Care Home: Brimstage Manor Nursing Home

What the care home does well Brimstage Manor presents with a warm pleasant atmosphere and residents appeared relaxed and comfortable with the staff. Visitors were seen to be made welcome throughout the day and they were able to spend time with their family member in their private rooms or in spacious lounges. Residents were observed to receive care in a respectful manner from the staff and they were given time to make their own decisions and choices where possible. Emphasis was placed on helping residents to maintain their independence but staff were around to assist as needed. A resident commented, "We could not have better staff and help".Health and social care needs had been identified in a plan of care based upon individual need. Care plans had been reviewed regularly to report any changes in the care provision. Risk management includes the completion of a dementia care assessment to provide staff with background knowledge of each resident`s dementia and an understanding of the psychological care required. Management of risks addresses safety issues whilst aiming for a better quality of life for the resident. Interviews with staff confirmed the importance of this. An incident that occurred during the time of the site visit was well managed by the staff in a professional and timely manner. The risks were reassessed and care plans updated with the relevant information. Meals were served in pleasant surroundings and residents were offered a good choice of hot and cold meals. A resident said, "The meals are very nice indeed". A good supply of fresh, frozen and dry goods ensure residents are served a well balanced diet. The residents` social programme was varied and based upon individual need and preference. The activities organiser was seen to spend time with residents on an individual and/or a group basis. Good interaction was noted and attention was spent in finding out what the resident wanted to participate in. The Brimstage Bugle is a newsletter that provides details of forthcoming events and relevant dates from bygone years. A resident said, "I like everything we do". The premises were attractively decorated with plenty of communal space for the residents to enjoy. The conservatory overlooks a spacious landscaped garden. Bedrooms had been decorated to individual taste and personal items from home were evident to make their rooms feel special and `homely`. Bathrooms seen were well equipped to ensure maximum comfort and safety for resident use. Appropriate locks had been fitted to external and some internal doors to keep residents safe. The management of the home includes canvassing the views of relatives and residents where possible to ensure they are pleased with the service provision. Surveys seen reported favourably on all accounts. During the site visit relatives commented on how the good the staff were and that they could not want for anything better within the home.Brimstage Manor Nursing HomeDS0000070280.V358466.R01.S.docVersion 5.2Page 7 What has improved since the last inspection? Not assessed - New Service What the care home could do better: The majority of residents are unable to give full consent to their individual plan of care due to the their dementia and frailty. Relatives and/or their representatives need to be more involved with this process and be approached for their consent and agreement to the plan of care. This will help ensure they are fully aware of the care and support being provided and any changes made. Century Healthcare are in the process of introducing new care documentation and this transition needs to be monitored carefully to ensure staff are aware of their implementation. A training session on their usage would be beneficial and this would help staff when transferring resident information. The management of medicines must be improved to ensure residents receive their medicines in accordance with the medicine policy for safe administration. This is stated in relation to residents who wish to administer their own medicines. This must be risk managed effectively to protect them. A number of staff have received training in safe working practices however a rolling programme is required for all staff to ensure they have the skills and knowledge to undertake their work effectively and safely. Training records must be kept to evidence courses undertaken and also staff induction. Records must be kept accurately and a training matrix would be beneficial to help with this process. Century Healthcare will provide this. Fire training is needed for staff however this has been booked for April 2008 and this is being introduced in line with Century Healthcare`s new fire policy and procedure. CARE HOMES FOR OLDER PEOPLE Brimstage Manor Nursing Home Brimstage Road Nr Heswall Wirral CH63 6HF Lead Inspector Claire Lee Key Unannounced Inspection 09:15 12 and 13th February 2008 th 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 Brimstage Manor Nursing Home DS0000070280.V358466.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. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brimstage Manor Nursing Home Address Brimstage Road Nr Heswall Wirral CH63 6HF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 342 4661 0151 342 2820 Century Healthcare Limited Mrs Helen Hill Cole Care Home 44 Category(ies) of Dementia (44) registration, with number of places Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is: 44 Date of last inspection NEW SERVICE Brief Description of the Service: Brimstage Manor was purchased by Century Healthcare last year and registered with the Commission for Social Care Inspection in November 2007. Mrs Helen Cole remains the Registered Manager for the service and the Registered Individual is Mrs Matta. The care home provides nursing care to residents who have dementia. It is located on the outskirts of Heswall and is set in extensive, well maintained landscaped gardens. Accommodation comprises of the original house and a purpose built extension called the Hesketh Unit. Fourty-four residents can be accommodated in thirty two single bedrooms and six shared rooms. There are two lounges, a conservatory and two dining rooms. All communal areas and bedrooms are pleasantly decorated and furnished. Bathrooms have suitably adapted equipment to assist residents with their personal needs. The Hesketh Unit overlooks a secure courtyard with a garden area, which the residents are able to enjoy during the warmer months. Access to all areas is provided by means of a lift or staircase. Doors to the premises are secure to ensure the safety of the residents. There is car parking space to the front of the premises. The free rate for accommodation ranges from £577.00 to £690.00 per week. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. A site visit took place as part of the unannounced inspection. It was conducted over two days for a duration of fifteen hours. Forty two residents were accommodated at this time. A partial tour of the premises took place and a number of care, staff and health and safety records were viewed. Discussion took place with three residents, three relatives, seven staff, the manager, Mrs Cole and also the Director of Nursing, Ms Julie Arrowsmith who was visiting at the time of the site visit. During the inspection four residents were case tracked (their care files were examined and their views of the service were obtained). This did not take place to the detriment of other residents whose needs were also taken into account. All the key and other standards were inspected. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents, relatives and staff prior to the inspection. A number of comments received are taken from interviews conducted and surveys received. An AQAA (annual quality assurance assessment) was completed by Mrs Cole prior to the site visit. The AQAA comprises of two self questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. Details from the AQAA are used through the report. What the service does well: Brimstage Manor presents with a warm pleasant atmosphere and residents appeared relaxed and comfortable with the staff. Visitors were seen to be made welcome throughout the day and they were able to spend time with their family member in their private rooms or in spacious lounges. Residents were observed to receive care in a respectful manner from the staff and they were given time to make their own decisions and choices where possible. Emphasis was placed on helping residents to maintain their independence but staff were around to assist as needed. A resident commented, “We could not have better staff and help”. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 6 Health and social care needs had been identified in a plan of care based upon individual need. Care plans had been reviewed regularly to report any changes in the care provision. Risk management includes the completion of a dementia care assessment to provide staff with background knowledge of each resident’s dementia and an understanding of the psychological care required. Management of risks addresses safety issues whilst aiming for a better quality of life for the resident. Interviews with staff confirmed the importance of this. An incident that occurred during the time of the site visit was well managed by the staff in a professional and timely manner. The risks were reassessed and care plans updated with the relevant information. Meals were served in pleasant surroundings and residents were offered a good choice of hot and cold meals. A resident said, “The meals are very nice indeed”. A good supply of fresh, frozen and dry goods ensure residents are served a well balanced diet. The residents’ social programme was varied and based upon individual need and preference. The activities organiser was seen to spend time with residents on an individual and/or a group basis. Good interaction was noted and attention was spent in finding out what the resident wanted to participate in. The Brimstage Bugle is a newsletter that provides details of forthcoming events and relevant dates from bygone years. A resident said, “I like everything we do”. The premises were attractively decorated with plenty of communal space for the residents to enjoy. The conservatory overlooks a spacious landscaped garden. Bedrooms had been decorated to individual taste and personal items from home were evident to make their rooms feel special and ‘homely’. Bathrooms seen were well equipped to ensure maximum comfort and safety for resident use. Appropriate locks had been fitted to external and some internal doors to keep residents safe. The management of the home includes canvassing the views of relatives and residents where possible to ensure they are pleased with the service provision. Surveys seen reported favourably on all accounts. During the site visit relatives commented on how the good the staff were and that they could not want for anything better within the home. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 8 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 Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 9 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 1,2,3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and/or their representatives have sufficient information to help them to make an informed decision as to whether the home is right for them. Residents’ needs are assessed to ensure the staff can provide the necessary care and support. EVIDENCE: Century Healthcare are introducing a new Service User Guide and Statement of Purpose for the home which will have all the relevant information regarding the service and the qualifications of the manager and staff. The company have a generic one which is then tailored to suit each service. One was made available at the time of the site visit. A Brimstage Manor information pack was also displayed and this was easy to read and contained all the required elements. The manager stated that residents and their representatives are encouraged to visit the home prior to admission and a trial period is always offered to ensure the service meets their needs and expectations. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 10 Three resident contracts were examined. They evidenced the fee rate and had been signed and dated by the relevant parties. Century Healthcare will provide news company contracts at the appropriate time in line with any changes made. Four of the residents care files were case tracked and pre admission assessment documentation was examined for three residents. The assessments had been carried out by the manager prior to admission to ensure the staff could meet their needs in full. Records showed previous medical history, details of medication, personal, social and psychological care. The assessment documentation provided the necessary information to formulate initial risk assessments and the plan of care. The dementia assessment included factors, which may affect the dementia resulting in changes in behaviour. The assessment aids staff in the care provision. With reference to the care a resident said, “Everything is just right”. An ethnic questionnaire was on file as part of admission process to help ensure the various strands of diversity were assessed. This assists staff in getting to know the resident and have a better understanding of their personal wishes and preferences. Intermediate care is not provided at Brimstage Manor therefore Standard 6 was not assessed. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A lack of risk management for residents who wish to administer their own medicines may place them at risk. EVIDENCE: As part of the case tracking process four resident care files were viewed and this included the provision of wound care. Care needs had been recorded in individual care files and the care plans seen provided satisfactory evidence of health care needs. For example, mobility and personal safety, personal hygiene, nutrition, continence, skin care, sleep and relevant medical conditions including care of their respective dementia. The information had been reviewed regularly with a summary of the most recent care provision to evidence any change in management or treatment. Staff had recorded the nursing intervention needed to ensure good outcomes for people. The care files seen did not evidence any form of consent or agreement to the plan of care by the resident and/or their representative however a communication sheet was seen in one care file to record relevant conversations. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 12 Agreement and consent should be sought where possible especially in the event of a representative making decisions on behalf of a family member. This may well occur due to the frailty of the residents. The existing care plans have typed information and Century Healthcare are introducing their own care documentation, which includes hand written care plans. Staff were a little unsure regarding the use of all the new documentation and arrangements were put in place for the Director of Nursing to meet with the manager to discuss this further. Staff need be clear about the implementation of new documentation to ensure there are aware of how to record the resident health care. A training session on their usage would be beneficial. Staff interviewed discussed residents’ needs with emphasis on their dementia and its management. Dementia care training and dementia care leaflets are made available to the staff to help ensure their competencies in providing this specialised care. A number of risk assessments had been completed as part of the care planning process and these identified any potential risk that may affect a resident’s well being. They included areas such as, nutrition, moving and handling, care of the dementia and care of the skin. Management of risks addresses safety issues whilst aiming for a better quality of life for the residents. Wound care management was effective with evidence of input from a specialist nurse to offer advice and treatment according to individual need. GP and other health care appointments are arranged at the home for the residents and evidence was seen of prescribed treatments. During the site the staff dealt with visit an incident that affected the welfare of a resident appropriately and in an efficient, timely and professional manner. Staff provided the necessary care to the meet the changing needs of the residents affected by the incident. Aids and equipment were in place to maximum independence for the residents. This included the provision of special beds and mattresses for those who are at risk of developing pressure sores and hip protectors, which provide added protection if a resident is at risk of falling. Comments regarding the care provision included: “My mother is cared for very well” (relative) “Very good care indeed” (relative) “The girls care for me” (resident) “Could not ask for better” (relative) Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 13 Staff were observed to encourage residents with their independence by accompany them for walks around the home and also with regard to choosing an activity to take part in (listening to music, helping to care for the budgerigar or having a hand massage) and to what they wished to eat at lunch time. The home is spacious and residents are able to walk around freely with the supervision of the staff. Medication was stored securely and the temperature of a clinical room maintained at a satisfactory level for the safe storage of medicines. Photographs of residents were in place, which helps to identify residents when administering medicines and medicine charts seen evidenced medicines administered. Amounts of medication delivered to the service were recorded with signatures and dates received. A risk assessment must be completed for residents who wish to administer their own medicines to ensure they can undertake this practice safely. Administering medicines covertly is only undertaken in exceptional circumstances. The manager and Director of Nursing are looking to conduct an audit of this practice to ensure it continues to be risk managed effectively with the consent of all parties involved. A small number of sticky labels were found on medicine charts where a medicine had been prescribed mid month. The preferred method if required is for a hand written entry transcribed with the required details. The Director of Nursing and the manager are discussing this further and an audit should be undertaken of this