Inspection on 16/03/10 for Bradbury House

This is the latest available inspection report for this service, carried out on 16th March 2010.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bradbury House 18/04/07

Bradbury House 25/10/05

Bradbury House 20/04/05

Bradbury House 02/11/04

Bradbury House 29/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Bradbury House New Street Braintree Essex CM7 1ES     The quality rating for this care home is:   three star excellent 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: Jane Greaves     Date: 1 6 0 3 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 33 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) 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Bradbury House New Street Braintree Essex CM7 1ES 01376348181 01376327225 bradbury@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Greenacres Homes Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 21 The registered person may provide the following categories of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Bradbury House is situated in the centre of Braintree, with easy access to town centre shops and amenities. The home is registered to provide care to 21 Older People (i.e. over the age of 65), and is not registered to admit people with dementia. The home provides 24-hour personal care and support, and has appropriate equipment to meet the needs of people who have limited mobility (e.g. through floor passenger lift, mobile hoist, grab rails, assisted bathroom, etc.). The home is an older style property, decorated and furnished in a homely manner. People are accommodated in fifteen single rooms and three double rooms; all three double rooms have ensuite toilets, as do ten of the single rooms. Communal areas Care Homes for Older People Page 4 of 33 Over 65 21 0 Brief description of the care home consist of an open plan lounge area, a separate dining room and an outside patio area with seating. The home is owned by Caring Homes Ltd., and the registered manager is Nicola Leaney. The current fees range from £453.11 to £753.30 per week. These fees were correct at the Key Inspection of 2010, people considering moving into Bradbury House should consider obtaining more up to date information from the home. The statement of purpose and service user guide are available in the home on request. Care Homes for Older People Page 5 of 33 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: three star excellent 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 was an unannounced key site visit. At this visit we considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent seven hours at Bradbury House. During the site visit we looked around the premises to see if it was pleasant and safe for people, we looked at some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to visitors, management and staff. Prior to the site visit the manager had completed and sent us (CQC) the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. The views expressed at the site Care Homes for Older People Page 6 of 33 visit and in survey responses have been incorporated within this report where appropriate. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 18th April 2007. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The home is operating to a good standard and people are very happy with the service they are receiving. There are areas where development could continue such use of the rear of the Medication Administration Records to identify reasons of instances why people had not received their medication and to ensure that medication fridge temperatures are consistently checked to ensure that medicines are stored at safe temperatures. The managers AQAA identified areas where the home hopes to continue to develop with improvements. Examples included to support residents who wish to grow some vegetables i.e. tomatoes, herbs and strawberries, plans for a new shower/wet room and make other bathroom areas more homely with soft furnishings to residents taste, a local Beautician Shop, coming in to do free beauty treatments for the residents twice a month and young Fitness Instructors from the local Gym coming in to do gentle exercises with the residents twice a month. Care Homes for Older People Page 8 of 33 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 33 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 33 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. People can be confident that the care home can support them because there is an accurate assessment of their needs that they, or their reprsentatives, have been involved in. Evidence: The provider organisation, Caring Homes Limited, has a website where people can download a brochure all about Bradbury House and the services and facilities available at the home. A Statement of Purpose and Service User Guide were available at the home, these documents provided the information that people would need to decide if the home could meet their needs. Staff and families confirmed that people were invited to test drive the home so they could be certain it was the right place for them. The managers AQAA stated We encourgage one or more day visits prior to admission. 