Inspection on 13/03/09 for Bracebridge Court

This inspection was carried out on 13th March 2009.

CSCI 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

Bracebridge Court 13/11/07

Bracebridge Court 15/11/06

Bracebridge Court 01/03/06

Bracebridge Court 15/08/05

Bracebridge Court 10/12/04

Bracebridge Court 24/06/04

Bracebridge Court 04/03/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Bank House

Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bracebridge Court Friary Road Atherstone Warwickshire CV9 3AL     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Beadsworth     Date: 1 3 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: Bracebridge Court Friary Road Atherstone Warwickshire CV9 3AL 01827712895 01827713754 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Warwickshire County Council, Adult Health & Community Services Name of registered manager (if applicable) Gordon Fraser Type of registration: Number of places registered: 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: 35 The registered person may provide the following category 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 (OP) 35 Date of last inspection Brief description of the care home Bracebridge Court is a Local Authority home for older people. It provides permanent care, short stays and day care with accommodation on three floors. The home is situated on a housing estate less than one mile from the town centre of Atherstone. There are local shops, including a hairdresser, an off licence and a newsagent within fifty yards, and a bus stop outside the home. There are car parking spaces to the front and rear of the building. On the ground floor, there is a large restaurant, a Care Homes for Older People Page 4 of 31 0 Over 65 35 care home 35 Brief description of the care home conservatory that is used mainly by day care and short stay residents, and a bar. There is also a hairdressing salon and a shop and short stay residents have their bedrooms and lounge on this floor. Fourteen people have bedrooms and communal lounges on each of the two upper floors. All bedrooms have en-suite toilet and wash hand basin facilities. On each floor, there are bathrooms and toilets suitable for people who need assistance. The kitchen, laundry and staff offices are on the ground floor, with a further office on the first floor. As well as front and rear staircases, there is a passenger lift to the upper floors. The home is staffed over 24 hours. It has a management team of a manager, assistant manager and three care officers. There is also a full time clerical officer; a full time activities organiser and staff provide care or domestic services. The home does not provide nursing care. Service users who require nursing attention at a level, which can be provided, by community nurses receive this as they would in their own homes. Care Homes for Older People Page 5 of 31 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: The inspection included an unannounced visit to Bracebridge Court. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment, AQAA, which is a self assessment and a dataset that is filled in once a year by all providers. This was completed in useful detail and fully answered all the questions we had asked. An AQAA informs us about how providers are meeting outcomes for people using their service. Surveys were not distributed by us on this occasion. Information contained within the AQAA from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting or observing them, talking to their families, where possible, about Care Homes for Older People Page 6 of 31 their experiences, looking at residents care files and focusing on outcomes. Additional care records were viewed where issues relating to a residents care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11:45 and 20:20. What the care home does well: What has improved since the last inspection? What they could do better: A care plan looked at did not describe the methods of dealing with the behaviour of a person with mental health needs. Although staff spoken with were able to describe the appropriate support required to manage this there is the risk of these needs not being met when relying on verbal communication and the memory of staff. It is recommended that the temperature of the medication storage areas is monitored using a minimum/maximum thermometer and records kept daily, to show that the appropriate temperatures are maintained. The registered manager of Bracebridge Court is acting as manager at another home in Care Homes for Older People Page 8 of 31 the absence of a registered manager there. It is recommended that this is limited to as short a period as possible. 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 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 31 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 31 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. Information required to make a decision about choice of home is available. Preadmission assessments are carried out to assess if the needs of prospective residents can be met. Effort is made to meet specialist, cultural and religious needs. Evidence: The AQAA told us that the home has a website. When we looked at this it gave a good reflection of Bracebridge Court and would be useful for anyone choosing a home. In addition to this there is an up to date Statement of Purpose and Service User Guide that also inform prospective and current residents about the services provided at Bracebridge Court. As before referrals are made by social workers and social services are responsible for their funding. Discussion and the AQAA told us that initially a full needs assessment is carried out by social workers who will also include information from others such as the Care Homes for Older People Page 11 of 31 Evidence: persons GP, District Nurses, Community Psychiatric Nurses or family and friends as appropriate. After the social worker has approval for funding and the clients preferred home has been decided the placement request is referred to that home. A further assessment to