CARE HOMES FOR OLDER PEOPLE
Bracebridge Court Friary Road Atherstone Warwickshire CV9 3AL Lead Inspector
Lesley Beadsworth Key Unannounced Inspection 16th November 2007 and 13th December 03:00 X10015.doc Version 1.40 Page 1 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 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bracebridge Court Address Friary Road Atherstone Warwickshire CV9 3AL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01827 712895 01827 713754 Warwickshire County Council, Social Services Department Gordon Fraser Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 2006 Brief Description of the Service: 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 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. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection included a 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. It informs us about how providers are meeting outcomes for people using their service. The AQAA was has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s 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 over two visits. The first visit was between 3pm and 06.40pm; the second visit was between 6pm and 10pm. What the service does well:
The home provides a very attractive, comfortable and clean environment throughout with attractive and well-maintained outdoor surroundings. It is tastefully furnished and decorated in a domestic manner and with some very stylish and traditional pieces of furniture and ornaments and the corridors are tastefully decorated with pictures, and photographs of nostalgia and reminiscence interest. Residents spoken with said that they enjoyed their surroundings and found them very comfortable. Bedrooms viewed had been personalised to the occupant’s wishes and with personal possessions that had been brought in when people had moved into the home. There was a lively and stimulating atmosphere with ample evidence of purposeful and person centred activity indoors and out of doors, including entertainment, holidays and outings. In discussion with staff and residents it Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 6 was clear that the rights of residents were respected and that they were able to follow their own interests. There is satellite television throughout the home and lounges have wall mounted extra large screen televisions positioned so that anyone in the lounge would have a good view of it. Residents spoken with said that the large screen made viewing very easy. The home has a licensed bar, the manager being the licensee. This has an attractive sitting area and was accessed by residents several times during both visits. There is also a small shop selling a variety of items that residents might want, which is equipped with old-style shop fittings including a traditional predecimal cash register, creating nostalgia and reminiscence discussion. There is also a hairdressing room for residents’ use. These facilities add to the comfort, independence and self-esteem of the people staying at the home. Residents are asked for feedback about the home and their comments are made available to the pubic whether they are positive or negative. There was good evidence of efforts made by the manager to address a concern, raised during feed back, that was very important to one resident. All residents spoken with said that they were happy at the home and that staff treated them well and with respect. Comments made by them included “they do us well”; “It’s like being on holiday” (made by a person on a short stay); “They treat us very well”. Menus are varied and offer ample choice and taken in attractive surroundings. Residents said, “The food is beautiful”. A complaints policy is displayed in the home and records are kept of the concerns raised and the action taken to address them. This gives residents and visitors the confidence that their concerns are taken seriously. The home was sufficiently staffed to meet the needs of the residents, with staff spoken to confirming this. The manager is a qualified social worker and registered with the General Social Care Council, and has achieved the Registered Managers Award. He has had many years experience of managing care homes. The manager told us that 90 of the staff have achieved National Vocational Qualification (NVQ) Level 2 or 3 showing that they have been assessed as being competent to carry out their job. This includes several domestic staff that records show have also completed NVQ Level 2. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
Pre-admission assessments are carried out but a record is not kept. These records should be in place so the home can show they have assessed that they can meet the needs of the resident. The format of care plans should be made easier to be able to extract information from. Care is needed to ensure that the appropriate information/instruction is in the right column as instructions to care staff were sometimes in the section related to the needs and strengths of the person. Information related to all needs should be in sufficient detail, as for example in the care plans seen mental health care was brief whereas the personal hygiene
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 8 care required was in good detail, creating the risk of the needs not being fully met. Risk assessments related to pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) need to be in place for each resident so that any risk can be identified and the appropriate action taken to minimise that risk. Whilst the plans are reviewed monthly staff have to refer back to the review forms in a different section of the care file to identify any changes. In order that all needs are met the care plans should also be updated. An audit of a random selection of medication showed some errors in the number of tablets remaining that could indicate that tablets had been signed for but not given correctly. The manager should ensure that staff competence drug audits that are unannounced are carried out at intervals in order to safeguard residents. Although two people were signing for the administration of Temazepam it was not being stored in the controlled drug cupboard as the home had been advised by the pharmacist that this was not a controlled drug. However we recommend that it is treated as such and therefore stored, recorded and administered in the same way. Care needs to be taken to ensure that all medication is appropriately labelled. One inhaler that had been issued by the hospital when a resident was discharged was without the name of the resident, the dosage directions and the date it was dispensed. This give rise to the risk of the wrong medication being given to the wrong person. Handwritten Medication Administration Record Sheets need to be checked and countersigned to ensure the accuracy of the record. The origin of the instructions for the medication should also be entered on the Medication Administration Record Sheets. Not all bathrooms had disposable towels and soap dispensers provided but these need to be considered in order to minimise cross infection by residents and staff. We have not been notified of an incident that took place when a resident sustained a fall and was injured. All such incidents must be reported to us promptly. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request.
