Inspection on 15/11/06 for Bracebridge Court

This inspection was carried out on 15th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bracebridge Court 13/03/09

Bracebridge Court 13/11/07

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bracebridge Court Friary Road Atherstone Warwickshire CV9 3AL Lead Inspector Jean Thomas Key Unannounced Inspection 15th November 2006 09:00 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.V316102.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.V316102.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.V316102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 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. 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. Bracebridge Court provides accommodation on three floors. Fourteen people have bedrooms and communal lounges on each of the two upper floors. On the ground floor, there is a large restaurant, a conservatory, used mainly by day care and short stay residents, and a bar. The home has a hairdressing salon and a shop. Short stay residents have their bedrooms and lounge on the ground floor. All bedrooms have en-suite lavatory and wash hand basin. On each floor, there are bathrooms and lavatories suitable for people with physical disabilities. The kitchen, laundry and staff offices are on the ground floor. As well as front and rear staircases, there is a shaft 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 and a full time activities organiser. In addition, 32 people 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.V316102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. In terms of the context for the inspection, it should be noted that throughout the report, residents represents those who are being cared for and the Home refers to Bracebridge Court. Where reference is made to the standards and the regulations this means the National Minimum Standards for Care Homes for Older People and The Care Homes Regulations 2001, respectively. This was a key unannounced inspection visit and took place on Wednesday November 15th 2006, commencing at 09.00am and concluding at 5:00pm. A key inspection addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspector had the opportunity to meet most of the residents and talked to three of them about their experience of the home. Residents were able to express their opinion of the service they received to the inspector and conversation was held with other residents. During the visit, records and documents were examined and an opportunity was taken to tour the premises. Six staff and the manager were spoken to and at the end of the inspection; feedback was given to the manager. 16 questionnaire surveys were sent to residents and their relatives. At the time of writing the report, twelve residents and six relatives had responded. An audit of residents’ surveys show satisfaction with the service provided. For example: residents know who to speak to if they are unhappy and the home is always fresh and clean. Staff listen and act on what residents say and are available when residents’ need them. An audit of relatives’ questionnaire surveys also shows satisfaction with the service provided. Comments noted include: Bracebridge Court is a very well-run home with friendly staff and superb care. I would recommend Bracebridge court to anyone. The staff are always very kind and caring and nothing is too much trouble. My wife and I are very happy with the care and attention paid to my cousin’s husband. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 6 Relatives and visitors are made to feel welcome and are informed of any important matters affecting their relative. If residents are unable to make decisions about their care then relatives or representatives are consulted. None of those surveyed had complained and all indicated there were sufficient numbers of staff on duty. Since the last inspection, there have been no complaints or allegation of abuse made to the commission or to the home. There has been one recorded incident involving a medication error by a staff member when administering medication. This issue was addressed in accordance with the homes disciplinary procedure and action taken to ensure the continued health and safety of residents is promoted and maintained. What the service does well: What has improved since the last inspection? What they could do better: Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 7 Previous requirements regarding care plans and staff training have not been met. The manager has begun to revise and update care plans and an extended three-month timescale was agreed for completion. A number of staff need to attend statutory training and updates in areas such as fire, which should be provided twice a year, moving and handling and first aid. Very few staff are appropriately trained to recognise the signs or symptoms of abuse therefore the home cannot be sure the health, safety and welfare of residents is being promoted and maintained. Rigorous staff recruitment procedures necessary to determine fitness and protect residents are not followed and practices are therefore unsafe. Further requirements are made to make sure rigorous staff recruitment procedures are followed so that the home can be sure residents are protected. Advice and consultation must be sought from health care professionals when monitoring records show significant changes in residents’ weight so that the home can be sure nutritional and health care needs are being met. 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.V316102.R01.S.doc Version 5.2 Page 8 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.V316102.