CARE HOMES FOR OLDER PEOPLE
Bracken House Bracken Close Burntwood Nr Walsall WS7 9BD Lead Inspector
Mrs Wendy Grainger Unannounced Inspection 19 September 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 Bracken House DS0000028915.V307404.R02.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. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bracken House Address Bracken Close Burntwood Nr Walsall WS7 9BD 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) 01543 686850 01543 670326 jakki.hamer@staffordshire.gov.uk Staffordshire County Council, Social Care and Health Directorate Jacayln Ann Hamer Care Home 36 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (36), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (20), Old age, not falling within any other category (20), Physical disability over 65 years of age (10) Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 3 Dementia (DE) - Minimum age 50 years on admission Date of last inspection 2nd November 2005 Brief Description of the Service: Bracken House was built in 1968 to provide care and accommodation to older people. Located on an estate the home is not in a conspicuous position, overlooking a school and near to the centre of the village of Burntwood. The City of Lichfield is approximately four miles away. Standing in its own grounds the home continues to be upgraded internally and externally. Occupancy at Bracken House is for thirty-six older people. The home provides care for long term stay older people with dementia or related conditions of old age. The two-storey building has bathing and toilet facilities throughout the home. The first floor can be accessed via the stairs or shaft lift. Within the home there has been created three lounge/diners, Roseview remains a self-contained dining room/lounge with a small kitchen area. The laundry and main kitchen are located on the ground floor away from any service users bedrooms. The home has a separate hairdressing room, treatment room and staff room on the ground floor. The home has recently undergone a major refurbishment throughout, each area was refurbished and decorated separately so as not to disrupt the residents life style. During this the home had to achieve a number of vacancies. Since the new registration the registration has reduced to thirtyfive older people. The vacancies are now being filled mainly from a home in the locality that is closing down. From the information received in the pre inspection questionnaire the current fees were £439. Additional costs would include hairdressing, £5 & £15 private chiropody £12, personal toiletries and periodicals. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection of this level 3 home took place on the 19 September 2006. The inspector was provided with the relevant records, reports and documents to complete the inspection, the staff, management and the residents who shared their home during the time at the home gave all assistance. The registered care manager had forwarded the pre inspection questionnaire from which, information will be included in the report. Included in the inspection was a tour of the home, observations of the staff working as a team to provided quality care. The home had recently been refurbished throughout the major refurbishment had included creating three separate living areas. No extra bathing/toilet facilities had been created; there were sufficient to meet the residents’ needs. Decoration had been a duel agreement with the residents where possible and or relatives. The tasteful re-decoration had provided residents with a light comfortable home. What the service does well:
The residents at Bracken House were able to choose their daily life style, this was evidenced during the inspection, and residents came freely to the office to chat in general about issues including the menus and lunch served. Residents spoken with were complimentary about the manager her staff and the home in total. One resident told the inspector that his day out in Llandudno with staff was “brilliant”. Speaking to three visitors each one with a different reason to find complimentary things to say about the home. One visitor was sitting with her relative as she draws near to the end of her allotted time. The relative said she would not have wanted her mother elsewhere, “she was kept clean, comfortable and all care possible was being given to her”. One person said that if she had been aware of Bracken House and the staff and care she would have chosen it over her previous home where her relative had had recently transferred from. Another relative said her mother had “put on weight, she did not know flinch from her and she was even communicating a little,” more than she was doing at another home. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 6 Arrangements were in place for the continued health care from other agencies; this was evidenced during the inspection. The inspector was told that the home had excellent support from the nurses and general practitioners. A community staff nurse completed a comment card “ a very pleasant clean and presentable visit. Staff very polite, cheerful and approachable at all times. (Keep up the good work well done) in addition “she was very satisfied with the overall care provided to residents”. Eight comment cards were forwarded to the Commission including one from a family who experienced respite care. Only two chose not to make additional comments but were satisfied with the home and care. “They are very good” “I am very satisfied with care thank you very much to all the staff “ “Since my mom came to Bracken she has received the most excellent care. I could not have given her better care myself. Mon is now walking and I was told at the previous home she would never weight bear let alone walk. I can now sleep easy in the knowledge that mom is in safe caring hands” “I feel confident with the care provided to be able to relax and enjoy my break and feel mother was in professional hands; excellent what a friendly team thank you” “ I feel that the home has a homely feel” “Mom was here for respite care while