practice also. Medicine awareness training has been arranged for March 2008 and all qualified staff and the manager are attending to update their knowledge. A competency assessment should be completed for all staff who administer medicines to ensure they can undertake this practice safely. As part of conducting quality assurance checks a monthly medicine audit is carried out and any discrepancies found are rectified. A returns book was in place and medication returned had been listed, signed and dated. Good standards of privacy and dignity were observed. Staff spoke respectfully to residents and they were seen to be patient and kind in their approach. Staff knocked on bedroom doors before entering and residents were helped with choosing their clothing. Residents seen were smartly dressed. A relative commented on the polite attitude of the staff and said, “They care for my mother with respect and dignity”. Likewise a resident spoke about the staff respecting her wish to go out most days and also her preference not to join in with the social arrangements ‘in house’. Although Standard 12 was not assessed the manager and staff implement the Liverpool Care Pathway for the Dying and the deputy matron is assisting staff with teaching material in relation to palliative (care of the dying) care. A study session took place at the time of the site visit. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 14 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): Standards 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a flexible routine and are able to make decisions and choices with regard to how they spend their day. Nutritious meals are served to residents to provide a well balanced diet. EVIDENCE: There is some structure to the daily routine however residents were observed to be relaxed, content and happy with the help offered by staff. Personal care was given according to need and residents were seen to be encouraged to make their own decisions and choices within the limits of their ability. This was observed for example, in relation to time of getting up, deciding to take a walk or joining with the activities organiser. Staff took time to talk with the residents or just to sit quietly with them. Visitors were seen to made welcome and a relative described the home as being excellent. They can visit their family member in their own room or in the communal areas. The hairdresser was providing a service at the time of the site visit and all the ladies appeared to be enjoying the time with her. Holy Communion is offered to enable residents to enable them to continue with their chosen faith. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 15 An activities organiser provides a good varied, imaginative programme of activities, which are person centred. A ‘Getting to know you’ form is completed when a resident arrives at the home and this details their social and family background and preferred interests. A record is kept in resident files to evidence their enjoyment and participation. Those seen were current. Social arrangements included, music, hand massages, outside entertainment, piano playing, making milkshakes, reminiscence therapy, private appointments for aromatherapy and foot spa. A bubble tube, which is used for relaxation, is portable and this is beneficial for residents who need to stay in their own room due to ill health. The activities organiser provides one to one therapy and also spends time with residents in their private rooms if required. A resident stated how much they enjoy caring for the budgerigar and relative was complimentary regarding the activities organiser’s enthusiasm. The Brimstage Bugle is a newsletter that provides details of the month’s social plan and other points of interest for the residents. It includes dates from previous years and things that happened for that month. February 2008’s was viewed. Minibuses are hired during the warmer weather for trips out. Some residents do not wish to join with the arranged activities and the manager and staff respect their right regarding this. Meals were served from heated trolleys and lunch was seen to be an occasion where residents got together. They were given time to each their lunch in an unhurried manner and staff were seen to offer discreet help when needed. The dining rooms were bright and furnished to a good standard with the tables laid prior to the meal being served. The menu was based over four weeks and offered a good choice of hot and cold meals three times a day. Snacks and drinks are available at other times and upon request. A resident said, “The food is very good, no complaints”. The kitchen was tidy and organised with evidence of plenty of fresh produce, dry and frozen goods. This helps to ensure residents received a good choice of meals. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area available evidence including a complaints will be listened to. and protect vulnerable people EVIDENCE: The complaint procedure was displayed on the notice board and details of it can be found in the Service User Guide and Statement of Purpose. The complaint log was viewed and no complaints had been received since the change of ownership. Relatives confirmed that they had no concerns and would speak to Helen (manager) if at all worried. Adult protection procedures were in place with an abuse policy and local procedure guidelines for the manager and staff to follow. Abuse training is provided at the time of induction within the Skills for Care Induction Standards. Staff interviewed were aware of the concept of abuse and had knowledge of the whistle blowing policy. New staff should access formal abuse training to ensure they are aware of local procedures. is good. This judgement has been made using visit to this service. Residents are confident their Policies and procedures are in place to safeguard from abuse. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 17 Satisfactory records were kept of financial transactions dealt with by the manager and administrator on behalf of the residents. This helps to protect their financial interests. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 18 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): Standards 19,20,21,22,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe, clean and well-maintained accommodation. EVIDENCE: Accommodation comprises of the original house and the Hesketh Unit. There are extensive grounds surrounding the premises, which the residents use during the warm weather. A Mediterranean courtyard has comfortable seating and plants to give a safe secure and pleasant area for resident and their visitors to sit and chat. Refurbishment and decoration is ongoing and the AQAA states that some areas have been identified in the proposal for the Dignity in Care Grant for the home. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 19 The safety of the residents is paramount and the stairways and exit doors have been fitted with appropriate protection to ensure resident safety. Specialist equipment and aids are provided to meet the needs of the residents and the lay out of the home provides space for residents to have time on their own if they wish. The spacious corridors have handrails and all areas are accessible by wheelchair. Now and yesterday photographs of the residents were displayed as this forms part of the reminiscence therapy. Communal space comprises of a lounge, dining room and conservatory in the main house and a lounge and dining room on the Hesketh Unit. The lounges have comfortable armchairs and the dining rooms sufficient tables and chairs. The rooms are bright and nicely decorated. A number of rooms overlook the landscaped garden and this provides a lovely view for the residents. Bedrooms had individual items from home including photographs and pieces of furniture to help them settle in and provide a homely feel. Bedrooms shared had screens to provide privacy. The manager stated that bedrooms are kept how the resident wants and that rooms are not tidied unnecessarily. New colour schemes in rooms were pleasing to the eye. Bathrooms have bath hoists to assist residents whose mobility is restricted. One bathroom has a ceiling track hoist, which aids residents who mobility is severely compromised. The bathrooms were found to be very clean. Hot water temperatures are regulated and regular checks of the hot water to the baths were found to be satisfactory. A resident said that there was always hot water available. Infection control is monitored effectively and the deputy matron leads an infection control group to help implement this. Hand washing literature and hand gel was available. All areas seen were clean. Plans are in place to relocate the laundry room as the existing one is in need or repair and modernisation. Emergency lighting is subject to an annual service contract and monthly safety check. Records seen were current. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 20 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): Standards 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of staff require training to ensure they have the skills and knowledge to care for the residents. EVIDENCE: The manager is supported in her role by a full compliment of qualified staff. This comprises of Registered Nurses (RN) and Registered Mental Nurses (RMN). Two qualified staff are on duty during the day with eight care staff. At night one qualified staff is on duty with five care staff. Sufficient domestic staff are employed to ensure the accommodation is kept clean. This was evidenced at this time. A bank chef is currently employed until a new chef is recruited. Kitchen staff support the chef and a maintenance persons assists with the general upkeep of the building. A gardener, administrator laundry assistant and housekeeper are also employed. The staffing rota was viewed to evidence staffing numbers. These was found to be satisfactory. Comments regarding the staff included: “Very good staff” (relative) “Excellent staff” (relative) “They are pleasant (resident) “I like them all” (resident) Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 21 Staff files were examined to evidence pre employment procedures and staff training. These evidenced a completed application form, past employment details and two references. Not all references were dated, the manger was advised. CRBs (Criminal Record Bureau) and POVA (Protection of Vulnerable Adult) first checks had been obtained however one staff file lacked a CRB for a previous post held at the home. This has now been obtained for the current position. Not all staff records evidenced an up to date training record and it was therefore difficult to ascertain the courses undertaken. Not all staff have received training in mandatory courses – moving and handling, infection control, food hygiene and first aid. A record of training must be kept to evidence courses undertaken. The Director of Nursing stated that this would be compiled (with dates) and a copy sent to the Commission. Century Healthcare will be implementing a training programme for all staff. Moving and handling has been booked for this month, health and safety in March 2008. No dates were available for food hygiene or first aid at this time. The AQAA refers to staff receiving training in the changes made to the Mental Capacity Act. Dementia care training is given in conjunction with material from the Alzheimer’s Association. The induction is given in line with Skills for Care Induction Standards, which provide good information regarding care and health and safety practices; one staff member did not have any written evidence of the induction given. A new member of staff confirmed that they were shown round the premises when they started and that they had been chaperoned during their first few shifts. NVQ (National Vocational Qualification) training is ongoing for staff and Century Healthcare are looking to introduce a new provider for this. Four staff are currently undertaking NVQ studies and four have been enrolled. 77 staff hold an NVQ in care. Staff reported, “I have recently completed my NVQ 2 and a palliative care course” and “I have been on many relevant courses over the years and the management always encourages carers to continue training”. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 22 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): Standards 31,32,33,35,37 and 38 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 managed thus promoting the health, safety and welfare of the residents. EVIDENCE: Mrs Helen Cole is the Registered Manager and is an RN and RMN. Mrs Cole holds a Degree in Nursing Studies and also has completed the Manager’s NVQ Award. To enable Mrs Cole to continue to be the accredited trainer for moving and handling Mrs Cole needs to undertake a refresher course, which Century Healthcare will provide. Feedback from relatives and staff was positive regarding the management of the service. Comments included: Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 23 “Staff have regular supervision sessions, but I also feel I could knock on managements office at any time and discuss any issues that I need support with, and in complete knowledge that anything I may speak of is totally in confidence” (staff member) “In times of staff sickness, which can be unavoidable, meeting residents’ needs can be a challenge, but as a team we work well together” (staff member) “Good management” (relative) Quality assurance processes include canvassing the opinions of the relatives. Questionnaires seen reported favourably regarding the service. Comments made are used by the manager to help enhance the care and support given to the residents and their families. Brimstage Manor has been awarded Investors in People, which is due for renewal this year. Staff and relatives meetings are held and the Brimstage Bugle provides details of the monthly events. Staff meetings should be held more regularly especially in light of the change of ownership. This will ensure staff are made aware of what is going on in the home and any proposed changes by the company. A member of the senior management team from Century Healthcare conducts a monthly visit and a report, which had been compiled from a recent visit, was found to be satisfactory. Staff supervision was not assessed as Century Healthcare are introducing new supervision sessions and appointed supervisees. This standard will be assessed at the next inspection. Resident’s finances were seen to be managed effectively to help safeguard their financial interests. The manager with the use of a training video gives fire training in house. A fire drill was conducted as part of the training programme in January 2008. The Estates Manager for Century Healthcare is instigating a new fire training programme and the sessions are booked for April 2008. This is mandatory for all staff and records must evidence their attendance. A new fire procedure is also being introduced and staff need to be made aware of any changes in fire prevention. A fire risk assessment of the premise was seen and the annual contract for servicing fire prevention equipment was current. Fire records showed fire alarms had been tested weekly. A spot check of safety contracts and safety certificates for the electric, lift, gas and bath/moving and handling hoists were all in date. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 24 Staff have access to policies and procedures to ensure they are aware of current legislation and good practices. A number of policies were viewed and this also included information relating to equality and diversity. This helps to provide person centred care and effective outcomes for people who use the service. Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 25 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 3 3 3 X 3 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 3 4 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Timescale for action Staff must ensure medicines are 12/04/08 administered safely to residents. This should include residents who wish to administer their own medicines. People using services must be able to manage their own medication within an appropriate risk framework to promote their independence. All new staff must receive an 12/04/08 induction and a record must be kept of the induction to evidence this. Residents need to have their care carried out by staff who know what their care needs are. Staff also need to understand the policy and procedures of the home, so that residents are safe. Training must be provided for 12/06/08 the staff in safe working practices. A training record must also be kept to evidence training undertaken to ensure staff have the skills and knowledge to provide the care and support to the residents. Requirement 2. OP30 18 (1) (c) (i) Schedule 4 2. OP30 18 (1) (c)(i) Schedule 4 Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations Staff should be clear regarding the implementation of the new Century Healthcare documentation when this is introduced for each resident. A training session would be beneficial for this purpose. An audit of the medicine charts is needed to review the practice of using sticky labels or hand written entries when medicines are prescribed mid month. An audit of administering medicines covertly should be conducted to ensure this continues to be risk managed effectively with the consent of all parties if no other method of administration is available. Staff should receive medicine awareness training and complete a competency assessment to ensure they can undertake this practice safely. Abuse training should be given to all staff as part of their training programme. A training matrix should be implemented to evidence staff training. Training dates should be forwarded to the Commission. The laundry room should be relocated to improve the overall facility. The manager should complete a moving and handling course to enable her to continue to be a trainer in moving and handling. Staff meetings should be held more frequently to ensure staff are kept informed of changes to the service. Staff should be advised of any change in the fire policy and procedure to ensure they fully aware of fire prevention procedures. 2. OP9 3. 4. 5. 6. 7. 8. OP18 OP30 OP26 OP31 OP33 OP38 Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Brimstage Manor Nursing Home DS0000070280.V358466.R01.S.doc Version 5.2 Page 29 - 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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