Care Home: Bromley Park Nursing Home

What the care home does well The home has retained a number of its staff including the qualified nurse team for a number of years. This provides residents with staff who understand the workings of the home and provides consistency in care. The manager has been in post for approximately ten years and is experienced with this type of resident group. An experienced staff team managed by skilled management manages residents` care. Good support is provided through the multi disciplinary team and GP. Leisure activities are organised and the voluntary "Pat a Pet "scheme, has proved to be of great benefit to the residents. The volunteer has been instrumental in the development of the sensory garden for resident to use. The activities organiser has worked hard to provide varied and appropriate sessions. What has improved since the last inspection? Since the last inspection there have been a number of areas where improvements have been made. All of the requirements arising out of the last inspection had been addressed. Improvements have been made in respect of the environment with on going redecoration and refurbishment of communal areas, as well as upgrading of bedrooms. This provides residents with comfortable surroundings in which to live. The appointment of an experienced and well-qualified deputy manager is an asset to the home. In addition the supernumerary hours allows him to spend time ensuring care practices provide residents with dignity privacy and respect. Staff are provided with more training and support so that they can safely and competently undertake their work. The records generally were well organised with information easy to access. The manager and the administrator have good systems in place to ensure records were well maintained. What the care home could do better: More care is needed when staff are completing food and fluid chats to ensure information is detailed and accurate. The serving of food must be at the correct temperature and some replacement of kitchen equipment may assist in this matter. CARE HOMES FOR OLDER PEOPLE Bromley Park Nursing Home 75 Bromley Road Beckenham Kent BR3 5PA Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 27th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bromley Park Nursing Home DS0000010129.V370429.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. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromley Park Nursing Home Address 75 Bromley Road Beckenham Kent BR3 5PA 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) 020 8650 5504 020 8650 6085 bromley.park@nellsar.com Nellsar Ltd Jacqueline Hayward-Gant Care Home 50 Category(ies) of Dementia (50) registration, with number of places Bromley Park Nursing Home DS0000010129.V370429.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 (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 50 18th December 2007 Date of last inspection Brief Description of the Service: Bromley Park Nursing Home has been registered to its current owners since 1993. It is a large, detached house in a residential area of Beckenham, and provides nursing care to a maximum of 50 residents, of either sex who are suffering with Dementia. The building has been adapted for its purpose and has had an extension added. Bedrooms are sited throughout the building and there are two lifts providing access to all floors. Communal areas are sited on the ground floor. Communal areas include a sensory room and a quiet area. There is a large back garden with an area dedicated as a sensory garden, which has been recently developed. Car parking to the front of the building. There is a bus stop outside the home. The weekly fees are between £590 for Bromley Social Services residents and from £ 700 up to £850 per week for private funded residents. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 stars. This means the people who use this service experience good. The inspection was conducted over a one day period by two inspectors. The manager facilitated the site visit assisted by the deputy manager and staff on duty. Periods of observation were undertaken in the communal areas. Prior to the inspection the manager had completed the AQAA and forwarded this to the CSCI. The AQAA contained good information regarding the service. Twelve comment cards were received during the site visit, including four from residents, two from relatives and six from staff. During the visit the we met with several relatives and residents. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated into this report. A selection of documents were inspected including care plans, staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the service does well: The home has retained a number of its staff including the qualified nurse team for a number of years. This provides residents with staff who understand the workings of the home and provides consistency in care. The manager has been in post for approximately ten years and is experienced with this type of resident group. An experienced staff team managed by skilled management manages residents’ care. Good support is provided through the multi disciplinary team and GP. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 6 Leisure activities are organised and the voluntary “Pat a Pet “scheme, has proved to be of great benefit to the residents. The volunteer has been instrumental in the development of the sensory garden for resident to use. The activities organiser has worked hard to provide varied and appropriate sessions. 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. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 7 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 Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 8 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): 3. 