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are encouraged to visit the home before admission and an assessment of the individual’s care needs ensures the home will meet their needs. EVIDENCE: Prospective residents have their initial care needs assessed by social services and are encouraged to visit the home before deciding whether to move in for a trial period. The manager understands the procedures required to ensure that the home could meet the assessed needs of the prospective resident. The manager or a senior care officer visit the prospective resident in their own home to assess their care needs and to provide information about the home. A record of the initial care needs assessment is held and used to determine whether the residents care needs can be met. Two residents spoken with said Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 10 they had been given the opportunity to visit the home before deciding whether to move in. One resident said she used to have regular short stays at the home and was familiar with the service. After an agreed trial period of usually four weeks, a review meeting is held with the prospective resident and their representative to determine whether the home can meet their needs. Two initial care needs assessments were read and held information about the residents background; personal circumstances and care needs, including the residents abilities and any limitations. The initial care needs assessment forms the basis of the residents care plan, and is recorded and agreed shortly after admission. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan but gaps in the care planning process may result in residents’ unmet needs. Evidence of updating information and changing actions does not always appear on care plans or daily records. Residents have access to a range of health care service and the administration of medication is generally well managed. Staff treat residents with respect and consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms. EVIDENCE: The manager was available to discuss progress with the previous requirements to develop the residents plan of care and to consistently complete daily records to demonstrate that the care provided is as prescribed in the care plan. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 12 Although progress has been made, these requirements have not been met and an extended timescale is provided in this report. The care plans of three residents identified for case tracking were selected for closer examination and showed the care plan was based on the initial care management assessment. Care plans held a range of information including past medical history and consultations and treatments with health-care professionals. Information about the residents capacity for independence and of the circumstances of when staff support is needed was also held. A record of one resident shows a review of continence management has taken place and identifies the need to seek professional advice from the continence adviser. Records held of visiting health-care professionals confirm this occurred and shows that the resident no longer meets the agreed criteria to receive free products from the Primary Care Trust (PCT). A number of gaps in care-planning, monitoring and daily recording were identified for example: • The care plan of a resident assessed as being at risk of developing pressure sores required staff to maintain regular change of position, to report and record any concerns.” The plan fails to include the frequency or include the need for monitoring records necessary for the home to be sure the resident’s care needs are being met. Information held on the plan also fails to identify whether the resident should be cared for in bed or whether it is in their best interests to sit out in a chair. Daily records make reference to a pressure wound but the care plan was not revised to reflect changes in the resident’s condition. A care plan identifies the need for one carer to assist the resident with bathing but does not make clear the level of support or assistance required. A detailed risk assessment for bathing must be carried out and the outcome used to inform care planning. One resident spoken to requires the assistance of two carers with personal care at night. Details of the care to be provided were not included in the care plan. One care plan fails to include the resident is hard of hearing and assessed the resident as not having communication difficulties. The inspector talked to the resident about their experience of the home and noted that the resident needs to be able to see the face of the person talking otherwise the ability to respond appropriately deteriorates. • • • • Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 13 The information held on daily records has improved but further work is necessary to make sure that daily recording accurately reflects the care provided is as identified on the care plan. Nutritional needs are assessed and monitored. One care plan includes shows tendency to gain weight, staff to offer food that does not encourage weight gain. Weight monitoring records are held but risks to the residents health and welfare are not responded to. For example, records show that during a fourweek period, a resident sustained a weight loss of 14 pounds and a second resident’s weight gained over 12 pounds. Records fail to show whether professional advice was sought from a dietician or other health care professional. Appropriate health care intervention must be sought so that the home can be sure, residents’ nutritional needs are being met and their health and welfare protected. Residents requiring specialist equipment such as a pressure relieving mattress, cushion or hospital type bed have their needs assessed by the community nurse who also provides any equipment deemed as necessary for promoting the health and welfare of residents. A tour of the premises showed that a significant number of residents have adjustable height beds supplied by the home. The manager talked about the arrangements for safe moving and handling practices and said two residents use the hoist for transferring. A number of risk assessments for moving and handling and for the prevention of falls were in place further work is required to make sure risk assessments are carried out for bathing and the use the bed rails. Residents are registered with local surgeries and generally receive health-care support services as