and safety. 2. 7 3. 16 4. 5. 6. 36 38 38 Bryher Court H59-H10 S13969 Bryher Court V231631 070605 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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