Inspection on 06/06/06 for Bracken Lodge

This inspection was carried out on 6th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Lodge 08/05/07

Bracken Lodge 22/02/06

Bracken Lodge 27/07/05

Bracken Lodge 15/12/04

Bracken Lodge 29/06/04

Bracken Lodge 05/01/04

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

CARE HOMES FOR OLDER PEOPLE Bracken Lodge 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB Lead Inspector Martin Bayne Key Unannounced Inspection 09:00 6th June 2006 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 DS0000020429.V299194.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. DS0000020429.V299194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bracken Lodge Address 5 Bracken Road Southbourne Bournemouth Dorset BH6 3TB 01202 428777 NO FAX 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) Mr W O`Flaherty Miss V Flemming Miss V Flemming Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places DS0000020429.V299194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Bracken Lodge is a large detached property, situated in a quiet residential area of Southbourne, Bournemouth. The home is positioned within 400 metres level walk from the centre of Southbourne, which offers a wide range of amenities, such as shops, post office, churches, GP surgeries and library. The home is also close to the cliff top and sea. Parking for visitors is available on surrounding roads and there is a good local bus service nearby. Bracken Lodge accommodates up to 18 older people with dementia, who are in need of 24hour nursing and personal care. The property has been converted for use as a care home and is arranged over three floors. A passenger lift is available to assist access between floors. The home has fourteen bedrooms, ten of which are for single occupancy. None of the bedrooms has en-suite facilities, but there are sufficient numbers of communal bathrooms and WCs available. The home has a lounge on the ground floor, which also provides a small dining area. This is the only communal space so recreational facilities are somewhat limited. There are issues over accessibility to some rooms but staff make good use of the space available. A secure garden is not available, but there is a paved patio area, with a water feature and pots of seasonal colourful flowers, where service users can sit out under staff supervision. Service users are encouraged to participate in a range of activities organised within the home. An inter-denominational service is held in the lounge every two weeks and service users are welcome to participate if they wish. DS0000020429.V299194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key inspection was carried out between 9:00am and 3:00pm with the aim of evaluating the home against the core Older Person’s Standards and to follow up on the requirements made at the inspection in February. Miss Flemming assisted throughout the inspection providing records and explaining how the needs of residents are met at the home. Time was spent talking with residents in the main lounge and observing the staff interacting with residents. Three members of staff were also spoken with and also three relatives who were visiting on the day. What the service does well: What has improved since the last inspection? At the last inspection there were three requirements made against the home. The first requirement concerned the registered manager Miss Flemming undertaking the registered manager’s award. Miss Flemming was due to complete the course, however due to problems within the college and out of her control, she is not due to complete this training until Aug. The second requirement was in respect of the induction training for the staff. Since the last inspection there have been no new staff appointed at the home, however meetings with the PCT and liaison with Skill for Care means that a compliant induction programme will be in place for the next member of staff who starts work in the home. The third requirement concerning fire training and the carrying out of a fire drill was met. The two recommendations made at the last inspection were found to have been met with the medication policy having been reviewed and updated and the more staff now having completed NVQ level 2. DS0000020429.V299194.R01.S.doc Version 5.2 Page 6 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. DS0000020429.V299194.R01.S.doc Version 5.2 Page 7 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 DS0000020429.V299194.R01.S.doc Version 5.2 Page 8 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): 3&6 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit form having a full assessment of their needs being undertaken to ensure that these can be met at the home, prior to a place being offered a the home. Relatives and placing authorities will be better informed about the home with the revision of the Statement of Purpose informing that the home has a locked door policy. EVIDENCE: The paperwork relating to two residents admitted to the home since the time of the last inspection was used to track required documentation and evidence of care practices in the home. It was found that in the case of both these two residents, Miss Flemming had visited their placements at the time of referral to carry out a pre-admission assessment. A record of these assessments was seen and covered all of the topics detailed in the Standards. Relatives had also DS0000020429.V299194.R01.S.doc Version 5.2 Page 9 been invited to visit the home and once a decision had been made to offer a placement at the home, a letter had been sent offering a trial placement. It was agreed that the Statement of Purpose would be amended to inform that the home operates a locked door policy for the protection of residents who are at risk of wandering and getting lost from the home. The home does not provide an intermediate care service and so Standard 6 does not apply. DS0000020429.V299194.