required. There is a stable and competent staff group providing continuity of care and supervision of residents needs. The home has a key worker system, which is well established and enables residents to develop positive relationships with staff. Staff were observed engaging with residents and were patient and encouraging. Staff ensure residents receive personal care in private and knock on doors before entering resident’s rooms. One resident had fallen out with another resident and was talking to a carer about what had happened. The carer sat and listened intently to what the resident was saying and was supportive and non judgemental. Three residents spoken with said the staff are “kind” and “always happy” and treat residents with respect. Residents have no limitations placed on them and have regular baths and can get up and retire when they choose. One resident said she used to have a bath once a week but following a care review this has increased to two baths a week. Two staff spoken with said consultations with health care professionals and Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 14 treatments take place in the privacy of the residents own room. Residents spoken to confirm this occurred. Records show that when moving into the home the resident was shown their room and given keys to their room. Examination of the storage, administration and handling of medication showed that medication is well managed and held safely and securely and administered by suitably trained staff. Medication is held in a secure designated cupboard and generally administered as prescribed. Examination of the Medication Administration Record (MAR) show that staff had reduced the number of Adcal tablets administered to one resident from two to one each day. The manager said the GP had reviewed the dosage and instructed that the number of tablets administered be reduced with immediate effect. Examination of records failed to confirm this occurred. Staff must secure written confirmation of changes to prescribed medication so that the home can be sure medication continues to be administered appropriately. Four items of controlled medication was held and stored separately and two staff signatures confirm medication is administered in accordance with approved procedures. The inspection found that compliance with the previous requirement and the practice of the senior carer dispensing medicine through another carer and then signing to state that the medicine has been administered although they did not see the resident take the medicine has ceased. The member of staff responsible for dispensing medicine administers the medicine to the resident and then signs the medication administration records (MAR) to confirm medication has been taken. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle, social activity and maintain contact with family and friends. Residents receive a healthy, varied diet according to their assessed needs and choice. EVIDENCE: Residents were observed to exercise their choice to enjoy the privacy of their own rooms or to join other residents in communal areas for company or meals. Residents stated that they access community facilities with support and maintain contact with visiting relatives and friends at the home. There is a flexible visiting policy and residents choose where they meet their guests. Residents felt that their visitors are made welcome. The home will organise visiting entertainers, group activities and church services at the home. With staff support, a number of residents have the opportunity to go on holiday. One resident spoken to said she been on holiday with a number of other residents to Spain and that they had been supported Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 16 by a small number of staff. The resident talked about the holiday and said what a good time they had. The home employs an activities organiser who arranges a wide range of social and therapeutic activities for the benefit of residents. The activities organiser was able to demonstrate a high degree of knowledge and understanding of the individual needs of residents. Records show a high level of resident participation in individual and group activities including: aromatherapy, reminiscence, jigsaws and board games. Residents’ who choose can have access to widescreen televisions and satellite programmes available in communal lounges. On the day of the visit, a number of residents on the first floor enjoyed a game of carpet bowls while other residents chose to participate in a range of activities taking place in the conservatory. The conservatory is used by people from the community who attend the home for day-care and provided there is capacity residents are able to access these additional resources. On the day of the visit, a hairdresser was providing services at the home. Four residents spoken to said they were very satisfied with the activities provided. One resident said, there is always someone here to entertain us another resident said I’ve just been to a coffee morning in the day centre. A cheese and wine evening had taken place the previous day and involved community visitors and relatives of residents. One resident spoken to told the inspector he had visited the optician the previous day and had fancied fish and chips for his lunch. The activities organiser accompanied the resident to the fish shop where he ate his lunch then to the pub where he had a drink before attending his appointment with the optician. The resident said how much he had enjoyed himself and how grateful he was to the home for enabling him to go out. The manager talked about the benefits of therapeutic stimulation for residents and said he was in the process of booking a number of seats for residents to visit the cinema to see the new James Bond film. Care plans selected for closer examination held details of residents past hobbies and current interests and records held of resident participation shows that a resident who enjoys completing quizzes continues to spend time pursuing her interests. One resident spoken