Care Home: Brunswick House Nursing Home

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What the care home does well A number of the staff have worked at the home for a long time, which results in continuity of care for the people who use the service. The home rarely has to use agency staff as they have their own bank staff or the staff cover any shortfalls themselves.At the inspection people who use the service, visitors and staff all felt the standard of food provided is very high and alternatives are always provided. All staff have received training in dementia care to be able to meet the needs of the people who use the service. The home has exceeded the recommended 50% of care staff with and working towards the NVQ 2 qualification. What has improved since the last inspection? The home has reviewed the medications systems used to ensure safe systems are in place and to reduce any potential risks to people who use the service. The Registered Manager has devised a quality assurance system that includes obtaining the views of people who use the service and relatives. Monitoring systems are now also in place. All requirements issued at the last inspection in relation to the environment have been addressed. The Registered Manager is undertaking a diploma in palliative care to work along side the Gold Standard `End of Life` pathway. What the care home could do better: The Registered Manager has a plan in place to review the documents used for care planning to ensure they are more person centred and able to demonstrate the involvement of the person or their representative. A robust recruitment procedure must be put in place to ensure all the required checks are undertaken prior to the new member of staff starting work at the home. CARE HOMES FOR OLDER PEOPLE Brunswick House Nursing Home 119 Reservoir Road Gloucester Glos GL4 6SX Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 13:00p 20 & 22 November 2007 th nd 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 Brunswick House Nursing Home DS0000058304.V344160.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. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brunswick House Nursing Home Address 119 Reservoir Road Gloucester Glos GL4 6SX 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) 01452 523903 01452 312033 Buckland Care Limited Mrs Susan Gough Care Home 46 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (46) of places Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named service user with Dementia under the age of 65 years. To be removed when the service user either leaves the home or reaches the age of 65 years. 14th November 2006 Date of last inspection Brief Description of the Service: Brunswick House provides accommodation for older people who require personal or nursing care. At the time of the inspection the home provides care for females only, however this may change if the home is not able to maintain its occupancy levels. The home also provides dementia care for a set number of people, but this is only personal care (not nursing dementia care). This group of people are integrated into the main home. Situated in a residential area on the outskirts of Gloucester City, the bus routes are on the main road, which is approximately quarter of a mile away. There is a Church of England church on this main road and in the other direction, about the same distance, a provisions shop. The house has been extensively extended and accommodation is provided over three floors. There is a passenger lift and two chair lifts installed on the shorter staircases. The home provides ample communal lounge and dining space. There is a mixture of assisted and unassisted bathrooms. An attractive courtyard garden can be viewed from a seating area within the home. The home has a copy of their Statement of Purpose and Service Users Guide on display in the main entrance. The current, self-funding range of fees is £550.00 to £650.00 per week. The RNCC (Registered Nursing Care Contribution) or “Free Nursing Care Contribution” is deducted from this amount. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection over two days in November 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The Registered Manager was available during the inspection as were other members of the home team. A total of 27 standards were inspected. People who use the service where able were spoken with to ascertain their views on the care and services provided. Surveys were sent to relatives/representatives of the people living at the home prior to the inspection to obtain their views. The comments received from the surveys returned and from speaking to people during the inspection have been used in the report. The Registered Manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings was given on completion and were received in a constructive and positive way by the Registered Manager. One requirement has not been complied with since the last inspection. On this occasion the timescale has been extended as indicated in the requirements made. However, unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement action to secure compliance. What the service does well: A number of the staff have worked at the home for a long time, which results in continuity of care for the people who use the service. The home rarely has to use agency staff as they have their own bank staff or the staff cover any shortfalls themselves. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 6 At the inspection people who use the service, visitors and staff all felt the standard of food provided is very high and alternatives are always provided. All staff have received training in dementia care to be able to meet the needs of the people who use the service. The home has exceeded the recommended 50 of care staff with and working towards the NVQ 2 qualification. 