ensure that the home is able to meet the persons needs is made by a senior member of staff at the home. The manager told us in the AQAA that this takes place within three working days of the referral to the home. Three care files looked at as part of the case tracking process. Two of these confirmed the admission process as they included a needs assessment made by the social worker and a pre-admission assessment made by the home, giving them the information needed to ensure that they could meet the persons needs. The third person had been admitted to the home as an emergency placement and there had not been time for a pre-admission assessment to be carried out. An assessment had been carried out by the home in a timely manner after moving in. A more thorough assessment is made with all residents once they have moved into the home. The home now ensures that the person is informed in writing of the outcome of their assessment. All pre-admission assessments are now documented and those looked at identified the needs of the person assessed. A care plan that informs staff of how to provide the care and support to meet these needs is devised from these assessments. The manager told us in the AQAA that the home had not had referrals for any person belonging to any ethnic minority group other than a person originally from Ireland. However he added that staff training related to equality and diversity continues, in the meantime, being, prioritising in those areas reflected in our resident and staff groups of disability, religion, gender, mental health and sexuality. Records looked at evidence that staff have undertaken equal opportunities or equality and diversity training, showing that there are real efforts made to meet these needs. Church services are held at the home for those people who choose to attend and are related to their religions and wishes of the residents, which are currently Protestant and Roman Catholic denominations. Some residents who choose to do so are enabled to attend church. The home meets the religious needs of the people living and staying at the home. Sexuality of the person is addressed in all the care plans. The gender of the person and their preferences of carers is also sensitively considered and addressed. Care Homes for Older People Page 12 of 31 Care Homes for Older People Page 13 of 31 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. There are care plans that have sufficient information to enable needs to be met. Residents have access to health care professionals. Choice, independence, privacy, dignity and respect are seen as an integral part of the care and support provided. The medication system safeguards the health and welfare of the people using the home. Evidence: Three care files were looked at as part of the case tracking process. All had care plans that reflected the assessments that had been recorded on the persons file. There had been some improvement in the organisation of these plans since the last inspection which helps in finding information needed. They included all appropriate headings. Each care file included daily records completed by care staff and which were in good detail and reflected the care provided. Care plans looked at were appropriate and up to date having been reviewed monthly, or as circumstances changed. Mental health needs had been care planned. One care Care Homes for Older People Page 14 of 31 Evidence: plan of a person with dementia showed changes that had occurred in the persons mental health. Behaviour patterns had been recorded but would have benefited from more detail. There was no evidence in this care plan of methods of dealing with this persons behaviour but staff spoken with were able to describe the appropriate support required to manage this. Relying on verbal communication and and the memory of staff could result in these needs not being met. The support needed should be included in the care plan. Staff and residents work together on their individual All about Me document which gives information about the resident and enabled staff to provide care and support needed in a more person centred way. Each resident has an attached worker, who has special responsibility to that person and who would assist in developing the document. The manager and staff told us that the residents and/or their representative are involved in the devising of care plans and this was evidenced by the plans having been signed by them and confirmed in discussion with residents. Records of falls, pressure areas, weight and bathing nail checks, nutrition and nutritional screening were in place within the files looked at. Completed risk assessments for tissue viability in relation to the development of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) were now in place and risk assessments for moving and handling (transferring a person from one place to another) were also in place. Individual risk assessments were devised as necessary, for example one of the care files looked at included risk assessments on the use of alcohol and the use of the persons mobility equipment. These would help to minimise any risk in these areas. Preventative measures such as pressure relieving cushions were in use for those people at risk of developing pressure sores. Records showed and residents spoken to confirmed that they could see the doctor if they wished and that they had visits from the chiropodist, optician, district nurses and other health care professionals when necessary. The manager told us in the AQAA that the home has excellent support from GPs and community nurses who visit regularly to provide direct care to service users and advice to staff. The medication system was assessed. As in all Warwickshire County Council services medication has had a particularly high profile in recent months and the AQAA tells us that there is a zero tolerance to errors in medication made by staff in order to safeguard residents health and welfare. The manager added that this has been managed in a manner that encourages disclosure should any errors arise. Care Homes for Older People Page 15 