Care Home: Bromson Hill Nursing Home

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What the care home does well Comments received from residents and relatives tell us that: "The home is always friendly and cheerful, and the surroundings bright and clean. There is often some event taking place among those residents able to participate. Our family, right down to toddlers and babies are always made to feel welcome, and we feel we can visit as and when we like." "Bromson Hill is a home where I feel welcome to call in anytime to see my mother. This applies to other relatives and friends to." "Mum`s room feels like her home not at all institutionalised." "The home is always clean and fresh with a good amount of activities for residents." "Overall a happy home." "Overall the care home looks after my elderly mother extremely well, they tend to every need and they are all very kind and caring, they keep their minds stimulated by all the activities, and she has settled in very well thanks to the care all the staff have shown to her." Complements were received for the chef. He served the meals, which helped the process to be more orderly and helped in the presentation of food. This helps the chef to be aware of resident`s food preferences. What has improved since the last inspection? Improvements in the home were significant at this inspection. The new manager and staff have worked hard to improve standards of care and comply with requirements made at the last inspection. People admitted to the home for respite care (Short stay) have their care needs re-assessed so that any changes are identified. This helps the home to be sure that they are still able to meet the person`s needs. Most of the care plans have been updated to demonstrate the homes ability to meet the current and changing care needs of each person admitted to the home. Work has started on making sure all residents have up to date and complete risk assessments. This will help to make sure that appropriate care plans can be developed to minimise the risk and protect the person for harm. Medicine practices had improved. Nursing staff were observed to make sure residents had taken their medicines before the nurse signed the MAR chart. This makes sure nurses practice safely and that residents are taking their medicines as prescribed to support their health and wellbeing. Improvements have been made in the kitchen to make sure that safe practices are carried out and maintained. This will help to prevent the risk of cross infection and promote the wellbeing of people who live in the home. Staffing levels are kept under review to make sure that sufficient numbers are on duty at all times. This will ensure that residents care needs can be met safely at all times. What the care home could do better: One requirement was made at this inspection visit related to staffing levels in the home and two recommendations related to good practice. Requirement: Staffing levels must be reviewed to ensure that sufficient numbers are on duty at all times. Attention must be given to meeting the full care needs, which includes the social and psychological needs of people with high dependency needs. This will help to make sure that the quality of their daily life is a positive experience. Recommendations: An appointed manager for the care home should forward an application to be considered for the role as Registered Manager for the home. This will help to make sure that people live in a home that is well led and managed in a way that puts their best interests at the centre of the organisation. An appropriate `End of Life` care plan should be developed and written with the resident and their family members or their representative. The plans should contain details of the care the resident wishes to receive during the period leading up to their death and after. This will ensure that they will be treated with dignity and respect at a very sensitive time. CARE HOMES FOR OLDER PEOPLE Bromson Hill Nursing Home Ashorne Warwick Warwickshire CV35 9AD Lead Inspector Yvette Delaney Unannounced Inspection 13th March 2009 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 Bromson Hill Nursing Home DS0000062186.V374280.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. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bromson Hill Nursing Home Address Ashorne Warwick Warwickshire CV35 9AD 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) 01926 651166 01926 650396 www.alphacarehomes.com Alpha Health Care Ltd Manager post vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2008 Brief Description of the Service: Alpha Health Care Ltd owns Bromson Hill Nursing Home. The home is a converted manor house, which has been extended to provide accommodation for up to 34 elderly residents who may require nursing care. The home is situated in the Warwickshire countryside close to Ashorne village. The house provides accommodation on two floors, which is accessible via a passenger lift or stairs. Accommodation is provided in both single and shared bedrooms. There are established gardens, which are well maintained and accessible to all residents including those who may require wheelchair access. Information provided at the confirmed the fees for living in the home to range between £468 and £680. Residents pay additional charges for the services of the hairdresser, Chiropodist and newspapers. Bromson Hill Nursing Home DS0000062186.V374280.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 Star. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulation requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This inspection was unannounced. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. This was returned to us in time for the inspection. Information contained within this document has been reviewed and considered and is included within this report where appropriate. Four people who were staying at the home were ‘case tracked’. The case tracking process involves establishing an individual’s experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide, Statement of Purpose, staff duty rotas, kitchen records, accident records, health and safety records and medication records. Residents were observed during lunchtime to see the choices and view meals made available. We looked around some of the home to view specific areas and décor of the home. What the service does well: Comments received from residents and relatives tell us that: “The home is always friendly and cheerful, and the surroundings bright and clean. There is often some event taking place among those residents able to participate. Our family, right down to toddlers and babies are always made to feel welcome, and we feel we can visit as and when we like.” “Bromson Hill is a home where I feel welcome to call in anytime to see my mother. This applies to other relatives and friends to.” Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 6 “Mum’s room feels like her home not at all institutionalised.” “The home is always clean and fresh with a good amount of activities for residents.” “Overall a happy home.” “Overall the care home looks after my elderly mother extremely well, they tend to every need and they are all very kind and caring, they keep their minds stimulated by all the activities, and she has settled in very well thanks to the care all the staff have shown to her.” Complements were received for the chef. He served the meals, which helped the process to be more orderly and helped in the presentation of food. This helps the chef to be aware of resident’s food preferences. What has improved since the last inspection? Improvements in the home were significant at this inspection. The new manager and staff have worked hard to improve standards of care and comply with requirements made at the last inspection. People admitted to the home for respite care (Short stay) have their care needs re-assessed so that any changes are identified. This helps the home to be sure that they are still able to meet the person’s needs. Most of the care plans have been updated to demonstrate the homes ability to meet the current and changing care needs of each person admitted to the home. Work has started on making sure all residents have up to date and complete risk assessments. This will help to make sure that appropriate care plans can be developed to minimise the risk and protect the person for harm. Medicine practices had improved. Nursing staff were observed to make sure residents had taken their medicines before the nurse signed the MAR chart. This makes sure nurses practice safely and that residents are taking their medicines as prescribed to support their health and wellbeing. Improvements have been made in the kitchen to make sure that safe practices are carried out and maintained. This will help to prevent the risk of cross infection and promote the wellbeing of people who live in the home. Staffing levels are kept under review to make sure that sufficient numbers are on duty at all times. This will ensure that residents care needs can be met safely at all times. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 7 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. Bromson Hill Nursing Home DS0000062186.V374280.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 Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 4 were assessed. Quality in this outcome area is good. People wishing to use the home have access to up to date information. This will help them make informed decisions about using the home. Residents’ are suitably assessed before admission to the home and residents and relatives are assured that their needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the homes Statement of Purpose and Service User Guide were seen at this inspection these have been updated. Both documents contain information that will help potential residents and their representatives make a decision about using the services provided by the home. A relative told us that they were “always well informed” about the home to help them make decisions. A resident told us in their questionnaire that, they received Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 10 information about the home from their daughter, as they did not have the opportunity to visit personally. Four care files were examined at this inspection three of which were for people admitted to the home since the last inspection. These were also followed through as part of the case tracking process. The three files show that preadmission assessments of these residents had been carried out. This will help to make sure that the home has the resources and ability to meet people’s care needs before they are offered a place in the home. Information available showed that an assessment of each person’s physical, health and social care needs and the level of support needed to meet their needs had been assessed. Other assessments of the residents care needs seen in care files include social care assessments carried out by social services and assessments of nursing care needs by nurses from the Primary Care Trust. Written assessments examined show that family members had been involved in the assessment process and for people assessed in the hospital information was obtained from patients’ hospital files and staff. A resident and their family member told us that they had been involved in the assessment process before admission to the home. One resident said I visited the home before making the decision to move in saying “I liked the building as soon as I saw it.” Another resident said “I particularly appreciated the home visit from the manager prior to my admission. I felt that I had a ‘friend’ at the home before I arrived, when I was particularly apprehensive and frightened.” Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is good. Improvements in care planning show that most residents health, personal and social care needs are identified which should ensure the delivery of appropriate care. Medicines are managed safely in the home. Staff show respect for people in their care, but do not always have the time to make sure people are treated as individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents were identified for case tracking. These residents were seen and the interaction between them and staff were observed throughout the day. Examination of the four files showed that the documentation in three files had improved and maintained at a good standard. Care needs were clearly identified and guidance was written to support staff to meet people’s needs. Risk assessments completed include an assessment of the risk of residents’ acquiring pressure area damage, falls, nutrition and continence. Assessments Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 12 had been completed and the information used to develop care plans. This practice will ensure that staff provide appropriate and safe care to people living in the home. The fourth care plan showed that the home is still unable to develop care plans, which clearly describes a persons care needs at the end stage of their life with clear guidance on how staff working in the home should meet these needs. However staff were observed to deliver appropriate care. For example the family told us that their relatives’ wishes had been discussed with them and the resident. Staff were observed turning the resident and giving oral care and meeting hygiene needs to help make them comfortable. A GP was also actively and regularly involved in the person’s plan of care. The residents care plan contained very little information to demonstrate that the person was receiving end of life care. Staff were also observed to be very attentive towards meeting the relative’s needs and making them feel comfortable and reassured during their visit. People told us during the visit and in their questionnaire responses that generally they are happy with the home. There were however a number of concerns expressed in questionnaires by residents and relatives. Concerns were related to people living in the home who rely heavily on staff to help them meet their physical, personal and health needs. A resident told us “I need to be helped with my eating and drinking as well as my physical needs. Sometimes I am hungry and feel that I am kept waiting too long for the attention I need, but I do try to be patient.” One resident and their family told us that staff don’t have much time to sit with them and talk saying that “Staff at the home are friendly and polite, but often too busy to engage in conversation at any useful length.” Reading the responses in other questionnaires it is difficult to include the comments made in this report without perhaps disclosing who the people are. A letter will be written to the manager of the home to let her know of these concerns. This will make sure that the manager is aware of what some people have told us about their experiences in the home. The result should be that all residents have the attention required to help meet their personal, health, emotional and social care needs, which will improve their quality of while living in the home. Entries in residents’ health records and comments by staff confirmed that people are supported to gain access to relevant health professionals where required, such as the GP, Optician, Dentist and Chiropodist. Residents said that they always receive the medical support they need. A resident told us Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 13 “This is very good (Medical support) the nurses look after most needs and the support of the local doctor when needed is excellent.” The management of medicines in the home was examined this showed us that procedures and practices had improved. Staff are now able to view resident’s prescriptions online. This will help to make sure that residents receive their medicines as the doctor intended. The monthly stock of medicines is safely stored in locked cupboards and trolleys. The medication administration records for the four residents reviewed through the case tracking process show that they are well maintained. There were no omissions on the records. The medicine fridge temperatures are being monitored. The recordings show that the temperature is being effectively maintained to keep this below 8ºC, which will ensure the stability of medicines. A protocol is available to support the safe administration of ‘when required’ medicines, these are medicines prescribed to be used occasionally. Observations made during the visit showed that residents were relaxed in the house and integrated well with staff and other residents. Speaking with relatives they said that they had been involved in planning the care needs of their family member. Residents looked well groomed and dressed. Residents’ personal care needs were met in their own bedroom or in one of the communal bathrooms and doors were closed demonstrating that staff respect resident’s privacy and dignity. Some of the residents in the home are dependent on care staff to support them in maintaining their privacy and dignity. Residents who were able to express themselves said that they are cared for and felt that staff respect their privacy. Care staff were seen speaking to residents politely and in a friendly manner. A resident told us: “I feel that I am extremely well looked after by all the members of the home and I am very happy and completely satisfied with the care that I receive.” Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. The home provides varied social and recreational activities that provide interest and pleasure for the residents. Visitors are welcome and help to keep service users informed about the wider community. Meals have improved offering both choice and variety for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities taking place in and outside the home continues to vary to help meet the needs of people living in the home. A resident and their relative were seen playing a card game and some residents played scrabble after lunch. Activities are promoted through activity news sheets, which are distributed to residents and displayed in the home. The Activity Organiser was working in the home on the day of inspection. A resident told us that the “…activities organiser is good.” Relatives, friends and other visitors are encouraged to visit throughout the day and maintain contact and involvement in the care of their relative. Visitors were observed to visit the home at the time of inspection. Conversations were Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 15 held with a number of relatives showed us that they were very positive about the quality of service provided in the home. Times of visiting were varied throughout the day and there were no restrictions. Some visitors were staying with their relative throughout the day and night due to deterioration in their health. Residents told us that the meals had improved and the cook was very good. A comment in a resident questionnaire said, “The new chef ‘X’ is excellent. When he is not on