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. Brunswick House Nursing Home DS0000058304.V344160.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 Brunswick House Nursing Home DS0000058304.V344160.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): 1, 2, 3 & 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people and their representatives have information available to them to be able make a decision about whether this home is right for them. Their needs will be assessed and confirmation given that they can be met. EVIDENCE: The homes Statement of Purpose and Service Users Guide were not examined in detail at this inspection as the homes AQAA (Annual Quality Assurance Assessment) stated the they want to make it more ‘user friendly’ by adding photographs. The home are still working on this but the Registered Manager said they have changed the positioning of these guides in the main entrance to make them more prominent to visitors. At the last inspection the home was required to identify how they demonstrate to people who use the service who are eligible to receive “RNCC or Free Nursing Care”. The home has chosen to do this on their invoices and to make Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 9 sure it doesn’t cause confusion consideration should be given to adding a minus symbol to this amount. The Registered Manager was happy to do this. As the home is also about to review their terms and conditions consideration should be given to ensuring they meet an additional Regulation that came in to force last September which requires care homes to describe how other services not provided in the fees can be accessed and paid for and if this would be any different if the fees were paid by another source. The pre admission assessment for one person who has recently moved into the home was seen. This assessment was completed prior to the person moving into the home and contained details of their needs. Evidence was seen of the letter sent by the Registered Manager detailing how the home can meet their assessed needs. A relative to a person who uses the service said they had visited the home prior to their relative moving in and they are very happy with the choice of home. Standard 6 intermediate care does not apply to Brunswick House Nursing Home. Brunswick House Nursing Home DS0000058304.V344160.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, 10 & 11 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs, however these are not always recorded. The principles of respect, dignity and privacy are not always put into practice by all staff. EVIDENCE: Although this outcome has been assessed as good for people who use the service there are shortfalls in the care planning system, which require improvement. The Registered Manager was able to demonstrate the written plan they have in place to implement to ensure they meet the shortfalls identified. This plan needs to be introduced as a priority. The care of three people was examined in detail and this included the person who was recently admitted to the home. The care records for these three people were read and the person where able was spoken to and a member of staff. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 11 All but the new person had reviews of their initial assessment. The home uses ‘Essential Care Component’ and the ‘Traffic Light’ systems as part of their ongoing assessment of needs. However none of the Essential Care Components were signed or dated when devised. All three people had individual care plans devised but they were not always based on their personal needs, however there was evidence that they had been reviewed. Ongoing records are also maintained. The home is using the Gold Standard ‘End of Life’ pathway and this includes using advanced care plans, which records their wishes. This is done in conjunction with their family/representative. Evidence was seen that people have access to external health professionals and during the inspection two GP’s were seen and a Community Psychiatric Nurse was visiting another person. Moving and handling assessments were seen for each person, however they were not dated or signed when devised so it was difficult to evidence if reviews had taken place. Also one person’s said they were on an air pressure-relieving mattress but in fact it was a static mattress. The Essential Care Component and Traffic light systems include assessments, which relate to health needs. No records of people’s weights were examined at this inspection but food and fluid charts to monitor nutrition were seen. Two relatives and two people who use the service were spoken to and all said they felt the care is very good and the staff are very helpful and nothing too much trouble. Medication systems used by the home were examined. Following the last inspection our Pharmacy inspector visited the home and the requirements issued were also followed up. All Medication Administration Records (MAR) were examined and no gaps in the recording were found. Records were seen for medication received, administered and returned via a designated clinical contract. Hand written entries on MAR were not always checked and signed by a second member of staff. Self-medication was not examined at this inspection. Care plans were in place for people who use ‘as required’ medication and the Registered Manager says these are reviewed monthly but this was not recorded. Audits were seen of medication systems used. An audit completed by external professionals also takes place and records were seen of these. Dates of opening were seen on several randomly selected liquid and packet medications. A number of people who use the service are taking controlled medication and these were checked against the records and all was correct. The Registered Manager confirmed that only qualified