of 31 Evidence: The home is awaiting the implementation of the new medication policy devised by the organisation and which the manager of Bracebridge Court has been involved in revising. This has been in the process of revision for a considerable time but we were told that it was about to be implemented. The pharmacist supplies most of the medicines in a monitored dosage system where each medicine is dispensed in a blister pack from which to administer on a daily basis. Some tablets and all liquids cannot be dispensed in this way and are in boxes or bottles. Medication is stored in locked cupboards within a locked store room. The keys to the medication cupboards are kept securely and are the responsibility of the senior member of staff on duty at the time. The store room seemed warm but during the day the manager monitored the temperature of the medication cupboards, which did not rise above 25 degrees Centigrade. It is recommended that this is monitored, and a record maintained, on an ongoing basis to ensure that the contents are kept at the appropriate temperature. This will assist in maintaining the stability of the medication, thereby safeguarding the people who use it. The temperature of the lockable medication fridge is checked and recorded daily using a minimum/maximum thermometer and is maintained at the correct temperature for medication that requires refrigeration. Records showed that the receipt, storage and disposal of general medication are carried out appropriately and safely. All medication seen was labelled correctly. Prescriptions are copied and kept at the home to check that medication received is what the doctor intended. The contents of the controlled drug cabinet were audited against the controlled drug register and the quantities were correct and their storage and records were appropriate. This now included Temazepam which should be managed in the same way as controlled drugs. An audit of tablets in boxes rather than the blister packs was carried out, checking the quantity remaining against the calculation made from the Medication Administration Record (MAR) sheets. These were all correct, suggesting that residents had received the correct medication at the correct time. This audit is also carried out by the manager weekly at irregular times. The AQAA tells us that self administration of medication is encouraged, following risk assessment, and this is in line with the homes philosophy of maintaining independence. All care staff have had accredited training with Boots. Anyone who is responsible for any part of the medication system also take the more in depth Distance Learning Programme, which is also accredited. This training assists in staff having the Care Homes for Older People Page 16 of 31 Evidence: information regarding medication to safeguard the residents. The people working at the home show a respect for personal possessions, for example laundry is cared for appropriately and as at the previous visit residents said that they had no concerns that clothes might be mislaid. Staff were seen to interact in a respectful manner with residents and this was confirmed to be the norm by residents spoken with. Discussion with the manager, staff and those residents spoken with showed that privacy, dignity and independence, along with choice, have a high profile and are the main culture of the home. Care Homes for Older People Page 17 of 31 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. Residents are occupied and stimulated by innovative and interesting activity in and out of the home. Visitors are made welcome and their needs considered. Residents have choices and control over their daily lives and enjoy the nutritious and varied meals provided. Evidence: The home has a designated activity organiser who is described by the manager in the AQAA as very creative and experienced and who works from the choice and personalisation agenda to provide extensive opportunities for service users to be stimulated both inside and outside the home. Discussion, records and observation further demonstrated this. The Home has regular and creative activity and occupation that visitors and the community are also often invited. There are weekly events such as cards, games, bingo, relaxation therapy, crafts, home baking musical movement and short term memory exercises, quiz nights with family and friends. There are also trips out, the home having access to their own vehicle, for a pub lunch; shopping; garden centres, day trips (including to Bourton on the Water, Cotswolds, river boat trips, Market Care Homes for Older People Page 18 of 31 Evidence: Bosworth, Bluebell Woods in the last year). Residents have the opportunity to go on holiday abroad in small groups and accompanied by staff and one resident spoken with said how much they look forward to this. The home also celebrates special occasions, for example bunting was in place for St Patricks Day when we visited and Easter bonnets were in evidence that had been made by some of the residents. Records showed that other special occasions were celebrated including residents birthdays. The manager told us in discussion and in the AQAA that residents had been involved in an Intergeneration Poetry Book which was done in conjunction with youth club members and further evidence of this was on display in the home and on the Warwickshire County Council website. There was also evidence on display in the home and in the activity room, of the many activities enjoyed by the residents. The home purchases free range eggs and chicken from a local farm and at regular intervals have eggs to hatch in the home for the interest and pleasure of the people living at the home. The recently hatched chickens had recently been returned to the farm at the time of the visit and a resident spoken with discussed the hatching with enthusiasm. Care Homes for Older People Page 19 of 31 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 appropriate policies and procedures regarding complaints and appropriate policies, procedures and training to safeguard residents from abuse. Evidence: A