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met although not recorded. Effort is made to meet equality and diversity needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were on display in the reception area of the home and accessible to residents and visitors. Discussion with the manager and looking at residents’ files showed that referrals for admission are made to the home by the social work team and care plans and assessments are then forwarded to the home for consideration. Preadmission assessments are carried out, either by him or one of the other senior staff to ensure that they are able to meet the needs of the prospective resident. However this assessment was not recorded in any of the files looked at, relying on the assessments and care plans from the social work team to be
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 11 the record of this information and from which to devise the care plan. There was no evidence that the service user is informed of the outcome of the home’s pre-admission assessment. It is necessary for the home to demonstrate they have assessed that they are able to meet each individual person’s needs prior to any agreement for admission and to directly inform the service user whether this is the case or not. Once a person is admitted to the home a more thorough assessment takes place over a series of days by gathering information from the resident to ascertain the needs of and how staff will meet them. Residents spoken with were able to recall being visited by a member of staff from the home, being asked about their needs and that they had been offered a visit to view the home prior to moving in. The majority said that they had relied on their family to make this visit. Training records provided by the manager showed that some staff have undertaken training in dementia and Parkinson’s disease in order to meet these specific needs, but consideration should also be given to further training in subjects related to specialist needs and to needs in later life, including continence management and sensory and physical impairment. The majority of staff had attended recent training related to equality and diversity to assist in meeting these needs in others. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. There are shortfalls in care plans that carry the risk of residents’ needs not being met and in the lack of pressure sore risk assessments. Residents have access to health care professionals and are cared for in a respectful manner. There are some concerns around the medication process that have the potential to cause risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at in detail. All contained a care plan that had been devised from the social work team’s assessment and care plan, the preadmission assessment and the assessment carried out during the first few days following admission. This is said by the home to be “driven by” the resident. The care files also include an ‘Additional Information’ booklet that family can be asked to complete so that they can provide further information about the resident’s needs.
