Inspection on 19/11/08 for Kings Bromley Nursing Home

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kings Bromley Nursing Home 17/10/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kings Bromley Nursing Home Manor Park Kings Bromley Staffordshire DE13 7JA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Beck     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Kings Bromley Nursing Home Manor Park Kings Bromley Staffordshire DE13 7JA 01543472552 01543472332 kbeuropean@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Ostle Type of registration: Number of places registered: European Care (Central) Limited care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia physical disability terminally ill Additional conditions: 55 Physical Disability (PD) - Minimum age 55 years on admission One Named person PD category minimum age 32 years on admission. One named resident MD category Terminall Illness Conditions apply TI 4 beds Date of last inspection Brief description of the care home Kings Bromley nursing home provides nursing and personal care to elderly persons. The establishment is an extended part two-storey detached property situated in the picturesque village of Kings Bromley, within easy access to public transport. It is set in Care Homes for Older People Page 4 of 27 Over 65 10 0 55 0 0 1 55 4 Brief description of the care home its own extensive grounds with enclosed patio and gardens. Thirty-six single and three shared bedrooms are located on the ground floor. First floor accommodation, including nine single and two double bedrooms, is accessed via stairs and shaft lift. The home provides spacious accommodation, which is furnished in a homely style. There are communal lounges on the ground floor and also a separate dining room adjacent to the kitchen. A homely environment has been created throughout. This is particularly evident on the smaller unit where the home provides care for people with dementia. The range of fees the home charges for residency were not included in the Service User Guide but people can contact the home for this information. A copy of the most recent inspection report is available upon request from the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection completed by one inspector from 09:00hrs to 15:00hrs. We looked at all of the information we have about this home to enable us to make judgements about the service they provide. We asked the home to complete the Annual Quality Assurance Assessment (AQAA), this gives us information about the service, the improvements it has made and the improvements it is planning. It also gives us statistical information about the home. We looked at information we have received in relation to complaints and safeguarding vulnerable adults. We spent time during this inspection talking to staff and to the people who live in the home. We did this so we could get a feel of what it is like to live at Kings Bromley Nursing Home. Care Homes for Older People Page 6 of 27 We looked in depth at the care of three people living in the home. This is our case tracking process and gives us the information we need to make judgements about how well the home is meeting peoples needs. We have also used the information from our last key inspection in October 2006 and from the homes Annual Service Review dated April 2008. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured their needs will be assessed in full prior to their admission to the home. They can feel confident the home will meet those needs once they agree to move in. Evidence: We looked at the care of three people as part of our case tracking process. We saw that in each case peoples needs had been assessed and clearly documented before their admission. People are fully involved in this process and their views are recorded in the assessment. If people are unable to participate in the assessment process the home will also work closely with family to make sure that peoples needs are recorded. We have recommended the home confirms they can meet peoples needs by writing to them once a decision has been reached about admission. This home does not offer intermediate care facilities. Care Homes for Older People Page 10 of 27 Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be confident their needs will be recognised and met. People can expect to be treated with respect and dignity at all times. Medication practices in this home are good and protect people from error or harm. Evidence: People living in this home will have all of their needs assessed and staff will plan care for them. We looked at three peoples care plans and risk assessments. Each care plan had been reviewed and changes in peoples condition had been recorded. The home uses risk assessments to help reduce risk to people these include, moving and handling, falls, nutritional screening and pressure sore risk development. There are also risk assessments that allow the staff to help manage peoples pain and agitation. When the home identifies a person at risk they complete a care plan that shows staff how to reduce and manage risks for people. We looked at care plan for one person who displays some challenging behaviour at times. We have recommended the home includes in this care plan a description of the type of behaviour displayed by the person and the necessary interventions staff are to use in order to keep the person Care Homes for Older People Page 12 of 27 Evidence: safe. Other care plans we saw were detailed and did give staff clear guidance in meeting peoples needs. The home is now using a more person centred approach to care planning on the smaller unit where people with dementia live. This means that care plans are more individualised and offer a realistic picture of peoples likes and dislikes in relation to their care. There are good systems in place for the ordering, administration and safe storage of peoples medication. We have made some recommendations to build upon current good practice. We have said that two staff should sign the Medication Administration Record (MAR) when handwritten entries are made. Staff should also record the amount of medication given when a variable dose has been prescribed on the MAR sheet. For example one or two paracetamol. We spoke to staff and to some of the people living in the home during this inspection about how peoples right to respect and dignity are met. Staff gave us good examples of how they would support people. They told us we always make sure that people are at ease when we are giving care, it is important to recognise that people may not understand what you are trying to do so you have to give them time. One person said they give me the time I need I dont ever feel rushed. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are encouraged to lead active lives and to take part in activities. Meals are of good quality and peoples individual dietary needs will be met. Evidence: We looked at the activity programme and planning the home has in place. We saw that improvements have been made and more activity has been planned for people to take part in. The home has also recruited more staff to enable them to deliver an activity programme. In addition to new staff the home has also arranged further training for staff to take part in so that activities that are planned are done so based upon peoples capabilities. Activities on offer include dominoes, skittles and quizzes. The use of doll therapy is also used with good effect on the dementia care unit. People were actively involved in the care of the babies (dolls) and appeared to be enjoying it. We saw lots of arts and craft work displayed throughout the home that people have completed. The home has an open visiting arrangements, relatives are encouraged to visit when they wish to. We saw some peoples bedrooms as we walked around the home. They were personalised to peoples individual tastes and some people had bought in favourite pieces of furniture and pictures from home when they moved in. This made the rooms Care Homes for Older People Page 14 of 27 Evidence: feel homely and decorated to peoples individual preferences. The home has recently had the kitchen completely refurbished and extended. This has made it larger and there is more space for staff to prepare meals in. There is a four weekly menu on display with plenty of choice for people. If people do not like what is on the menu an alternative meal is always offered. People told us the food is very nice, there is alot of choice and it is hot. Meals are served in the dining rooms which are pleasantly decorated and offer a relaxing place for people to eat their meals. People can also choose to eat their meals in the privacy of their own rooms. Those people who require a specialised diet will have one and people who need assistance during mealtimes to eat and drink will be supported. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can feel confident their views and concerns will be listened to and acted upon. Staff have been adequately trained to recognise and report abuse this will help to protect people and keep them safe. Evidence: The home has a complaints policy that is available to all people. It is displayed in the service user guide for the home and in the reception area. The home has not received any complaints during the past 12 months. We have been made aware of one concern by an anonymous source. We were unable to substantiate the concern raised. We spoke to staff about the protection of vulnerable adults. They confirmed that they had training and were able to tell us the different types of abuse that may occur and what they would do about it if an allegation was made to them. The home also has a copy of the local authority guidance so that they will be sure of who to contact in such an event. Bed rails are in use in this home. Before people use this type of restraint a comprehensive risk assessment is completed. The bed rails we saw were fitted correctly and were regularly checked by the maintenance team. This will mean that the risks associated with using this type of restraint is reduced for people. The home has good recruitment processes in place and the manager makes sure that all new staff have a Protection of Vulnerable Adults (PoVA) check and a Criminal Records Bureau (CRB) disclosure before they begin working in the home. These checks Care Homes for Older People Page 16 of 27 Evidence: will help the home prevent unsuitable people from working with vulnerable adults. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained and comfortable home. Evidence: The home is well maintained and kept in good order. There is a programme for renewal of fabrics, furniture and decoration. When we looked around the home we saw there was plenty of space for people to move about and for staff to use equipment such as hoists and wheelchairs. Peoples rooms are pleasantly decorated and they are encouraged to choose the design themselves when they move in. The smaller unit has been decorated with memory aides, sensory boards and other interesting designs. All of these things help to stimulate the senses and memory for people who have dementia. The home is decorated throughout with art work completed by people during the arts and craft sessions. The home has a large garden and grounds and most people have a lovely view from their bedroom windows. There is also a small courtyard garden for people to access if they wish. There was only one issue which is being addressed by the home. The offensive odour on the smaller unit was very overpowering when entering. The manager has told us that there are plans to replace all of the carpet in the corridors and some of the bedrooms on this unit. They are confident this will address the problem. Once this has been done it will be a more pleasant place to live for people. Care Homes for Older People Page 18 of 27 Evidence: The home has a good sized laundry and systems in place to make sure peoples clothing is washed and dried. The washing machines reach disinfection temperatures and will therefore reduce the risk of