copy of the complaints procedure is displayed in the reception entrance hall and is included in the Service User Guide. Residents we discussed the subject with knew who to speak to if they had any concerns. A complaints log is kept to record any complaint made about the service and a how that complaint was managed. This was looked at but no formal complaints had been made since the last inspection. A compliments, comments and complaints box is provided in the entrance hall to provide a system where these can be made anonymously by visitors or residents if they wish. The box is checked weekly by senior staff although the manager said that it is not used very often. The AQAA told us that the home has an open approach, which the manager felt reduced the cause for complaints arising, and this was evidenced in our observations and discussions. Residents had no hesitation in approaching the manager, or other staff during our visit. Discussion and records showed that the Management Board is pro active in addressing Care Homes for Older People Page 20 of 31 Evidence: concerns. An example given by the manager in the AQAA and in discussion was the residents concern about sunlight in the conservatory. Solar reflective panelling was fitted to improve the comfort for the people using this area as a result of this being raised as a concern at the Management Board meeting. The home has the Local Authority safeguarding policy and staff spoken with knew how to identify abuse and what to do if it was witnessed or suspected. Safeguarding training is undertaken by all staff, confirmed in training records, and as the policy of the Local Authority this is to the level that is appropriate to their role and responsibilities. There have been no safeguarding issues in the past year. The financial practices safeguard the financial interests of the people living at the home. The recruitment policy and practices minimise the risk of the employment of unsuitable people thereby protecting the people who live and stay at the home. Care Homes for Older People Page 21 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there comfortable and pleasant surroundings, which are clean, free of offensive odour and safe and well maintained. Evidence: Accommodation is provided over three floors. Short stay clients have their bedrooms, a lounge/dining room, toilet and bathing facilities and a small laundry on the ground floor. This floor also has the restaurant, the main laundry and smaller seating areas around the entrance hall. The first and second floor provides accommodation for permanent residents with bedrooms and a lounge on each floor. The gardens around the premises are attractive and well maintained providing pleasant outdoor areas for the residents to enjoy. The environment of the home continues to provide residents with comfortable and attractive surroundings and wherever possible fixtures and fittings are domestic and homely in appearance. It is decorated and furnished to a high standard. The communal areas have a high quality non-slip and washable flooring that although it is several years old continues to look attractive and to assist in maintaining infection and odour control throughout the home. The manager told us that residents have a say in how the home is decorated and Care Homes for Older People Page 22 of 31 Evidence: furnished, both at the Management Board meetings and informally. Reports of monthly inspections carried out by the organisations representative have always included positive comments about the environment. Some improvements to increase the comfort for the people using the home have been made since our last visit. Lighting in the lounges and corridors has been improved and now offers sufficient lighting for the residents; the second floor lounge has been refurbished; a new bathing facility has been provided on the first floor and the front garden has been landscaped. All bedrooms have ensuite facilities and all those looked at had been personalised with the occupants belongings. All looked comfortable and all residents spoken with said that they were comfortable in, and happy with, their rooms. The whole home is bright, cheerful and homely accessories such as ornaments add to the comfort of the home. Corridors and other communal areas have photographs and pictures that create interest and as the majority are of past times and events within the lifetimes of the people using at the home added to their nostalgia, reminiscence and interest. Hand washing facilities of soap dispensers and disposable towels are available in all areas where staff and residents would be expected to wash their hands, disposable gloves and aprons are readily available. Hence infection control was maintained and cross infection minimised. The laundry area was visited and was clean and well organised. Laundry equipment is appropriate for the disinfecting and sluicing of laundry. All areas of the home visited were clean and free of any offensive odour. Care Homes for Older People Page 23 of 31 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. There are sufficient care staff available to meet the needs of the residents supported by ancillary staff. Robust recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. Evidence: The manager told us that the usual care staff on duty was five in the morning; four in the afternoon and evening and two at night. Current and past rotas looked at confirmed this. They are supported by ancillary staff who are available in sufficient numbers and at appropriate times to minimise the amount of time that care staff have to carry out tasks that take them away from time with residents. There are therefore sufficient staff to meet the needs of the residents. The manager told us that staff turnover and sickness absence are low, virtually zero, and that staff are willing to cover absences. This means agency staff do not need to be used. There is therefore continuity of care in the home and residents rarely need to meet staff with whom they are unfamiliar. Apart from the newest recruits 100 of the care staff, and some of