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 13 Care plans were completed on the format provided by the Local Authority, which covered all areas of need. These were cumbersome, and difficult to extract information from, which would be especially the case for temporary or new staff. The plans consisted of columns with the headings, ‘Care Plan’; date; ‘Strengths, Needs and Causes of Problems’; ‘Aims and Objectives’; ‘Care staff instructions and Guidance to achieve Aims and Objectives’ and also columns for review dates. Some of the instructions required by care staff to enable then to meet the residents’ needs, for example “encourage drinks and mince meat as struggles to chew”, were in the column related to strengths and needs which could be misleading to a member of staff looking for instructions on what care to provide. Instructions for mental health care were brief and did not give care instructions in the appropriate column, whereas personal care was written in good detail, person centred and would enable care staff to meet those needs. In many cases the information required was somewhere in the care file but their complexity made it difficult to find. These shortfalls could result in residents needs not being fully met. Staff showed through discussion that they are aware of the needs of residents and what care was required. Care plans viewed had been reviewed monthly until October. No reason was given as to why this had not continued. Changes in circumstances were recorded on the review sheets in a different section of the file and this information was not transferred to the care plan, as the format does not lend itself to be added to without the whole plan being rewritten. Anyone needing up to date information therefore needed to look at these reviews as well as the care plans, which is time consuming and could result in needs not being met. Care files had records of falls, one of which showed evidence of an injury resulting from a fall. This resident was case tracked and it was evident from observation that the injury was significant but we were not notified of this incident as is required. Weights were recorded monthly. Two of the three residents whose files were looked at had maintained their weight but one resident had lost weight. Whilst this remained within satisfactory limits related to the resident’s height there was no evidence that the person had any intention to lose weight or of a reduced appetite. There was no record to show that this had been referred to a GP and there was no reference to this in the section entitled ‘Health Key Events’. To safeguard the resident’s welfare this action needed to be considered and recorded. The care files also included moving and handling assessments to ensure that any risk in transferring a resident from one place to another was identified and minimised. Nutritional screening information was included in the care file to ensure that the resident’s nutritional needs were also identified and met. However there were no assessments seen regarding pressure sore risk (a break in the skin due to pressure, which reduces the blood supply to the area) thereby creating the risk of the omission of any appropriate safeguards to
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 14 prevent pressure sores being sustained. The manager advised that there were no residents at the home currently with a pressure sore. Each care file included a record of activities that the resident had joined in. These were detailed and showed involvement in a range of activities. However the record included all the names of the residents involved in these activities, which contravenes the Data Protection Act and makes access to personal files difficult. Residents’ on going health care needs were being met with evidence of visits to or visits by other health professionals. All residents observed or spoken with during the visit were well groomed and looked well cared for. Daily records completed by staff were detailed and showed the care provided. The home has a medication policy provided by the Local authority. This was in the process of being updated. All staff responsible for medication had undertaken accredited medication training and a delegated senior member of staff oversaw the medication system in order to ensure that is was safe and appropriate. Medication Administration Record Sheets were examined. The receipt and disposal of medication was recorded satisfactorily. There were no unexplained gaps or inappropriate codes used on the Medication Administration Record Sheets. The home now keeps copies of prescriptions to demonstrate any changes in medication and to be able to monitor that the medication ordered what is received. This ensures that the residents receive the correct medication. A random audit of medication was carried out. The majority were accurate but the numbers of Warfarin tablets for two residents were incorrect. One of these had a half tablet more than could be accounted for and the second had two and a half tablets too many. This could indicate that tablets had been signed for and not given. Handwritten changes or additions made on the Medication Administration Record Sheets by staff were not countersigned by a second person to validate the accuracy of the entries. These handwritten records must also show where the instructions for the medication originated, for example from the GP or the hospital. A change of Frusemide tablets from one tablet to two needed to be rewritten rather than just the number changed on the Medication Administration Record Sheets in order to avoid errors being made. To further safeguard residents from errors the extra tablets prescribed should be included in the multi dose system blister packs by the pharmacist rather than being supplied in original containers, as was the case. The management had attempted to reduce the risk of errors by completing a list of changes of medication at the front of the Medication Administration Record Sheets folder
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 15 but this relies on staff looking at this and remembering the information during administering the medication. There was no specimen signature list in the folder but the manager said that this was normally in place. An inhaler prescribed and dispensed by the hospital failed to have a name, the dosage or the date in which it had been dispensed. This information may have been on the original packaging but care needs to be taken that any medication used is correctly labelled in order to ensure that it is correctly given and to the right person. Although two people were signing for the administration of Temazepam and it was being stored in the controlled drug cupboard it was not entered in the controlled drug register as the home had been advised by the pharmacy that this was not a controlled drug. However we recommend that it is treated as such and therefore stored, recorded and administered in the same way. Other controlled drugs were stored and recorded appropriately and balances tallied. Terms of preferred address are on the residents care plan and heard to be used by staff. Having spent time in the lounges and around the building residents were seen to be cared for in a respectful manner ensuring that their dignity and self-esteem were maintained. Residents, management and staff showed a comfortable rapport and interacted well together. Those residents asked said that their own clothes were always returned to them and that there was not a problem with clothes going missing. To further assist this, the home has a separate small laundry for people staying at the home for respite or phased care. Individuality and independence were encouraged shown by observations made throughout the visit and during conversation with residents, staff and management. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. Residents are occupied and stimulated. 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was ample evidence that residents are involved in purposeful activity. Residents and day care clients were pickling and bottling onions in the conservatory on the first day of the inspection visit. There was a Bingo evening taking place on the second night that had been organised by the supportive resident and relative group and there was a lively and stimulating atmosphere throughout the home on both days. The manager advised that residents were frequently consulted at residents meetings about the community being invited to some social events, as in the case of the Bingo evening, and that they had agreed on each occasion. Residents spoken with about the Bingo confirmed this, saying that as it took place in the restaurant it did not interfere with them if they chose not to attend. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 17 Contractors from the locality who had recently contributed a large number of gifts in order to raise funds for the home also support the home. Residents spoken with were able to talk about the many activities that they are able to join in with, their trips out, holidays with the home and they spoke of a recent trip to Blackpool. The residents also benefit from the home owning its own vehicle for outings. A large number of photos and pictures hung in the corridor, which apart from being good quality and decorative were of reminiscence and nostalgia interest for the people living at the home. The home had a licensed bar, the manager being the licensee. This had an attractive sitting area and was used by residents several times during both visits. There was also a hairdressing salon for residents’ use and a small shop selling a variety of items that they might want. This was accessible to them throughout the day and was equipped with old-style shop fittings including a traditional pre-decimal cash register, creating nostalgic and reminiscent discussion. These facilities in the home also add to the comfort, independence and self-esteem of the people living and staying at the home. There was satellite television throughout the home and lounges viewed had wall mounted extra large screen televisions, sited so that anyone in the lounge would have a good view. Residents spoken with said that the large screen made viewing very easy. This would also be useful for any resident with visual impairment. Residents spoken with said that their visitors were made welcome and that there were no restrictions to them visiting. A visitor spoken with was complimentary regarding the way in which he was always received at the home. Relatives, visitors and the local community are encouraged to be part of Bracebridge Court and this was seen on the second visit when there was a good attendance to the Bingo session and also on speaking to visitors. In discussion with staff and residents it was clear that residents’ rights were respected and that they were able to follow their own interests. Residents said that they made choices on how they spent their time, going to bed and getting up when they wished, having a choice of meals from the daily menus, sitting where they wished and other routines being flexible. Residents’ meetings were held fortnightly with minutes available to residents, staff and visitors. The dining area is known as the restaurant, is made up of several booth-type sections and is attractive and comfortable. The menus are varied and nutritious with residents saying that they could always make choices of what to eat. The menus are displayed on a notice board for residents’ information with two choices of each main course at lunchtime and five choices of dessert. At teatime residents are offered a choice between a cooked meal, sandwiches
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 18 and/or soup. Staff said that go around the home after breakfast to ask residents what for their meal choices for the day and residents confirmed this. Residents spoken with said that they enjoyed the food at the home, making comments such as, “the food is beautiful” – a comment made by several residents, and “there’s a choice of two dinners every day”. The kitchen was visited and found to be clean and in good order with temperature recordings and cleaning schedules in place. Protective clothing was provided for staff entering the kitchen to prevent contamination. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure was displayed in the home so that residents and visitors knew what to do if they had any concerns. Residents spoken with knew who to speak to if they had concerns and said that they felt they would be listened to. Records were available of complaints made and showed what action had been taken to address them. This gives residents and visitors the confidence that their concerns are taken seriously. A resident’s relative made a complaint to us regarding the care given when the resident sustained an injury and question raised about how this injury had occurred. This was satisfactorily investigated by the manager, and required no further action. Another complaint was made to the home regarding the frequency in which the passenger lift was out of action. The lift had been fully repaired by the time of the second visit and plans were in place for a stair lift to be provided, to act as a back up if ever the lift was out of action in the future. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 20 The home has a vulnerable adults procedure that staff spoken with were familiar with. There have been no adult abuse referrals made regarding the home. According to discussion with the manager and training records viewed, the majority of the staff have either undertaken recent training or in the process of completing a distance learning work book, related to protection of vulnerable adults thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. All recruitment practices safeguard residents from the employment of unsuitable people. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 26 Quality in this outcome area is excellent. The home offers comfortable surroundings, which are clean, free of offensive odour and safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was refurbished and redecorated to a high standard approximately fifteen years ago and this standard had been maintained by regular redecoration and maintenance. The environment was pleasant, comfortable and clean and was furnished with domestic type furnishings, including many good quality traditional pieces of furniture and ornaments. Floor coverings in corridors and lounges and on stairs consisted of a non-slip laminate-type material that was domestic in appearance and looked attractive. There was no offensive odour noted in any of the areas visited. Residents spoken with said that they enjoyed their surroundings and found them very comfortable.
