Inspection on 16/06/10 for Bramble House

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

CQC found this care home to be providing an Adequate 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

Bramble House 17/09/08

Bramble House 20/09/07

Bramble House 13/11/06

Bramble House 19/06/06

Bramble House 25/10/05

Bramble House 25/04/05

Bramble House 26/10/04

Bramble House 02/06/04

Bramble House 16/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Random inspection report Care homes for older people Name: Address: Bramble House 96a & 98 Stroud Road Gloucester Glos GL1 5AJ one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Adam Parker Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Bramble House 96a & 98 Stroud Road Gloucester Glos GL1 5AJ 01452521018 Telephone number: Fax number: Email address: Provider web address: marcusgreen@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Ms Teresa Moss Type of registration: Number of places registered: Conditions of registration: Category(ies) : Forestglade Limited care home 29 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 29 The maximum number of service users who can be accommodated is 29. The registered person may provide the following category of service only: Care Home providing personal care only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following category: Dementia (Code DE) Date of last inspection Brief description of the care home Bramble House is situated on the outskirts of the City of Gloucester and is within easy walking distance of a local shopping complex. A previous building project has joined the original house with an adjacent house via a link corridor. There are four assisted baths and a shower within the home and there are fourteen rooms with en-suite Care Homes for Older People Page 2 of 11 Brief description of the care home facilities. The home has extensive gardens at the rear of the building including an orchard. Car-parking space is at the front of the home. Information about the service including Inspection reports are made available by the provider to prospective service users through the homes Statement of Purpose and Service Users Guide. Current fee levels were not checked at this inspection. Care Homes for Older People Page 3 of 11 What we found: This random inspection took place on one day in June 2010 and was completed by two inspectors one being a pharmacist inspector. The home was last inspected in September 2009. Before the inspection we received a number of survey forms that had been completed by people using the service. The home also supplied us with a completed Annual Quality Assurance Assessment (AQAA). This gave us information about the service such as where they thought they did well and areas that could be improved. It also gave us some numerical information called a Dataset. A tour of the premises was undertaken, all areas were found to be clean, fresh and well maintained. The laundry had cleanable floor and wall surfaces and hand washing facilities were available. We looked at the records for two people who had recently started using the service. The home had obtained information from the funding authority and health care professionals before they moved in and had undertaken full assessments of the persons needs. Care plans had been completed that covered a variety of assessed needs and had been written promptly after the person had moved into the home. In addition care plans had been reviewed on a monthly basis. However care plans could be improved if they contained more information specific to a particular resident. In a discussion with the activities coordinator it was evident that she had obtained this type of information through her work in the home and this could be used to produce more individualised care plans. A number of risk assessments were in place such as for moving and handling and for people at risk of falling. There were records relating to input from health care services and one care plan for managing a persons diabetes included guidance for staff on when to seek input from community nurses. Following a recommendation at the previous inspection the homes adult protection policy was examined. The specific contact details for relevant agencies had not been added to the policy which also contained some outdated information relating to contacting us. Staff recruitment was looked at. Examination of the files of recently recruited staff showed that robust recruitment procedures were in place with all the required information and documentation being obtained before a member of staff started work in the home. Following a recommendation at the previous inspection the record keeping around recruitment was looked at. This still needed to improve and a record should also be kept of the dates that references are received by the home as a clear indication that the correct sequence of recruitment procedures has been followed. The recruitment and selection policy was looked at, this did not include the need to risk assess any information found on an applicants Criminal Records Bureau disclosure which was raised at the previous inspection. Two members of staff were spoken to and they told us about the training they had received which was relevant to their role in the home. The issue of window restrictors was looked at again. In Squirrel Corner the original type of window restrictors were still in place and the home had not been able to have replacements fitted. In the meantime however residents in these rooms should be risk assessed to check if such windows present any possible risk to them. It was also noted Care Homes for Older People Page 4 of 11 that one of the windows was wide open in room 23 and this should also be subjected to a risk assessment. Although a number of security measures are in place it is still recommended that a risk assessment is carried out with regard to the security of the premises. Accidents and incidents had been recorded and where required, these had been reported to us. We received ten survey forms from people using the service at Bramble House, all completed with help from the activities coordinator. Nine indicated that the home was Always fresh and clean and one that this was Usually. One person commented I like it here very much and Ive been here a few years now. Another stated I like the food, my room, how clean it is here. another comment we received was When I pull the attendance bell there is always somebody there in minutes. Positive comments were also made about the food provided. The pharmacist inspector looked at how medicines are handled in the home. We saw that improvements have been made since the last inspection so that people can be more confident their medicines will be given safely. Records for the administration of medicines had generally been completed accurately. Medicines storage has been moved and steps taken to ensure they are stored at a