the domestic staff, have achieved National Vocational Qualification (NVQ) Level 2 in Care. The new recruits are undertaking the training for this qualification, which shows that staff have Care Homes for Older People Page 24 of 31 Evidence: been assessed as competent in their role. Training records and staff files evidenced that all mandatory training for staff is up to date and in the past year staff have undertaken training in moving and handling, fire awareness, food hygiene, control of substances hazardous to health (COSHH), emergency aid, safeguarding and the use of a hoist. This training enables staff to work safely. Specialist training undertaken includes, Strokes and Dementia Awareness, giving staff the knowledge and skills to assist them in meeting these specialist needs. Other training that the records show has been undertaken includes, infection control, culture and values, safer handling awareness, communication and medication. All new staff receive induction training to assist them to have knowledge and skills to work safely and appropriately. Three staff files were looked at with regard to the homes recruitment practices. These files were well organised and in good order. All Criminal Record Bureau and Protection of Vulnerable Adults checks had been completed before a recruit began employment at the home and all three files included the necessary two written references. There was evidence that applicants had completed an application forms and attended interviews and that references and employment history had been validated. These practices safeguard residents and minimise the risk of the employment of unsuitable people. Care Homes for Older People Page 25 of 31 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. A person with the appropriate qualification, extensive management experience and high standards manages the home. The monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Staff receive the support of staff supervision. Health and safety practice protect residents and staff at the home. Evidence: The registered manager of Bracebridge Court was also managing another Local Authority home on a temporary basis in order to raise standards there and until another manager is appointed. He told us that he visits Bracebridge Court at least weekly and senior staff said that it was usually more often than this. He also told us that he is confident that the senior staff at Bracebridge are competent to manage the home in his absence and continues to be contactable by phone. In the AQAA he said that the senior team is very well established and works very well together and that the stability of the staff team enables an effective Senior Team to organise and lead Care Homes for Older People Page 26 of 31 Evidence: very effectively. He has been the registered manager of the home since 1990, which in the AQAA the manager told us the evidence suggests that this has resulted in consistency, stability and continued improvement. He has a social work qualification and the Registered Managers Award. Staff and residents spoke highly of him and they were seen to interact well and had no problems in approaching him. Discussion with staff, residents and senior management in the past, observations made at inspection visits and the outcomes for people living and staying at the home suggest that he has high standards and is committed to residents maintaining independence and a lifestyle of their choice. This is supported in the making possible of pastimes and occupation that interests and stimulates the people living at the home, negotiating for funding and improvements with the success of this being evident in all areas of the service. The Local Authority Quality Assurance Programme is used. This is extensive, thorough and covers all areas of the services provided at the home. Monthly visits are made by a representative of the Responsible Individual of the service who writes a report of their findings against the Quality Assurance Programme. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Some money is held by the home for each resident. There were appropriate records of transactions made, and cash that balanced against these records. Receipts were available for inspection for all transactions made. This safeguarded the financial interests of the people living at the home. Staff records showed that supervision is carried out monthly, which is more often than required and was up to date in the records seen. Care staff are supervised by the assistant manager and team leaders and the senior staff by the manager. He in turn is supervised by his line manager. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. There had previously been problems with the passenger lift but these had been addressed as a result of the Management Board, in order to improve reliability and was in full working order at the time of the visit. The manager told us in the AQAA that the home had also purchased equipment that enables the staff to transport people up and down the stairs safely and comfortably between floors if the passenger lift fails again and which we saw at the home. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house Care Homes for Older People Page 27 of 31 Evidence: checks on the fire system were up to date. No concerns regarding health and safety were observed by us and the indications are that the home is a safe place to live and work. Care Homes for Older People Page 28 of 31 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 29 of 31 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 7 It is recommended that methods of managing a persons behaviour is included in the care plans rather than relying on verbal communication and and the memory of staff members. It is recommended that the temperature of the medication storage area is monitored and the minimum and maximum readings recorded daily. It is recommended that the managers responsibities at another service is for a short a time as possible. 2 9 3 31 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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