duty, the meals can be variable in quality and cooking!” Another resident expressed concerns that due to a medical condition they told the home the type of foods that they could not eat but feel that no attention has been paid to their request. The cook served the meals this helped the process to be more orderly and helped in the presentation of food. There was a choice of two meals for the main course at lunchtime, pasties or fish with potatoes or chips and vegetables. Residents were also offered a choice of about six desserts. Condiments were available salt and pepper, vinegar and sauces. Residents were able to request something different if they did not like the meal being offered. The hot trolley was seen to be clean. Residents are able to sit in the dining room to eat their meals. There is also a smaller dining area in the reception area of the home where a small number of residents sit and eat their meals. This is not private at all times as the front entrance to the home opens into this area. The inspector had a meal with some of the residents sitting in the main dining room. The meal was tasty and residents were openly heard to speak up and compliment the food. A member of staff said “…since the new cook was appointed there seem to be less complaints about the food, he is very keen to encourage poor eaters by cooking special meals.” The system of preparing soft meals to far in advance before staff were ready to support residents to eat their meals had stopped. Staff took residents meals to them, as they were ready to help them to eat. Care staff were observed to provide discreet assistance to residents who needed support and were very attentive to the needs of all residents while they ate. Bromson Hill Nursing Home DS0000062186.V374280.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 Quality outcomes are good. Complaints are investigated and ongoing training for staff related to adult protection supports the rights and protection of residents from abuse, which increases their feeling of safety and quality of life in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors in the home. Relatives spoken with said that if they had any concerns they would speak to the manager. There have not been any complaints received by the Commission since the last inspection. Residents told us “I leave complaints to my son or daughter-in-law to explain.” A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that staff had attended recent adult protection training sessions and staff were able to confirm that they had received training. Residents looked comfortable in the home and comments received through conversation with people using the service expressed that they felt safe in the home. The home has not had to make any referrals through adult protection procedures. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. The environment is maintained and adapted to support residents in having a positive experience of living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The main redecoration and refurbishment in communal areas has been completed. Some work continues to complete the re-decoration programme in resident’s bedrooms. Residents have access to the main lounge for sitting and being comfortable and the separate dining area is now in use. A resident told us: Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 18 “The interior decoration carried out this year has improved the appearance. Still some work outstanding eg cushions in main dining room (perhaps just dress curtains) some carpets need replacement etc.” Observation of equipment and aids used to assist residents in their mobility and ease of access around the home has been reviewed and the equipment replaced as necessary and is clean. An example is the replacement of hoists used in the home. The re-decoration programme has helped resident’s bedrooms look bright, clean and furnished with appropriate furniture, which helps the home to maintain its character. Some bedrooms had been personalised with items of residents own furniture, pictures and ornaments. This made the bedrooms look homely and helped residents to feel comfortable. Resident’s have access to en suite facilities, which consist of a toilet, and sink. At the last inspection the bath on the first floor was out of order. This had been refurbished and the bath and toilet were working and the bathroom was clean. Observations in the laundry area showed that the room was organised to demonstrate the system for managing clean and soiled linen or clothing. Designated laundry staff are employed. Procedures carried out currently ensure that staff follow the procedure for the home related to the prevention of cross infection. It was very positive to note that improvements had been made in the kitchen. Previous inspection visits showed that there were poor practices carried out. The kitchen and kitchen storage areas were clean, the hot trolley in the kitchen had been removed and surfaces used to prepare food were clean. Bins were appropriately placed so as not to cause an obstruction. The storage of food in the fridge and freezers showed that they were appropriately secured and labelled to show the date and time they were opened. The previous poor practice of pre-cooking foods a week or more before they are due to be eaten was not seen. Records of temperatures of food served and received in the home were recorded. Records show that fridges and freezers were clearly identified and temperatures maintained were within acceptable levels. Cleaning records were also completed to meet the procedures set in the home and to meet food hygiene standards. The improvements seen in the kitchen will help to protect people who live and work in the home from the risk of harm to their health due to cross infection. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is adequate. Information related to the training and recruitment of staff ensures that skilled staff are available to support meeting the care needs of residents. The number of staff on each shift continues to present concerns for people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files for three members of staff were examined, staff were very receptive and spoke well of the changes made in the home since the appointment of the new manager. Duty rotas for a four-week period was examined these show that the manager is supernumerary, which is good practice. This allows the manager time to manage and monitor practices in the home. Speaking with staff they appeared happier and moral had improved. Duty rotas examined, talking with the manager and information from staff show that staffing levels have improved. Residents and their relatives expressed concerns at the last inspection visit about the shortage of staff in the home. These concerns have been expressed again in questionnaires although not as strongly as previously. One resident told us that they “…accept that the exceptions on occasions due to short staff etc cannot be Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 20 helped. I know the staff always try hard in these circumstances.” Another resident said “The staff are very good and I am very happy here.” Other concerns related to staffing involved people living in the home who rely heavily on staff to help them meet their physical, personal and health needs. A resident told us “I need to be helped with my eating and drinking as well as my physical needs. Sometimes I am hungry and feel that I am kept waiting too long for the attention I need, but I do try to be patient.” One resident and their family told us that staff don’t have much time to sit with them and talk saying that “Staff at the home are friendly and polite, but often too busy to engage in conversation at any useful length.” The personnel files of three recently recruited staff members were examined and they contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable elderly people living in the home. Staff training records demonstrate that staff complete an induction programme and receive mandatory training in Health and Safety, Infection Control, Fire Training, Moving and Handling, Abuse Awareness and Food Safety. Staff felt that the induction covered everything they needed to know. Staff told us that training opportunities had improved. There was also evidence that both nurses and care staff had attended training related to the people that they care for. Examples of these include dementia care, management of falls and prevention of pressure sores. Attending training related to the conditions and care needs of residents living in the home is good practice. Attending specialised training will ensure that staff have the appropriate skills and up to date knowledge to be able to carry out their role in meeting the care needs of people living in the home. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. The overall management approach in the home promotes and protects the health, safety and welfare of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager for the home was present at the inspection. The manager previously worked as the deputy manager. She was knowledgeable about the care and well being of people living in the home. Observations made indicate that the manager is approachable and has good interaction with residents, relatives and staff. Visitors to the home stated that they found the managers and other nursing and care staff approachable. A resident told us: Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 22 “There have been ups and downs in terms of management over the last twelve months but currently the situation has stabilised Pauline (acting manager) and now Maggie (current manager) are doing a great job.” All staff working in the care home, which includes nurses, care staff and ancillary staff were more enthusiastic at this inspection visit about working at Bromson Hill. Staff told us that they feel they are listened to more and are involved in the running of the home. There are clear lines of accountability discussions with residents, relatives and staff demonstrate that they are aware of who is who in the homes and their responsibilities. Staff told us that things have improved “Since the appointment of the new care home manager the atmosphere seems better, I feel we all work well as a team and support each other.” The home’s Quality Assurance file contained evidence that audits are carried out on the services provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress. Residents and relatives meetings are held and the outcome used to support improvements in the home. The personal monies of people living in the home are kept securely in separate bags and accurate records of income and expenditure are available. The records of the four residents followed through the case tracking process where asked for. Monies and records available show that balances are accurate and auditing is regularly carried out. Records examined include maintenance, contracts and servicing documentation for electrical equipment, gas, clinical waste and all other services supplied to the home. Resident aids and equipment have also been serviced this includes hoists seen in use during the inspection visit. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 24 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 OP27 Regulation 18 Requirement Staffing levels must be reviewed to ensure that sufficient numbers are on duty at all times. Attention must be given to meeting the full care needs, which includes the social and psychological needs of people with high dependency needs. This will help to make sure that the quality of their daily life is a positive experience. Timescale for action 30/04/09 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 An appropriate ‘End of Life’ care plan should be developed and written with the resident and their family members or their representative. The plans should contain details of the care the resident wishes to receive during the period leading up to their death and after. This will ensure that they will be treated with dignity and respect at a very sensitive time. DS0000062186.V374280.R01.S.doc Version 5.2 Page 25 Bromson Hill Nursing Home 2. OP31 An appointed manager for the care home should forward an application to be considered for the role as Registered Manager for the home. This will help to make sure that people live in a home that is well led and managed in a way that puts their best interests at the centre of the organisation. Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bromson Hill Nursing Home DS0000062186.V374280.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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