to said how much he enjoyed watching sport on television and told the inspector he had access to Sky digital programmes on the television in his room. The resident was hard of hearing and had text on the bottom of the screen so he was not dependant on hearing to enjoy programmes. The meals provided in the home are good with specialist diets and choice catered for, including diabetic and soft diets. A discussion occurred with a cook on duty regarding the catering facilities, equipment, records of menus and consultation with residents. Residents meetings provide further consultation regarding services provided at the home. Four residents spoken to said they were “very satisfied” with the food, which was described as “varied Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 17 and plentiful”. On the day of the visit for the main meal, residents were offered brisket of beef with vegetables or cheese salad followed by a choice of five different desserts. This is commended. Breakfast is served flexibly according to individual preferences. The choices include cereal, toast, preserves, fruit juice and eggs. Records are held of all food provided so the home can be sure residents nutritional needs are being met. The inspector joined residents for lunch. This was a relaxed and sociable occasion with staff providing appropriate and effective support. Residents enjoyed a non-alcoholic drink with their choice of meal. The care plan of a resident selected for closer examination identifies the need for a soft diet observations at a meal time show staff were aware of the resident’s nutritional needs and a soft diet was provided. Residents reported that they had a good choice at breakfast and a range of savouries and cakes at tea. Drinks are served between meals. One carer assisted a resident to eat and provided this care with warmth, sensitivity and skill. One resident who had difficulty expressing her views and opinions verbally was shown the menu and selected her preferences by pointing to the meal she wanted. Staff training records show that staff attend training in food safety. In discussion, the cook on duty said that she was also trained in the Control of Substances Hazardous to Health (COSHH) and Hazard Analysis Critical Control Points (HACCP). Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures in place for the protection of residents and complaints are listened to and taken seriously but the absence of staff training on adult protection and the prevention of abuse may place residents at unnecessary risk. EVIDENCE: Warwickshire County Council (WCC) Social Services Department (SSD) has a corporate complaints procedure and each home has a revised complaints procedure that meets the requirements of the Care Homes Regulations 2001. The home also has a policy and procedure for the Protection of Vulnerable Adults (PoVA). A copy of the home’s complaints procedure was displayed in a number of prominent positions in the home including the reception area. The manager talked about the complaints procedure and said the home had not received any complaints since last inspection. Three residents spoken with said they were not aware of the complaints procedure but would talk to the manager if they were dissatisfied with any aspect of the service provided. Residents said they were very satisfied with the service and had no cause to complain. An audit of residents and relative’s questionnaire surveys showed that none of those Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 19 surveyed had complained about the service. Since the last inspection there have not been any complaints made directly to the commission. The last inspection identified gaps in staff training in Adult Protection resulting a requirement that staff attend appropriate training. Since the last inspection no further training has been undertaken and staff training records show that only eight of 22 care staff have attended training on the protection of vulnerable adults. The inspector was told that the home submitted nominations for attendance at recent corporate training events but due to the high demand for places, the home was unsuccessful. A number of places have however now been secured for training in the New Year. Discussions with two care staff on duty demonstrated that they have a good knowledge base and understanding of issues related to preventing and handing concerns related to the protection of vulnerable adults and although they were not aware of the ‘Whistle blowing’ policy and procedure they would report any concerns to the manager. Staff said residents are well cared for and had their rights respected. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 20 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, 20,21,22,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The design, layout and facilities provided, enables residents to live in a safe and comfortable environment. EVIDENCE: The home has a warm and welcoming atmosphere and is generally well maintained. The home is on three levels and a passenger lift is provided to assist residents’ to access to their rooms. Each floor has a communal lounge and a kitchenette with the main dining room located on the ground floor. Suitable accessible communal bathrooms and toilets are situated close to lounge and dining areas. Each bedroom has ensuite facilities, which are of a good size and meet resident’s needs. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 21 The furnishings in communal areas of the home are of a good standard and residents rooms visited were personalised and include items of furniture the resident had brought into the home with them. In the absence of natural light in some areas of the home, the output from electric lights was considered poor. For example, corridors on the first and second floors and the main dining room were dim and residents with sight impairment may have trouble moving around the home safely and independently and may have difficulty identifying their food. It is therefore strongly recommended that lighting be upgraded to make sure the environment is safe and suited to the individual needs of residents. Ramps provide access to the grounds, which are safe, attractive and well maintained. There is a sluice facility on each floor, which is used for cleaning commodes. The home has a policy and procedure for the prevention and control of infection. A tour of the premises showed staff have access to protective clothing including disposable gloves and aprons and observations of staff practices confirm staff wear disposable gloves when carrying out personal care tasks. The laundry was found to be clean and well managed. Two residents spoken to said the laundry service was good and their clothes were returned promptly. Residents were nicely presented and wore clothes suited to the season. The clothes hanging in one resident’s wardrobe were clean and well maintained. Observations noted include staff regularly entering food preparation areas in the kitchen without wearing protective clothing. Such practices are unsafe and may increase the risk of infection or cross contamination. Staff training records show that not all staff attend training in infection control. One carer spoken with said she was not trained in the prevention of infection or cross contamination. Staff practices may therefore be unsafe and may place residents at risk. Soiled incontinence pads are held in designated bins and collected regularly for disposal by external contractors. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Qualified staff are available in sufficient numbers to provide care for residents but the absence of rigorous staff recruitment practices and is unsafe and place residents at risk. EVIDENCE: On arrival at the home, there were appropriate staff numbers and skills mix available to provide for residents welfare. Care staff exhibited appropriate skills and attitudes in their interactions with residents. Residents stated their approval of staff and services received at the home. Four weeks staff rotas were examined and show sufficient numbers of staff on duty to meet the assessed needs of residents. There is a stable staff group and the manager demonstrated commitment to ensuring staff access corporate training opportunities. Records examined show staff training had been completed in moving and handling and food hygiene and 15 of 20 care staff have completed a National Vocational Qualification (NVQ) level 2 or equivalent. Only two staff hold a first aid certificate therefore a qualified first aider is not always on duty. Three staff spoken to said they were regularly supervised and attend annual appraisals to identify any training needs. Staff talked about the staffing arrangements and said there were always sufficient numbers of staff available Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 23 to meet the needs of residents and any shortfalls as a result of staff absence were covered by staff employed by the home. The staff induction process requires that new employees work along side an experienced worker until assessed as competent and capable. A range of health and training is included in the process. The induction records of the two most recently appointed staff were not available for inspection as the documentation is held by the worker until completed and as the workers were not available on the day of the inspection clarification of what was included could not be obtained. The records regarding recruitment, induction and staff profiles of the two most recent employees were inspected and discussed with the manager. These records showed serious shortfalls in the staff recruitment process. For example, the following documentation and information was not secured before two new workers began working with vulnerable adults: application forms, references, identification, staff induction or supervision. Only one of the two files held a current photograph of the worker and evidence of the outcome of a Criminal Record Bureau (CRB) disclosure and checks made against the PoVA register. The failure by the home to follow rigorous staff recruitment procedures is unsafe and place residents at risk. This shortfall resulted in an immediate requirement being issued for the registered person to carry out a risk assessment, secure a CRB disclosure and checks made against the PoVA register. The registered person must not in future employ people to work at the care home without securing all the information necessary to determine fitness. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 24 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed and residents’ benefit from having their care needs met by staff that are supervised, qualified and experienced. Health and safety policies and procedures are in place to safeguard residents. Quality assurance monitoring is implemented as a core management tool and any shortfalls in the service addressed. EVIDENCE: The manager is a qualified social worker registered with the General Social Care Council (GSCC) and has completed the Registered Manager’s Award (RMA). The manager is experienced and continues to update his knowledge Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 25 and understanding. Since the last inspection, he has attended training, which looks at equality and diversity and managing performance. All the residents spoken to know who the manager is and said he was always available and easy to talk to. One resident said the manager had set his television up for him. Three residents said the home was very well managed and their relatives and visitors were always made to feel welcome. Three staff spoken to said residents were well cared for and the manager and senior staff were always available to offer any support or guidance as needed. Staff records read showed formal one to one staff supervision is carried out and used as part of the normal management process to monitor staff practices to ensure residents’ health, safety and welfare is maintained. The pre inspection questionnaire completed before the visit to the home shows that the manager does not act as appointee for any