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Inspection on 25/08/09 for The Browning Care Home

Also see our care home review for The Browning Care Home for more information

This is the latest available inspection report for this service, carried out on 25th August 2009.

CQC found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides care for four residents and is able to provide a good level of one to one support. Many of the homes residents have been with them for a number of years and are well known to the staff who care for them.The home provides a warm,comfortable environment for its residents. The home provides a fresh and varied diet for its residents, residents are given individual choice of what to eat. The home ensure that the health and wellbeing of its residents are being met by regular contact with health care professionals. Residents were seen to be treated with respect and dignity.

What has improved since the last inspection?

The home have provided a separate office space.

What the care home could do better:

The home would benefit from redecoration and upgrading of furniture and carpets. Staff need to be supported by the proprietor to do their job in a safe and secure manner. Staff need to attend up to date training to ensure they are aware of the current thinking in the field of residential care. Staff should be available in sufficient numbers to meet the assessed needs of residents.

Key inspection report Care homes for older people Name: Address: The Browning Care Home 19 Browning Road Banbury Oxfordshire OX16 9LA     The quality rating for this care home is:   two star good 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: Andy McGuckin     Date: 2 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 25 Information about the care home Name of care home: Address: The Browning Care Home 19 Browning Road Banbury Oxfordshire OX16 9LA 01295261496 01295701027 daveheather@ackrill8400.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Heather Ackrill care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Dementia - DE Date of last inspection Brief description of the care home Browning Care Home is the family home of the proprietors and is registered to provide personal care for up to four residents aged 65 years and over. The home has no registered manager at present. The home is on the outskirts of Banbury in a residential area with properties of a similar nature. The home has a combined lounge and dining room on the ground floor used by residents, and also by the proprietors. Bedroom accommodation is situated on the ground and first floors. The residents bathroom is on the first floor and has a washbasin, bath and toilet. A stair-lift is provided. The home now has a seperate office space. Fees charged for the service can be obtained by the Care Homes for Older People Page 4 of 25 2 0 Over 65 0 4 Brief description of the care home home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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: The inspection took place on a weekday morning. The inspection took into account the homes Annual Quality Assurance Assessment ( AQAA ). The AQAA is the homes opportunity to let us know what it has done to make improvements to the service and to inform the us what its plans are for future improvement. The AQAA also gives the service the opportunity to say what if anything may stop them from achieving these goals. The Commission undertook a site visit to the home to establish compliance with regulations. We looked a key documentation to ensure that the home was able to evidence that it was able to meet the requirements and standards contained in the Care Standards Act. We sought the views of service users, staff and visiting professionals. We spent time with the Proprietor to assess the current business plan and any plans they may have for the future. We spent some time with the member of staff on duty to gain a picture of what it is like to work there. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents with sufficient information on which to make an informed decision. A full and comprehensive assessment takes place prior to a resident being offered a permanent placement. Evidence: The home provides prospective residents and their families with a Statement of Purpose and a Service User Guide. These documents contain core information as to what the home is able to offer and what it is not. It details whom it can care for and whom it cannot. A copy of the homes terms and conditions of residence gives details on what each resident can expect from the home. A copy of the written contract and the Statement of Purpose are given to the resident on acceptance to the home. One new resident has joined the home since the last inspection. She were given the opportunity to visit and assess the home prior to admission. Visitors to the home are made welcome at all reasonable times, the home has no set Care Homes for Older People Page 10 of 25 Evidence: visiting times. A full assessment of the prospective residents is undertaken prior to admission and where appropriate interested professionals are included in this assessment. Service users are encouraged to visit the home for lunch and short stays prior to admission as a further assessment to ensure the home can meet their needs. The home does not provide an intermediate care service. All placements are reviewed shortly after admission to check suitability on both sides. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to tighten up on its recording systems especially around medication, but the home is able to meet the assessed health care needs of its residents Evidence: The inspector viewed all 4 residents files. These files contained the minimum information required but would inform someone new to the resident what is required. The size of the home and the small number of staff mean that residents are well known to all staff who see them on a daily basis. All residents have individual communication needs which are well known to staff who have developed methods of maximising residents participation in the life of the home. The home has a policy on the administration and dispensing of medication this was viewed and on the day of the inspection errors were found in the recording of medication given. Evidence was found that the medication had been given but had not been signed as given by the carer. I am satisfied that the medication was administered. I am confident that this was an oversight and the proprietor assured me that procedures would be tight ed up. All staff have had recent training in the administration and recording of medication. Files read evidenced that past history, likes and dislikes, family contacts, physical and Care Homes for Older People Page 12 of 25 Evidence: emotional history were all recorded and held on file. Visits to health care professionals are recorded on the daily record sheet. A daily and nightly record is kept of all relevant information or change to the persons plan. This information is used at handover to inform the incoming carers of any changes or information they need to know, Residents were seen to be treated with respect and their wishes and requests are met where possible. Residents were clean and well dressed. Residents have made known to either family or representatives their wishes following illness or death and the home is very clear that it will carry out these requests. The proprietor stated that the home is for life and they will care for the residents for as long as they are able or it is felt appropriate. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes residents are increasingly becoming more home based in their need for activities. The home respects this and offers activities within the home to suit the individual resident. Evidence: Evidence was found that the home had built up a picture of the residents prior to moving into the home and took into account there past history of work and family and also what leisure activities they were involved in. Where this could be met within the home it was included in the residents care plan. Activities are planned to the willingness and ability of the resident group and often by request are centred in the home. The home does have transport and where a resident wants to go out this can be easily arranged. Much of the entertainment and activity takes place on a one to one basis due to the small size of the home. Residents find this is a positive aspect of what the home has to offer. The home has a large screen TV and video. Games, jigsaws and books are all available. Papers are ordered daily. The home has a small friendly dog, which, is very well received by the residents and forms an important part in the homes life. Evidence was found at the inspection that the home encourages residents to maintain contact with family, friends and community. Relatives and friends are welcome to visit Care Homes for Older People Page 14 of 25 Evidence: the home and are made welcome. The home offers residents the chance to attend church and or religious services. Some services may be offered within the home by request. The home can cater for all residents taste in food individually on a daily basis. Residents are asked in the morning what they would like and this is then prepared fresh. The home uses fresh produce where possible. The home is very aware of the likes and dislikes of the residents, and have structured menus accordingly. All staff preparing food has the appropriate training and certification. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has no formal quality assurance systems and no formal complaints have been made since the last inspection. The home do however listen to comments made and take action on them. Evidence: Feedback from residents and their representatives indicated that, where there is cause for complaint or dissatisfaction, the home has formal processes for it to deal with them. The homes complaints procedure was viewed and found to be robust and up to date. The home ensures, where possible, that residents legal rights are protected and that residents are not exposed to any form of abuse. Staff have been trained in the identification of abuse and are aware of their responsibilities in this area. Service users legal rights are protected by the appointment of relatives or friends to act on the residents behalf. Where this is not possible an independent advocate would be appointed. The inspector was informed that one complaint has been made since the last inspection but also many letters of complement about the high level of care given to residents past and present were viewed. The home does not have a formal method of quality assurance but listens to residents and their relatives and would take appropriate action if residents were not satisfied with the service given. One complaint has been received by us since the last inspection. This complaint was concerned with the number of staff on duty and what would happen in an emergency. The proprietor was aware of the complaint and has addressed the issue with the complainant. Care Homes for Older People Page 16 of 25 Evidence: Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home would benefit from upgrading and redecoration but is maintained to an acceptable standard and provides a homely atmosphere for its residents. Evidence: The home is located on a small residential street of similar properties. The home has easy access and transport links to Banbury, Chipping Norton and Oxford. The home has four residential beds and a small sleep in room where the proprietor or the night time worker sleeps. All rooms have equipment to assist the residents mobility. There is a small communal lounge with a very large flat screen television. There are books games and cuddly toys in evidence, The home has a upstairs bathroom and downstairs shower both of which are in a reasonable condition. The kitchen is a domestic kitchen and is able to cater for the small number of residents it has. All equipment is working and is regularly maintained. The home is generally well maintained is very clean and on the day of inspection was free of odour. The home would benefit from an upgrading of carpets, furnishing and decoration. The garden is well maintained and is able to provide a quiet and peacefully area in which residents can sit in good weather. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst staffing levels could be considered very low. The current residents require fairly limited input due to their physical limitations. Staff in the home are able to call on backup if the need arises and this can be done quickly. Evidence: The home employs 3 care staff and has two carers who can come in at short notice. This means that there is only one member of staff on at any time. The proprietor confirmed that he was confident that staff could be brought in at short notice in case of an emergency. He felt that the current residents needs were fairly limited due to there decreasing mobility. He acknowledged that training, formal supervision and appraisal had not been taking place and that he spent less time at the home than in previous years. All staff working in the home attend an induction training which is provided by the proprietors initially and backed up with video training and external trainers. The induction covers a range of topics including Health and Safety and Protection of Vulnerable Adults. Staff employed in the home are experienced and have been with him for some time. Files evidenced that staff are being formally recruited and interviewed and that references are being taken up prior to staff starting work. Staff training and supervision need to be brought up to date. The proprietor confirmed that all new staff had references that were traceable back to source. Care Homes for Older People Page 19 of 25 Evidence: Staff are well known to the proprietors and meet with them on a daily basis. The inspector has required that training and supervision are reviewed and formalised as soon as possible. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not managed to the same level as it used to be. There is no registered manager in post at present. Evidence: There has been a significant change in the management of this home in that the registered manager who is also a co proprietor no longer works at the home. There is one carer on duty at all times with a back up in the form of the proprietor or one of two casual carers if required. Many of the residents have limited mobility and choose to stay in bed or to watch television. Which does not require much staff input. The carer who shops and prepares meals has assistance from her husband in the kitchen and normally only works as a carer at the weekends. There was no evidence that there had been any instances where an emergency had not been dealt with due to lack of staff. The home does not have the same level of management support as it used to due to the above facts. The care of residents however does not seem to have been affected as all residents were well cared for and happy. The home has robust policies and procedures to ensure that residents are safeguarded Care Homes for Older People Page 21 of 25 Evidence: from physical, financial and emotional harm. All staff have been trained in adult abuse procedures and the home is subject to external financial audit. All records inspected were in the main found to be accurate and up to date. Information was presented in such a way as to enable those caring for residents to do so with as much information as was required. All documentation required to ensure the health and safety of residents was accurate and up to date. From the evidence seen,comments recieved from residents, their relatives and staff this service would be able to meet the individuals various religious , racial or cultural needs. The health and safety of both the residents and staff were found to be being safe guarded. Care Homes for Older People Page 22 of 25 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 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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 25 of 25 - 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!