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 & 10 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from care plans being developed through assessment to inform staff of their care needs. Health needs of residents are met at the home and medication is administered safely by trained members of staff. Privacy and dignity of residents is respected by the staff. EVIDENCE: It was found for both the residents tracked though the inspection that a care plan had been developed through the assessment process. The care needs were discussed and these reflected the residents’ needs and actions staff should be carrying out in caring for the residents. Due to the mental frailty of the residents they are not able to sign care plans and so where appropriate, relatives are invited to sign on their behalf. Risk assessments had also been undertaken where appropriate concerning moving and handling, risk of falls and where bed rails are required. There was evidence provided that where DS0000020429.V299194.R01.S.doc Version 5.2 Page 11 appropriate turning charts are in place for residents bed bound and at risk of tissue breakdown and nutritional charts for those residents whose weight is a cause for concern. Records are maintained of doctors’ visits to the home. A system was found to be in place for the monthly reviewing of care plans. There was evidence form the care plans seen and the daily records that appointments and referrals are made appropriately to health professionals, such as GPs and psycho geriatricians. Miss Flemming reported that the home had good relations with the GP practices and district nurses. Chiropodists, opticians and dentists also visit the home to meet other health needs of residents. With regards to privacy and dignity there was evidence that residents are referred to by the name and title of their choice. Screens are provided within double rooms, personal care is carried out within the privacy of their bedrooms and residents are supported to maintain their personal appearance. All of the residents seen were in clean clothes with personal grooming tended to. Within care plans are indications as to the usual times that residents wish to get up and go to bed. The home has policies and procedures for the safe administration of medication. Medication ordering is carried out by Miss Flemming and the trained nurse are responsible for administering medication to residents. The home has a medication trolley and also a cabinet for surplus medication. Medicines are administered from the containers supplied by the pharmacist and then recorded onto the medication administration record. The trained nurse on duty hold he keys to the medication trolley and cabinet and is responsible for medicines on that their shift. Miss Flemming informed that staff are used to being patient with residents and will go back at a later time should a resident be in an incompliant mood to take medication. There was evidence that resident can refuse medication. The medication administration records for all of the residents were seen and it was found that there were no gaps within the records. It was recommended that where staff are having to make entries of medications prescribed onto the medication administration records, a second member of staff should sign that the entries have been recorded correctly. DS0000020429.V299194.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in making choices that reflect their expectations and preferences. Residents benefit from an open visiting policy and a varied and balanced diet. EVIDENCE: In the hallway was displayed the activities to be held each day within the home. Staff were also observed to spend individual time with the residents. Miss Flemming informed that resident are often taken out individually for short walks away form the home. At the time of inspection one of the residents who enjoys the warm weather was sitting in the garden and had been provided with sun screen to ensure they were protected from the sun. Old time music was playing in the lounge to the enjoyment of residents. An activities co-ordinator is employed by the home to hold movement and exercise groups. On the day of inspection three relatives were visiting and they said that they were very happy with the standards of care within the home. One informed that their relative had made considerable progress since being admitted to the home. They all said that they were made welcome when visiting the home and are informed of their relative’s health and changing needs. DS0000020429.V299194.R01.S.doc Version 5.2 Page 13 With regards to spiritual needs two services are held within the home, one Baptist and one Free Church. The home was currently accommodated two Roman Catholic and one resident of Jewish faith, however they do not with for visiting members of their faith. Breakfast is served to residents within their rooms between 7:00am to 9:00am at the time the resident chooses and assistance given to those residents who require help with eating. A mid-morning drink is served between breakfast and lunch, which is served at midday. The home does not have a separate dining room and so residents have lunch in the lounge. Residents are assessed nutritionally and the staff have recently been on training to use a nutritional screening tool. The menu for the week was seen, which reflected a wholesome and nutritious diet. Residents are assessed as to the level of assistance they require. Some have food cut up or pureed and some require assistance with eating. Residents enjoy a glass of sherry after lunch at the weekends. Afternoon tea and cakes is served to residents at 3pm and then a light evening meal between 4:30pm and 5:00pm. At about 8:00pm residents are offered a drink and a light snack. DS0000020429.V299194.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well publicised complaints procedure available to them and their relatives as well as policies, procedures and staff trained in adult protection. EVIDENCE: The complaints procedure for the home is displayed in the hallway and also within each resident’s bedroom. Since the time of the last inspection there have been no complaints made against the home and none have been brought to the attention of CSCI. The home maintains a log of all complaints made against the home. The home has copies of all the relevant policies and procedures for the protection of vulnerable adults, including ‘No Secrets’. All of the staff have received training through the PCT on adult protection and the home also has an instruction video for training new staff. DS0000020429.V299194.R01.S.doc Version 5.2 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 the following standard(s): 19 & 26 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a homely, safe environment to the residents where there are infection control policies and procedures in place to protect residents. The home will be enhanced by the exterior of the building being decorated and the laundry room floor being repainted. EVIDENCE: Bracken Lodge provides a small ‘homely’ environment for its residents. On the day of inspection the home was clean and there were no adverse odours. Miss Flemming informed that there were plans for the exterior