nurses administer medication and they receive training. A medication round was observed, at times it was noticed that the recommended best practice of ensuring the medication is stored securely at all times and the MAR are taken by the nurse to the person was not always Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 12 followed. The Registered Manager said they have looked at the best procedure for the home and have found that this is the safest. A written risk assessment must be devised to support this decision. Records are maintained of the medication fridge temperatures. The Registered Manager has reviewed and re-written the medications policy since the Pharmacy inspectors visit. Privacy and dignity was discussed with people who use the service and staff were observed interacting with people. On the whole the staff respected peoples dignity and privacy, however it was noticed on two occasions that members of staff took people to the toilet on a commode chair without a lid and both of these were during a mealtime. Visitors to the home were also present in one room. Whilst the outcome for the people involved was they were taken to the toilet the staff must use a wheelchair for safety and dignity of the people who use the service. Brunswick House Nursing Home DS0000058304.V344160.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 & 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to make choices about their life. A programme of activities is provided to meet people’s recreational interests. Links with family, friends and the local community are encouraged and maintained. EVIDENCE: The home has a designated person to provide activities for people who use the service on weekday afternoons. During the inspection a music and movement class was taking place and Holy Communion. On the day between the inspection a ‘clothes show’ took place and several people said they enjoyed it. The activities coordinator was seen to be providing one to one activities on one day and painting the nails of one person who was enjoying it. People said they are able to join in if they wish but several people said they like to make their own activities. A comment received on a survey sent to us prior to the inspection said that they do not know when and what is happening with activities. A poster was Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 14 seen in the front entrance advertising the planned activities for November and December. One person said they have the hairdresser weekly. One person was going to a day centre on both days of the inspection. One person still has their dog which is very much part of the home. Visitors to the home confirmed that they are able to come and go as they please and that the staff make them feel welcome when the come. Staff were seen to assist one person to their telephone at a certain time slot so they could speak to their family. Information about advocacy services is displayed on one of the boards in the main entrance. People who use the service said they are able to make decisions about their daily life and where necessary staff were seen to assist people. A number of rooms belonging to people were seen and they all had their own personal possessions on display. One of the cooks was spoken to about meal provision. The menus are devised every four weeks and this is done by the cooks based on the favourite meals of people who use the service. A list of people’s likes and dislikes and any special meals are in the kitchen. The home is able to cater for people who require special diets. Following a recent Environmental Health Department visit the home has been awarded ‘4 stars’. Alternatives were seen being offered to people who had requested a specific food item, however these are still not being recorded. Two meal times were observed and people were able to have their meal where they request it. The care staff serve the meal so they are able to monitor what people are having. Both meal times were seen as a sociable event and at lunchtime two relatives were visiting and they were able to assist their relative. Drinks and snacks are provided through out the day. People spoken to said they enjoy the food provided and this was backed up by the very small waste they have from each meal. Two relatives also said they felt the food was very good. Staff were seen to assist people discreetly and were always encouraging them to be independent. Two comments received on surveys sent to us prior to the inspection were; ‘breakfast and suppers don’t look appetising’ and ‘not enough fresh fruit’. The Registered Manager said that the cook normally takes fresh fruit around each day if it is not included in the pudding. The home has a menu board in the main lounge to inform people what available for each meal. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 15 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 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and visitors have access to a complaints procedure that would benefit from being more visible in the home and systems are in place to protect people from possible abuse. EVIDENCE: The home has both a concerns and complaints folders, however the home has not received any complaints and has investigated the two concerns received and these have been addressed. The home has a copy of their complaints procedure in their Statement of Purpose and Service Users Guide, which are on display in the main entrance to the home. Consideration should be given to displaying a copy of their complaints procedure separately from these guides in an accessible place in the home. A number of people who use the service and relatives were asked who they would approach if they had any concerns or complaints and they said the Registered Manager or the nurse in charge. The Registered Manager said that since the last inspection she and the deputy manager have both undertaken the one-day enhanced adult protection training. All staff have either completed the ‘alerters’ guide training with the local council or abuse training with another training provider. All new staff does this training as part of their induction. Staff spoken with confirmed they Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 16 have done training about abuse. Policies and procedures are in place for abuse ,whistle blowing and managing aggression. The Registered Manager is aware of the procedure for reporting any suspicions of abuse and the procedure for reporting staff to the POVA list. The Registered Manager is looking at undertaking training in the Mental Capacity Act shortly. Brunswick House Nursing Home DS0000058304.V344160.