cross infection. Staff have received infection control training and there are hand washing facilities throughout the home. Gloves and aprons are freely available for staff use. All of these measures will help reduce the risk of cross infection for the people living in the home Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff who have been recruited safely, trained appropriately and who have the knowledge and skills to meet peoples needs. Evidence: The home has enough staff on duty to meet the needs of the people living there. Staffing levels are responsive to peoples needs. People told us the staff try very hard and are marvelous, couldnt wish for better. Since our last visit in October 2006 the home has improved upon the training staff complete. The numbers of staff who have completed their National Vocational Qualification (NVQ) has increased. Most of the staff have now completed their NVQ level 2 and are progressing with the level 3. The manager has also secured further NVQ training in subjects other than health and social care, such as activities, customer care and hospitality and team building. Other training has also included the Yesterday, Today and Tomorrow training endorsed by the Alzheimers Society. This training helps staff to understand the experience of dementia and how to support people living with the illness. We looked at the recruitment processes the home has. We saw from the four staff files we looked at the are good systems in place for ensuring people are recruited safely and that the people in the home are protected from unsuitable workers. All new staff are supported by the home when they start working there. There is a Care Homes for Older People Page 20 of 27 Evidence: structured induction that meets the Skills for Care induction standards and training for all new staff. Each new worker is also designated a supervisor for supervision and support during this time. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well and run in the best interests of the people living there. Evidence: There has been no change in management since our last inspection. The manager is approachable and clearly has a good relationship with both staff and the people who live in the home. When we completed our Annual Service Review of this home in April 2008 we were told by people we surveyed that the manager was always available, she was approachable and people felt comfortable raising their concerns or views with her. The manager was able to demonstrate throughout this inspection her knowledge of the service the home provides, a clear vision for future improvements and an understanding of current good practice areas. This was particulalry evident when discussing the care of people with dementia. The quality assurance system is based upon the National Minimum Standards, this allows the home to look at the standards of care they are providing and make changes where needed. The home consults with the people who use the service by asking them Care Homes for Older People Page 22 of 27 Evidence: to attend residents meetings and by completing surveys about the care and attention they receive. The manager has also completed her Dementia Care Mapping training. This enables her to complete observational assessments of the quality of care for those people who have dementia and may not be able to verbally explain how they are feeling. Once an observation has been completed the manager will complete and action plan with staff for further improvement in the delivery of dementia care for people. The area manager also visits the home on a monthly basis to complete an unannounced inspection as required by Regulation 26 of the Care Home Regulations 2001. These visits make sure that any quality issues people may have are highlighted and can be addressed. The home has also completed an Annual Quality Assurance Assessment (AQAA) this document was sent to us when we asked for it and contained information we needed to make some judgments about this service. The information in the AQAA was found to be accurate, reliable and very clear supporting the homes ability to self assess its performance. The home encourages all people to take care of their own money wherever possible. There were only two people who were keeping their money with the home for safekeeping. We looked at the systems in place for doing this and found them to be satisfactory. The home keeps good records of all transactions and is able to provide and audit trail for people so that they can see where their money has been spent. The health and safety of people living in this home is protected by good staff training, up to date safety checks and regular maintenance of the building and equipment. We sampled some of the safety certificates and found them to be in order. Fire procedures and fire checks were all up to date. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 17 The home should record the current and the minimum and maximum temperature of the drugs fridge. This will make sure that peoples medication is being stored correctly. 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The home should inform people in writing that they can meet their needs once their assessment has been completed. staff could further develop challenging behaviour care plans by recording the type of behaviour that can displayed and the interventions needed by staff in order to address this. Staff should record the variable dose of medication on the MAR sheet. This will enable an audit of this medication to be undertaken and also give staff a clear record of the medication people are taking. Two staff should sign the MAR records when completing a handwritten entry. The home should consider the removal and replacement of the carpet on the small unit. This should address the Page 25 of 27 2 8 3 9 4 5 9 19 Care Homes for Older People overpowering smell of urine and offer a more pleasant environment for people to live in. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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