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Inspection report

Date of Inspection: 12 August 2013
Date of Publication: 18 July 2014
Inspection Report published 18 July 2014 PDF | 93.66 KB

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 12 August 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with staff and talked with commissioners of services.

Our judgement

There were not enough qualified, skilled and experienced staff to meet people’s needs.

Reasons for our judgement

When we visited Brandon House Nursing Home we looked to see whether there were sufficient staff with the right knowledge, experience, qualifications and skills to support people. Care was provided over two floors in the home. At the time of our visit there were 31 people living at the home, two of which were in hospital. 18 people were cared for on the ground floor and 13 people on the first floor. We saw that people living there had high dependency needs. Three people who used the service required “one to one” support from staff. Funding for this was provided by local health services which provided extra staff to those employed directly by the service. This meant they were additional to the home’s own staff complement.

The registered manager had resigned their position and left the service three weeks prior to our visit. The deputy manager had also left their position in that period. A manager from another home within the provider group had stepped in as Acting Home Manager. They had been in position for three weeks. The Quality Assurance Manager from the provider group was providing managerial support on a daily basis.

Prior to our visit we were aware a number of staff had recently left the home. At our visit we were told there were currently four nurses employed permanently, one of whom had recently tendered their resignation. There were 32 permanent care staff on full and part time hours. There were not enough permanent nursing or care staff to cover all the shifts. In the week before our visit the service had relied on agency staff to cover 200 hours on the rota. Rotas seen confirmed this level of agency cover.

We were told that during the day there was one nurse and four care staff on each floor from 8.00am to 8.00pm. From 8.00pm to 8.00am there were two carers on each floor and one nurse to cover both floors. We were concerned that due to the dependency levels of people within the home, there was insufficient nursing cover at night. One member of staff told us, "They used to have two nurses now they only have one for both floors. I don't think the care is safe, especially if there is an emergency such as a fall and everyone needs to assist." Another told us, "The situation has got worse. They want us to work alone sometimes but I cannot put my residents at risk. We've asked the agency but they are struggling to find nurses to backfill." The Acting Home Manager told us the provider had given authority the previous week for an extra nurse to be put on the night rota. This had not yet been implemented.

We arrived for our visit at 7.30am. The nurse on night duty with responsibility for all 29 people in the home was an agency nurse. During the day there was one nurse on duty who was employed by the service. Agencies approached had been unable to provide a nurse to cover the day shift. The employed nurse had managed to secure another nurse to cover the day shift at 9.00pm the night before.

During our visit we saw there was one nurse and four to five care staff on the ground floor. We observed that people's needs were being met in an unrushed manner.

We saw there were three care staff on the first floor. One of those staff was only on the rota to work until 2.00pm. This meant that from 2.00pm until 8.00pm there were only two staff on the floor. There was an agency care worker who moved between floors to provide extra cover when needed during the day.

During the afternoon we observed a member of agency staff and a member of care staff from the ground floor were the only staff on the first floor. Each nursing and care staff were allowed a thirty minute break during the afternoon. The care staff on the first floor had taken their break at the same time. Staff from the ground floor had been moved up to cover their break. The nurse was not on the floor. One person became agitated because the agency worker was an unfamiliar face. The other member of care staff shouted across the room in an attempt to calm that pe