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 the service. The registered manager ensures that all prospective residents are appropriately assessed prior to admission; making sure that their care needs can be met. Intermediate care is not provided by this service. EVIDENCE: At the time of the site visit there were 40 residents in the home and one in hospital. Two care plans were looked at in detail; these documents included a lot of information pertaining to the person who uses the service. There was evidence that the home’s management makes sure that a thorough Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 9 assessment takes place prior to the person being offered a place in the home. One such assessment, conducted by the newly appointed deputy manager, contained good information on the resident and the care required, identifying any particular areas of need. The care plans confirmed that if a referral was made by Social Services the paperwork was sent to the home manager prior to the assessment being undertaken. As this home offers specialist dementia nursing care it is vital the assessment contains as much information as possible so that the home manager is able to determine whether or not the persons care needs can be met. The care plans confirmed that relatives and healthcare professionals had been involved in the pre admission assessment. Relatives spoken to during the inspection said that they had been asked for their views on care needs and their expectations of the service to be provided by the home. Staff spoken to said that the information contained within the assessment helped them to formulate care plans and risk assessments individual to the health, personal and social care needs of the person. Staff also said that the information provided gave them an insight into the persons needs enabling them to care for the person. In particular, information relating to their past life, the type of dementia the resident suffered, and the best way to cope with any aspects of challenging behaviour were felt to be beneficial. In addition, information on the resident’s wishes and preferences enabled them to provide care specific to them. Documents to confirm assessment information included forms for best interests’ decision making, a strengths assessment and a life profile of that individual resident. Relatives spoken to confirmed that they received enough information about the home and the services offered, this included a visit to the home prior to admission enabling them to make an informed decision as to whether it was the right place for them to be and that they felt the assessed health, personal and social care needs of their relative could be met. Comments in one comment card indicated that the manager had spent a considerable time with the relatives ensuring that the service was right for their relative. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 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 the service. The care plans seen reflected the assessed health, personal and social care needs of the individual and gave clear guidance on how these needs were to be met. The health care needs of the person using the service were identified at the pre-admission assessment ensuring that appropriate healthcare professional input was accessed prior to admission and as needed. The medication policies, procedures and practice ensure that the people who use the service are given the correct medication at the correct time by competently trained staff. The people who use the service feel confident that they will be treated with respect ensuring that their privacy and dignity is maintained at all times Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 11 EVIDENCE: Several care plans were looked at in detail on the day of the inspection. The care plans were personalised to the individual resident and identified their specific personal, health and social care needs. They provided information on specific ways in which these needs were to be met respecting the independence, privacy and dignity of the individual being cared for in the home. The care plans also included risk assessments relating to moving and handling, mobility, cot sides, challenging behaviour and dementia. There were care plans relating to activities and how the residents social care needs were being met. All residents had a monthly review the outcomes were documented and signed by those present; care plans were updated as part of this review process. The care plans were to a good standard particularly in respect of the care to be provided to residents. The manager did comment that some relatives found signing the care plans on behalf of their relatives tedious and were reluctant to engage. In such cases a simple statement that this opportunity had been offered to the relative would suffice. The care plans themselves are cumbersome and would be time consuming to digest the information within it, particularly for temporary workers. The manager was aware of this and was in the process of looking at alternative ways to address this and a short summary was in place as an aide memoir et the resident’s care needs. Feedback was also obtained from the home manager and staff in respect of the completion of care plans. The care plans seen confirmed that there had been input from some of the resident’s family, and healthcare professionals. Services from other healthcare professionals were usually accessed via the GP; these services included referrals to the hospital consultants, psychogeriatricians, psychiatrists and physiotherapists as well as the district nurses and the tissue viability nurse. The home was able to access optical, dental and podiatry services for the residents as and when required. These visits were recorded on a separate sheet, which provided details of the visit and outcome. Relatives spoken to said that they were happy with the services provided by the home and that they felt their relative was well looked after, one relative said they were kept informed of referrals made, of hospital visits and admissions to hospital; relatives surveyed felt that the staff had the experience, skills and competency to care for their relative. Food and fluid charts were well completed although staff must take action if insufficient fluid is being taken. Terms such as intake “normal diet one plate “should be avoided. In the event that a resident needs the close monitoring of a food intake chart, then this must be accurately completed. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 12 Several comment cards indicated that residents were well cared for. The medications were inspected with the assistance of a qualified staff member. The staff member was confident and well able to give an overview of the systems in use, policies and procedures. The medications were safely managed and stored correctly. Guidelines for all medications to be administered “as required “, had been developed. All medication charts viewed were completed with the resident’s photograph and allergies. In addition guidelines on “covert administration of medication “had been developed in line with current guidance. The medication administration records were fully completed. The homely remedies information had comprehensive information on the use of such preparations. The medication room was tidy and well organised. Drug reference books were available for staff to check medications and their possible side effects. During a tour of the home it was obvious that the staff cared about their residents, there was an established rapport between them; the staff spoke to the residents respectfully being mindful of their right privacy, dignity and independence. Relatives spoken to confirmed that the staff were easy to talk to and would do anything for their relative; that they felt comfortable and trusted the staff with all aspects of their relative’s personal care. They were confident that the staff had the necessary skills, competence and experience to care for their relative. The management and staff at the home are aware of their responsibilities relating to the Data Protection Act and are trained to deal discreetly with the affairs of the residents and were aware of the need to maintain confidentiality on behalf of the residents in their care; making sure that the residents are aware of the information held about them and how it is used, how they can access it enabling them to maintain their legal, civic and political rights. There was a lot of equipment in use and available to meet residents needs. Support is provided through the Primary Care Trust for any healthcare issue, which may arise. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 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 the service. The home endeavours to provide appropriate activities to the residents supporting and encouraging them to maintain their chosen lifestyle in their home environment. The residents are provided with a nutritious and healthy menu; choices are available and they eat in nice surroundings enabling them to feel comfortable and receive appropriate support and encouragement. EVIDENCE: Periods of observation were undertaken in communal areas by both inspectors. Signs of well being were evident amongst residents these included engaging with their visitors, staff and on another, involvement with their surroundings i.e. singing to the music looking/reading books or newspapers and generally they were alert to their environment. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 14 The home has a good activities co-ordinator who provides a wide range of activities for the residents to enjoy. An activity assessment is completed for all residents detailing aspects of their past life, what they did and what hobbies they did and activities undertaken were documented, relatives were encouraged to complete a life profile to help with reminiscence sessions making them more personal to residents own experiences. During the inspection there was music playing in the large lounge, residents and staff were singing a long. In the second lounge a number of residents were watching television, this was an altogether quieter area and there were also a number of visitors in this lounge talking to their relatives. The activities co-ordinator was helping some more able residents to complete a questionnaire about the home and the care they received. The residents in these two areas looked happy and were smiling and laughing the staff were interacting well and were aware of the residents making sure they were enjoying themselves, supporting and encouraging them to join in with the singing. One resident was using a colouring book, on speaking to her she said she liked the home and the staff were kind. There is a notice board between the two lounges giving details of the day, the date, the weather, and the staff on duty and what was happening in the home. In addition there were photos and details of the animals namely the two rabbits Wendy and Jean, and the two budgies Sooty and Blue. The home also has a fish tank in the lounge with four parrot fish. Since the last inspection the home has created a sensory garden and a sensory room for residents to spend time in. Care plans relating to the use of these two areas were found in the two care plans looked at, and it was evident it was proving to be a success particularly for residents with challenging behaviours. Part of the lunchtime service was observed. Tales were laid in preparation for the meal. Adapted cutlery and plate guards to assist residents to eat independently were in use. It was evident that many improvements had been made, a choice of meals was offered and there were colourful illustrations of the food on offer that day. The plates of food seen well presented, however the dessert which was supposed to be hot was left on a table and was cold, this issue needs to be addressed and was discussed with the home manager during the feedback session. The cook was spoken to and proved to be qualified and knowledgeable about her role. She knew about special diets e.g. diabetic, gluten free, reducing and low fat; the dietary needs of the residents were recorded. A sample of the kitchen records were inspected all appeared to be completed accurately and was up to date. The kitchen and the equipment was in a clean condition, although one sink was out of order and this issue needs to be rectified as soon as possible. Some equipment has been replaced since the last inspection; Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 15 however the cooker, microwave, grill and one of the freezers need to be looked at with a view to replacement. The cook stated that the floor is to be replaced. The store cupboards and freezers were inspected they was plenty of food available a lot of fresh produce is now being used, local suppliers have been sourced by the manager and the quality of food bought is much improved. Bromley Environmental Health has awarded the kitchen a four star clean food award. One residents’ comment card included the following “I enjoy the food here – always tastes nice especially fish and chips”. Relatives were in visiting throughout the day of the site visit. Relative’s comments included the following: “They do a blooming good job here “, “I love it here especially enjoyed the party here last Friday “. Both of these relatives were regular visitors to the home. Bromley Park Nursing Home DS0000010129.V370429.