8 people responding to surveys prior to this inspection visit confirmed they had received Care Homes for Older People Page 11 of 33 Evidence: enough informaiton to help them decide if Bradbury House was the right home for them and that they had been given a contract confirming the homes terms and conditions. Relatives spoken with confirmed that they visited the home prior to the person moving in and felt that they had been given good information. People spoken with confirmed that the manager had visited prospective residents before admission to Bradbury House to undertake a thorough assessment of their needs. One professional we spoke with told us: It was a smooth process, the manager was easy with information and very co-operative. A relative confirmed that the manager had involved the family with the pre admission assessment and kept them well informed throughout the process. We looked at the pre admission assessment for a person that had recently moved into the home. This showed that the resident, their family and other professionals were involved in the assessment. Areas assessed included previous medical history, mobility, history of falls, breathing, eating/drinking, sleeping, continence, cognitive ability, personal hygeine support needs, skin integrity, hairdressing preferences, bathing preferences and night time routines and preferences. There was also a residents individual preference questionnaire completed as part of admission process addressing such topics as: Do you wish to choose who your key worker is? Do you wish to speak to CQC when they visit? What time do you go to bed? What time do you get up? Who visits you? Who calls you? Do you want your relatives to be invited to residents meetings? Do you have preferences regards to activities? etc All this information was gathered together to provide a basic plan of care to be further developed as the person settled into the home and was supported to explore more choices. The manager told us how one persons physical and emotional state had changed considerably in the two weeks from the pre admission assessment until moving into Bradbury House. The pre admission assessment had formed the basis of the care plans but these had to evolve organically as staff succeeded in encouraging the person to take fluids and food. The care plan and corresponding risk assessments for the person were noted to be really effective working documents, changing as the staff knowledge of the person grew. Care Homes for Older People Page 12 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that they will receive good and consistent care that meets their individual needs in ways that they would wish. Evidence: Many people living at Bradbury House were able to express their views about the care and support they receive. A sample of what people told us includes: I have never felt as contented in my life Ive never met such lovely people, everybody here respects me You couldnt have a better place, youve everything you want here Quite ordinary here, as it should be really I havent been ill since I have been here, but I think they look after us well I think they are kind to us, they look after our dignity well Couldnt be better here another person said I second that! On surveys everyone felt that they always received the care and support that they needed. Management and staff spoken with had a good awareness of peoples individual needs, and were seen to support people in their preferred individual routines. Care Homes for Older People Page 13 of 33 Evidence: People looked happy, comfortable and well cared for. A sample of the comments received from relatives included: I cant fault it, nothing is too much trouble Home from home My (Relative) loves it here If my (relatives) off colour they always ring us to let us know They are on the ball, calling the GP as soon as anyone is unwell and they keep us up to date the whole time. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs and meet them in an individual way we looked at three peoples care records in some detail. Care plans provided very clear advice and guidance for staff to follow to ensure that people received individualised care and attention to meet their personal preferences from personal hygiene to eating, drinking, sleeping and spiritual needs. For example, one care plan we looked at at that addressed a persons short term memory loss stated: Explain activities and routines during both the daytime and night. Use a kind and gentle tone, provide short and clear explanation at eye level with the resident. Keep their surroundings familiar including the layout of their bedrooms and the placement of photo frames and ornaments etc. (Persons name) loves to refer to their life history book. We saw that as far as possible residents or their families were involved in agreeing care plans, and had signed to acknowledge this. From discussion and records looked at, people received good health care at Bradbury House. People told us that they were always able to see a doctor when they needed to. We saw that assessments had been undertaken in relation to key areas such as tissue viability, nutrition and falls. Where assessments indicated a level of risk we saw that specialist equipment such as mattresses cushions or beds were put into place in a timely manner. Records showed that people accessed appropriate health care professionals to meet their individual needs. We observed care staff alerting the deputy manager to the fact that one person was particularly sleepy today. We observed another carer alerting the deputy manager that one persons legs were very painful today and causing them distress. The deputy immediately went to each person in turn and provided the attention they needed to be more comfortable. We overheard a resident requesting to be supported to go to the toilet. Staff offered the person the choice whether to walk with a frame and assistance or to be hoisted into a wheelchair if their legs were too painful for them to mobilise. The persons care plan clearly showed that this was the agreed protocol to encourage the person to be as ambulant as possible whilst ensuring they were kept as Care Homes for Older People Page 14 of 33 Evidence: comfortable as possible. Staff said the person would walk if they could but some days it was just too painful to do so. It was positive to see the way the staff team supported the person to be responsible for their own decision making. Medication was neatly stored in a locked trolley in the clinical room. Most of the medication was