Care Home: Brunswick House Nursing and Residential Home

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What the care home does well The Manager was appointed in September 2009 and provides very good leadership and day to day management. Staff and residents said that she is approachable and that she knows them all individually. The Manager is proactive about putting the needs of the residents first. Despite difficulties over the last year the staff remain committed to providing a good service to the residents. The residents enjoy their meals and are always offered a choice at every mealtime. The chef works hard to ensure residents nutritional needs are met as well as ensuring residents enjoy their meals. What has improved since the last inspection? The Manager has made great improvements since she has been at the Home. The staff said that they feel well supported and that they are benefiting from the Manager clarifying everyones roles and responsibilities. After an initial setback, the management company have increased the staffing levels at the Home and the staff are now able to meet the residents needs more effectively. Staff and residents said that the staff now have more time to spend with residents and that call bells are not taking so long to be answered. The standard of care provided to the residents has greatly improved. The residents are treated with respect and dignity. There has been a big reduction in complaints, both to the Manager, and to the Commission over the last six months. Two activity co-ordinators have been appointed and there is now a range of activities taking place at the Home, including some at weekends. Residents told us that they really enjoy these. The outstanding accommodation issues relating to health and safety have been addressed. The lifts are now all working. New carpet has been laid to one of the main staircases. Fencing has been provided to ensure a secure garden. The domestic hours have been increased and the Home is now a lot cleaner. Staff are receiving a lot more training and said that they really appreciate this. The Manager has moved her office downstairs so that she is much closer to residents and staff. Everyone who spoke to us said that this is a positive move. What the care home could do better: There are still some outstanding issues relating to the accommodation that need to be addressed. For example, some of the bathrooms need to be updated. Training needs to continue to be provided to the staff team. There had been a real lack of training over many months and so it will take some time to ensure that all staff have received updated mandatory training as well as training about issues specific to individual residents. The management company are currently recruiting a deputy manager which will strengthen the management team and relieve some of the workload from the Manager. Senior staff need to attend leadership training so that they are more able to provide effective supervision/leadership to the care staff. Key inspection report Care homes for older people Name: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lella Hudson     Date: 2 7 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Brunswick House Nursing and Residential Home 81 Bacton Road North Walsham Norfolk NR28 0DN 01692405818 01692404423 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.brunswick-house.co.uk Brunswick House Care Home Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Brunswick House is a care home providing personal care and nursing care for up to seventy-five people. The Home is located in the town of North Walsham and is close to all local amenities. Brunswick House is a large detached property on two levels and stands in its own grounds with an extensive parking area. It is divided into three units: Grant Hadley, the first floor of Brunswick and the ground floor of Brunswick. The Home provides nursing and residential care. The home also has a day centre in the grounds. The weekly fees are currently between £555 to £730 and are agreed dependent on individual residents needs. Please contact the Manager for up to date information Care Homes for Older People Page 4 of 25 Over 65 0 75 10 0 1 0 1 1 2 0 0 9 Brief description of the care home about fees. In October 2009 the Home went into administration and is now being run by the administrators. They have appointed a management company to oversee the management of the Home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains information gathered about the Home since it went the Key Inspection in September 2009 when the quality rating was assessed as being Poor. The Home went into administration in October 2009 and this remains the situation at the current time. The administrators have appointed a management company to oversee the management of the Home. We carried out a Key Inspection in December 2009 at which time the quality rating remained Poor. We carried out a Random inspection in March 2010. This Key Inspection was carried out on the 27th April 2010 by two Inspectors. The quality rating has improved to Adequate. During our unannounced visit we spoke to staff, residents, relatives and the Manager. We looked at records and were shown around the accommodation. There were 47 residents living at the Home at the time of this visit. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: There are still some outstanding issues relating to the accommodation that need to be addressed. For example, some of the bathrooms need to be updated. Training needs to continue to be provided to the staff team. There had been a real lack of training over many months and so it will take some time to ensure that all staff have received updated mandatory training as well as training about issues specific to individual residents. Care Homes for Older People Page 8 of 25 The management company are currently recruiting a deputy manager which will strengthen the management team and relieve some of the workload from the Manager. Senior staff need to attend leadership training so that they are more able to provide effective supervision/leadership to the care staff. 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. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 organisation provides written information about the service provided at the Home. Effective pre admission assessments are carried out prior to residents moving to the Home. Evidence: The organisation have updated the Statement of Purpose to reflect that the Home is currently in administration and also now includes the name of the Manager. The local authority have not been placing residents at the Home since October 2009 due to the previous quality rating of the Home being POOR. There have been some new admissions who are privately funded. Detailed pre admission assessments have been carried out for new residents. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is provided in a way which respects the residents privacy and dignity. The care plans have been much improved and now contain clear guidance to staff about how to meet residents needs. Evidence: During the Random Inspection that was carried out in March 2010 we were told by residents and staff that there had been a lot of improvements regarding the care provided to residents. Residents said that they were not having to wait so long for call bells to be answered. During this visit to the Home we were told by staff and residents that these improvements have been maintained. Staff said that they are always able to offer residents a bath when they want to have one and that they are able to answer call bells more quickly. Residents confirmed that this is true. One of the relatives told us that they are very happy with the care provided to their relative and that they would not have them living anywhere else. Care Homes for Older People Page 12 of 25 Evidence: The staffing levels have been maintained at a suitable level and the Manager has brought in a lot of improvements with regard to how the work of the nurses and care staff is organised. We looked at a selection of care plans and could see that these are now much more detailed and that regular reviews take place. The nurses told us that they currently have time to carry out the reviews due to the number of residents living at the Home. There were 47 residents at the Home on the day of our visit. We observed staff supporting residents throughout the day and only heard staff being kind, caring and respectful. There was lots of laughter within the Home and easy conversation between staff and residents. The Manager has liaised with the necessary professionals involved to complete a Deprivation of Liberty referral for a resident and the appropriate steps have been taken to limit the constraints placed on the resident. There is a need for staff to receive training with regard to providing care for residents with dementia. Very little, if any, training has been provided about dementia care. The Manager has been concentrating on ensuring that all staff receive updated training in mandatory subjects and does have plans to now extend training to other areas such as Dementia Care and specific illnesses/disabilities. The Manager also has plans about developing the way in which care is provided to ensure that it is done in a very person centred way. The role of the keyworker is being developed and there are plans for the nursing staff to attend leadership training. We looked at the medication system in use and could see that appropriate records are kept of medicines that have been ordered, received at the Home and administered to residents. Regular audits are carried out to identify any errors/problems at an early stage. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy their meals and their nutritional needs are met. Activities are now being provided on a regular basis and the residents appreciate this. Evidence: There have been a lot of improvements since the last Key Inspection with regard to the provision of activities. There are now two members of staff employed as activities organisers. Residents told us that they enjoy the activities and like to have something meaningful to do during the day. Activities are arranged at weekends also. The activity staff have spent time with residents finding out what they are interested in and what they would like to do. They are involved in fundraising for additional equipment. There are plans to improve the garden areas so that residents can spend time outside in the nicer weather. The residents continue to enjoy the meals provided at the Home. The chef is responsible for planning the menus and residents are always given a choice. During our visit we could see that residents can choose from a wide range of options at mealtimes. One of the residents requests a particular lunch every day and this is always provided for them. Care Homes for Older People Page 14 of 25 Evidence: The care plans contain nutritional assessments and we could see that fluid and food charts are completed when required. Mealtimes are now a more enjoyable time for residents. The Manager has made changes to the way in which tasks are carried out with regard to supporting residents with their meals. This means that staff are more focused on supporting residents in a respectful way without rushing. Residents have a choice about where they have their meals. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are taken seriously and action taken to address any issues. The Home has Safeguarding procedures and staff have started to receive appropriate training which aim to provide protection to residents from abuse. Evidence: The Commission have not received any complaints about the service since the last Key Inspection. The Manager said that she has received one complaint and that this was investigated but found not to be substantiated. We looked at the records relating to this and could see that there is a clear audit trail for the investigation. The Manager has booked training for all staff to attend Safeguarding training and approximately half the team had attended at the time of our visit. The Manager has a good understanding of the local Safeguarding procedures. Communication between the staff and residents/relatives has improved greatly over the last few months. The Manager is available on a drop in basis for one afternoon a week and is happy to meet with relatives at other times if needed. Residents told us that they can speak to staff now more easily as staff have more time to spend with them. They said that they are asked for their opinion about a wider range of issues now and so any minor issues are dealt with quickly. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 accommodation has been improved but there are still areas in need of updating. Evidence: Previously there had been complaints about the cleanliness of the Home and we had noted that the number of domestic staff on duty was not adequate for the size of the Home. However, during this visit we were told that the number of domestic staff on duty has increased. We also noted that the Home was clean and that the bedrooms are being cleaned much earlier in the day than was happening previously. The outstanding health and safety issues have been addressed. For example, new carpet has been laid to one of the staircases, the garden has been made more secure and the lifts have been repaired. The outside patio areas are in the process of being cleaned and the Manager has plans to improve these areas to make them more attractive for residents to sit in nicer weather. Some of the bathrooms are still in need of improving and there are plans for this to take place. There are still some areas of carpet that are worn/frayed and in need of replacing. The Home has several communal lounges and dining rooms and residents are able to choose where they spend their time. The majority of the bedrooms are ensuite and Care Homes for Older People Page 17 of 25 Evidence: residents are encouraged to personalise their rooms. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staffing levels are now sufficient to meet the needs of the residents. Appropriate recruitment procedures are in place. Staff have started to be provided with training. Evidence: There have been ongoing problems with the staffing levels within the Home but during the Random Inspection in March 2010 we found that the increased levels were adequate to meet the needs of the residents. During this visit to the Home we found that the staffing levels have been consistently provided and that the improvements in this area have been consistently maintained. During our visit we spoke to residents, staff and the Manager about the staffing provision in the Home. Staff all told us that they feel that they now have time to spend with residents rather than always being in a rush. They said that they feel that the residents are now able to get up and go to bed at times that suit them and that they are not waiting too long for call bells to be answered. This was confirmed through discussions wtih residents. Staff said that they feel that they now have a better understanding of their own roles and that of others within the staff team. They said that the Manager has ensured that there is clarity about staff roles and responsibilities. They also said that the Manager has reviewed and changed some of the ways that the shifts are organised and that Care Homes for Older People Page 19 of 25 Evidence: this has also led to improvements. We looked at a selection of staff files and could see that appropriate checks are carried out prior to staff starting work at the Home. The Manager has carried out a continuous process of recruitment since she started work at the Home and this is ongoing. During previous Inspections we identified that staff had not received appropriate training. During this visit, and at the visit in March 2010, we saw evidence that a lot of training has been provided to staff over the last few months. Training has been provided in a range of mandatory subjects such as moving and handling, Safeguarding, Fire Safety. The Manager has further dates planned to ensure that all staff have received mandatory training. She is liaising with the management company with regard to the provision of training. There is still a need to ensure that that staff also receive training about specific issues relating to individual residents such as dementia care. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 well managed in a way which puts the needs of the residents first. There are systems in place to review the service provided at the Home on a continuous basis. The Home continues to be in administration. Evidence: The Home went into administration in October 2009 and the administrators have appointed Healthcare Management Solutions Ltd to oversee the management of the Home. The current Manager of the Home, Lesley Horsfield, was appointed in September 2009 and is currently going through the registration process with the Commission. Mrs Horsfield has appropriate skills, experience and qualifications to manage the Home. She has made great improvements at the Home since she started work there. Staff and residents spoke highly of the Manager and gave us lots of examples of improvements that she has made. Care Homes for Older People Page 21 of 25 Evidence: Residents and staff told us that the Manager spends time with them and gets to know them individually. Staff told us that she is approachable and will deal with issues when they are raised with her. The Manager has moved her office downstairs so that she is nearer to residents and staff. All who spoke to us said that this is a positive move. The management of the Home is too much for one Manager to continue to do alone and the management company are currently recruiting for a deputy. The Home has an administrator but some of her hours have been changed as she covers reception during the afternoons as there is now only a part time receptionist. The Manager receives ongoing support and supervision from one of the management companys area managers. The need for senior staff to receive leadership training remains and the Manager has plans for this to take place. This will enable the senior staff to take a more active role in providing effective supervision to the care staff rather than the Manager trying to do it all. We looked at the records relating to money being looked after for one of the residents and could see that clear records are being kept with regular audits carried out. The Home has a range of systems in place for measuring the quality of the service being provided at the Home and there is evidence that action is taken to address shortfalls. We looked at a selection of health and safety records and can see that improvements have been made to protect the health and safety of residents. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 that the staff receive training 31/01/2010 which is relevant to their role To ensure that the staff have appropriate skills to carry out their roles effectively Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: 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). 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. 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