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 22 The premises are close to all amenities being 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/grocery/newsagent shop within fifty yards, and a bus stop outside the home. The location of the home enables residents to maintain contact with, and aids interaction by, the community. There are car parking spaces to the front and rear of the building. The manager advised that the home is run as a ‘hotel-type’ accommodation and one short stay service user said that it was “like being on holiday” when coming to Bracebridge Court. Accommodation was provided over three floors with short stay service users having bedrooms, a lounge, toilet and bathing facilities and a small laundry on the ground floor. The first and second floor provides accommodation for permanent residents with ensuite bedrooms and a lounge on each floor. As mentioned in the Daily Life and Social Activities section of this report the corridors are tastefully decorated with pictures, and photographs of nostalgia and reminiscence interest. The ground floor also accommodates a small shop for residents to purchase items and a licensed bar where they can purchase drinks during ‘opening hours’. These add to the comfort of the people living and staying at the home. All bedrooms were single with ensuite toilet and washbasin facilities. Bedrooms viewed had been personalised to the occupant’s wishes and with personal possessions that had been brought in when people had moved into the home. Each floor provides a smaller living area with a main lounge, smaller sitting areas and a kitchenette. This reduces the affect of institutionalisation in a large home. Bathroom facilities were provided on all floors and included assisted bathing and showering facilities. Despite specialist lifting equipment/baths in the bathrooms they were comfortable in appearance, having been decorated and tiled in an attractive manner. Not all bathrooms had disposable towels and soap dispensers provided but these need to be considered in order to minimise cross infection by residents and staff. These facilities were available in all other staff hand washing areas such as the laundry, kitchen, separate toilets and the staff cloakroom. The laundry area was visited and had equipment with the appropriate washing programmes to maximise infection control. The area was clean and well organised. Some of the home’s lighting was less bright than ideal due to the Tiffany-type light shades in some of the communal areas. However these were attractive and best use had been made of other secondary lighting. The manager advised Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 23 that further lighting in corridors had been budgeted for to further improve the brightness in the home. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was sufficiently staffed to meet the needs of the residents, with staff spoken to confirming this. Catering and domestic staff are in sufficient number and available at appropriate times to avoid care staff being taken away from their role to assist with meal preparation or domestic tasks. Residents spoke highly of staff with such comments as, “they do us proud” and “they treat us very well” “I’m happy here” being made by them. Staff interacted well with residents and conversations between staff and residents were respectful whilst including a jovial banter. The manager said that 90 of the staff have achieved National Vocational Qualification (NVQ) Level 2 or 3 showing that they have been assessed as being competent to carry out their job. This includes several domestic staff that records show have also completed NVQ Level 2.
Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 25 Other training undertaken by staff at the home includes dementia care, protection of vulnerable adults, First Aid, hoist training and ‘Moving and Handling’. New staff have also undertaken Basic Hygiene and Foundation training as part of their induction training to give them the skills to enable them to start their job. Three staff files were looked at and all held the required information and evidence showing that the home follows a safe method of recruitment. The manager advised that they tend to be able to retain staff and this was confirmed by some of the staff spoken with that had been at the home for many years. Staff meetings take place regularly, giving staff the opportunity to be involved in the way in which the service is delivered, and minutes were available for inspection. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. A person with the appropriate qualifications and who has previous management experience manages the home. The service and practices are audited to ensure that all services operate in the best interests of residents. The home is safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a qualified social worker and registered with the General Social Care Council, and has achieved the Registered Managers Award. He has had many years experience of managing care homes. Training records also show that he has continued to undertake subsequent training to add to his knowledge and skills. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 27 The manager is supported by an assistant manager, three care officers in the management team and an administrative assistant. Each senior member of staff has designated responsibilities within the management team and there appears to be successful teamwork between them. Staff spoken to said that they felt supported by the manager and that he and the other senior staff were approachable. Some residents spoken with also said that they knew they could go to them if they had any concerns. Throughout the visits there were numerous occasions when residents approached the manager for assistance with a variety of things and were comfortable to do so. Each request was dealt with promptly and sensitively. The home uses the Local Authority Quality Assurance Programme, which is extensive, covering all areas of the service. Feedback is also gathered from residents regarding the service and action taken to address issues. A third party carries out an unannounced visit each month to audit sections of the Quality Assurance and a report of the visit is forwarded to us and to the manager. These practices support standards being maintained and any necessary improvements to be implemented. Some money for some residents is held by the home for safekeeping. Any transactions made from this are recorded and receipts held, safeguarding the financial interests of residents for whom money is held. A random check of records and cash balances was made and all balanced appropriately. Health and safety check were made and were up to date. In house fire safety checks and equipment were also up to date with weekly fire alarm tests being treated as a non-evacuating fire drill. As mentioned in the section related to Health and Personal Care we had not been notified of an incident that took place when a resident sustained a fall and was injured. All such incidents must be reported to us promptly. Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must contain sufficient detail in regard to all areas of need. This will ensure that these needs are met in a person centred manner. All residents must be assessed regarding their risk to the development of pressure sores. This will ensure that residents are protected by the risk of their occurrence being minimised. All residents must have access to other professionals to ensure that all their health needs are appropriately met. To include residents’ identified as having any significant weight gain or loss. (The previous timescale of 31/11/06 was not met) Medication must be audited at intervals to monitor the competence of staff responsible for medication. This will ensure that people receive the correct medication. Medication must be appropriately labelled. This will ensure that people receive the correct
DS0000035064.V350709.R01.S.doc Timescale for action 15/02/08 2. OP8 13 15/02/08 3. OP8 13(1) 30/01/08 4. OP9 13 15/02/08 5. OP9 13 15/01/08 Bracebridge Court Version 5.2 Page 30 7. OP37 17 8. OP38 37 medication. Records must be maintained in accordance with the Data Protection Act and enable residents to have access to their personal file without having access to other residents’ information. Incidents of injury and other notifiable events must be reported to the Commission promptly. 15/01/08 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP4 Good Practice Recommendations The pre-admission assessment should be recorded in an appropriate format. Consideration should be given for staff to undertake training in specialist subjects so that these needs can be met. Care plans should be devised in a format that allows information to be easily extracted and for updated information to be added in order that residents’ needs are met. Where practical residents should sign care plans and reviews to show their agreement and involvement. Temazepam should be recorded as a controlled drug. Handwritten Medication Administration Record Sheets should be checked and countersigned and the origin of the medication instructions should be recorded. The Registered Person should make sure that the home is sufficiently bright to meet the needs of individual service users. Appropriate hand washing facilities that maintain infection control should be provided in all bathrooms to avoid cross infection. OP7 4. 5. 6. 7. 8. OP7 OP9 OP9 OP25 OP26 Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bracebridge Court DS0000035064.V350709.R01.S.doc Version 5.2 Page 32 - 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!
