Inspection on 25/05/05 for Bracken House

This inspection was carried out on 25th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bracken House 12/09/07

Bracken House 19/09/06

Bracken House 02/11/05

Bracken House 14/12/04

Bracken House 09/06/04

Bracken House 21/01/04

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 Bracken House Bracken Close Burntwood Nr Walsall WS7 9BD Lead Inspector Wendy Grainger Announced 25 May 2005 09:00 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 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 E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Bracken House Address Bracken Close Burntwood Nr Walsall WS7 9BD 01543 686850 01543 670326 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Farrier - Ray Staffordshire County Council Jacayln Ann Hamer Care Home 36 Category(ies) of DE - 3 registration, with number DE (E) - 36 of places MD (E) - 20 OP - 20 Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: DE - Minimum age 50 years on admission Date of last inspection 14 12 04 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. There are no en-suite facilities. Within the home there are three lounges, with a large separate dining room off one of the lounges.Rose view is 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.There are possible plans to reconstruct the home to include three separate group living dining room areas, and to erect a conservatory. The number of bedrooms within the home will remain unchanged Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There have been no requirements made for this home for sometime. The inspector was confident that if there were the management would respond fully within the allocated time scale. Residents were still enjoying their breakfast when the Inspector arrived. The large dining room caters for the number of residents that choose to use it. Rose lounge has a small kitchen facility to cater for the residents in this wing. The commitment of the staff maintained high standards throughout the home. Staff were sufficient in numbers during this peak time to assist residents where necessary. They demonstrated their commitment to the residents and were sensitive to their needs. Personal information in respect of the residents was available from the care plans. Management and staff worked as a team to provide quality care on a daily basis. The entire staff were known to the residents who responded to them. No resident was admitted to the home without a full assessment of his or her needs taking place. Arrangements would ensure that any health needs would be continue via other professional agencies. Residents spent time in the office and lounge with the inspector extolling the quality care and superb skills of the staff. One resident told the inspector that living at Bracken was better than living alone she confirmed that she could lock her bedroom door. They also informed the inspector about their outings; and they can hear the staff and management laughing because it’s a happy home. The entire day was relaxed and comfortable with plenty of banter between the staff, management and residents. The extensive planned refurbishment of the home had been reduced drastically due to funding. There remained plans to upgrade the home but to a much lesser degree. The management would be sending letters to relatives to explain about the changes and that their relative would have to be temporally moved to another Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 6 bedroom. One resident in his survey has recorded that he wants to choose his own wallpaper. The Commission had received two relative comment cards the families were happy with the care and that their relative was settled and how helpful all the staff were. From the five resident comment cards two felt the food was only sometimes liked. One lady would like to be more involved in the decision making within the home. No resident chose to speak to the inspector. At the time of this inspection there were nine vacancies, this was in preparation for the refurbishment when each of the bedrooms will be upgraded. The home was still committed to respite care for a while. What the service does well: What has improved since the last inspection? A quantity of kitchen equipment had been purchased. A sit on lawn mower and a hand mower had been purchased. Two hostess trolleys had been purchased ready for the refurbishment plan for the home to commence. The new sinks and vanity unit were being stored ready for the refurbishment. An arbour had been built out side the dining room and identified the name of the home. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 7 The residents had prepared all the hanging baskets and pots. The Head of Hotel services had passed his test to drive the ambulance and now takes residents out for trips. 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 E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 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 standard(s) 1,3,5, The home continued to follow the appropriate procedure prior to and following the admission. EVIDENCE: The statement of purpose and the service users guide remains unchanged, each of the documents were displayed for any person visiting the home to read. No resident has been accepted into the home prior to a full assessment of his or her need being assessed. The home continued to offer trial visits, prior to admission. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7,8,9 10 11 The care plans contained all aspects of care related to individual residents. Heath care continued as required., Residents were respected as individuals and supported by the staff team working together. There was a safe system in place for the receipt, storage and administration of medicines. From the complimentary letters and cards residents were treated with respect in their last days. EVIDENCE: The role of evaluating the care plans for each resident was being extended to the key staff responsible for the care. The senior staff oversaw the records. The care plans were in a module form. Records evidenced that the staff continued to recognise the changes in residents. The inspector case tracked two residents’ plans. One resident was receiving full care. She was warm, comfortable, her nightdress was clean and fresh, staff had provided her with a fresh dated jug of juice. The care manager delegated Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 11 one person on each shift to be responsible for all her care. Clear records were evident of food and fluid intake. The second care plan was for the respite person. Information and reports provided the appropriate information to continue the care required. Any required specialist equipment was provided via the nursing agency. District nurses had a regular routine to visit the home, at the time of the inspection it was three times a week. Two of the management were taking an extended training course for medication. This will then be part of the training for other senior staff responsible for medication. An alternative area had been identified for the storage of medication. The small room was well ventilated to protect the medication. Records were satisfactory. The inspector had no concerns as to the commitment and dedication to meeting the needs of the residents; this was observed throughout the inspection and shifts. Numerous thank you cards and letters had been received. Relatives maintained contact with the home after their loved one had passed on. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12 13 14 15 Residents were offered the choice to experience a social life via the numerous opportunities available. The home had a warm friendly atmosphere created by the staff for the residents. Residents were able to access meals of their choice, knowing that it would be well presented and prepared. EVIDENCE: The residents that choose to be part of the entertainment enjoyed a very lively morning. Residents were observed to dance with the staff spontaneously during the live musical entertainment. The activity organiser came in after lunch. Residents confirmed that they were knitting and had been taken out to Chasewater. They were aware that other trips were planned. The staff were committed to fund raising for the residents. The recent evening event raised £263 for the funds. Visitors were observed to visit during the day. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 13 During the recent elections residents were enabled to vote via the postal voting system. The main kitchen had recently been given good reports by the Environmental Health Officer and by the representative for Social Services. Residents were provided with a varied menu each day there was two options plus one vegetarian. Residents were provided items particular to them, i.e. bread with lunch. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 14 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 standard(s) 16 17 18 Via training and from the documents provided the home followed the practice of protecting residents from any form of abuse. EVIDENCE: The home displayed the complaints process within various documents; three residents confirmed that they were aware of whom to speak to in the event of a complaint/concern. The home had received no complaints internally or via the Commission. Residents’ legal rights were protected via the families and or other professionals. Within the in-house and foundation training; the staff would be made aware of their responsibility to protect residents from any form of abuse. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19 20 21 23 24 25 26 Bracken House staff and management provide a home that was suitable to meet the needs of the residents. The home is comfortable with a well maintained environment. EVIDENCE: Located on a small estate Bracken House overlooks a school. The home maintained an excellent standard of hygiene, for which staff should be proud. Some of the residents confirmed to the inspector that they had completed the pots and hanging baskets to be displayed in the garden at the rear. The rolling programme of decorating has been put on hold waiting for the planned refurbishment. Small necessary areas were freshly decorated. The accommodation is comfortable and bedrooms were personalised to suit individuals. The majority of the radiators had been covered the remaining ones will be within the refurbishment possibly in the next ten weeks. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 16 Toilets and bathrooms were appropriately sited around the home with assisted facilities being available. The staff monitored the home for health and safety aspects from the training they had received. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 30 The home had on going training for all the staff to ensure the quality care and commitment to the residents. Policies and procedures for recruitment were robust to ensure the safety of the residents. EVIDENCE: There were sufficient staff on duty during the day and within the week to meet the needs of the residents. The home had a qualified chef, cook and housekeeping staff that support the carers. There were four staff on duty during the night time shift. Two of the housekeeping staff had achieved level II NVQ, two more were to be registered in September for the course. The majority of the staff has First Aid training. On going NVQ training in care continued. The staff were experienced and were observed to meet the needs of the residents they care for. The care home had policies and procedures in place for the recruitment of staff, which includes an application form references, criminal records bureau checks and POVA checks; all of which were completed prior to employment. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 33 34 35 36 37 38 The residents benefited from the easy style of management and staff care. The home was operated for the resident’s best interests. The entire staff ensured that as far as possible the health and safety of the residents was paramount. Records were maintained in line with the requirements. EVIDENCE: The Head of Home had recently obtained her Registered Managers Award. On going in-house training was also part of her commitment to the residents and home. She would like to further extend her knowledge with more formal training. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 19 Staff confirmed that the Head of Home and the open door policy she operated supported them. Regular training opportunities were offered to promote their knowledge. An exceptionally relaxed inspection was experienced; the residents due to the ethos of the home experienced this, which was cascaded down from all the staff responsible for care. Records evidenced that the management as part of the quality assurance process sought families’ and residents opinions. The records maintained by the Head of Hotel were well maintained a minimum number were checked and found correct. Supervision was on going arranged on a regular basis. Records and training stored appropriately the Head of Home is to rearrange the format of the training matrix for clarity. Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 4 x 3 4 3 3 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 Standard No 16 17 18 Score 3 3 3 4 4 3 3 4 3 3 4 Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? 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 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 Good Practice Recommendations Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Stafford - 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 © 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 Bracken House E53-S28915 BRACKEN HOUSE V225175 2505051 Stage 4.doc Version 1.30 Page 23 - 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!