Inspection on 12/04/07 for Rose Brae Nursing Home

This inspection was carried out on 12th April 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rose Brae Nursing Home 08/04/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rose Brae Nursing Home 8 Spital Road Bebington Wirral CH63 9JE Lead Inspector Julie King Key Unannounced Inspection 12th April 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 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. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rose Brae Nursing Home Address 8 Spital Road Bebington Wirral CH63 9JE 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) 0151 334 5549 0151 334 5549 Mr Shaid Hussain Mr Zaheed Hussein, Zulqarnain Hussain Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 25 service users to include:*Up to 25 service users in the category of OP (Old age not falling within any other category). 25 nursing care beds, 8 personal care beds within the overall total of 25 New Service Date of last inspection Brief Description of the Service: Rose Brae is a converted three storey mature house, situated in the residential area of Spital, Bebington, and is close to local amenities. The home has two lounges and a conservatory, and at present one of the lounges is used as a dining room. All areas of the home are accessible by wheelchair, including the large, landscaped rear garden and patio area. There is car parking at the front of the building. Fees range from £390 - £550, or by private arrangement, and do not include hairdressing, chiropody, newspapers, etc. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of a key inspection, this site visit was conducted over 5.5 hours, during which a full tour of the premises took place; staff and care records were examined. The acting manager and registered provider accompanied the inspector throughout this visit. A selection of staff on duty plus some residents were spoken to during this visit. There were no relatives present during this site visit, but questionnaires have been sent out by CSCI to obtain their views on the service. What the service does well: What has improved since the last inspection? What they could do better: Some bedroom furniture needs to be replaced (already identified by the registered provider), and the management, quality assurance, communication and all records pertaining to staff and residents need improvement in accordance with the National Minimum Standards and accompanying regulations. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 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 Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, but the home is not able to provide assurances to residents that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: All residents have a pre admission nursing assessment before they are admitted to the home; the manager, or one of the senior nurses in the home undertakes the assessment. The overall standard of these assessments is just adequate, with some assessments being completed fully, but others lacking in detail and relevant information. It is required that the pre admission assessment tool is utilised in more detail to ensure that all prospective resident’s needs are fully identified, therefore Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 9 providing adequate information upon which to formulate a more detailed care plan. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS out-patient’s appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s individual health, personal and social care needs are minimally recorded, providing staff with some of the information they need to meet each resident’s care needs. Medication management is inconsistent, potentially placing residents at risk. EVIDENCE: Most of the care plans seen evidenced the actual care delivered by staff to meet the needs of the residents, but the standard and quality of the recording and reviews varied depending upon which Registered General Nurse (RGN) had completed them. It is strongly recommended that the manager completed regular, documented audits of all care files and MAR sheets to check accuracy and content of all relevant paperwork. Evidence was available to show that GPs, NHS services and visiting professionals were involved in resident’s care. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 11 Also available were monthly reviews, but these varied from a detailed analysis of the residents needs combined with a revised plan, to “care as plan”, which is insufficient. Daily reports were the same – varying in relevance and detail. Examination of medications evidenced that there were gaps in the medication administration records (MARs), and the disposal of controlled drugs was not being managed correctly. Having gaps in these records does not evidence if medications were given to the resident or not. It was also concerning to find three copies of one resident’s medication record, all with conflicting information. When questioned, the acting manager was not able to clarify why duplication and conflicting information had occurred, and was requested by the inspector to complete a full investigation within the next two weeks. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with the local community are good, and support and enrich the resident’s lives. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in, such as outings, bingo and manicure therapy, but the recording of this information is minimal. Residents spoken to said, “I love being here”, and, “I’ve got plenty to do”. Presently, the care staff are carrying out activities as there is no designated co-ordinator, but the post is being advertised at the moment. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors in the communal lounges, or in their own bedroom. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 13 The gardens are accessible and tidy, and are an ideal setting for residents to sit with their relatives, especially in the summer months. The residents, who said they are “well fed”, enjoy their meals. Special diets, such as for diabetics are catered for. The cook has obtained her food hygiene certificate, and all records relating to the management of the kitchen were up to date and complete. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of adult protection requirements, thus helping safeguard the residents from risk of abuse. EVIDENCE: Rose Brae has an in-house complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that service users, relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, and staff spoken to were able to inform the inspector of their knowledge of adult protection procedures. The home does not have the latest Wirral Adult Protection guidelines, published in October 2006. The acting manager was strongly recommended to obtain a copy of this as soon as possible. Residents said that if they had any problems they felt they could “talk to the girls or sister [RGN]”. The CSCI has not received any complaints about this service since the previous inspection. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 15 Some staff have completed training in adult protection, with others having training planned for the near future. It is recommended that housekeeping staff also complete adult protection training as soon as practicable. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most resident’s rooms are personalized, providing residents with a homely place to live. EVIDENCE: All communal areas and bedrooms were examined, and some evidenced that they have been painted and had new soft furnishings. Bedrooms were highly personalised, with many residents bringing in their own furniture, artefacts, small possessions, etc. The residents who had had their room painted said how pleased they were with the improvements, and said “I love my room now its been done up”. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 17 Some areas require attention to improve the safety, décor, furniture or floor coverings as follows: • Many room had trailing flexes going across floors presenting as a tripping hazard • No evidence of how the person(s) responsible for checking bed rails has been trained and assessed as competent, and bed rails seen were not fitted correctly regarding distance from the head of the beds. Incorrect fitting can lead to accidental entrapment and subsequent serious injuries. • Wardrobes with numerous items above head height not secured to the wall • Some malodorous bedrooms with floor coverings stained – require replacement The registered provider accompanied the inspector during the environmental tour, and is in process of completing an improvement plan for the environment as a whole. Most communal areas were seen to be in the process of being redecorated at the time of this site visit. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a consistency of permanent staff within the home, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files were examined as part of the case-tracking process. None of the seen contained all the required documents and records. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) evidence was available, as were some references, minimal training information, NVQ training, proof of identification and basic inductions. The inspector has requested a copy of the planned training programme for the coming year, which ought to show training and development for all staff. Some staff have completed training in wound care, moving & handling, and some age-related conditions relevant to the residents. Most staff have not received all mandatory areas of training, such as COSHH (Control of Substances Hazardous to Health), infection control, health & safety, moving & handling, fire and first aid which should have been a basic requirement for their job. This was discussed with the Responsible Individual Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 19 who has assured the inspector that suitable and sufficient training will be provided and recorded as soon as possible. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall management of this service is below standard, thus potentially placing residents at risk. EVIDENCE: The acting manager is not registered with the CSCI, but has the support of an experienced deputy manager for assistance with the day-to-day running of the home. Overall this home has deteriorated (with the exception of the environment) since the previous site visit, and documented audits and checks of resident’s care files were still not available. There was little evidence of ongoing quality assurance, but the registered person is currently in process of collating Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 21 resident’s representatives questionnaires, and staff meetings are held on a regular basis. Risk assessments regarding environmental issues, such as the numerous trailing flexes were not available for the inspector, so it was not possible to ascertain whether or not risk assessments had been completed. The fire risk assessment was not available, nor was the staff training record to evidence fire prevention and actions to be taken by staff if a fire is discovered. The recording of resident’s accidents and incidents, especially regarding any follow-up or actions taken is not fully compliant with requirements; and does not evidence what actions the RGN’s have taken following a resident’s fall. All record keeping must comply with the Care Standards Act 2000 and accompanying Regulations, but RGNs must also comply with their professional codes of conduct issued by the Nursing & Midwifery Council. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 22 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 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Not Applicable 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 OP3 Regulation 14 Requirement The registered person must ensure that suitable and sufficient pre-admission assessments care completed by a competent person on all prospective residents prior to admission. The registered person must ensure that the care home can fully meet the needs of all residents, and that that all information relating to those needs is documented. The registered person must ensure that all residents have an up to date, relevant and regularly reviewed care plan, relevant to their assessed and changing needs. The registered person must ensure that risk assessments, such as for nutrition, are completed for each resident. The registered person must ensure that all medications received into the care home are DS0000068896.V335533.R01.S.doc Timescale for action 31/05/07 2 OP4 12 31/05/07 3 OP7 15 31/05/07 4 OP8 13 31/05/07 5 OP9 13.2 30/04/07 Rose Brae Nursing Home Version 5.2 Page 24 managed, stored, administered and recorded in accordance with current good practice requirements and guidelines. 6 OP18 13.6 The registered person must ensure that all staff receive suitable and sufficient training in the prevention of adult abuse. The registered person must ensure that all areas of the care home are clean and free from malodour, and kept in a good state of repair at all times. The registered person must ensure that all staff complete training suitable to the needs of the residents, and that this training is documented. The registered person must ensure that all records and documents as specified under this regulation are obtained for all persons employed. 30/06/07 7 OP26 16.2 30/04/07 8 OP28 18 31/07/07 9 OP29 19 30/06/07 10 OP30 18 31/07/07 The registered person must ensure that all staff complete mandatory training as soon as practicable, and that this training is recorded. The registered person must ensure that the manager has the qualifications, skills and experience necessary for managing the care home. The registered person must ensure that the quality of care, including nursing, is improved, and regular audits are completed to assess quality within the service. The registered person must ensure that all risks to the DS0000068896.V335533.R01.S.doc 11 OP31 9 30/06/07 12 OP33 24 30/06/07 13 OP38 13.4 30/04/07 Rose Brae Nursing Home Version 5.2 Page 25 residents, staff and visitors are identified and suitable action is taken on their findings to minimize the risks. 14 OP38 23.4 30/06/07 The registered person must ensure that all staff complete suitable and sufficient fire training, including the actions to be taken if a fire is discovered, and the procedure for saving life, as soon as possible, and that this training is clearly documented. 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 3 Refer to Standard OP12 OP18 OP38 Good Practice Recommendations It is recommended that all activities are recorded clearly in each resident’s care file. It is strongly recommended that the registered person obtains a copy of Wirral’s Adult Protection Procedure 2006. It is strongly recommended that the registered person obtains training for designated staff for the competent checking of bed rails. Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 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 © 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 Rose Brae Nursing Home DS0000068896.V335533.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!