Care Home: Brindley Court Nursing and Residential Home

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What the care home does well The service has addressed the requirements we left at our last inspection and is continuing to make improvements for the outcomes for people who live at the home. What the care home could do better: We have made recommendations for improvements in the following areas To provide another mealtime assistant to work on the ground floor unit in order to ensure that all of the people who live at the home benefit from the services provided by the assistant. To develop a supportive care plan when people have a DNAR in place so that staff are clear about the specific support and care required for individual people. Random inspection report Care homes for older people Name: Address: Brindley Court Nursing and Residential Home Station Street Longport Stoke-on-trent Staffordshire ST6 4ND two star good service 06/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Yvonne Allen Date: 0 6 0 7 2 0 1 0 Information about the care home Name of care home: Address: Brindley Court Nursing and Residential Home Station Street Longport Stoke-on-trent Staffordshire ST6 4ND 01782828428 01782828429 brindley.court@ashbourne.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Yvonne Jacqueline Hof Type of registration: Number of places registered: Conditions of registration: Category(ies) : Modelfuture Limited care home 52 Number of places (if applicable): Under 65 Over 65 52 0 old age, not falling within any other category physical disability Conditions of registration: 0 52 The maximum number of service users who can be accommodated is: 52 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 (OP) 52 Physical disability (PD) 52 Date of last inspection 0 9 0 3 2 0 1 0 Care Homes for Older People Page 2 of 10 Brief description of the care home Brindley Court Care Centre provides personal and nursing care for up to fifty-two male and female persons. The home provides accommodation for mainly older people but can accommodate up to thirteen people, aged between 35 and 60 years on admission who have a physical disability. The home is a two-storey purpose built brick building. It has fifty-two single bedrooms and each of them has an en-suite comprising of a toilet and wash hand basin. The home has lounges and dining facilities on each floor. A passenger lift that is accessible to people allows easy access around the home. There are appropriately adapted bathing facilities to each floor. There is a central kitchen and laundry. Externally, the home has pleasant secure gardens for service users to enjoy and there is ample parking space. The home is situated close to the A500 and is within easy access of local shops, bus service, a train station and road networks. The fees charged by the home at the time of the inspection visit ranged from 360.00 to 540.00 pounds. Care Homes for Older People Page 3 of 10 What we found: We carried out this Random unannounced inspection visit of the service on 6th July 2010, arriving at the home at 11am and leaving at 3pm. We did this inspection in order to assess whether the service had met with the legal requirements of our last report and whether the necessary improvements have been made. Prior to this inspection visit we had received information about the service from Stoke On Trent Social Services department. As a result of several Safeguarding referrals being received, the Social Services department have been conducting a large Scale Investigation of the service over the past weeks. Social Services have also been carrying out reviews of the care of some of the people who live in the home, so their feedback is important to us. The home (regional manager) has also been sending us a copy of their updated action plan which they have provided on a weekly basis to Social services. Both the action plan from the Providers and the feedback we have received from Social Services so far indicates that the home is continuing to make improvements in all of the identified areas. In respect of the requirements we had left We looked at how the service monitors the hydration needs of people who live in the home. When we had visited previously we identified that peoples fluid intake was not always monitored and recorded as it should be and that we were unable to assess whether people were receiving adequate fluids. So during this inspection visit we looked at several fluid intake charts for people living on both floors in the home. We looked back at the last few weeks of recording and we found that this had improved considerably. We also noted that staff are encouraging people to drink and documenting this. We also noted that where there are concerns that people are not drinking enough then the doctor (GP) is called to see them. We noted that there were drinks available around the home within reach for people and when we asked people about this they told us Oh yes they make plenty of hot drinks and I can have a cold drink whenever I like. People who are unable to ask for a drink are offered regular fluids, according to charts and records, and the staff we spoke to confirmed that they do this. On the second floor unit there is a meal time assistant who is responsible for helping people to eat and drink throughout the day. She told us that she sees her role as important and that she oversees the serving of meals and drinks and ensures that people receive the food supplements for which they are prescribed. Her record keeping was particularly good in respect of the monitoring of peoples food and fluid intake. It was identified, however, that there is only one meal time assistant provided and that she only works on the second floor unit. We recommend that another assistant be provided to people living on the first floor unit so that all of the people living in the home benefit from this. Care Homes for Older People Page 4 of 10 We looked at how the service monitors and records peoples weight. This has improved considerably since we carried out the last inspection. We noted that there are a significant number of people who are weighed weekly by the service. Their nutritional needs are assessed and monitored using a recognized assessment tool. However we were concerned to note that one person had lost 6.5kgs in one month and now weighed 28.5 kgs. The service has monitored this person closely, she has been weighed weekly, has a risk assessment in place and a care plan to meet her nutritional needs. The nurses have acted appropriately and have