Care Home: Bradwell Hall Nursing & Residential Home

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What the care home does well What has improved since the last inspection? It was pleasing to find that there has been an increase in the number of hours provided for activities and entertainment in the home. There is now an activity co-ordinator for each unit provided. This has improved the social and therapeutic services provided to the people who live at the home. A change in management of Audley unit has improved outcomes for the people who live there. There are definite improvements in the standards of personal and nursing care provided on this unit. There has been some redecoration, refurbishment and purchase of new equipment since the last inspection. This has helped to improve the comfort of the environment for the people who live at the home. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Bradwell Hall Nursing & Residential Home Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ Lead Inspector Yvonne Allen. Peter Dawson. Wendy Jones. Key Unannounced Inspection 21st July 2008 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 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.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. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bradwell Hall Nursing & Residential Home Address Old Hall Drive Bradwell Newcastle Staffordshire ST5 8RQ 01782 636935 01782 719025 Edward-Twigge@hotmail.com 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) Bradwell Hall Nursing Home Limited Wilhamina Thomas Care Home 171 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (93), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (10), Old age, not falling within any other category (58), Physical disability (20), Physical disability over 65 years of age (58) Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Chatterley Unit may comprise of 30 in total: 30 DE(E); 10 MD(E); 5 DE - minimum age 50 years on admission Sneyd Unit may comprise of 30 in total: 30DE(E); 10 MD(E) Chester Unit may comprise of 33 in total: 33 DE(E) Keele Unit may comprise of 20 in total: 20 PD Audley Unit may comprise of 45 in total: 45 PD(E); 45 OP; 10 PD - Minimum age 60 years on admission Breward Unit may comprise of 13 in total: 13 PD(E); 13 OP; 10 PH - Minimum age 60 years on admission. 11th June 2007 Date of last inspection Brief Description of the Service: Bradwell Hall is a purpose built family run home that provides both nursing and personal care for up to 171 people. It is situated within extensive grounds in a pleasant residential area on the outskirts of Newcastle-under-Lyme. The home comprises of six units – Audley Unit has recently been extended by 15 beds. This Unit provides nursing and personal care for frail elderly people. Chester Unit provides nursing and personal care for frail older people and up to fifteen older people with dementia care needs. Keele Unit provides nursing care for younger physically disabled people. Sneyd, is a nursing unit for older people with mental health problems. Chatterley Unit provides both nursing and personal care to older people with mental frailty. Breward Unit provides nursing and personal care and support to older people who may also have a physical disability. The units are all on one floor and can be accessed independently. Each of the units has a lounge, dining room and kitchen area. The majority of the Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 5 bedrooms are single with en-suite facilities consisting of toilet and wash hand basin and there are assisted bathrooms. The original house is central to the units and houses the reception area, ground floor meeting rooms, administration offices and central kitchen that provide the main meals to all of the units. The laundry is situated to the side of the main house. The fees charged by this home range from £280.00 to £730.00. Extra charges apply for Hairdressing, Toiletries, Newspapers and Transport. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Overall quality rating for this service is 2 star. This means that the people using the service experience good quality outcomes. We, the commission, carried out an unannounced Key inspection visit at this home on 21/07/08. This inspection took a full day and three inspectors were involved. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. It was completed to a good standard and gave detailed information about the services offered. Information from this AQAA was used to plan the inspection visit and references to it have been included in this report. Also, prior to the inspection visit, we had sent out surveys to some of the people who live at the home, some relatives and some of the people who work at the home. This enabled us to obtain the views of these people about what the home is like to live and work in. We got a good response from this and these comments have been included in this report. The ways in which we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home We spoke with the staff who work at the home Discussions were held with the Registered Manager and Providers of the home We spoke with a visiting dietician who has been working with the home. We examined relevant paperwork and documentation at the home. We walked around the home and we visited all the units. We looked at how staff interact with and care for the people who live at the home. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 7 At the end of the inspection visit we discussed our findings with the Registered Manager and Providers. There were no immediate requirements made. There were 3 requirements and 8 recommendations made as a result of this inspection. What the service does well: What has improved since the last inspection? It was pleasing to find that there has been an increase in the number of hours provided for activities and entertainment in the home. There is now an activity co-ordinator for each unit provided. This has improved the social and therapeutic services provided to the people who live at the home. A change in management of Audley unit has improved outcomes for the people who live there. There are definite improvements in the standards of personal and nursing care provided on this unit. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 8 There has been some redecoration, refurbishment and purchase of new equipment since the last inspection. This has helped to improve the comfort of the environment for the people who live at the home. 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 summary of this inspection report can be made available in other formats on request. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 9 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 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 10 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): Standards 3 and 4 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have their needs assessed prior to admission but it cannot always be guaranteed that they will be appropriately placed. The providers will need to ensure that people are accommodated in a unit that can meet individual assessed needs. EVIDENCE: One of the people who completed a survey told us that she had visited the home prior to admission and - “I knew enough to satisfy me.” Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 11 The home consults the assessment information to see if they can meet the prospective resident’s needs before they make the decision to accept the application for admission and offer a place. Comments we received from relatives included – “I am always informed and helped” “I am phoned on my mobile at work to keep me informed”. “On my mother’s ward staff are always willing and able to give time, support and information” We looked at a random selection of care plans throughout the units. It was identified that pre admission assessment of needs had been carried out prior to a placement being offered. These assessments are generally undertaken satisfactorily. Staff have the necessary specialist skills and ability to care for individuals who are admitted. One person did not have an assessment in her file and the manager told us that she had been on holiday when this person had been admitted. It became evident later that this person was moved form another unit. She is an 84-yearold lady on a Younger Persons (YPD) unit. We were told that this lady sleeps on Keele (YPD) unit but spends the day on Breward (elderly care unit). This was raised at feedback with the provider, as this lady was not appropriately placed on Keele unit. Also the staffing levels on Breward unit are arranged to provide care and accommodation for up to 13 people not 14. We recommend that this practice should cease. We spoke to a relative who commented that when he came to look at the home he was shown around Breward and he thought that it would be entirely suitable for his relative. However when his relative was admitted to the home she was admitted to another unit. He was not satisfied that this had happened and felt he had been deceived. He had insisted that his relative was moved to Breward as intended. We recommend that when the home confirms in writing that they can meet the needs of people, they confirm the unit they are to be admitted to so that this is made clear to people moving in. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that their personal, nursing and health care needs will be met and that they will access to outside agencies and other healthcare professionals. The Providers will need to ensure that Safeguarding Policies are strictly followed in order to help keep people safe. EVIDENCE: We looked at several individual care plans of people accommodated in all the units throughout the home. Since the last Key inspection, the home has introduced a new computerised care planning system named the “Resman” system. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 13 The overall standard of care planning is good - Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each plan or health action plan. They give a comprehensive overview of people’s health needs and act as an indicator of change in health requirements. Care plans could be further improved by being made more person centred. This would help ensure that the delivery of personal care is individual, flexible, consistent, reliable, and person centred. Also, there is not much evidence of people’s involvement in their care plans. People who live at the home, and/or their representatives, should be able to participate in the reviews and evaluations of their care. Residents have access to healthcare and remedial services. At the time of the visit we met with the GP on Audley unit who had been called in to see person who was unwell. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services. Comments from relatives included – “They treat my mother like their own with tender loving care” and “I am always told of any changes to medication or to nursing practice.” “The care home is thorough in its care and its standards are high” and “My mother wouldn’t be alive today if it was not for the care she receives.” “In the past my mother has been very difficult. Her needs were met by employing some one to be with her on a 1:1” Comments from some of the people who live at the home included – “Yes I am looked after very well. If I have any queries I always ask and you’re happy to help.” “Very good. I like all the carers. They try their best to do everything for you.” “They give you your tablets. They come into me in the middle of the night and gave me two! Whatever Ive needed theyve always seen that Ive got it” “They do very well when youre ill, they look after you, but Im really not a poorly person.” We also met with the dietician who has been working with the home to assess nutritional needs of individuals and help improve their dietary intake. She spoke highly of the staff and told us how helpful and cooperative they had been. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 14 We saw that people have the aids and equipment they need and these are well maintained to support them and staff in daily living. The owners of the home are committed to providing the necessary aids and equipment needed. A new stand-aid hoist has been purchased since the last Key inspection. We observed a noticeable improvement in the standard of personal and nursing care provided to the people who live on Audley Unit. The last Key inspection had highlighted areas for improvement on this unit and it was identified that these areas had all improved. There were good records of personal and nursing care maintained in bedrooms – and these showed clearly that people are afforded regular care throughout the day and night. We saw the good standards of care afforded to people who live on Chester and Chatterly units. We noted how people with dementia care and other mental health needs on these units are treated with dignity and respect. We saw how the staff on Sneyd unit had managed to nurse a number of people back to health following a period of poor nutrition and the development of pressure damage. The Provider recognised that this should never have been allowed to develop in the first place, and there has been a change in management on this unit. This is an example of staff working together with other healthcare professionals in order to address the situation and dramatically improve the health of people living on the unit. However it was very concerning, especially in light of the number of people affected, that this was not dealt with as a safeguarding referral in the first place. We discussed this with the Providers during feedback at the end of the visit. It is a requirement of this report that the Providers refer any instances of neglect and/or abuse according to the local Vulnerable Adults procedure, which the home has in place. This will help to ensure that people are protected and kept safe from harm. Some of the people who live on Breward unit have very high dependency and continuing care needs. Some of the people have critical care needs and two people have a tracheotomy in place to help them breath. It was identified that, the nurses who regularly work on this unit have received the necessary training in the use of and care of tracheotomy tubes. However, other nurses who are asked to cover for holidays and absence have not received this training. This therefore leaves these people, and the nurses themselves, vulnerable. It is required that all nurses who work on this unit receive training in the use and care of tracheotomy tubes. It was identified that staff at the home were using an inappropriate “Do Not Attempt Resuscitation” form. This was one of the home’s own forms. The home Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 15 needs to ensure that it remains removed from the process and decisionmaking and that only the form agreed with the Primary Care Trust is used. This is to ensure that vulnerable people are safeguarded, and that the process of not attempting resuscitation is open, transparent and robust. We looked at the medication system on some of the units. Whilst most were found to be in keeping with policies and procedures, we had some concerns about the handling of medication on Sneyd unit. Covert medication was taking place in respect of one person. On examination, however, this was in agreement with all concerned and had been agreed with medical staff, and met with guidelines of the Mental Capacity Act. On the same unit we found that medication was not consistently disposed of in accordance with requirements. It is required that medication, which has not been used, be disposed of as per the home’s medication policy and procedures. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The increase in activity hours at the home has helped to ensure that individual social and therapeutic needs are assessed and met and personal autonomy promoted. The meals provided are satisfactory but not all of the people are aware of what is being served. EVIDENCE: We received the following comments from some of the people who live at the home and their representatives “In my husbands wing faith needs are met” Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 17 “The patients in my husbands wing are all more or less incapable of choosing a way of life. It is dictated by the state of their health. However where their needs are understood, all efforts are made to accommodate their wishes.” “I get bored” “Yes there are always activities on offer” “Some of the care staff are a little pushed for time due mainly to a shortage of staff. This means that after meal times my husband has food left on his face and clothes from the last meal. I understand this mainly as he is difficult to feed at times” “I enjoy sing songs, trips out and church services.” “I went to Brampton Park last week.” “Yes always plenty of activities, but I like to do my own thing.” “I came to the Bingo, even though I didnt win. I went to Birthdays parties and had a sherry and coke.” “I love shopping. Ive never tried arts and crafts though; I wouldnt think Id fancy it. I like group activities, there arent many.” “I am bored, have to wait too long for staff to help, they are busy.” “I occupy myself, staff are very good they have endless patience and a good sense of humour.” “Nothing bad to say about the meals.” “Yes I enjoy the meals provided.” “Hot meals are coming up cold.” “I do eat them, I clean my plate, and I’m putting on weight! They could do better meals though.” One lady told us that the Roman Catholic Priest visits her every month. It was pleasing to find that there has been an increase in the number of hours provided for activities and entertainment in the home. There is now an activity co-ordinator for each unit provided. This has been a definite improvement since the last Key inspection. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 18 People living at the home are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible, staff gather information on community-based events and try to make individual arrangements for people to attend. Regular activities include - outings, pub lunches, and music for health. Community ties are maintained through church group’s visits from nursery children, open visiting. On Chatterly Unit we observed singing, dancing, playing bingo, laughing, good tactile experiences for residents needing this – all seen in one afternoon. Relatives who were visiting at the time of the visit told us - “staff are too busy to spend time with residents now, because of increased dependency of the people they are looking after. We visit everyday so that we can be sure our relative is okay and we take her out for walks etc as staff don’t have time to do this, something as simple as just getting a bit of fresh air, makes all the difference.” Another set of visitors told us - “ Our relative is fine, she doesn’t actively get involved with activities but we have seen staff talking to her on a one to one basis, which suits her better. The staff do try.” An individual who lives at the home told us, “ I go out quite a bit because my relative visits often. But I also go out with the activity co-ordinator sometimes. It’s a pity the home doesn’t have it’s own mini bus or car to take us out. If I want to go into town I have to hire a taxi.” Menus were not readily available on Breward unit. An individual was heard to say, “What’s this is it fish?” when served chicken nuggets and chips, and continued to be unhappy about the chips, saying “surely they can do better than this.” A relative said “we think the chips could be nicer, our relative says they are like bullets sometimes.” The meal choice today on Breward Unit was chicken nuggets and chips or steak pie. People choose their preferred meal the day before. We were told that if they don’t like what they order, they could have something else. Staff have a variety of snacks to choose from as an alternative or will contact the kitchen to ask for something else. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 19 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home can be assured that any concerns they might have will be listened to and taken seriously. The systems in place at the home help to keep people safe. However, the Providers will need to ensure that Safeguarding Policies are strictly followed in order to ensure continued safety. EVIDENCE: The home has a complaints procedure that is clearly written and easy to understand. This was clearly visible throughout the home. We asked people who live in the home if they would know who to go to if they had any concerns about the home. These are some of the comments received “If I have any problem I can talk to Bradwell Hall Director Mr Edward Twigge and any concern is resolved”. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 21 “Yes, I always talk to Lynne, her advice is very good. She encourages me to walk on my zimmer.” “The ladies in uniform.” “Not to sure who to go to.” “I always speak to Lynne.” “I do but I never have done, I tell Lynne and she sees to it, I call her bossy lady but she isnt.” “I know who to go to.” “Go to the head of were you are living.” Since the last Key inspection, we, the commission, have received a small number of complaints about the home. All of which have been referred to the Providers to investigate. We received some serious concerns prior to this inspection visit about the care of people living on Sneyd unit. When we visited this unit we found that, although these concerns had been justified at the time, the Providers had now addressed the issues and measures had been put in to place to ensure compliance with good care practice in future. As highlighted earlier, it is concerning that the Providers did not refer the care practices on Sneyd unit to the Safeguarding team. Instead the Providers chose to investigate these issues themselves. A requirement has been made as a result of this report in order to ensure the on going safety of the people who live at the home. We had also received a complaint regarding the treatment of two relatives in respect of an individual who had passed away on Audley Unit. The two relatives felt that the treatment they had received from two staff members had been unfair. The issues of concern were mainly to do with family dispute and, as such, we were unable to become involved. However, the Providers told us that they would be willing to meet with the people involved in an attempt to try and resolve the situation. We spoke to a relative who confirmed that if he had any complaints he would approach the manager, and gave an example of where this had happened. We checked the complaints records in the managers office and details of the relative’s complaint had been logged with the outcome. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 22 We were told that concerns and minor complaints are addressed by each unit manager. More serious complaints are referred to the Registered Manager and/or Providers. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the home know when incidents need external input and who to refer the incident to. We spoke with six staff members of different grades who were all aware of their roles and responsibilities. Staff confirmed that they receive training and instruction in the Protection Of Vulnerable Adults. There is a clear system for staff to report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: The following comments were received from people who live at the home and their representatives – “The residents are very hot and uncomfortable in the hot weather with only small windows to let in fresh cool air. It could benefit from air conditioning as sometimes in the winter the are too hot or too cold.” Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 24 “My room is lovely and clean.” “I think the carpets are lovely, Id take a piece of that up with me if I could. They always do the rooms out.” “Ive always found it clean, Ive no complaints about the cleanliness of the home.” We visited all the units throughout the home and looked at all the communal areas and a random selection of bedrooms. Bedrooms are well presented, personalised and adapted to suit individual needs. Where necessary specialised equipment is provided either to help with pressure relief, nursing care or mobility. Bedrooms are only shared in limited situations and when this happens it is only by agreement with the people concerned. They are always given the choice to move into a single room when one becomes vacant. Screens are provided for privacy and the rooms reflect the chosen décor and personal belongings of both people. Since the last inspection some areas have been redecorated and refurbished and there is a rolling programme in place to continually update the home. For people with dementia there is an environment, which has been adapted to suit their needs. The use of pictorial signage is in place to help with orientation. Where appropriate the lay out and design of the home allows for small clusters of people to live together in a non-institutional environment, although this is not consistently translated in practice. People sit mainly in the large lounge areas but staff arrange the seating into smaller groups where possible. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers and of good quality. The home is well lit, clean and tidy and smells fresh. The management has a good infection control policy. They seek advice from external specialists, such as NHS infection control staff, and encourage their own staff to work to the home’s policy to reduce the risk of infection. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 25 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally satisfied that the care they receive to meet their needs, but there are times when staffing levels are inadequate and people may need to wait a time for staff support and attention. EVIDENCE: All staff are clear regarding their role and what is expected of them. People using the service report that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with. This is what some of the people who live at the home have told us – “The carers are to be praised for their continual patience and friendly approach” “Yes staff are very good” “Not enough staff available, things like that. The staff seem to be so busy” Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 27 “They do what they can they do the their best.” “On the whole I think that they are very good at helping people like me” “They tell me things for my own good. I find it hard on the zimmer, but they tell me it would do me good.” “The carers are to be praised for their continual patience and friendly approach.” The service has a recruitment procedure that meets statutory requirements and the National Minimum Standards. The procedure is followed in practice and there is accurate recording at all stages of the process. The recent recruitment drive at the home has been successful and a number of new staff have started. It was identified that one new starter was rostered on night duty and didn’t appear to have any direct supervision; this was raised with the provider for them to look into. We looked at 4 staff recruitment files for newer staff, most of the required information and checks had been received. The provider confirmed that new starters would be supervised. It was noted that one person was allocated to work nights (on Breward) again with no evidence that she was being supervised. The provider again agreed to look at this. At the time of the inspection visit, with the exception of Keele unit, there was sufficient number of staff on duty to meet basic care needs of the people who live there. The Agency had been contacted and agreed to send another carer but they did not arrive. At the time of the visit there were 5 staff during the early shift instead of 7. Observation identified that people were left for long periods unsupervised. One person said - “ The staff are always busy, but I like to do my own thing anyway.” “ If I needed some one they would come to me.” “ The staff are good here, we have a lot of fun and they treat me well.” One member of staff interviewed on Breward unit commented that staffing levels were not sufficient due to the dependency needs of people, a number of whom require two staff to assist them with personal care. A relative commented that he didn’t think staffing levels were sufficient now because of dependency levels and cited evidence of this including lack of engagement of people because staff were too busy. He commented that staff used to garden with people and take them for walks but now were unable to do this. He also said when two staff were helping the more dependent service users this meant there was no one available to look after the others. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 28 Discussed with the unit manager who confirmed the difficulty and stated “we are going to try to rota a third member of staff in the evening to assist from 6 pm to 10pm.” Staffing issues were discussed at feedback. The Provider commented that referrals had been made to social services to review the needs of 6 people, but they were waiting for a response. We spoke with several members of staff, all confirmed that they felt supported and that their training was up to date. They confirmed that staffing levels are difficult due to dependency needs of people. All staff receive relevant training that is focussed on delivering improved outcomes for residents. The home puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people in a person centred way. There is a staff training and development programme in place at the home. This includes good levels of NVQ training. Some staff are in need of Dementia care training in order to be able to meet the challenging needs of people with this type illness. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 29 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and managed in the best interests of the people who live there. EVIDENCE: The AQAA sent in to us contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the home have made and where they still need to make improvements. It shows clearly how they are going to do this. The data section of the AQAA is accurately and fully completed. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 30 There has been a change in Registered Manager at the home since the last Key inspection. The previous manager has now changed roles and is unit manager of Audley Unit. The Registered Manager has previously managed a large nursing home and is skilled, competent and possesses the required qualifications for this role. The manager’s practice, skills, and knowledge, is based on continuous development, gained through training and enthusiasm for the role. Discussions with the Registered Manager and Providers identified that she has decided to terminate her employment as manager of the home, with the possibility of taking on another role. The Providers were advertising the position of Registered Manager at the time of the inspection visit. All of the units throughout the home have a manager in place and the people who live there tell us that they would refer to the unit managers if they had any concerns. Staff tell us that they are supported by the manager in their immediate workplace but that they could also approach the Registered Manager with any concerns and/or suggestions. They feel that they are listened to in staff meetings and that their suggestions are taken seriously. The management of Audley unit has improved since the last inspection and this is reflected in comments made by some of the staff and people who live there. “It’s much better here now and I feel more supported” “I have good care all the time.” “Yes, I always talk to Lynne, her advice is very good. She encourages me to walk on my zimmer.” There is a Quality Assurance system in place at the home. The managers are improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. Meetings including people who live at the home are held but not very often. More work is needed in this area especially in respect of obtaining the views of the people who live at the home. This is so that people can feel more included in the running of their home. People are supported to manage their own money where possible. Where this is not possible there is a clear reason why. Individuals have access to their records whenever they wish. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 31 The home works to a clear health and safety policy. All staff are fully aware of the policy and are trained to put theory into practice. Regular random checks take place to ensure they are working to it. We saw evidence of this as we walked around the home. Records are of a good standard and are routinely completed. Risk assessments are included in all care plans. People are aware of safety arrangements and have confidence in the safe working practices of staff. Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 2 x 3 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 33 no 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 OP18 Regulation 13(6) Requirement It is a requirement of this report that the Providers refer any instances of neglect and/or abuse according to the local Vulnerable Adults procedure, which the home has in place. This is to ensure that people who live in the home are protected from harm and kept safe. It is required that medication, which has not been used, must be disposed of as per the home’s medication policy and procedures. This is to safeguard people who live at the home. It is required that all nurses who work on Breward unit receive training in the use and care of tracheotomy tubes. This is to safeguard people living on the unit who have tracheotomy tubes in place. Timescale for action 20/08/08 2 OP9 13(2) 20/08/08 3 OP8 18(1)(c) (i) 20/08/08 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 34 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 OP3 Good Practice Recommendations It is recommended that when the home confirms in writing that they can meet the needs of people, they confirm the unit they are to be admitted to so that this is made clear to people moving in. People should only be admitted to a unit, which can meet their assessed needs and to which they have similar needs to those around them. Care plans could be further improved by being made more person centred. This would help ensure that the delivery of personal care is individual, flexible, consistent, reliable, and person centred. The service should demonstrate how residents are involved in care plan reviews and evaluations. PREVIOUS RECOMMENDATION. Staffing levels should reflect the dependency of the people who live at the home in order to ensure that needs are met. All staff working on the dementia care units should receive training in dementia care so that individual specific dementia care needs are met. New staff should be regularly supervised as part of their induction training and Providers will need to increase the frequency of formal staff supervisions. This is to ensure that staff deliver care safely and to a high standard. More regular involvement of people in the running of the home would help ensure that individuals feel included. Their views and opinions should be sought, documented and acted upon. 2. 3. OP4 OP1 4. 5. 6 7 OP7 OP27 OP27 OP36 8 OP33 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Bradwell Hall Nursing & Residential Home DS0000026940.V369931.R01.S.doc Version 5.2 Page 36 - 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. 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