Care Home: Brierton Lodge Nursing Home

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What the care home does well People get good information from the home so that they can make a decision about whether to move here. The home keeps good care records so that staff know how to support people in the right way. People are treated with respect. Relatives said that people living here are "very well treated". There is an excellent range of activities for people, and people can lead their own lifestyle. People said that the quality of the meals is "very good". People can choose what they want to eat and where they dine. Visitors said that home is always "welcoming, warm and friendly". The home is warm, well decorated and comfortable. Staff have good training in health and safety, so they know how to support the people in a safe way. The home is very well managed, and is run in the best interests of the people who live here. What has improved since the last inspection? There are more activities over 7 days a week, and some activities are also provided in the evening now. The home has created a very life-like pub within one lounge. This is a good activity for people to visit. The home has a puppy that is being trained as a pat-the dog. The people who live here were very engaged and interested in the puppy. Staff have had customer care training to help them answer queries from relative and visitors. One staff has completed a Dementia Champions course. She is enthusiastic about using this knowledge to support staff to further improve the service in the dementia unit. What the care home could do better: There were no requirements made at this inspection. A small number of things could make the service even better, such as: providing a welcome pack for people who live on the first floor; making the bathrooms more homely; making sure all staff who work in the dementia unit have training in dementia care needs; and checking that there are enough staff with first aid training to cover all days and nights. Key inspection report Care homes for older people Name: Address: Brierton Lodge Nursing Home Brierton Lane Hartlepool TS25 5DP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrea Goodall     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Brierton Lodge Nursing Home Brierton Lane Hartlepool TS25 5DP 01429868786 01429267129 barnardc@bupa.com www.bupacarehomes.co.uk BUPA Care Homes (ANS) Ltd care home 62 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 62 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 31 Dementia - Code DE, maximum number of places: 31 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 31 Physical disability Code PD, maximum number of places: 31 Date of last inspection Brief description of the care home Brierton Lodge is a purpose built care home for up to 62 people with nursing needs. The majority of admissions to the home are from hospital through Continuing Health Care arrangements. The home operates two specific units: on the ground floor it Care Homes for Older People Page 4 of 30 31 31 0 31 Over 65 0 0 31 0 Brief description of the care home provides care for older people and people with physical disabilities; on the first floor care is provided for people with dementia and mental health needs. The home is square shaped, built around a central enclosed garden. The accommodation consists of 54 single bedrooms and 4 double bedrooms. At this time the home uses all bedrooms as single occupancy. All bedrooms have private en-suite faciltities. Adequate toilet and bathing facilities are also provided around the home. At the time of this visit weekly fees ranged from £525.30 for general nursing up to £619.40 for dementia nursing care. There are additional charges for hairdressing, newspapers and travel where required. The manager should be contacted for up-to-date fee levels. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit we looked at information we have received since the last visit on 12th March 2008, and the last annual service review on 23rd August 2008. We looked at any changes to how the home is run. We looked at how the service has dealt with any complaints or concerns since the last visit. We asked the Provider for their view of how well they care for people in their AQAA (an annual quality assurance assessment). We received surveys from three relatives, and six staff. We made an unannounced visit to the home on 1st December 2009. An Expert by Experience joined the inspector for part of this visit. An Expert by Experience is someone who is familiar with, or has experience of, social care services. She talked with residents and staff, joined them for a lunchtime meal and looked at the service they receive. Her comments and observations are included in this report. The inspector made another visit to the home on 2nd December 2009. During the visits Care Homes for Older People Page 6 of 30 we talked with people who use the service, their relatives, the manager and staff, and visitors. We joined residents for meals and looked at how staff support the people who live here. We looked at information about the people who use the service and how well their needs are met. We looked at other records which must be kept by a care service. We checked whether staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was clean, safe and comfortable. We checked what improvements had been made since the last visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There were no requirements made at this inspection. A small number of things could make the service even better, such as: providing a Care Homes for Older People Page 8 of 30 welcome pack for people who live on the first floor; making the bathrooms more homely; making sure all staff who work in the dementia unit have training in dementia care needs; and checking that there are enough staff with first aid training to cover all days and nights. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are fully assessed before they make a decision about moving here so that they are assured the home can meet their needs. Evidence: Brierton Lodge provides good information for potential residents, or their relatives, about its services in a service users guide and a statement of purpose. These are easy to read and set out the homes service and its aims and objectives. This information is available in the home for visitors to read. In this way some people had good information about the home when they were making a decision about whether to move here. People who are moving to the ground floor of the home are each provided with a welcome pack which includes good information about meals and mealtimes, visiting health professionals, the daily shop times, and local facilities. However the welcome pack is not currently provided to people who comes to live on the first floor unit. Care Homes for Older People Page 11 of 30 Evidence: Instead there are only two copies which are kept in the nurses office. This means not everyone has the same information, and could be seen as discriminatory. Most of the people who come to live at Brierton Lodge move here from hospital. At this time the PCT (Primary Care Trust) has a contract to block-book 45 of the places at the home. In this way people have been first assessed by the PCT (and/or a social worker) and then referred to Brierton Lodge. The manager of Brierton Lodge then carries out an assessment to make sure that the home can meet the needs of the potential new resident. Many of the people who come to live here are quite poorly, and the home has a lot of new admissions. The manager commented that the home works well with the PCT to make sure that assessments and decisions are carried out at the right pace for each person to make sure that the home can be the right place for their care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live here receive good support so that their personal and health care needs are well met. Evidence: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. For example how to help people with their mobility, diet, and emotional well being. Overall, the care plans at Brierton Lodge provide staff with good guidance which show them how to support each person with their individual needs. Most care plans are detailed, easy to follow, and up to date. It is good practice that there is a record to show that residents (or their relatives) have been involved in discussing their own care plans. One persons care plan about their dementia care needs shows that their behaviour can be quite challenging. However there was not much guidance in the care plan to show how staff should support him, for example to redirect him to quiet area. Although current staff are very familiar with his needs, new or relief staff would not have this information. (The manager felt that there was sufficient information in the Care Homes for Older People Page 13 of 30 Evidence: care plan and risk assessment to show staff how to respond to challenging behaviour.) The care records also show that peoples health care needs are assessed and regularly checked. The home has detailed assessment records of peoples mobility, nutrition, risk of falling, and risk of skin pressure. These are linked to the persons care plan so that staff know how to support the person with their health care needs. Many of the people who come to live here are very poorly and the home provides end-of-life care for them. It is good practice that the home is currently working towards the Gold Standards Framework (which includes training and guidelines for the best possible care for people when they are nearing the end of their life). All staff are to have retraining in nutritional care, following a complaint about someones care, as this is an important part of caring for someone who is poorly. The home provides nursing care so there are qualified general nurses (RGNs) on the ground floor and qualified mental health nurses (RMNs) on the dementia unit on the first floor. The home also has very good links with other health professionals. There are surgery visits by GPs three times a week (although people can also choose to retain their own GP if they prefer). There is a consultant psychiatrist visit every week for people living in the dementia care unit. There are also medical consultant visits to people living on the ground floor every fortnight. The manager also commented that there are good links with Community Matrons, and access to out-of-hours medical services. In this way, people have very good access to health care support during their stay here. It is also good practice that an RMN from the dementia care unit has completed a Dementia Champions training course which is accredited by the Alzheimers Society. In discussions this member of staff is clearly very motivated about this role, and has plans to use her training to improve the way staff support and engage with the people who live here. The home would support people to manage their own medication if they were assessed as capable of doing so. At this time none of the current residents manage their own medication so the nursing staff take responsibility for managing medication on their behalf. Medication is stored securely and safely, and records of the administration of medication were in good order and up to date. At the most recent audit of medication in August 2009, by a PCT Pharmacy Technician, the home scored 93 for the way that peoples medication is managed at this home. During discussions residents and their relatives commented positively on the services Care Homes for Older People Page 14 of 30 Evidence: and felt that people living here are very well treated and that staff are friendly and helpful. The expert by experience said, The family members with whom I spoke were very happy with the care that their parents were receiving. One relative told me that the girls are angels, I go away from here knowing that my mother is happy and well cared for, her clothes are nice and clean and she is always well dressed. I also observed care staff getting down to the level of a resident in a wheelchair, to talk to her and waiting for a response without deciding or making assumptions that they knew what the resident wanted to do. I observed the respect given to a resident who clearly did not know where he was going and the question would you like to go to your room posed and asked in such a caring manner. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have excellent support to make choices so that they lead a lifestyle that matches their individual preferences. Evidence: It was clear from discussions and observations that people lead a flexible lifestyle within the home. For example they can have breakfast at whatever time they choose. They can dine in the dining room or their own room. It is excellent practice that the home employs three activities staff who provide activities and social events on a daily basis, and some evenings. The home has created its own small pub in an area of a lounge. This is furnished and decorated with traditional artifacts that would found in an old fashioned snug, including a small bar and tables set out with beer mats. People from both units have the chance to use this interesting facility as a sociable, stimulating and reminiscence activity. It was evident that there is a good range of activities on offer. The expert by experience said, One resident told me he likes to be in the garden but he cant do that without one of the girls, and it is too cold at the moment. I asked him what he did during the day, he said we play with the Wi, which is an activity which the Care Homes for Older People Page 16 of 30 Evidence: activity worker has introduced to the residents. He also liked watching T.V. in his room. Other activities enjoyed are bingo, listening to old records and visiting the Sensory Room. A regular visitor said, There seems to be plenty to do. Hes enjoyed playing dominoes and bingo, and an evening in the homes pub. The expert by experience said, One gentleman resident told me that the girls are lovely, one of them takes me to the shop to buy my paper. I like to get my own paper. Another resident told me that she likes the girls very much, they will do anything for you. She also praised the visiting hairdresser and said I feel better when I get my hair done. Another innovative activity at this home is the cruise events. The expert by experience said, This consists of six days (one day a week) whereby the residents do a virtual visit to a particular country i.e. Spain, Italy, Germany, and Portugal etc. Staff and residents dress up for the occasion in the National dress of the country and the cook prepares dishes eaten in those countries. This is both good fun and stimulating for residents and the care staff. People who are poorly in bed said they are kept comfortable, and staff were seen to be spending time chatting with them. It is excellent practice that the manager is training a boxer puppy to be the homes own pat-the-dog. It was clear that several residents brightened up when they saw him and enjoyed petting him as he went around the rooms. People with dementia were also very engaged and interested in him. One staff on the dementia unit also brings her labrador into work and the people on this unit clearly enjoyed his presence and spent time talking to him and patting him. There is a good range of meals, and it is good practice that written menus are available on tables for people to make informed choices. People are asked in the morning what they would like for that days lunch. The home provides a choice of lighter lunchtime options, as many people have enjoyed a late breakfast, so the main meal is in the evening. The expert by experience said, I spoke with the cook and she told me that residents can have a full English breakfast if they wish, or a choice of cereals and toast. Todays lunch time menu consisted of homemade soup, sandwiches with various fillings, fishcakes and beans, followed by a semolina and apricot pudding. There was an alternative choice and the cook said that if a residents did not see anything on the Care Homes for Older People Page 17 of 30 Evidence: menu that they wanted, then she would do her utmost to please them with an alternative of their choice. The main meal of the day is the evening meal which is always a cooked meal with an alternative menu followed by a lot of fresh fruit. In between lunch and dinner being served, today there were fruit scones and small cakes with a cup of tea. There are water machines in lounges and tea is served mid-morning and midafternoon. The expert by experience noted that several people spend time in their rooms but that they did not have jugs of water and tumblers to help themselves to a drink in this warm environment. It is good practice that the home recently achieved the Golden Apple award from Hartlepool Borough Council for its healthy menus and meals. Many people need a lot of support to eat meals. The expert by experience said, I observed residents being fed at the residents pace of eating. Nothing was rushed and it was done with care and kindness. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have clear information so they would know how to make a complaint. The staff team have had suitable training so they know how to protect residents from abuse. Evidence: Most people have good information about what to do if they are not happy with the service. This is included in the welcome pack which people on the ground floor have in their bedrooms. There is also written information in the service users guide in the reception area, although this would be harder to retrieve. It was also clear that the manager makes herself available to people and their representatives to discuss the service. Residents and relatives said that they would feel comfortable about mentioning any concerns, if they had any, and were confident it would be put right. The home keeps clear records of comments, complaints and compliments about the service. There have been a small number of complaints over the past year, of which two were upheld. These were mainly about about communication by staff to relatives queries. As result the home has arranged for all staff to have customer care training. This shows that the home takes comments seriously in order to continually improve the service for the people who live here. There were a large number of written compliments about the home by relatives which described the staff as enthusiastic, warm, and understanding. Care Homes for Older People Page 19 of 30 Evidence: All staff have previously had training in protection of adults, and new staff receive this training as part of their induction. There are also written protocols for staff about how to report any poor practice. The manager is familiar with the council-wide safeguarding adults arrangements that are led by Hartlepool Borough Council. These are robust procedures for dealing with suspected abuse. Arrangements are being made for all staff to complete training in the local safeguarding adults procedures in the near future. In this way the home makes sure that staff know what to do to protect the people who live here. The manager is also fully aware of the Mental Capacity Act and how this impact on peoples rights to make their own decisions whilst living at this home. For example she is arranging for an independent mental capacity advocate to support one person who has no family representatives. She is also fully aware of deprivation of liberty safeguards and has worked with the local authority to ensure that people live in a safe way. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well maintained and decorated so that people live in accommodation that is safe, warm, and comfortable. Evidence: Brierton Lodge is a purpose built care home that has been operating for around 15 years. There is level access into the central area at the front of the home and there is a passenger lift to access the first floor. The home is well maintained, and benefits from the input of a maintenance staff who carries out routine checks and repairs. A programme of redecoration is also planned for next year. The home is built in a hollow square design and has well kept garden at its centre. Residents described this as a very pleasant and well designed place to sit out in better weather, although most people would need the support of staff or visitors to use it. There is extensive grassed areas all around the building. There is a spacious car park to the front of the home with level access into the reception area. Although the home is registered for 62 places, this includes four rooms which were previously used as shared rooms. However these rooms are only used for single occupancy now, so the home actually offers 58 places. The ground floor provides accommodation for people with nursing care needs. The first floor provides accommodation for people who have dementia or other mental health needs. Both Care Homes for Older People Page 21 of 30 Evidence: floors have lounges, dining rooms and bathrooms. The expert by experience said, The upper floor has been fully refurbished to a high standard with good quality furniture, fitted carpets, matching bed linen, and is tastefully decorated. There are two dining rooms on this floor, one set out as a dining room only and the second is set up as a dining room but with the addition of comfortable settees and arm chairs for residents to have a chat, following the end of their meal, if they so wish. It is good practice that the corridors on the dementia care unit have street names, all bedroom doors are different colours, and there are simple pictures on bathroom and toilet doors. This helps people to find their way around the unit. There are also memory boxes (filled with familiar objects or pictures) outside most bedroom doors to support people to recognise their own room. One visitor said, It was great to see paintings on the walls which had been created by the residents. I was also impressed by the use of old photographs, colored doors and street names. The expert by experience reported, I found the Home to be very clean and odour free. Bath and shower rooms were clean and fully fitted with bath aids to enable the residents to be safely assisted when they are bathing or showering. One relative said it would be helpful if there was the provision of another Trixie bath hoist because this hoist had to be shared between two floors, and it could take a good while before her mum could be bathed. Linen trolleys are stored in some bathrooms when not in use. These were not a hazard but did make the bathroom look functional rather than homely. Also boxes of protective gloves were on display in bathrooms which detracted from the rest of the homely atmosphere of the building. The lock to one bathroom was not working. (The home later stated that it was fixed on that day.) These issues could have an impact on peoples dignity. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable, competent, trained staff to ensure that the people who live here are protected and that their needs are met. Evidence: The care staff team consists of a manager, two heads of unit (one for each floor), nursing staff, care staff and activity staff. There are also housekeeping, catering, administrative and maintenance staff. At the time of this visit there were 48 people living at Brierton Lodge. Throughout the day the home provides two nursing staff on on each floor and about four care staff on each floor. It was evident that this level of staffing is sufficient to meet the needs of people on both units. One visitor said, There is very good staff presence here, even at mealtimes. Lots of people are supported to eat in their own rooms, and there were enough staff to support that. BUPA has robust recruitment and selection procedures to ensure that all checks are carried out of new staff before they start work here. Several residents and relatives had positive comments to make about the staff. Some visiting relatives said, We are very satisfied with the care, and staff are always very friendly and approachable. When I ring up they are always helpful and tell me how she is. Care Homes for Older People Page 23 of 30 Evidence: The home enjoys a low staff turnover of staff, and this supports good continuity of care for the people who live here. The manager commented that the home has retained some nursing staff for many years. She felt that this was partly because they could continue to develop their training and skills whilst working here and that there are career opportunities within the home. For example one nursing staff staff has also become a trainer within the home. The expert by experience said, I spoke with several members of staff who told me that they were really happy working with each other and with their residents. They said that they felt fully supported by their Manager and could go to her at any time. They felt also, that if they identified any training needs, then that training would be given to them. Around 77 of the care staff team have achieved a national training certificate in care (called NVQ level 2). In the staff survey several staff commented that one of the things that Brierton Lodge does well is the great training. Around 12 care and activities staff have some training in dementia care. Training records show that a third of the care staff who work in the dementia unit do not have any certificated training in dementia care at the time of this visit. However all staff complete an introductory workbook about the needs of people with dementia care. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and is run in a way that upholds the best interests of the people who live here. Evidence: The manager has worked here for over 14 years. She has been the registered manager here for over 12 years. She is a qualified nurse and has also achieved the Registered Managers Award. It is clear that she is still very motivated in her role and has continued her own professional development and skills. The manager is supported and supervised by a regional manager of BUPA. The staffing structure of the home includes two heads of unit and senior nursing sisters who are responsible for supervising the care of residents. In this way there are clear lines of accountability within the organisation and within the home. Bupa Care Homes has a Personal Best programme for staff that encourages them to work to the best of their capability and to the ensure the best outcomes for the people Care Homes for Older People Page 25 of 30 Evidence: who live here. This programme has won the Chartered Institute of Personnel and Development Annual People Management Award. Bupa Care Homes has also achieved its Investors in People accreditation for the seventh year runnning. Bupa has quality assurance processes that include a number of audits of the home, and at least monthly visits by a representative of the organisation to check on its operations and report on its progress. Bupa also seeks the views of relatives via its marketing team who ring them directly for their views. Residents views are sought informally on a daily basis and via surveys from time to time. If requested the home will support residents to keep their personal monies safely. Their monies are kept in a bank account. Using computerised statements, the home can then debit their account for services and purchases, such as hairdressing, chiropody and toiletries. Receipts are kept for each transaction. The maintenance staff carries out and records routine health & safety checks of the building and equipment, for example water temperatures and fire alarm systems. These were in good order and up to date. There were no health & safety issues noted during this inspection. Staff training records show that staff receive induction training in health & safety matters, then certificated training. The staff training records show that all staff have had up-to-date training in infection control, fire safety, use of hoists & slings, and moving & assisting. It is very beneficial that one head of unit is also a moving & assisting trainer so she can provide this training whenever staff require it. At this time 9 staff have up-to-date training in first aid, but these are mainly support staff so it is not clear whether this covers all times of the day and night. (The home later reported that nursing staff also act as first aiders.) Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 A copy of the welcome pack information should also be provided to each resident (or their relative) accommodated on the first floor. Water and tumblers could be placed in bedrooms so that people would have access to a drink whenever they want. Consideration could be given to storing linen trolleys in unused rooms, and small bathroom cupboards could be used to discreetly store protective gloves. The broken lock to the main bathroom on the ground floor should be fixed. Consideration could be given to the provision of another Trixie hoist so that this equipment is available on each floor. One bedroom would benefit from redecoration to address scuff marks on the walls. All care staff working in the dementia care unit should have training in support of dementia care needs. The home should check that there are sufficient staff Page 28 of 30 2 3 15 21 4 22 5 24 6 7 30 38 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations trained in first aid to cover all times of day and night. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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