I went on holiday so I was not able to visit, anyway she has told me (and I have seen) that the staff are wonderful and very caring” Eight of the residents had commented on forms provided to the inspector “ I was originally somewhere else and was not happy; I was asked by the managers to look at Bracken after I was told about the home. I received all the support I need, staff listen to me, I enjoy the entertainment and join in the quizzes. I felt poorly and all I wanted was tomato soup and this was what was served. The home is always always fresh and clean, I am happy here and don’t know any person that isn’t. “I visited before I came in “ “there is always staff around the home to ask “ “I would like more days out like my lovely day out in Llandudno “ a big improvement would be a second lift and a small wall mounted fire extinguisher in the smoke room” “I feel very lucky to be at Bracken the staff are very helpful I was given all the information I needed to choose the home” “If I need anybody I just pull the bell”” I am not a big eater but enjoy what I have and know something else would be prepared if necessary.” “ I was worried about moving and the first few days were strange but I have settled down and am happy here I am a lucky lady” “ the staff would change the food if I did not like it” “I enjoy the activities” “Good menu I have put weight on” “key worker is very good” “I like to watch TV and read my paper” “ staff make sure I receive all the medical support I need” “ I can maintain my independence and still have lots of support” Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: 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. Bracken House DS0000028915.V307404.R02.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 Bracken House DS0000028915.V307404.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 Quality in this outcome area is good. This judgement has been made using available evidence including speaking to residents and visitors about the admission experience. No resident was admitted to the home without a full assessment of his or her needs. Access to the required documents prior to admission was readily available. EVIDENCE: Five new residents had been admitted to the home since the completion of the refurbishment. More admissions were planned; each of the residents had had experience of residential care homes. Two relatives were spoken with; both families were very satisfied with the process of their relative being admitted to Bracken. They were fully involved at each stage; their relative had met staff and management and where possible visited the home. There has been an enormous amount of planning between both Head of Homes to ensure the transfers went smoothly.
Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 10 A full assessment of personal and health needs were collated and evidenced in the documents seen. Evidenced during the inspection were relatives of the prospective residents being shown bedrooms and welcomed by the staff, furniture and personal possessions were also being brought into the home ready for the move. The Statement of Purpose had recently been updated to include the qualifications achieved by the staff. Plans remain to develop this document into Braille. Bracken House DS0000028915.V307404.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area was excellent. This judgement has been made using available evidence including a sample of the care plans, speaking to residents, observations of the staff on duty and their interactions with residents. Arrangements were in place for the continued health care of residents. Care plans sampled were meaningful and contained the varied support required to enable residents to continue with their chosen life style. The staff on duty were relaxed and continued to provide the appropriate support for individuals. The home had a system in place for the safe handling and storage of medication. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 12 EVIDENCE: The sample of three care plans identified that individuals diverse needs were met from the details recorded. The plans identified that following discussions with a resident that he only wanted two checks during the night. All aspects of the risk had been explained and agreed by the resident. More personal care was required by another resident and recorded. The care plans reflected the current care required and they had been regularly reviewed. The Head of Home had delegated the monthly dependency levels and summaries to staff; with an overview by her. The inspector was told that the home had excellent support from all the professional agencies that visit the home. Records of their visits and outcomes were evidenced. The system for the administration of medicines ensured the safety of the residents. Records were current; storage was satisfactory. A locked facility was provided in the event a resident chose to self medicate. During the inspection the inspector observed all the staff on duty interact with the residents and each other. This included the activity organiser who was present. Staff observed the privacy and dignity of the residents when assisting them or just passing the time of day, they were respectful and the interaction was a two-way thing. A number of the residents told the inspector that the Head of Home and all the staff were special people who cared for their needs. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including the social life of the home, speaking to residents and viewing the menus. The staff provides the facilities for the residents to maintain a social life of their preference. Contact was maintained with families and friends. Catering provides the residents with a nutritious balanced diet, and met individuals’ preferences. EVIDENCE: A number of the residents have an enduring dementia, the activity organiser spent time with residents stimulating them as was observed during the inspection. Some of the residents joined in the musical morning entertainment. The inspector evidenced the pleasure this was giving the residents with residents joining in.
Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 14 One resident who has limited verbal communication agreed with the inspector that the music was good; she had been clapping and singing along. A person who has different types of animals including reptiles is to visit the home. The staffs give their own personal time to fund raise for the residents funds. A planned Curry & Quiz night plus external entertainment in November was part of the fund raising for 2006. A record of activities was maintained. During the inspection the contact with families was evidenced. Relatives spoken with confirmed that they were contacted by the home about their relative. They were exceptionally complimentary about the care provided and the friendliness of all the staff. Residents were spoken with prior to and following the lunch, each one was satisfied with the food provided and digested today. One resident had a particular preference for fish, which he is served on a regular basis. Qualified catering staff offer alternatives and choice on a daily basis. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including speaking to staff in respect of training. The complaints process was made available to any person, staff and residents at the home. The safety of the residents was a priority for all the staff and was enhanced by training. EVIDENCE: The home had comprehensive policies and procedures in the event of a complaint being made. The commission or Head of Home had not received a complaint. The Head of Home would maintain a record if necessary. Staff when spoken with provided the inspector with confirmation of their training in the protection and care of the residents, via the appropriate training. Resident surveys and comment cards confirmed they were aware of whom to speak to if they had a problem. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a tour of the home and from speaking to residents about their home. The total refurbishment has provided the residents with an exceptionally comfortable and well decorated home. EVIDENCE: A sample tour of the home identified a well maintained and very comfortable home. Residents spoken with were happy and comfortable. One resident in particular had moved his room and had an en-suite facility for which he was absolutely thrilled about. Where ever possible residents had been involved in the decoration of their rooms and had an input into other areas decoration.
Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 17 The staff maintains the home to exceptional standards of hygiene throughout. Adequate hand washing facilities and bathing were available, each area included hand gel and paper towels. In the recent refurbishment two toilets for disabled residents had been created from existing toilets. The lounge/dining room created was suitable for its purpose, large enough to use for entertainment as evidenced during the inspection. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,28,29 Quality in this outcome area is good. This judgement has been made using available evidence including a review of staff records and the recruitment process. Adequate numbers of suitable trained and experienced staff are correctly employed to meet the individual and diverse needs of the residents. EVIDENCE: The Head of Home had been in the caring profession for a number of years. She was on duty supported by care staff including senior staff, catering, housekeeping and Head of Hotel Services. The staff were in sufficient number to meet the needs of the residents. 74 of the staff team had an NVQ qualification in care. Obligatory training was current and confirmed by the staff spoken with. One Care Shift Leader was waiting to be accepted on the NEBBS course for management. Training for 2006 has included dementia awareness for the care of adults and part of it includes Vulnerable Adult awareness. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 19 The Head of Home has the Registered Managers Award and attends all the obligatory training. Recruitment was handled correctly. The Head of Home will ensure that a copy of a birth certificate in respect of the staff that have been employed for a number of years would be placed on file. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including speaking to residents, relatives, checking the required records. The home is operated in the best interest of the residents by experienced committed management and staff. EVIDENCE: The entire staff team work as a team to provide a relaxed homely environment for the residents. The senior staff, each has different responsibilities to ensure that the records and systems operated smoothly. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 21 Samples of the finances held on behalf of certain residents were found to be accurate. From discussions with the residents and relatives, it was obvious from the positive comments about all the aspects of care and the home including the staff that all care was provided satisfactorily. The home was financially viable and the Public Liability Insurance was current. A check on the records identified no concerns as to the manner in which they were maintained. Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 22 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 X 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 4 X 4 4 4 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 X X 3 X 3 4 Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP29 Good Practice Recommendations To complete the records for the staff employed for sometime to complete Schedule 2 Bracken House DS0000028915.V307404.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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