residents for their benefits or manage any savings. The organisation acts as agent to collect benefits on behalf of a small number of residents. There is a record of the personal allowance paid to the resident. This record is signed by the resident or witnessed by a second member of staff. A receipt is issued for monies held for safekeeping and a receipt retained for any items purchased on the residents behalf. A minority of residents manage their own finances. Other residents’ finances are managed with informal assistance from relatives or through power of attorney arrangements. A quality survey was carried out in May 2006 by Age Concern whose representatives visited the home and talked to residents about the service they received. Individual questionnaires were completed during the consultation process and the outcome of an audit of responses sent to the home. The findings of the quality audit show service satisfaction in relation to food and drink, social and cultural activities and safety in the home. Shortfalls identified include the lack of hot water and the attitude of one or two staff. The manager talked about the outcome of the quality audit and of how the shortfalls had been addressed, for instance the hot water, system was upgraded to the satisfaction of residents and issues relating to staff were addressed during one to one supervision and observation of staff practices. The findings of the quality audit were reported back to residents at one of their meetings. Since the last inspection, the home has received a number of commendations, which are displayed in the home and thank staff for the care service they provide. One comment noted includes “ many thanks for our wonderful holiday in Benidorm.” Examination of documentation shows that regular visits at least monthly by the registered person or their representative to monitor the service are not being Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 26 implemented as required by the Care Home Regulations 2001 and must be addressed so that we can be sure the service is being regularly monitored and the health, safety and welfare of residents protected. Records of any accidents or incidents are held on resident’s personal record file and are reported to the commission in accordance with the Care Homes Regulations 2001. We obtain information before inspections. The information includes confirmation that all necessary policies and procedures are in place and are upto-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents and staff safe. Records held show the fire equipment in the home was last checked on 11/08/06 and that the fire alarm is tested weekly. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 27 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 28 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 manager/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 Timescale for action 15/02/07 2. OP7 15 3. OP7 15 4. OP7 13 The Registered Person must ensure care plans set out in detail changes in their needs with documentation of action taken to meet and address any change in circumstances. (Timescale for compliance 31/05/06 partially met) The Registered Person must 15/02/07 ensure care plans set out in detail, the action needed to be carried out by care staff to ensure all aspects of the health; personal and social care needs of the service user are met. (Timescale for compliance 31/05/06 partially met) The Registered Person must 31/12/06 ensure daily health related statements, are completed consistently to demonstrate care prescribed and care given. (Timescale for compliance 31/05/06 not met) The Registered Person must 30/11/06 ensure risk assessments include any activity that may pose a risk such as bathing and the use of bed rails. DS0000035064.V316102.R01.S.doc Version 5.2 Bracebridge Court Page 29 5. OP8 13(1) 6. OP9 13 7. OP18 18 8. OP29 19 schedule 2 9. OP30 18(1)(c) 10. OP33 26 Where a risk is determined, a care plan must be devised describing the action to be taken to minimise the risk. The Registered Person must arrange for service users to receive where necessary treatment, advice and other services from any health care professional. To include residents’ identified as having any significant weight gain or loss. The Registered Person must ensure written confirmation of changes to prescribed medication is held so that the home can be sure medication continues to be administered safely and appropriately. The Registered Person must ensure that all staff receive training related to the protection of vulnerable adults. (Timescale for compliance 31/05/06 not met) The Registered Person must ensure rigorous staff recruitment procedures are followed and must not in future employ persons to work at the care home without first securing all the information necessary to determine fitness. The Registered Person must ensure that all staff are up to date with statutory training requirements and attend training related to the care of service users living in the home. (Timescale for compliance 31/05/06 not met) The Registered Person must visit the home unannounced at least once a month and write a report upon the conduct of the care home. A copy of this report must be available and open to DS0000035064.V316102.R01.S.doc 30/11/06 30/11/06 28/02/07 16/11/06 31/01/07 30/11/06 Bracebridge Court Version 5.2 Page 30 11. OP38 13 inspection. The Registered Person must ensure staff wear protective clothing when entering food preparation areas. 30/11/06 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. Refer to Standard OP25 OP38 Good Practice Recommendations The Registered Person should make sure that the home is sufficiently bright to meet the needs of individual service users. The Registered Person should ensure that a qualified first aider is always on duty. Bracebridge Court DS0000035064.V316102.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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.V316102.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. 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