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, 22 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable and pleasant environment, however improvements to safety are necessary as these can potentially place people at risk. EVIDENCE: A tour of the environment took place with the majority of rooms belonging to people who use the service seen. All the requirements issued at the last inspection have been addressed. The Registered Manager said the home has a plan in place for redecoration and for continued replacing furniture. During the tour of the home it was noticed that some of ceiling lights appeared dim and the Registered Manager was going to look at this. One person’s room was found to be odorous, however the home is working hard to address this. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 18 People who use the service who were spoken with all said they liked their rooms very much. A comment received on a survey sent to us prior to the inspection said ‘the redecoration programme downstairs is visible’. A number of people who use the service have specialist equipment to include electric beds and the Registered Manager said the home has plans in place to provide more. The local Primary Care Trust provides some equipment. It was noticed on both days of the inspection that one person did not have protective bumpers over their bedrails. This must be addressed as this can place people at risk of entrapment. If the home has not done it they must complete risk assessments. On the second day of the inspection it was noticed that the domestic had left her cleaning basket unattended on the second floor corridor in the new extension. Cleaning chemicals were present in this basket. This must not happen as it can potentially place people who use the service at risk and the home must ensure they are stored securely at all times. Staff were seen wearing protective clothing when required and this was seen stored at places through out the home. Another comment received on a survey said ‘Cleaners are apt to skip jobs’. No issues were found with the cleanliness of the home during the inspection. Another person had commented that ‘Washing goes astray’ but no further comments about the laundry were received from people who use the service or relatives during the inspection. The laundry was seen and the Registered Manager said they have plans to redecorate this area. Infection control policies and procedures were not examined at this inspection. Brunswick House Nursing Home DS0000058304.V344160.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 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that they have sufficient numbers of staff with the required skills to meet the needs of the people who use the service. However lack of a robust recruitment procedure can potentially place people who use the service at risk. EVIDENCE: Although this outcome has been assessed as good for people who use the service there are shortfalls in the recruitment processes used by the home that must be addressed as a matter of urgency. The duty rotas were examined and discussed with the Registered Manager who feels the staffing levels meet the needs of the people who use the service. Ancillary staff are also available to assist the care staff. The Registered Manager is extra to the staffing numbers and she works mainly office hours. The homes Annual Quality Assurance Assessment (AQAA) says the home has only had to use agency staff once in 18 months as the Registered Manager explained the staff in the home are very good at covering any shifts and the home has it own bank staff. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 20 People who use the service and visitors to the home that were spoken to all praised the staff saying they are friendly, helpful and nothing is too much trouble for them. Staff who were spoken with said they all enjoy working at the home as they have a good team spirit. A number of staff have been working at the home for over 10 years. The Registered Manager said that eight staff have obtained the NVQ 2 in Health and Social Care and thirteen are working toward it. One member of staff is undertaking NVQ 3 award. Four personnel files of staff appointed since the last inspection were examined. The majority of the required checks were in place, however two files were found to have gaps in employment that were not explored or records made as to why they had gaps. One of these members of staff is from overseas and the home had not applied for a Criminal Records Bureau Disclosure check (CRB) or a POVAfirst check prior to them starting work at the home. The records of another member of staff indicated they had also started work at the home prior to the POVAfirst check being returned. The POVAfirst check and CRB must be applied for prior to any member of staff starting work at a care home and the POVAfirst check must be received by the home prior to them starting work. This poor practice can potentially place people who use the service at risk. The Registered Manager said