supplied in a Monitored Dosage System, where bottles and packets of medication had been supplied they were dated to indicate when they had been opened. The Medication Administration Records (MARs) were generally well completed with the exception of when a code had been used to indicate that medication had not been given or had been refused for some reason. The reason for these omissions had not been completed on the reverse of the MARs sheets. The staff were able to provide the information necessary however this needs to be recorded. There were individual documented protocols for all medications to be given as required (PRN) such as painkillers. There was information included within the protocol to inform staff how to read the non verbal communication for each person to ascertain if they were in pain. All PRN medications were clearly recorded on the MARs ensuring an accurate audit trail was maintained. It was clearly indicated on the MARs where creams and ointments were to be administered and when and the times for this were highlighted in a colour coded system to indicate morning, noon, evening or bed time. Controlled medications were stored in a locked cupboard within a locked room inside the managers office. We checked and agreed the controlled medications against the register. Insulin was stored in the fridge in the clinical room. Records were available to confirm that fridge was monitored to ensure medications were consistently maintained at a safe temperature. However this may not be done every day, the previous entry was for three days before this visit. There were no people living in the home wishing to self medicate at this time however every room had a lockable facility to support people to do so. Staff training records showed that 10 people in the home had received training to support them to administer medications safely. The training was provided by a local pharmacy and was due to be refreshed 3 yearly. Observation on this day showed us that the manager and staff did not shy away from discussing difficult or sensitive topics with residents, such as the death or serious illness of close relatives. There was a clear awareness and understanding that people needed support in all areas of their lives including their emotions and that emotional Care Homes for Older People Page 15 of 33 Evidence: ill being could manifest itself into physical ailments if not dealt with appropriately. The registered manager told us that when residents of the home passed away people were supported to attend the funerals of their friends and, in some instances, the wake had been held at Bradbury House giving all parties the opportunity to grieve. Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a fulfilling lifestyle, maintain contact with friends and family and enjoy good food. Evidence: The home had a dedicated activities person who was enthusiastic and energetic and actively explored new ideas to provide stimulation and engagement for the people living at Bradbury house. We arrived in the early morning on the day of this visit and the activities co-ordinator was already engaged in putting up decorations for the St. Patricks day celebrations the following day. Whilst they were doing this they were engaging residents in conversation and banter. Prior to this inspection site visit the manager had provided a great deal of documentary evidence to confirm the care and support provided at Bradbury House, it was clearly evident from our observations on this day that people enjoyed their life and that it really was like a home from home. The managers AQAA stated: Many outings throughout the year often accompanied by family and friends. Come Dine with Me evening organised for the families to get together informally, where the manager was cook for the evening, prior to this some Care Homes for Older People Page 17 of 33 Evidence: of the residents asked to be involved in preparations, i.e. peeling vegetables, helping to set the tables, as this was for their loved ones. It appeared that this gave them the feelings of still being Mum and providing food and fun, but the following day several family members who had attended Come Dine with me got told off by their Mums for drinking too much and being too noisy! Which appeared to also give much pleasure and hilarity to staff and families. Many of our residents have enjoyed activities, (i.e. 10 tenpin bowling) and foods (i.e. Chinese) that they have never tried before coming to Bradbury. A Chinese evening is now a regular event and something that they ask for. This year a wonderful repeat canal boat trip with champagne and lovely spread on the boat where every resident came and many of the staff, friends and families too. The manager told us she believed that Activities should be classed as one of the top components of care, need to keep people stimulated and comforted. This ethos was evident throughout the staff team. It was very positive to note that activities were not seen as the sole responsibility of the activities co-ordinator but all staff were continuously involved in providing stimulation as part of daily life including the cooks. There was a constant buzz of activity with staff adopting the butterfly approach, darting gently from one person to another making sure people were engaged with what was going on around them and had stimulation and interaction. We saw staff gently stroking peoples hands, tickling them and hugging them ensuring their emotional needs were being met. We saw staff looking at magazines with residents and discussing articles and recipes. We saw staff sitting with residents looking through their own personal photograph albums containing photos of many family members and memories of many happy and sad events creating milestones in their lives. One person we saw started to gently cry as she looked through this book of memories, the staff