of the home to be repainted and for some of the carpets to be replaced. The home has a small enclosed garden to the front of the home and a small enclosed courtyard at the rear. Residents are able to bring possessions to personalise their rooms and are provided with bedroom door locks, however none at the time of inspection held DS0000020429.V299194.R01.S.doc Version 5.2 Page 16 a key to their room. All of the radiators in the home have been covered in order to protect residents from burns and hot water outlets to the baths have thermostatic mixer valves to protect residents from scalding. The home has an infection control policy and staff are trained in the procedures in place for the home. Staff are provided with protective clothing and gloves. Alcohol gels are provided to staff when required. The laundry room is situated outside off the courtyard to the rear of the home and can be accessed without passing through food preparation areas. The laundry room is equipped with commercial machines that have a sluice cycle. The home also has three sluice rooms with bedpan washers. Miss Flemming reported that the handyman was due to repaint the floor in the laundry area. DS0000020429.V299194.R01.S.doc Version 5.2 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 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, 29 & 30 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a well trained, long standing staff team. The recruitment procedures will be improved with a revision of the staff application form. EVIDENCE: The home has a compliment of about 16 staff. The staff records for two staff on duty were inspected and it was found that a Criminal Record Bureau (CRB) check had been carried out and that PovaFirst checks had been received before they started working a the home. There have been no new staff appointed since the time of the last inspection. It was recommended that the staff application form be amended to gain information from applicants required under regulation, such as seeking a reference from the last place of employment of not less than three months where applicants worked with vulnerable adults and also signing a statement as to whether they suffered any health difficulties not suitable for carrying out their employment role. At the time of inspection there were 15 residents accommodated. The normal staffing levels for the home during the daytime are to have one trained nurse on duty with three care assistants and a cleaner and during the night time to have one trained nurse and one care assistant, both on awake duty. Miss Flemming informed that due to current low occupancy levels there during the daytime the home was operating with one less care assistant. A staffing roster DS0000020429.V299194.R01.S.doc Version 5.2 Page 18 was seen that reflected the above staffing levels. Three of the members of staff one duty were spoken with all of whom said that the current levels of staffing met the needs of the residents accommodated. Miss Flemming inform that she had authority to increase staffing levels and that in the past when there has been a need, such as when a resident presented with challenging behaviour staffing levels can be increased. At the last inspection a requirement was made concerning induction training for new staff. Miss Flemming was able to provide evidence of her discussions with the PCT and liaison with Skills for Care on the development of an induction programme that would be implemented when a new member of staff is employed at the home, thus satisfying the requirement. At the last inspection a recommendation was made that a minimum of 50 of the staff team should be trained to the standard of NVQ level 2. Since the last inspection two staff have completed this training, one is nearly completing the course and two others are due to commence this training. Some of the overseas staff hold nursing or other health related qualifications and it was suggested that Miss Flemming check the equivalence in Britain of these qualifications as some may have equivalence. All of the staff have received training in core subjects such as moving and handling, first aid, basic food hygiene, health and safety, fire safety and infection control. All the staff have received training in the care of dementia and some of the staff have received training in how to manage challenging behaviour. DS0000020429.V299194.R01.S.doc Version 5.2 Page 19 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 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the interests of the residents and is well managed. Health and safety of residents is promoted in the home. EVIDENCE: Miss Flemming has been employed as registered manager of the home since 1989 and as reported earlier in the report that due to circumstances beyond her control is not due to complete the NVQ level 4 course in management until August of this year. At the last inspection a the fire procedure for months. It was found fire safety training and requirement was made that the staff be made aware of the home and that a drill be carried out every six at this inspection that the staff have now all received a drill was carried out on the 3rd March this year. The DS0000020429.V299194.R01.S.doc Version 5.2 Page 20 fire logbook was inspected and it was found that tests and inspection to the fire safety systems were being carried out to the required timescale. A fire work place risk assessment has been carried out by an external provider. The home had a current certificate for the employers liability insurance. The staff spoken with said that there was an open management style adopted and that Miss Flemming also directly in providing care to residents. DS0000020429.V299194.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000020429.V299194.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Refer to Standard OP29 Good Practice Recommendations It is recommended that the staff application be revised to seek references form where a person has been employed with vulnerable adults and that a health declaration statement is added. It is recommended that where staff need to write medications onto the medication administration records, a second member of staff check and sign the record. It is recommended that the home revise the Statement of Purpose to reflect that the home operates a locked door policy. 1 2 3 OP9 OP1 DS0000020429.V299194.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000020429.V299194.R01.S.doc Version 5.2 Page 24 - 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. 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