she was not aware that staff from overseas who have a police check in their country need to have one in this country. She said she would ensure this does not happen again. One of these members of staff is a qualified nurse and a copy of their Nursing Midwifery Council pin number was not obtained. Photographs of staff are also required. The homes AQAA states that their induction training is provided by an outside company that meets the Skills for Care common induction standards. The Registered Manager also confirmed this and said the home is also registered with Skills for Care. At this training all staff are issued with booklets to work through. None were seen at this inspection. Evidence was seen of staff completing the homes induction programme. The induction training covers moving and handling, abuse, food hygiene and first aid. The home has started to record who the mentor is for new staff on their off duty. The Registered Manager said the home has a rolling programme for mandatory training and a random selection of training certificates were seen. The Registered Manager is looking to devise a training matrix for the home. She said all staff have completed training in dementia. The home is undertaking the Gold standard framework and training for both qualified nurse and care staff is planned in the areas of nutrition and wounds. The home is due to receive training from the Care Home support team. Brunswick House Nursing Home DS0000058304.V344160.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, 33, 35, 36 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent person supervises the management and administration of the home. A quality assurance system is in place to help ensure the home is run in the best interests of the people who use the service. EVIDENCE: The Registered Manager has been in post for four years. She is a qualified nurse and has completed the NVQ 4 management training. At the present time she is in the process of undertaking a diploma in palliative care. She keeps herself up to date with the mandatory training. People who use the service, visitors to the home and staff all said they could approach the Registered Manager if they had any concerns. Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 22 Since the last inspection the Registered Manager has devised a quality assurance system that includes obtaining the views of people who use the service and relatives. Audits are now taking place and records were seen for care plans, medication, health and safety, infection control, activities, kitchen and accidents. Meetings take place for people who use the service and notes were seen of the last meeting. The home has had one relatives meeting and they are looking to plan another one. Staff meetings also take place and records were seen for some of these. The home does not store monies for people who use the service. A number of randomly selected staff supervision records were seen. The Registered Manager undertakes supervision of ancillary staff and qualified nurses and then the qualified nurses supervise the care staff. All staff have an appraisal each year. The homes AQAA contains details about servicing of some of the equipment used in the home and confirmation of this was seen at inspection, except for portable appliance testing. Checks relating to fire equipment were seen and fire training for staff is due this month. The Registered Manager said the local Fire Service has checked the homes fire risk assessment and the home has an evacuation policy. Checks were seen for water temperatures, which take place on a monthly basis. Brunswick House Nursing Home DS0000058304.V344160.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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A 3 X 3 Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes 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 OP15 Regulation 17Schedul e 4 (13) Requirement Timescale for action 31/12/07 2. OP22 13(4c) 3. OP26 13(4a) 4. OP29 19 The Registered Person must ensure that a record of food provided for residents is in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual residents (this is in relation to alternatives provided for residents outside of the menu choice). This requirement remains outstanding since the last inspection. The use of bedrails without 22/11/07 ‘bumpers’ can place people at risk of entrapment and the home must complete a detailed risk assessment of why they are not being used or ensure the staff put them in place. Cleaning chemicals must not be 22/11/07 left unattended in the home as this can place people who use the service at risk. New staff employed in the Home 15/12/07 must be subject to full recruitment processes prior to DS0000058304.V344160.R01.S.doc Version 5.2 Brunswick House Nursing Home Page 25 them starting work to reduce any potential risks to people who use the service. (This refers to a full employment history, together with a satisfactory written explanation of any gaps in employment. And a Criminal Records Bureau Disclosure and where applicable a POVAfirst check). 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 OP16 Good Practice Recommendations Consideration should be given to placing a copy of the complaint procedure in a conspicuous place, making it more obvious to people who use the service, relatives and visitors. This remains outstanding from the last inspection. Provide a March 2007 edition of the British National Formulary so that staff have up to date information about medicines they use. This remains outstanding from the last inspection. 2. OP9 Brunswick House Nursing Home DS0000058304.V344160.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Brunswick House Nursing Home DS0000058304.V344160.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. 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