member sensitively hugged the person and gently talked about the memory that had evoked these emotions. The staff member did not leave the person until they were smiling and relaxed again. There were many photos in all the communal areas of the house depicting residents and staff enjoying time with each other inside the home with activities and celebrations and outside the home on various day trips and outings. Relatives told us how they had been involved in a quiz night at the home the previous week and were looking forward to the St. Patricks day party the day following this visit. They said they were encouraged to be involved and that they felt part of a larger extended family at Bradbury House. The service had a supportive ethos relating to risk assessment with the clear understanding that risk assessments were there to support people to take risks of Care Homes for Older People Page 18 of 33 Evidence: every day life not to remove risk carte blanche. For example one resident in excess of 80 years old enjoyed a snow ball fight this winter and all residents had the opportunity of attending a Bonfire night party at the home. The manager told us Can do anything if you make it as safe as possible. The managers AQAA included: Many of our residents said that they wished they could celebrate Guy Fawkes day, with a real bonfire and fireworks, but felt this would not be possible due to restricted space and the safety risks. They were all really delighted when this was achieved with a small bonfire in a brazier and fireworks, all overseen and supervised by a member of the fire brigade. All wrapped up warm with hot chocolate and marshmallow drinks, a real traditional 5th November with residents ecstatic at having sparklers one resident in particular commented You dont get better than this. The organisation had developed a corporate menu that the care homes in the group were advised to follow. Bradbury House used this menu as a base however continued to provide a menu according to their residents individual choices and preferences. The kitchen been refurbished since inspection of 2007 and was now light, bright and much easier to clean. We saw fluid and food intake charts for two people that were at risk of either skin tissue breaking down or malnutrition. Whenever staff offered people fluid or food it was being recorded what had been offered, how much they had taken or if it had been refused. We noted there was a constant round of hot and cold drinks provided for people throughout the day. Whilst the morning drinks were being prepared we heard staff saying X normally has milky coffee or tea but they may fancy a cup of hot chocolate, ask them!. This showed that people were not just given the same thing everyday but were consulted about what they fancied at that time. We saw a copy of the menu, it was varied and provided choices at each meal and there was a daily option available of a full English breakfast. In the homes annual quality assurance survey 93 of respondents indicated they found the meals to be very good or excellent. At lunchtime we observed people being offered a glass of sherry with their meal. Staff were seen providing gentle and discrete assistance to help people eat their meals. This was done by sitting next to the resident and providing help at the persons own pace. Staff wore appropriate protective clothing when serving the lunchtime meal for the residents. It was very positive to hear the staff asking the registered manager to don Care Homes for Older People Page 19 of 33 Evidence: an apron as she entered the dining area. One resident was not happy as she had peas on her plate and she did not like peas. We saw that the cook visited the person after lunch service to apologise for the peas! Care Homes for Older People Page 20 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely through practice in the home. Evidence: There have been no complaints made to the commission about Bradbury House since the previous inspection of this service in 2007. The manager told us of one complaint that been logged due to a leaking overflow causing a potential slip hazard during the icy weather. Many plumbers were involved before the root cause was found and the issue resolved satisfactorily. There was a folder in a communal seating area with many letters and cards of thanks from families and representatives of people living at the home, praising the staff and management for the care and kindness lavished on the people living there. In the homes recent annual quality assurance survey 100 respondents indicated they were aware of formal complaints procedure and were aware how to make a complaint and how to raise any issue with the management. Residents told us: Nothing to complain about Staff training records showed that all staff employed to work at the home had completed training to provide them with awareness of Adult Safeguarding Procedures, this training was refreshed annually. Care Homes for Older People Page 21 of 33 Evidence: Staff meeting minutes of January 15th 2010 included: Nikki refreshed with staff their knowledge of Adult Safeguarding Procedures and the referral process and had a very good feed back from staff and stated how pleased she was with their knowledge. Nikki gave scenario questions to staff in relation to Deprivation of Liberty (DOL)and all staff discussed these areas and got involved and came back to Nikki with the results. Nikki informed that they were correct at identifying the need for DOL referrals and how they would process them. The staff said they all found this helpful way of learning and informative. Nikki discussed the recent legislation around the Mental Capacity Act and asked staff to identify assessments process and the rights of people with and without full mental capacity and best interest care planning . Nikki again said she was pleased with staff knowledge