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): 16 and 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 the service. The people who use the service are able to feel safe and protected in the home due to the homes’ policies and procedures; and that the staff receive training relating to complaints and to the Protection of Vulnerable Adults. EVIDENCE: The manager promotes an open ethos fro dealing with complaints and has an open door policy where by she can be contacted at most times. The organisation has robust policies and procedures in place relating to complaints, documents can be found in the Service User Guide and in the homes’ Statement of Purpose and it is also displayed in the entrance hall of the home. From speaking to relatives visiting the home at the time of the inspection; it was evident that they were aware of the complaints procedure and knew how to instigate it if necessary. They also said that if they were not happy or if they had any concerns they would refer them to the nurses and the management of the home. They said that they felt confident that their issues would be dealt with appropriately and resolved quickly to their satisfaction. The home has a complaints log and records all the details of any complaint received, from the acknowledgement of the complaint, through the Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 17 investigation to the outcome and resolution. The manager stated that a record is kept of all complaints and that the complainant is kept informed at all stages of the investigation and of the outcome. In the complaints log there was evidence of the above information retained and this was well organised and information easy to extract. Since the last inspection many of the staff have undertaken training in the Protection of Vulnerable Adults, this is an ongoing process. Staff had access to the homes’ policy and procedure relating to the Protection of Vulnerable Adults and the “Whistle-blowing”. The staff spoken to including the newly appointed deputy manager were aware of POVA and the different forms of abuse; they also confirmed that they had attended specialist training relating to POVA and to the Protection of Vulnerable Adults. The home has a copy of the Local Authority Multi Agency Protection of Vulnerable Adults guidelines and policy and procedure. Bromley Park Nursing Home DS0000010129.V370429.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): 19 and 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 the service. The people who use the service live in a home that is clean, pleasant, hygienic, comfortable, safe and well-maintained, with access to safe and comfortable indoor and outdoor communal facilities. EVIDENCE: A tour of the home was undertaken as part of the inspection process – the home was found to be clean and well maintained with no unpleasant odours. The reception area of the home was well decorated with two armchairs a fish tank, and a suggestion box. The certificates were displayed detailing registration, insurance and a Membership certificate of the Registered Nursing Home Association. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 19 The Statement of Purpose and the Service User Guide were also displayed as were the fire safety policy and procedure; there was a visitor’s book, a file with thank you letters, previous inspection report, and Mental Capacity Act information. The “event” notice board had lots of information appertaining to the care of the elderly, literature about organisations dealing with dementia, and support organisations. Since the last inspection a number of improvements had taken place including the replacement of corridor carpets. Twelve bedrooms have been upgraded. The bedrooms seen were personalised to the individual with pictures, photo’s, ornaments and small items of furniture. Bedroom carpets have been replaced; some furniture and soft furnishings have all benefited the comfort of residents. Toilet and bathroom doors have been painted green, toilet seats are red, residents bedroom doors have numbers and names but also a symbol important to the resident, handrails in the corridors are also red, all of these changes making it easier for residents to recognise where they within the home and to encourage some independence in finding their was around. A bathroom has been refurbished and has a hydrotherapy bath to help residents relax whilst having a bath to make it a pleasant experience for them. A sensory room and a sensory garden have been incorporated into the environment enabling the peoples who use the service to relax in a calm environment. It was evident from checking health and safety records and from observations made during a tour of the premises that the home complies with the relevant environmental, health and safety legislation relating to heating, lighting, water supply and ventilation of the residents accommodation. In addition it meets the individual needs of the people who use the service providing any equipment which may assist to make their lives better. Bromley Park Nursing Home DS0000010129.V370429.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): 27, 28, 29 and30. 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 the service. The management of the home ensures that all staff are trained in order to have the skills and competency necessary to meet the personal, health and social care needs of the residents in their care. This outcome is achieved by implementing thorough recruitment and selection procedures, supported by ongoing training, supervision and appraisal systems. EVIDENCE: The home has a team of qualified and unqualified staff to address resident’s needs. There are male and female care staff which allows for choice when persona care is being addressed. The staff group is multi cultural and a number of languages are spoken. On the day of the site visit there were three qualified staff seven care staff activities laundry domestic and administration staff. Since the last inspection a new deputy has been appointed full time with two/three supernumerary days for staff supervision, auditing and overseeing care. This is to be commended. There were two staff vacancies both currently being advertised. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 21 Three members of staff were interviewed as part of the inspection process – all confirmed that things had significantly improved in the home, that there was a supportive and encouraging management team. They said that they received more training relating to dementia and coping with challenging behaviour. Staff are encouraged to undertake further training e.g. NVQ 3 and 4 and there were more opportunities for training in specific areas e.g. POVA and Safe Administration of Medication. The staff spoken to felt they worked more as a team, they felt more involved and valued. Staff confirmed that there was a good system for supervision and annual appraisals which provided support in their working lives. Staff personnel files evidenced robust recruitment procedures were in place to provide protection to residents who live in the home. Staff files were well organised. Qualified staff has their nursing registration status checked, in addition to the standard checks on CRB/POVA clearance references and attendance at a formal interview. The deputy manager was interviewed; he had been in post three months. He confirmed an induction period covering all mandatory topics. He is a Registered General Nurse9 RGN), and has completed the RMA. In addition he had previously completed a health and safety course through Greenwich University, and the NVQ assessors course D32 and 33. The deputy manager is a qualified moving and handling trainer and is in the process of updating staff training in this area. A lot of training is being done in house by the homes manager and the deputy manager this has included training in the Mental Capacity Act (a video and workbook); Aggression and Challenging Behaviour; Infection Control and Care Planning. Twelve staff have completed a level 2 Dementia course. The home is due to start the Gold Standard Framework September 2008. This is a comprehensive system for end of life care. Staff training is also accessed through the Bromley training consortium which provides a varied selection of staff training topics to staff in care homes. The general feeling was that they worked in a pleasant environment, had really good informative handovers and had more input into the general well being of the people in their care. Staff felt that their views about the care provision in the home were listened to and that any suggestions they had were considered and implemented if appropriate. In a staff comment card the following statement was included “good training for staff and up dates on service users”. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 22 A relatives comment card indicated that weekends needed more staff and that on occasions he had pointed out things several times as staff themselves had not noticed them Staff need to be extra vigilant both in terms of care provided and the environment in which they work. Bromley Park Nursing Home DS0000010129.V370429.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33,35,36,37 and 38. 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 the service. The home, the residents, relatives and advocates benefit from having a qualified, competent, accountable, and committed manager and management structure in place. The home has open and transparent quality assurance systems in place ensuring that the aims and objectives can be measured and are achievable. The home has systems in place to ensure the health and safety of the residents, relatives and staff. EVIDENCE: Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 24 A qualified nurse who is trained in mental health general nursing manages the home. In addition she has completed the RMA and NVQ level4 qualifications. Ms Hayward Gant has many years experience of managing this service, which has provided great stability and consistency to the staff and residents providing safe management in the home. This is to be commended. The home’s manager is required to undertake a number of audits to make sure that the quality of the service is regularly reviewed and monitored. These audits have been implemented by the organisation and the home manager sends regular reports to the head office. Audit reports are sent to the head office on a monthly basis and then discussed with the area manager at monthly meetings and then at head office with the senior management team along with other home managers within the organisation. Evidence was seen of the monthly Regulation 26 visits which are required by the CSCI, these were completed by the area manager. There were also monthly audits of accidents, infection control, accident and emergency admission to hospital, pressure sore monthly return, care plans, medication, valuables and mattress and pressure relieving equipment. A number of service certificates were seen and found to be current and reflective of regular maintenance on the items. These included the gas safety certificate, portable appliance testing and five year electrical inspection. The lift inspection certificates were checked inspections were carried out on the 15/04/08. The legionella risk assessment had been conducted May 08. Fire records included those for fire training and checks made on the alarm system, emergency lighting and fire escape routes. The fire risk assessment was available in large print. The fire emergency plan was also on site. The LFEPA has assisted with the fire risk assessment in so much as they had confirmed that it was appropriate for the building. Fire training is conducted by an ex fire officer who is external to the home. He addresses this with all staff three times a year. Policy and procedure manuals were updated in February 2008. The home manager is responsible for the monies of one resident; there is a cheque book, and monies spent are recorded on a spreadsheet. Receipts are kept for expenditure, the balance of monies was checked and found to be correct, verified by the receipts and spread sheet. Valuables kept in the safe at the home are checked weekly. The home pays for toiletries, which are distributed as, and when needed, relatives are then invoiced; this is the same for the podiatrist and hairdresser. The home does not hold resident’s monies the relatives have financial responsibility. Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 25 Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 4 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 x 3 3 3 3 Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bromley Park Nursing Home DS0000010129.V370429.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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