referred this person to the GP who has reviewed the person on several occasions over the last weeks. The GP had decided not to refer this person to the dietitian but had prescribed nutritional supplements, which the person had been receiving for several weeks. We also noted that a person who had difficulty swallowing had been referred to the Speech And Language Therapist (SALT) for an assessment. They had been out to see the person, made recommendations, and, as a result, this person was now eating and drinking better and was gaining weight. We noted that, where required, the GP has prescribed nutritional food supplements to people at risk of malnutrition and these are recorded on the Medication Administration record (MAR) charts and the staff administer these accordingly. From our examination of care plans we identified that a person had a Do Not Attempt Resuscitation (DNAR) proforma in place which had been signed by the GP and a nurse. This was following a discussion with the persons relative. However, there are no clear guidelines on what constitutes Resuscitation nor is there an accompanying care plan in place to support this decision and to offer guidance and direction to staff. We discussed this with the interim manager. The service should review the care plans of people who have DNARs in place in order to ensure that carers and nurses are clear as to the specific care and support required. Social Services had told us that they had some concerns about the procedures for medication at the home. As a result of this we looked at the storage, administration and disposal of medication at the home. We were informed that, on the previous day, the dispensing pharmacy Boots had visited the home to undertake a quality audit of medication. We were shown the results of this audit, which identified that all areas were satisfactory apart from the procedures relating to Homely Remedies. We were told that the service was addressing this area and making the necessary improvements. We also noted that there was medication training in place at the time of the inspection visit. This training was being delivered by Boots. At the time of our visit the GP was present and was reviewing the health care needs of some of the people who live at the home. This included a review of their medication. We observed the lunchtime medication being administered on the second floor unit. This was carried out according to their policies and procedures. People were receiving their medication according to their prescription charts and without delay. The last time we visited the service we had concerns about the lack of supervision of people who live in the home and who are at risk of falling. We looked at this area and found that there are risk assessments and care plans in place for falls risk including management of this. People who are at risk of falls were being supervised in lounge areas as there were plenty of staff around. We noted that care plans have been updated and Care Homes for Older People Page 5 of 10 amended in respect of falls risk. The last time we visited the home it was very busy and call bells were left ringing for long periods. On this visit, however, the number of carers on duty had been increased, call bells were quickly answered and there was a calm atmosphere about the home. During our last visit we were informed of an incident where a person had been left on a deflated alternating pressure mattress, which had put this person at risk of developing pressure ulcers. We made a requirement for the service to address this and to ensure that this does not reoccur. During this visit we were satisfied that people were being appropriately nursed on alternating pressure mattresses and that these mattresses appeared to be correctly inflated to the required pressure. In the absence of the Registered Manager the service is being managed by an Interim Manager. This manager is supported by an Area Manager. We met both of these managers during this inspection visit. The interim manager told us about the immediate changes and improvements she intends to make in the home in order to improve outcomes for the people who live there. These changes include extending the domestic hours so that there is domestic cover in the afternoon/evening periods. This should help to keep the home clean throughout the day. The manager is also reviewing the provision of meals and mealtimes in order to improve this outcome. The interim manager told us that she is a person who gets things done and takes immediate action where necessary to make improvements. During the visit we received information from the relatives of a person living in the home. They told us that they had raised concerns several times about the care of their relative and nothing had been done about it. They told us that they have spoken to the new interim manager this morning and that she has promised to take up their concerns and look into them. We spoke with the manager about this and she told us that she will be addressing their concerns as a priority. The manager said that she will also be holding staff, residents and relatives meetings to explain the changes and to keep people informed. We were informed that the deputy manager is leaving this week after working at the home for 10 years. We spoke with the deputy himself who was on duty on the nursing unit. He confirmed that he is leaving and staff told us that he will be very much missed. Discussions with the managers identified that they are actively recruiting suitable nurses to work at the home. From the information we were given and the records we examined, it is clear that our requirement to continue with the management review of the service has been met. What the care home does well: Care Homes for Older People Page 6 of 10 The service has addressed the requirements we left at our last inspection and is continuing to make improvements for the outcomes for people who live at the home. What they could do better: 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 set out on page 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 7 The service should review the care plans of people who have DNARs in place in order to ensure that carers and nurses are clear as to the specific care and support required. The service should provide another mealtime assistant to work on the ground floor unit so that all of the people who live in the home can benefit from this service. 2 8 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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