Care Home: Brocklehurst Nursing Home

What has improved since the last inspection? Since the last inspection visit the requirement made in relation to the storage of the drug trolleys has been met. As recommended in the last inspection report meals on the first floor and now served direct from a heated trolley. What the care home could do better: From speaking to staff and some visitors to the home it appears that due to the number of people living at the home and the high level of needs more staff are needed to ensure that everybody`s needs can be met in a timely and unhurried manner. One visitor said that although the staff are wonderful there is not enough of them and she sees people having to wait for assistance because the staff are so busy. Improvements are needed to ensure that all plans of care include people`s personals choices and preferences particularly around personal hygiene. To ensure that people are not put at any unnecessary risk the care plans relating to pressure sores need improving.Brocklehurst Nursing HomeDS0000021635.V374797.R01.S.docVersion 5.2Page 7Procedures must be put into place to assess people`s ability to make decisions under the Mental Capacity Act to ensure that people`s capacity to make their own decisions is appropriately assessed. To ensure people are not put at any unnecessary risk and inline with comments made by the H.M Coroner following an inquest into the death of a person living at the home, any visitors or volunteers to home that transport a person in a wheelchair must be appropriately risk assessed. The use of a lap belt must be risk assessed prior to its use to ensure that people are not put at any unnecessary risk. Key inspection report CARE HOMES FOR OLDER PEOPLE Brocklehurst Nursing Home 65 Cavendish Road Withington Manchester M20 1JG Lead Inspector Geraldine Blow Unannounced Inspection 16th April 2009 09:30 DS0000021635.V374797.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 2 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 Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brocklehurst Nursing Home Address 65 Cavendish Road Withington Manchester M20 1JG 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) 0161 448 1776 0161 434 3795 keri.sherwood@anchor.org.uk Anchor Trust Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 (aged 60 years or over) whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 41 15th April 2008 Date of last inspection Brief Description of the Service: Brocklehurst Nursing Home is a purpose built care home of 41 beds providing care for people over the age of 60 years. The home is on two floors with a passenger lift between the two floors. Accommodation is provided in 31 single and 5 double en-suite rooms with a variety of communal space for residents to use. The home is situated in West Didsbury on the site of the old Withington Hospital. The centre of West Didsbury is about a quarter of a mile away. Main roads give ready access to Manchester and the motorway network is close by. The last inspection report is available on request for people to read. The charges for fees range from £473.54 to £740 per week. There are additional charges for magazines, papers and hairdressing. Brocklehurst Nursing Home DS0000021635.V374797.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. This means the people who use this service experience good quality outcomes. This report is based on information gathered by the Care Quality Commission (CQC) since the last inspection on 15 April 2008 and supporting information received in Annual Quality Assurance Assessment (AQAA) submitted by the manager prior to this visit. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. References to we or us in this report represent the CQC. Staff and some people living at the home were sent comments cards so that we could get their views on how the home is run. We received five completed comment cards from staff and three comment cards from those sent to people living at the home. Two of those cards were completed by relatives on their behalf and one was completed with the help of somebody else. Some of the comments are included in the body of the report. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. The visit took place on Wednesday 15 April 2009. This report is an overview of what the inspector fond during the visit. As part of the visit we spent time examining relevant documents and files. We also spent time talking with several people living at the home, some members of staff and some visitors to the home. We also walked round the home and looked at the communal areas and some bedrooms. Feedback was given to the deputy manager during the course of the visit. What the service does well: Brocklehurst continues to offer a clean and pleasant environment for the people who live there. Everybody spoken to and information received in the completed comment cards indicated that this is always the case. Staff were friendly and helpful during the visit and were observed to be kind and attentive to the people living at the home. People living at the home and visitors all commented on how wonderful the staff are. Some comments include the staff are wonderful, I cant praise the staff enough and this is a Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 6 brilliant home and so are the staff. One visitor said this is just like home from home. Staff spoken to all said that where possible people are encouraged to make their own choices around their day-to-day lives. Visitors spoken to said that they were able to visit whenever they liked and staff always made them feel welcome. They also said that staff were good at keeping them informed of any issues concerning their relative. People have an assessment of their needs before being admitted to the home to make sure that all of their needs can be met and people are encouraged to come and visit the home before making a decision to move in. A team from Withington Community Hospital provide a variety of activities in the home. Some of the activities include a weekly concert, art and craft, manicures and a reminiscence group. There is a weekly activity programme on display. What has improved since the last inspection? What they could do better: From speaking to staff and some visitors to the home it appears that due to the number of people living at the home and the high level of needs more staff are needed to ensure that everybodys needs can be met in a timely and unhurried manner. One visitor said that although the staff are wonderful there is not enough of them and she sees people having to wait for assistance because the staff are so busy. Improvements are needed to ensure that all plans of care include people’s personals choices and preferences particularly around personal hygiene. To ensure that people are not put at any unnecessary risk the care plans relating to pressure sores need improving. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 7 Procedures must be put into place to assess peoples ability to make decisions under the Mental Capacity Act to ensure that peoples capacity to make their own decisions is appropriately assessed. To ensure people are not put at any unnecessary risk and inline with comments made by the H.M Coroner following an inquest into the death of a person living at the home, any visitors or volunteers to home that transport a person in a wheelchair must be appropriately risk assessed. The use of a lap belt must be risk assessed prior to its use to ensure that people are not put at any unnecessary risk. 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. Brocklehurst Nursing Home DS0000021635.V374797.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 Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to make sure that people’s needs are assessed before admission to ensure their care needs can be met. EVIDENCE: The deputy manager confirmed that admissions to the home are only made after a pre admission assessment of the persons needs has been undertaken. In addition to the homes own assessment they also receive information from the care managers assessment of the placing authority or the funded nurse assessment. This is to ensure that the home can meet the assessed needs of the person. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 10 Evidence was seen of these assessments on the three care files looked at during this visit. People who are thinking about moving into the home and/or their relatives are encouraged to visit, have a look round, meet staff and other people living at the home. Visitors spoken to confirmed that this was the case. People spoken to and information received in the completed comment cards confirmed that they had received enough information before making a decision to move in. The Statement of Purpose is available for people to look at in the main reception and the Service user Guide is available on request. Brocklehurst does not provide an intermediate care service. Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the 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 health, social and personal care needs of people were being met by staff that respected their privacy and dignity. EVIDENCE: Three care plans were looked at during this visit. The care files were organised and easy for people to find information. The deputy manager stated that the team leaders undertake monthly care plan audits. This is considered good practice. The information included in the individual plans of care were of varying standards. Two of the personal details sheet were not signed or dated and some information sheets were only part completed. This was discussed with the deputy manager during the visit. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 12 Other parts of the care plans contained details of peoples personal choices and preferences. For example one file contained information about a persons request for the times of his position change during the night and when we spoke to this person he confirmed that staff carryout his request. However other parts of the care plans were not detailed and did not contain peoples personal preferences, with particular reference to hygiene needs. For example all three files documented offer bath/shower at least once a week. In one file there was no evidence that a bath or shower had been offered or received since admission to the home in February and in another file since mid March 2009. There was no formal assessment for oral hygiene needs and in some of the files the care plan relating to this need was vague. It is recommended that all parts of the individual plans of care include details of peoples personal choice and preferences. One file identified that the person had an ulcer and had been seen by the Tissue Viability Nurse (TVN). However the care plan did not include details of how the ulcer was to be cleaned or how often the dressing needed to be changed. There was not progress notes or evidence that the ulcer had been regularly dressed. There was a later entry from the TVN stating that the ulcer had now healed. The plan of care had not been updated to include this information. To ensure that people are not put at any unnecessary risk the incidence of pressure sores/ulcers, their treatment and outcome are recorded in the individual plan of care and reviewed on a continuing basis. Since the last visit there has been concerns raised due to an accident that happened when an injury occurred while a volunteer was transporting a person in their wheelchair. The HM Coroner sent us a copy of the inquisition. This included action that needed to be taken by the home to prevent any recurrences of similar circumstances. In the main all action had been taken, however to minimise any risk and inline with comments made by the Coroner any visitors or volunteers to home that transport a person in a wheelchair must be appropriately risk assessed first. In addition it was of concern that in two of the care files it identified that the person required the use of a lap belt, which is considered a form of restraint. The use of the lap belt had not been appropriately risk assessed. The daily progress and evaluation notes were repetitive and do not accurately reflect the care delivered by staff. The daily evaluation notes should be reviewed to make sure that good quality, useful information is being recorded and it accurately reflects the care given. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 13 We examined the records and stocks of medication for the three people whose care plans we looked at and a couple of other people living at the home. The deputy manager confirmed that monthly audit of medication is undertaken. The requirement made in the last inspection relating to the storage of the medication trolleys had been met and they were now seen to stored in appropriate places. On the whole there were no gaps in the recording of medication, with the exception of one tablet on one day, and medication had been signed into the home, again with the exception of one. It was noted that one medication was being given and the quantity of tablets had not been signed into the home, therefore making it impossible to audit that medication and ensure people are receiving their medications as intended by the GP. These discrepancies were discussed with the deputy manager and the nurse in charge. Suitable provision had been made for the safe disposal of unused medication from the home. Staff spoken to confirmed that people are treated with respect and dignity. This was confirmed by watching staff interact with people. All comments received by people living at the home and visitors to the home were positive about staff attitudes and the high level of care received. One visitor said that her relative was receiving far better care than the last place he was at and the home is brilliant. Another visitor said ‘I cant praise the staff enough’. Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided and people are able to maintain contact with family and friends. People have a choice of varied, well-balanced meals. EVIDENCE: A ‘recreation team’ from Withington Community Hospital continues to go into the home to provide a variety of activities. The planned activities are on display on the notice board. The care files looked at had a Life History record. However it was disappointing that in one file it had not been completed and in another file it was only part completed. To ensure activities are based on the preference of the people living at the home it is recommend that the Life History assessment is fully completed for all people. Staff spoken to all said that they thought the activities provided were good. However one visitor said she thought there could be more stimulation provided. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 15 All people spoken to confirmed that they were able to visit the home whenever they wanted. Visitors spoken to said that they are always made to feel welcome and staff keep them informed of any issues relating to their relatives. Visitors were seen to be relaxed and cups of tea had been provided. Based on direct observation, people and their visitors benefit from a relaxed and homely environment. From speaking to people living at the home, visitors and staff it appeared that people are encouraged to exercise choice and control over their lives. However there is a need to ensure that peoples capacity to make decisions is assessed and recorded as required under the Mental Capacity Act. A weekly menu is on display in the main reception and meals were varied and fresh vegetables are provided daily. A choice is available at each mealtime and everybody spoken to confirmed this. One person was describing a meal the chef had made especially for him because it was just what he fancied and he had really enjoyed it. Another visitor said that the staff sit and help people to eat their meal however long it takes. The AQAA confirmed that a choice of drinks are offered through out the day and snacks and fruit available on each unit. Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are handled well and taken seriously ensuring people feel listened to. EVIDENCE: There is a complaints procedure, which was seen on display in the main reception. All returned comment cards indicated that they knew how to make a complaint and knew who to speak to if they are not happy. All the returned comment cards from staff indicated that they knew what to do if somebody wanted to raise a concern or complaint. Visitors spoken to all said that they would be happy to raise any concerns and felt that they would be listened to and action would be taken. One visitor said that she had no complaints and couldn’t praise the home enough. A comment received in a comment card was I can’t praise the carers enough. There was no internal system in place for the manager to analyse complaints or concerns so that any patterns of poor practice can be identified at an early stage and fully addressed. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 17 There was a copy of the Manchester Safeguarding Guidance and the deputy manager was able to clearly describe the correct actions to be taken in the event of an allegation of abuse being made. Staff spoken to confirmed that they had received training relating to safeguarding adults. However the training record indicated that over half of the staff had not received the training and no training and been booked. To ensure people are fully protected from abuse all staff must review appropriate safeguarding adults training. Since the last inspection visit there have been two allegations of abuse that have been appropriately investigated. Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean and pleasant environment is provided for the people who live there. EVIDENCE: There are a number of communal areas, a hairdresser’s room and an enclosed garden area. As part of this visit a tour of the building was undertaken which included all the communal areas and several bedrooms. The home was clean, tidy, well decorated and furnished to a high standard. There were no offensive odours and people spoken to all confirmed that the cleanliness of the home was always of a high standard. The received comment cards also indicated that the home was always clean and fresh. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 19 Bedrooms were seen to be personalised and comfortable. The deputy manager stated that small supplies of personal protective equipment (PPE) such as gloves, apron and wipes were kept in peoples bedrooms where appropriate and staff had access to such equipment as and when needed to reduce the risk of cross infection. As recommended in the last inspection report to reduce the risk of cross infection hoist slings were seen to hang on individual hooks. There was a copy of the NHS infection control guidelines available in the home for all staff to access. Brocklehurst Nursing Home DS0000021635.V374797.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff may not be adequate to meet all of the needs of the people living there. EVIDENCE: From talking to staff and visitors to the home it appears that there may not be enough staff numbers to meet the needs of the people living there. The home accommodates a high percentage of people assessed as requiring continuing health care and therefore these people have high dependency of needs. A number of staff spoken to confirmed that the needs of the people living there were high and everybody would benefit from more staff. One visitor spoken to during the visit praised how hard the staff worked but said that she has witnessed people having to wait some time for assistance because staff are so busy. One comment received in the returned staff comment cards was the needs of service users are increasing and I feel we need to increase our staff levels to ensure we keep up our high standards of care. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 21 To ensure that peoples needs are being appropriately met the staffing numbers should be reviewed to ensure that enough staff are on duty at all times. The deputy manager confirmed that 27 care staff are employed. Twelve care staff have successfully completed training in the National Vocational Qualification (NVQ) Level 2 or above and two staff members have expressed interest in undertaking the training. One carer spoken to said that she had expressed an interest in undertaking the training and felt very supported by the manager. The recruitment records were looked at for three members of staff to see whether the required documentation was in place and if the necessary safety checks had been made. There was evidence of Criminal Record Bureau checks (CRB) having been undertaken. However one file did not have proof of identity or address and another file did not have proof of address. This does not fully protect people living at the home. It was noted in two files that no notes had been taken during the interview process. To help evidence that the person is fit to work in the home it is recommended that interview notes are taken and kept on file. Staff files contained some photocopied documents, for example a birth certificate and worker registration scheme. However there was no evidence that the original documents had been seen. It is recommended that that all photocopied documents are signed to indicate that the original had been seen. The administrator confirmed that there is a computerised system to identify when nurse PIN numbers are due for renewal and she regularly checks the Nursing and Midwifery Council (NMC) for nurse suspension, PIN renewals or exclusion from the register. The deputy manager confirmed that all new members of staff must attend an induction day and complete an induction training booklet that has been developed by Anchor. Four of completed staff comment cards indicated that induction covered everything very well and one indicated that it partly did. One comment received was excellent induction. There was a training matrix for staff, which included a record of all mandatory training attended. In addition each staff member had an individual training record, which included training that was not mandatory training for example catheterisation. The training records indicated that training was ongoing. When staff are due to attend training or updates of training they are sent an individual memo informing them of the training date, time and venue. All staff spoken to confirmed that training was available and staff are encouraged and supported to attend. All returned staff comment cards indicated that they are given training relevant to their role. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 22 The deputy manager confirmed that nobody had received any training in the Deprivation of Liberty Safeguards (DoLS), which came into force on 1 April 2009 and forms part of the Mental Capacity Act. To ensure that everybody is aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) staff must attend training in accordance with legislation. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 35 People using the 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 managed in the best interests of the people living there. EVIDENCE: The registered manager is registered with CQC and has the required qualifications and experience to run the home safely and in the best interest of the people living there and the staff working there. People living at the home benefit from a committed workforce and manager. People spoken to were confident that the manager is available if needed and they felt she would listen and act on what is said. All of the returned staff Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 24 comment cards indicated that the manager regularly meets with them to give support. Some comments included that the Manager is happy to speak with any staff member if requested to do so and encouragement if given by regular staff meetings. There is a system in place for small amounts of money to be held and used on behalf of people. The system was secure and records provided evidence of running totals for individual people and included receipts for any purchases made on peoples behalf. However it is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. The homes administrator confirmed that regular meetings are held for the people are living at Brocklehurst and people can have their say about what goes on in the home. She also confirmed that quality assurance questionnaires are left out for people to give feedback on the quality of the service provided. The information provided in the AQAA demonstrated that the home’s maintenance certificates and records were up to date. Evidence was seen that fire safety checks were regularly undertaken. Brocklehurst Nursing Home DS0000021635.V374797.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 2 3 X X 3 Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 13 Requirement Timescale for action 30/04/09 2. OP8 13 To ensure people are not put at any unnecessary risk an appropriate risk assessment must be undertaken prior to any visitor or volunteers to the home transporting a person in a wheelchair. In addition the use of the wheelchair lap strap must be risk assessed prior to its use. To ensure that people are not 30/04/09 put at any unnecessary risk the incidence of pressure sores/ulcers, their treatment and outcome must be recorded in the individual plan of care and reviewed on a continuing basis. 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 The daily evaluation notes should be reviewed to make DS0000021635.V374797.R01.S.doc Version 5.2 Page 27 Brocklehurst Nursing Home 2. 3. 4. 5. OP7 OP7 OP18 OP18 6. 7. OP27 OP29 8. OP30 9. OP35 2.sure that good quality, useful information is being recorded and it accurately reflects the care given. To ensure that peoples needs are appropriately met it is recommended that an oral assessment is undertaken on admission. It is recommended that all parts of the individual plans of care contain detailed information and include peoples personal choice and preferences. To ensure people are fully protected from abuse all staff should receive appropriate safeguarding adults training. The registered manager should have a system in place to analyse complaints and concerns so that any patterns of poor practice can be identified at an early stage and fully addressed. To ensure that peoples needs are being appropriately met the staffing numbers should be reviewed to ensure that enough staff are on duty at all times. To ensure that staff are safe to work with people living at the home all staff files should include proof of identity and residency. In addition it is recommended that that all photocopied documents in staff files are signed to indicate that the original had been seen and that interview notes are taken and kept on file to evidence that the person is fit to work in the home. To ensure that everybody is aware of their responsibilities under the Deprivation of Liberty Safeguards (DoLS) staff should attend training in accordance with legislation. Procedures should then be implemented to assess peoples ability to make decisions under the Mental Capacity Act to ensure that peoples capacity to make their own decisions is appropriately assessed. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. Brocklehurst Nursing Home DS0000021635.V374797.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 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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