Inspection on 24/05/06 for The Ashford Nursing Home - Brabourne Care Centre

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The Ashford Nursing Home -... 10/08/07

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Springfield House

Sutton Lodge Nursing Home

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St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Ashford Nursing Home - Brabourne Care Centre Hythe Road Ashford Kent TN24 0QJ Lead Inspector Lisbeth Scoones Unannounced Inspection 23rd May 2006 09:30 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 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.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. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Ashford Nursing Home - Brabourne Care Centre Hythe Road Ashford Kent TN24 0QJ Address 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) 01233 643555 Opus Care Limited Claire Sherwood Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users with Palliative care needs are restricted to 10 (ten). Service Users to be accommodated in the Mountbatten Suite, Edinburgh Suite and Maxwell Suite only. Service User under the age of 65 years old is restricted to one (1) whose date of birth is 18/03/1948. This is the first inspection Date of last inspection Brief Description of the Service: The Brabourne Care Centre is a newly registered, purpose built, large, detached three storied building with plenty of car parking space. It is set in newly planted gardens and situated on the Hythe Road close to its sister home, the Ashford Nursing Home, the town centre and junction 10 of the M20 motorway. The home is served by public transport with local amenities nearby. The home is on three floors, of which the top and ground floors are currently registered. All the rooms are single en-suite. Every floor provides a number of communal areas, including a lounge, dining and quiet areas. There are two passenger lifts. Brabourne care centre is currently registered to provide nursing and palliative care for 53 residents. When the middle floor is registered the bed capacity will be 82. At the time of the inspection, the manager advised that weekly fees are in the range of £438,11 to £811/£890. Additional extra costs are clearly identified in the Welcome and Introduction Pack, which is given to all prospective residents. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 23 May 2006 between 09.30 and 16.30. The manager, Mrs Sherwood, deputy manager, Mrs C Beer and staff on duty assisted with the process. The Mountbatten Suite positioned on the second floor has 20 residents. Although the ground floor is also registered, there are currently no residents. The middle floor is yet to be registered. Newly registered, the home has experienced some instability in respect of staffing although new staff have been recruited who have yet to start. The inspection process consisted of information collected before, during and after the visit to the home. Information obtained on the day included discussions and meetings with a number of residents and staff. Documentation was examined in respect of pre-admission assessments, care planning, medication, complaints and training records, policies and procedures, duty rota, social events calendar and recruitment documentation. A comprehensive feedback session was provided to the manager the day after the inspection. What the service does well: The home provides a homely, modern, spacious, light, well-designed environment for its residents. One residents said, “ it is like being in Buckingham Palace”, another “ I like the privacy of my own bathroom” The home provides an imaginative and varied programme of activities. A resident said, ” I enjoyed the music yesterday”, another, “I like the entertainment here.” Staff interacted with the residents in pleasant and dignified manner. Newly appointed staff said they enjoyed the induction training and are looking forward to commence their NVQ. Residents said they enjoyed the food. A resident commented, “ I prefer an egg for breakfast and that is what I get.” The manager and deputy manager are aware that staffing the unit has unexpectantly been difficult and that certain managerial issues have been delayed as a consequence. The manager is confidant that these issues will shortly be resolved when the recruitment drive has been completed and the deputy manager’s time freed up for training, supervision and audit. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 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. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.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 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Pre-admission assessments do not clearly identify the need for equipment to reduce the risk of skin breakdown. EVIDENCE: A sample of pre-admission assessments does not clearly identify the risk of possible skin breakdown and the equipment needed to reduce such risks. Whilst it was said that the majority of such equipment would be provided from the loan store, there sometimes is a delay in the delivery. At the feedback session, the manager advised that the home has purchased two pressurerelieving mattresses. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans do not identify all residents’ needs and are not reviewed as often as risk would dictate. Visits from GP’s, specialists and care managers are not clearly recorded. Medication records are well maintained. The non- administration of “as required” medication should trigger a GP review. Residents are treated with kindness and respect for their privacy. Staff are trained in the care of the dying. EVIDENCE: Most care plans seen were comprehensively maintained. However, some care plans did not identify all care needs and at times the daily record did not relate to the care identified in the care plan. It was recommended that these be audited for clarity and consistency. Not all care plans had been reviewed in The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 10 accordance to identified risk. As mentioned in standard 3, pre-admission assessment should inform the writing of the care plan. During a tour of the unit, it was noted that several residents at risk of developing pressure ulcers had been supplied with a pressure-relieving mattress and chair cushion. Some residents had been supplied with bedrails following risk assessments. Nutritional assessments are undertaken to determine any risk in that respect. See also standard 15. It was evident that the home consults with consultants and specialist nurses. It is also evident that resident’s care is regularly reviewed. It was however difficult to ascertain when such consultations/visits and reviews had taken place. It was recommended that these be clearly documented as an aid to provide an audit and guidance for staff. This issue was particularly relevant for two resident with a mental health problem. The residents had been appropriately referred. Medication records were well maintained. It was however recommended that, when a medication is not required, the GP be consulted for a medication review. It was evident that the staff know the residents very well and they talked to the residents with kindness and respect. The home is registered to provide palliative care and staff training is provided. Induction training includes Loss and Bereavement. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 11 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are provided with a varied and imaginative programme of activities according to their abilities and interests. Residents receive wholesome, varied and balanced meals. EVIDENCE: The housekeeper is currently involved with the planning and delivering of a varied and imaginative activities programme. It was evident that she enjoys the role. When the home extends its occupancy, an additional member of staff will be involved with this task. Residents spoken to said they enjoyed the music and other entertainment. An activities programme is on display. A resident said he enjoyed the musician and that the staff take him for a walk around the grounds when they have time. The home has a hair and beauty salon and residents are given the opportunity to have reflexology and hand massage. Residents said and the menus indicate that the meals are varied, wholesome and balanced. A resident said that the food is good. Another that the portions The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 12 are sometimes too large. In the care plans it was noted that nutritional assessments are undertaken. A resident was receiving supplementary liquid drinks to ensure an effective calorie intake. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 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 18 Quality is this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a complaint procedure and residents know that their complaints will be listened to. Residents are protected from abuse and staff training is provided. EVIDENCE: Whilst it is evident that the home takes complaints seriously, these are however not recorded in a complaint file. As a result, the action taken to address the complaint is not recorded nor is the outcome. A resident said, “ I have my moans but will always tell the staff who would then deal with it.” Staff spoken to demonstrated a good awareness of adult protection issues and the route to take if this ever needed to be reported. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 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, 22, 26 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents are provided with a safe, spacious, light and well-designed environment. The communal areas are homely, comfortable, tasteful and colourful. Residents are provided with specialist equipment to maximise their independence. The home is clean and hygienic. EVIDENCE: Newly built, the home is bright and comfortable. Residents are provided with a single en-suite room, all with large windows and pleasant views. The corridors are wide thus providing optimum moving space. Two lifts are available. Additional storage space has been provided for large pieces of equipment as hoists and wheel chairs. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 15 Whilst all rooms have an en-suite facility, if an assessment determines the need for a commode, this would be provided. A resident spoken to confirmed this. The home is clean, fresh and pleasant. Staff are trained in infection control issues. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 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, 28, 29, 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ needs are not always met by the numbers and skill mix of staff. Staff are provided with the induction and on-going training they need to care for the residents. The home has good recruitment procedures. EVIDENCE: As already indicated, there has been a degree of staff instability, which the manager soon hopes to resolve. It is not clear whether dependency assessments are taken into account when setting staffing levels. The home has a large number of highly dependent residents. It is questioned whether two members of staff on night duty for 20 residents is sufficient bearing in mind that 18 of them need two staff to care for them. The deputy manager is currently not available for sufficient supernumerary duties to undertake care plan audit or provide formal staff supervision. See also standards 7 and 36. Staff spoken to said that some of the residents needed more attention than others and they wished they had more time for everyone. A resident said he sometimes had to wait a long time for staff to attend to his needs. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 17 The deputy manager is a keen trainer and hopes to soon introduce individual training and development profiles for all staff. Staff spoken to praised the quality of the training so far received. In respect of the category of registration, the home must ensure that all staff are trained in palliative care. The manager showed the staff-training plan, which includes dementia care. The home encourages and provides NVQ training. Currently 50 of the staff are NVQ trained, some at level 3. Good recruitment procedures are used and records kept. It was however recommended that an effective audit system be introduced, thus demonstrating that all checks, references and training records are on file. For one employee a reference was missing, for another the training file was empty. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 18 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, 33, 35, 36, 38 The quality of this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a well managed home but systems must be developed and introduced for quality assurance and staff supervision. The health, safety and welfare of residents and staff are promoted but the home must ensure that the CSCI is informed of any untoward event. EVIDENCE: The registered manager, Mrs C Sherwood, is a registered nurse with 30 years experience and has been running a care home since 1989. She has a qualification in management. She is supported by a deputy manager and other senior staff. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 19 Mrs Sherwood meets with the residents and staff on a daily basis during the week and has regular staff meetings. Quality assurance audit tools are available but still need to be introduced as well as residents’ satisfaction surveys and formal visits by the “Responsible Individual”. Mrs Sherwood said that such systems would be introduced. The home does not get involved with residents financial affairs, although for two residents the home was asked to look after small amounts of money. The administrator keeps records of any transactions undertaken. Due to the staffing problems already identified, formal staff supervision is currently not provided. It was evident for conversations with the deputy manager that she is keen to start the process. Accident records had been well maintained. The home was however reminded that any incident within the Regulation 37 criteria must be reported to the CSCI without delay. The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 20 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 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 4 x x 3 x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 2 2 Standard OP33 OP36 OP38 Regulation 26 18 (2) 37 Requirement That the home is visited in accordance with the Regulation That staff receive formal supervision That any untoward event be reported to the CSCI without delay Timescale for action 30/06/06 30/06/06 24/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP3 OP7 OP8 OP16 OP27 OP29 Good Practice Recommendations That pre-admission assessments identify risk of skin breakdown and availability of equipment. That care plans include all care needs and are timely reviewed. That visits by consultants, specialist nurses and care managers are comprehensively recorded. That complaints are comprehensively recorded That staffing levels are set in accordance with residents’ dependency and staff experience. That recruitment files are complete. DS0000066468.V295907.R01.S.doc Version 5.2 Page 22 The Ashford Nursing Home - Brabourne Care Centre Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 The Ashford Nursing Home - Brabourne Care Centre DS0000066468.V295907.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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