and interest. Staff recruitment process were robust ensuring that all the checks necessary were completed before people started to work at the home. Care Homes for Older People Page 22 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and pleasant home. Evidence: The managers AQAA states under the section: How we have improved in the last 12 months: Refurbishment of kitchen with new wall tiles, flooring and wall cupboard, looks so much fresher and easier to clean, have achieved gold award from EHO this year patio/garden area improvements/sensory planting and trellis to improve privacy garden, swing, bird table, new gazebo and covers to protect residents from sun, new patio furniture and water feature. New carpets on upper landing, and pictures that residents have chosen on the walls. Individual bedrooms refurbished/decorated. New armchairs for lounge and bedrooms, new beds and headboards. Individual refurb and decorations chosen by residents. The managers AQAA continues with plans for improvement over the next 12 months as being: To refurbish downstairs bathrooms, with new comfy, warm atmosphere, less clinical. Replace and add some soft furnishings to some bathrooms to resident taste. To adhere to our plan of refurbishment to all areas of home where required and to continue upgrade bedrooms, replace carpets, when required or prior to a new admission. The homes annual quality assurance feedback from residents showed that 93 felt Care Homes for Older People Page 23 of 33 Evidence: that the cleanliness, tidiness and decor of the home rated as either very good or excellent. We looked around all the communal areas of the home, these were clean and tidy and in a good state of repair. The home is an older style property in the centre of Braintree town, there is no room for expansion and is therefore challenged by a lack of space for activities, storage of equipment such as hoists etc or a dedicated hairdressing salon. However, this meant the environment provided an intimate warm and friendly ambiance. Residents and relatives we spoke with said that the environment was the first thing that attracted them to the home as it provided a homely and inviting feel. We saw that suitable equipment to meet peoples needs was available, with appropriate moving and handling equipment and specialist beds, mattresses and chair cushions being in use where needed. The laundry room was clean, tidy and orderly. Staff training records showed that 19 of the 20 staff had attended infection control training so that they are aware of good practice that will keep people safe, this training was refreshed every three years. We saw that the home had infection control procedures in place and provided staff with appropriate personal protective equipment such as disposable gloves and aprons. Care Homes for Older People Page 24 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported for by caring and well trained staff. Evidence: We received positive comments about staff working at Bradbury House, these included: The nurses are very kind, They take such good care of us, and The staff couldnt do better for you. Staff surveys received, discussion and our observation on the day showed that staff were positive about their role and felt that there was good teamwork. Staff comments in surveys included: we work well as a team, we all enjoy our job, Good staff team work well together and because the care team works well together we all give very good care to our clients. External stakeholders were surveyed as part of the homes annual quality assurance process, the following comment was included in a returned survey: Staff want to be at work and have enthusiasm and dedication to give best care. Staff turnover at the home was relatively low with many staff having worked there for a number of years. The manager told us that agency staff were not used at Bradbury House, should the home be short of care staff she pitched in and worked alongside the care staff. She told us Paperwork goes on hold and I go on the floor. This meant Care Homes for Older People Page 25 of 33 Evidence: residents had a sense of stability and received care and support from people that they know and were familiar with. On the day of inspection twenty people lived at the home. We looked at staffing rotas and saw that staffing levels were being maintained at a senior or the deputy manager plus 3 care staff for day shifts and a senior and care staff member on waking night shifts. Additional support hours were provided for domestic, laundry, catering and residents activities. During the site visit there were always staff around in the communal areas to monitor, interact with, and assist people. People spoken with felt that staffing was sufficient to meet their needs. All residents responding via surveys indicated that there were always staff available when they needed them. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the managers AQAA and discussed at the site visit showed that all care staff working at Bradbury House had achieved a minimum of NVQ level 2. The service has therefore achieved over the 50 basic target and show a commitment to maintaining a well trained workforce, this should be commended. The previous inspection found that recruitment procedures and practice at Bradbury House were satisfactory and protected residents. We looked at the files of one member of staff who had been most recently started work at the home to ensure that good practice was being maintained. We saw that all proper checks had been undertaken to ensure people were safe to work with vulnerable people including Criminal Records Bureau checks and references. There was good evidence to show that residents had been involved with the interview process including direct quotes from residents documented such as Seemed very kind and Looked happy, a lovely smile. On completed staff