suitable temperature. People living in the home are registered with a number of local doctors surgeries. Medicines are supplied to the home using a monthly blister pack system. Only one person living in the home is able to look after one of their own medicines, a risk assessment is in place to make sure that this is safe. All other medicines are looked after and given by staff. Staff told us that recent training had been provided by their pharmacist. At the time of the inspection most morning medicines had been given but two peoples medicines were given later because they were still in bed. Staff told us that when they gave medicines they prepared them in the clinic room where it was easier to concentrate and then took them in a medicine cup to the person. Consideration needs to be given to the risks of carrying medicines round the home in this way and whether there are other, more secure methods, for example using a lockable carrying case. A medicine policy, which describes the medicine system in the home is kept with the medicines administration record sheets so that staff can check the safe procedures to use. The pharmacy provides printed medicines administration record sheets each month for staff to complete. Systems are in place to allow medicines to be audited to check that they have been given correctly. We checked four records and found they were all correct. We checked several blister packs, these had only been started three days previously but showed that medicines had been given as prescribed. We checked last months administration records and those recently started. No gaps were seen in the records but in a few cases when a medicine had not been given, a reason had not been recorded. If medicines that are prescribed regularly are not given a reason must be recorded. If medicines are given when required this must be agreed with the doctor and the prescription amended. Care Homes for Older People Page 5 of 11 Four care records we looked at would benefit from more information for staff to help them to give medicines safely and appropriately. For example one person had appropriate information about giving some medicines concealed by food or drink but we saw that it was different medicines which were now given in this way. Staff confirmed with their pharmacy, during the inspection, that these medicines were suitable to be given in this way. This information needs to be regularly reviewed to ensure that it remains appropriate. Records showed that another person often refused to take their medicine. This person had been visited by their doctor and community nurse. However it was not clear what action, if any, staff needed to take if the person did not wish to take their medicines. Another person was prescribed a medicine at night when needed, to treat anxiety. We saw that the prescriber had confirmed the dose to be given. However there was no care plan in place for managing this persons anxiety and no written guidance about signs that this medicine was needed. This means that the medicine may not be given in a consistent way. Records are kept of the receipt and disposal of medicines in the home. We saw that disposal records are kept on loose sheets of paper and recommended that staff discuss this format with their pharmacy. It is important that these records would be accessible if there was a need to look at them in future. Suitable secure storage is available for medicines. A medicines fridge is available. Records of the room and fridge temperatures show they are suitable for storing medicines. Suitable storage is available for controlled drugs, which need additional security. A register is used to record the safe use of these medicines. We found one discrepancy with this record where the use of a medicine had not been recorded so the balance was incorrect. Also the dose had been changed and it was not clear from the administration record how much had been used. A record made in the communications book at the time confirmed that a doctor had visited and changed the dose. Staff must ensure that they receive written confirmation from the prescriber if the dose of medicine is changed. This is to ensure that people are given the correct dose. This is particularly important for medicines controlled by the Misuse of Drugs Act 1971. What the care home does well: The home has a good system in place for assessing the needs of people who may use the service and working to meet their health and personal needs. Care plans are written on the same day that a person is admitted to the home. There have been improvements to the way that medicines are handled in the home in relation to safe administration,recording and storage. The home provides a clean and well maintained environment that has been adapted to the needs of residents. Pictorial signage was in use to help residents to find such areas as the garden and the toilet. Robust recruitment procedures are in place to protect people using the service. Accidents and incidents are recorded and reported to us when required. Care Homes for Older People Page 6 of 11 Requirements made at the last key inspection of the home in 2009 were checked and the home had complied with these. What they could do better: 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 set out on page 2. Care Homes for Older People Page 7 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 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, 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 2 7 9 Residents care plans should be more individualised. Where people receive medication covertly or on an as required basis this should be accurately reflected in care plans and care records. Where medication prescribed to be given on a regular basis is omitted then the reason for this must be clearly recorded on each occasion. Serious consideration should be given to how medicines can best be transported securely around the home to minimise any risk to people living in the home. Update the adult protection policy to include the specific contact details for relevant agencies and remove out dated information. Record keeping around recruitment should improve with accurate records kept including a record of when written employment references are received by the home. The staff recruitment and selection procedure should reflect the need to conduct a risk assessment on any information Page 9 of 11 3 9 4 9 5 18 6 29 7 29 Care Homes for Older People 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 on an applicants Criminal Records Bureau disclose. 8 38 Risk assessments should be carried out with regard to the residents on the first floor of Squirrel Corner and in room 23 with regard to the type of window restrictor in use in these rooms. A risk assessment should be completed regarding the security of the premises. 9 38 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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