Inspection on 08/05/07 for Bracken Lodge

This inspection was carried out on 8th May 2007.

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 06/06/06

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 Unannounced Inspection 8th May 2007 09:45 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 Lodge DS0000020429.V339642.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. Bracken Lodge DS0000020429.V339642.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 Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 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 24-hour 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. At the time of the inspection the fees for the home ranged from £590 to £620 per week. Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection of the home, the aim of which was to evaluate the home against the key standards and to follow up on the three recommendations made at the last inspection. The Registered Manager assisted throughout the inspection in providing records concerning the running of the home and discussing residents needs. A sample of care records were used to track required paperwork through the inspection. Time was spent in the lounge area observing how the residents were supported by the staff. A tour of the home was made and some members of staff spoken with. What the service does well: What has improved since the last inspection? At the last inspection there were no requirements made, however there were three recommendations. It was found at this inspection that all three had been complied with, namely: The staff application form had been revised to seek appropriate references. Medication administration recording had been tightened with the practice introduced of a second member of staff signing and checking the record where hand entries were having to be made on the medication administration records. The Statement of Purpose had been reviewed to inform that the front door is kept locked in order to protect residents are risk of wandering and getting lost from the home. Bracken Lodge DS0000020429.V339642.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. The summary of this inspection report can be made available in other formats on request. Bracken Lodge DS0000020429.V339642.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 Bracken Lodge DS0000020429.V339642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit from their needs being assessed prior to being offered a place at the home, however they would be better informed if the home then sent a letter to inform that their needs can be met at the home. EVIDENCE: At the last inspection it was agreed that the Statement of Purpose would be amended to reflect that the home has a locked door policy for the protection of residents who could get lost should they wander from the home. It was found at this inspection that this document had been amended and prospective residents or relatives are offered a copy of the Statement to help them in the decision of choosing an appropriate home. Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 9 At the time of inspection there were 17 residents accommodated in Bracken Lodge, all placed through care management arrangements. The personal files for three residents were used to track the records that provide evidence of how residents are supported and cared for in the home. In the case of each person a pre-admission assessment had been carried out by the Registered Manager to ensure that the home could meet the needs of the person referred. In addition, a copy of the care management assessment had also been obtained from the care manager, together with a care plan. It has been found at previous inspections that once a decision had been made to accommodate a person, a letter would be sent offering a place and informing that the home can meet the person’s needs. Letters had not been sent out for these residents and a recommendation was made that for future admissions, the practice of sending a letter out to inform that needs can be met, should be re-instated. Bracken Lodge DS0000020429.V339642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their health needs being met through care planning and risk assessment and by being treated with respect and dignity. EVIDENCE: The care plans for the three residents tracked through the inspection were seen. It was noted that photographs of residents were on the door of their rooms and it was agreed that a copy of the photo would be attached to the care plans to assist new staff to identify residents. The care plans reflected the needs of the residents and were systematically organised into separate headings such as mental health, physical health needs, night time care needs, moving and handling, continence support, hygiene and communication needs. The plans were easily understood, informing of how staff were expected to meets the needs of the person. It was found that reviews of the plans were taking place each month so that the plans were up to date. The care plans had Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 11 been developed from various assessments such as the overall assessment of need, a moving and handling assessment, nutritional assessment and other risk assessments. Within the care plans and the daily recording, there was evidence that the health needs of the residents are met and supported within the home, with GP visits being arranged when necessary, chiropody, dental and eye care needs. There was evidence that the home worked closely when required with the Community Mental Health Team. In the case of a resident where bed rails were used, a risk assessment had been undertaken and relatives consulted. Care plans informed of the times when residents wished to rise and go to bed, their dietary likes and dislikes, spiritual needs, interests and hobbies. Concerning privacy and dignity of residents, staff are inducted on how they are expected to treat residents when they start working at the home. The medication administration records for the residents tracked through the inspection were seen. Only the trained nursing staff administer medication to residents. The records had been completed fully with no gaps found in the records. Due to the mental frailty of all the residents accommodated at the home, all medication is administered to residents. The medicines are stored in a purpose built medication trolley and surplus stock in a fixed cabinet in the office. Medicines were orderly stored away in line with good practice. A recommendation was made at the last inspection that where hand entries have to be made on the medication administration records they are checked and signed by a second member of staff to reduce the possibility of errors being made. It was found at this inspection that the recommendation had been complied with. Bracken Lodge DS0000020429.V339642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their social and spiritual needs being met; being able to maintain contact with friends and families and by being offered a good standard of food. EVIDENCE: As part of the assessment process a short history of people’s interests, hobbies and life style choices are made through the help of families. Since the last inspection the home has employed an activities co-ordinator who holds sessions with residents two times a week. The manager informed that there were plans to increase the number of these sessions. Notes were seen of the activities undertaken, which showed that all residents are included. The manager informed that there was an expectation on staff for them to interact with residents when time allowed. This is usually in the afternoons when staff are not so busy with direct physical caring. The staff were observed mixing with the residents and there appeared to be a good rapport between the two. Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 13 Two church services are held in the home each month, one Baptist service and one held by New Life Ministries. The manager informed that amongst the resident group were two people of Roman Catholic faith, however they did not wish to be visited by a priest. Spiritual needs are included as part of the assessment process. Visitors are made welcome at the home and there are no restrictions of when visits can be made. The manager informed that there were plans to hold structured meetings with families and staff so that they can be more involved in the home and the way that it is run. When the inspector arrived residents were having breakfast and being assisted by the staff. Some residents were having porridge; some cereals and one had a sandwich. The likes and likes of residents are known and the home tries to give them things that they like individually. The records of food provided to residents was seen and this reflected a varied and balanced diet. There was some choice of meals such as the example given above. Some residents require pureed food and this is presented in separate portions of individual vegetables and meat so that it is visually more appetising for the person. Some residents require assistance with feeding and this was clearly identified in the care plans. Residents enjoy a glass of sherry after lunch at the weekends. Breakfasts are staggered, dependent on when residents get up; lunch is served at midday, afternoon cakes and tea at 3pm and a light evening meal at about 5pm. At 8pm residents are offered a drink and a light snack. Bracken Lodge DS0000020429.V339642.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. 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 a visit to this service. Residents benefit from there being a well publicised complaints procedure and the staff being 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. Bracken Lodge DS0000020429.V339642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents benefit from a ‘homely’ environment where infection control measures and procedures are in place; however the elimination of odours in the building would enhance quality of the physical environment. EVIDENCE: Bracken Lodge provides a homely environment for the residents. On the day of the inspection the home was clean, however there were some odours in the building particularly in the lounge on the ground floor. The manager informed that the carpet cleaners were scheduled to visit in a week’s time to address this problem. Since the last inspection the exterior of the home has been redecorated, new light fittings provided throughout the building, the laundry floor re-painted, (as agreed at the last inspection), and new carpets provided in Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 16 some of the bedrooms. The garden to the front and side of the home has also been re-landscaped, creating an enclosed and safe sitting area for the residents. The manager informed that there were plans to re-carpet the lounge. The home has infection control procedures and staff are trained in these as part of their induction. Staff are provided with protective clothing such as gloves and aprons and also provided with alcohol gels. The laundry room is situated out of the building off the courtyard and is accessed without going 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. Bracken Lodge DS0000020429.V339642.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff being recruited in line with good practice, their being trained and deployed in sufficient numbers to meet residents’ needs. EVIDENCE: The home has a staff team of thirteen people, many of whom have worked at the home for a long period. The staffing roster was seen. Between 8am and 8pm there is one trained nurse on duty supported by two healthcare assistants. During the night time there is one trained nurse and one health care assistant, both on awake duty. The manger informed that staffing levels are sometimes adjusted should the residents’ needs require a higher level of staffing. The home also employs a cook and cleaners. Since the last inspection there have been two healthcare assistants who have started working at the home. Their recruitment records were seen. There was a record of the interview and all of the checks and records required under Schedule 2 were in place; including a Criminal Record Bureau check and a check against the register of people deemed to be unsuitable to work with vulnerable adults. Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 18 There was a record of the staff induction that was compliant with Skills for Care induction standards. The home has a 95 proportion of staff trained to NVQ level 2 or above. All staff receive mandatory training in First Aid, fire safety, moving and handling and basic food hygiene. Records were seen for some of the staff to evidence this. The manager informed that all of the staff had also received some training in caring for people with dementia. Notices were seen on the staff notice board on training courses that were coming up that staff could apply to attend. Bracken Lodge DS0000020429.V339642.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. 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 a visit to this service. Residents benefit from the home being well managed and run in their interests. EVIDENCE: Miss Flemming has been employed as Registered Manager of the home since 1989. Since the last inspection she has completed NVQ level 4, the Registered Manager’s Award. In April a quality assurance survey was conducted involving residents, relatives and professionals about how the home met needs of people who live there. Bracken Lodge DS0000020429.V339642.R01.S.doc Version 5.2 Page 20 Miss Flemming informed that the home does not get involved in residents’ finances. The fire log book was seen and tests and checks to the fire safety system have taken pace to the required timescales. Bracken Lodge DS0000020429.V339642.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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X 3 X 3 X X 3 Bracken Lodge DS0000020429.V339642.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. 1. Refer to Standard OP4 Good Practice Recommendations It is recommended that once a decision has been made to accommodate a person after their assessment, a letter is sent to inform of the decision and that the person’s needs can be met at the home. It is recommended that steps are taken to eliminate the odours on the ground floor. 2. 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