surveys received all people said that their recruitment was carried out fairly and thoroughly. We saw from staff files that induction processes were in place to ensure that staff had a good initial introduction to the home and that they also undertook a range of training and the Skills for Care Common Induction Standards through a workbook. On Surveys, and in discussion, staff made positive responses to questions about training saying that training offered gave them the skills that they needed. Comments included: Excellent training and support and We have all the training we need to make sure we can provide good care to the residents. On surveys and in discussion relatives felt that staff had the right skills for the job. Comments included: The staff are brilliant! Cant find any fault, always kind, cheerful and show real love and affection for the residents and Staff always seem to know Care Homes for Older People Page 26 of 33 Evidence: what they are doing and provide the best care for (Persons name), we count ourselves lucky that we were able to get (Relative) a place there. Care Homes for Older People Page 27 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well managed home that has a person centred ethos ensuring the it is run in their best interests. Evidence: The managers AQAA stated: We aim to provide high quality personalised individual care within a safe environment whilst recognising the residents rights to continue to have their wishes and choices met, in a loving homely safe environment, to maximise their independence and ensure equality and diversity. All residents have a very in depth care programme, to ensure continuity of care. Bradbury House has a strong focus on supporting people to remain at the home until their death. Admit people with quite specific care needs and strives to do this with sincere compassion for those we care for whilst supporting their families. Many families have remained close friends and continue to participate in Bradburys activities. The ethos described in this statement concurs with our findings on the day of this inspection site visit. The manager was experienced and well qualified for the role. She was a Registered Care Homes for Older People Page 28 of 33 Evidence: Nurse, though not working in that capacity at Bradbury House, and had achieved the Registered Managers Award. Discussions with the manager during the site visit, and in training records, showed that she had attended training alongside the care staff team, to maintain her skills and update her knowledge base and continued to actively seek out new information relevant to the home and the care of the people living there. The manager demonstrated a person centred approach towards the staff employed to work at the home, she listened to staff and supported them both through work and personal lives. This helped staff to provide the same level of personal care and support for the people living at the home. Both staff and residents were very positive about the manager, finding her supportive and approachable. Comments in surveys included: We have an excellent manager who gives us all the support we need and more and Bradbury House has a fantastic reputation due to the manager. She is never too busy to talk to the residents or help out on the floor and She is always thinking of the residents and what will make their lives better. The manager had strategies in place to ensure that the quality of the service was kept under review and that people were encouraged to express their views about the service. We saw that regular staff meetings and residents meetings took place. The provider undertook regular quality reviews of the service. Surveys were sent out annually to residents, their relatives and other people involved with the home. We saw that the latest one of these had taken place earlier this year, a comprehensive report of results had been produced and these have been referred to in this report. Responses to surveys had been very positive. The AQAA completed by the manager prior to this inspection visit was adequately completed and showed us that management know what they need to do better, and how they can continue to improve the service for the benefit of the people living at Bradbury house. We looked at the facilities and procedures in place for looking after peoples personal monies. Monies checked were correct, with receipts in place for all transactions. This showed that people can be confident that if they, or their families, ask the home to support them to look after their personal monies, this will be done in a way that safeguards their interests. Records viewed showed that the staff team received regular supervision to support them in their roles and that annual appraisals were also undertaken. The managers AQAA identified that systems and services within the home were Care Homes for Older People Page 29 of 33 Evidence: monitored and maintained. A partial tour of the premises showed that the home seemed well organised and safe. The manager provided us with a copy of the provider organisations comprehensive Health and Safety/Maintenance Audit undertaken in February 2010. This demonstrated that the service had achieved 98 compliance. Training records showed that staff were kept up to date in core areas such as moving and handling, health and safety and food hygiene. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 31 of 33 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 1 9 The registered person should ensure that where prescribed medication is not administered for any reason this is correctly recorded. Accurate records need to be maintained of medication fridge temperatures. This so that people can be sure their medication is being stored at consistently safe temperatures. 2 9 Care Homes for Older People Page 32 of 33 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!