CARE HOME ADULTS 18-65
Braemar House 38 Seaway Road Preston Paignton Devon TQ3 2NZ Lead Inspector
Michelle Finniear Announced Inspection 28th October 2005 09:30 Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 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 Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 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 Adults 18-65. 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. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Braemar House Address 38 Seaway Road Preston Paignton Devon TQ3 2NZ 01803 666011 01803 666011 braemarhouse@btinternet.com 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) Miss Rian Marie Hill Miss Cara Marie Hill, Mrs Anna Teresa Hill Miss Rian Marie Hill Care Home 12 Category(ies) of Dementia - over 65 years of age (1), Learning registration, with number disability (12), Learning disability over 65 years of places of age (12) Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Braemar House is a large semi-detached property situated on the level, near the beach and all local facilities, whilst being within easy walking distance of the local Community Resource Centre. The home provides accommodation for up to 12 adults with learning difficulties who may also have some level of physical disability. The home is situated in a residential area of Preston and service users are encouraged and supported to be an integral part of the local community. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours on a weekday in October 2005. This inspection was announced, which means that the owner and service users were given prior warning of the date and time of the inspection. To complete this inspection a tour was made of all areas of the home, time was spent informally with all the service users who live at the home, and one relative attended the inspection to discuss the care provided. Discussions were also held with the owners and staff on duty. Records such as care plans, the fire log book and some health and safety records were seen, and the owner completed a pre-inspection questionnaire. Five relatives and five service users also completed comment cards, on such areas as privacy, food, safety, activities and on how to make a complaint. What the service does well:
Braemar House provides a comfortable and informal living environment, close to local shops, facilities and the seafront of Paignton. The home has access to transport facilities, but is within easy walking distance of the local resource centre. Service users have personalised and individual accommodation in single rooms, many with en-suite facilities, and a choice of communal space. Many of the service users have lived at the home for a significant number of years as a group, and are well settled with strong relationships between them. This could be seen with one service user in particular who has deteriorated physically in the last two years, but is however included in all activity. The home is family run, with owners who work at the home daily. This means they know the service users very well, and are in close contact, so would be able to identify potential changes in service users at an early stage. The home has good systems for consulting with service users, staff and relatives about how the home operates. Comment cards completed for this inspection contained such comments as “I am very pleased with the treatment and the atmosphere” “I can’t praise the staff enough” “ We have been delighted with the standard of care and every aspect of the home” “Star treatment”
Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 6 “First class care, and the staff are always very friendly and helpful to me. They work extremely hard” and “The staff and owners are always happy to see you at anytime”. These views were confirmed by a relative who attended the inspection. 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. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, Braemar House has a comprehensive statement of purpose and service user guide providing service users and prospective service users with full details of the services the home provides and enabling an informed decision about admission to the home. EVIDENCE: The service user guide and statement of purpose for the home were examined. Braemar House has a comprehensive statement of purpose and service user guide providing service users and prospective service users with full details of the services the home provides, so enabling an informed decision about admission to the home. The service user guide is provided in formats suitable to meet the needs of the current service user group, and contains the required information in plain language. The guide also contains copies of the homes statement of terms and conditions or contract, which has been made available in a pictorial format to ensure that as far as possible service users can understand the contractual basis on which they are living at the home. No new service user has been admitted to the home since the last inspection. Discussion was held with the manager on the most recent admission and the process which had been followed on that occasion. This process had involved the obtaining of full assessments and pre-admission visits from the service user and the care manager had taken place. These assessments and visits are Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 9 important in ensuring that the home is the right place for the service user and to ensure that the home can meet their needs. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, Braemar provides a caring environment where service users needs are assessed, recorded and met in a consistent fashion. Lifestyle choices and preferences are respected, EVIDENCE: Three Service user plans were sampled for this inspection. Service user plans are drawn up with the support of the service user and contain information on goals service users wish to achieve and the support they need to do this. Plans are signed by the service user and are written in easy to understand language or use symbols where appropriate to facilitate this. Plans were then referred to the individual service users, and verified through other records and discussions with staff. The plans were found to be an accurate reflection of the care and support needed or given, and in the case of one plan concurred with the service users understanding. Plans contain information on the management of risks, which is important in ensuring service users lead lives that are not overly restrictive, and can take part in activities that contain an element of risk in an informed manner. Risk
Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 11 taking is important on occasions in ensuring the full development and potential of the service user. Service users are encouraged to make lifestyle choices, which may include developing personal relationships and friendships, following chosen activities, hobbies and interests, visiting family, participating in household tasks and self care skills. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 Service users receive a wholesome and varied diet. EVIDENCE: The main meal of the day at Braemar house is usually taken in the evening as many service users are out all day. However on the day of the inspection all service users were at the home and therefore the main meal was taken at Lunchtime. The meal consisted of pork chops, mashed potatoes and fresh vegetables with a fruit flan and cream for dessert. Meals are home cooked. Service users confirmed that they had cereal and toast for breakfast, and assisted in some meal preparation including making packed lunches for when out at day centres or work placements. Menu plans are consulted upon, which helps to ensure that service users have choices in the meals that they eat. Meals are eaten communally, with one service user requiring support in eating having their meal in the same area as other service users so as to engage in the social aspects of mealtimes when they feel able to do so. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 13 The home also currently caters for one service user with unstable diabetes. The service user concerned is actively involved in the management of their care and every attempt is made to ensure that they can eat the same or similar meals as the other service users. This helps them to not feel different or excluded from certain foods. One way in which the home does this is to ensure that if a jelly is used for dessert it is sugar free, so that all service users can enjoy the same dessert. One service user at the home on respite confirmed that they had cooked a spaghetti Bolognese for everyone the other night, which they had enjoyed. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 Service users palliative care is planned sensitively. EVIDENCE: Discussion was held with the owners on Palliative care, and their policy in relation to maintaining care for a service user with a potentially life limiting illness. At the time of the inspection additional specialist equipment is being considered, including moving and handling equipment and another specialist bed. An occupational therapist has visited and given advice on current and future needs. A moving and handling risk assessment and plan was not available, and this is advised to ensure that all potential risks are managed and communicated effectively. Evidence was seen of specialist healthcare support being provided including mammography services, diabetic nurse specialists and optical care. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Braemar House has a satisfactory complaints system, which ensures service users have opportunities to air their views. Arrangements for protecting service users from abuse and neglect are satisfactory. EVIDENCE: Braemar house has a complaints procedure which has been given to all service users and was seen on display within the home in the entrance hallway. The procedure is available in formats which mean that all service users will be able to understand the process, or have had it explained to them and this is recorded. Service users who completed comment cards indicated they would know who to speak to if they were unhappy with the home or their care, and this was confirmed in conversation. Discussion with a relative who attended the inspection, and comments from those who completed comment cards indicated an understanding of the homes complaints process. No formal complaints have been received about the home, however the home has recorded a request from a service user in relation to the service which has been actioned. Adult protection training has been given to staff in relation to the homes own policy which is linked to the locally issued alerters guidance. The home has a full policy and procedure for adult protection including information on Service user rights and a whistle blowing policy. Minor amendments needed to be made to the policy, and the home owners agreed to amend this in accordance with the issued guidance from the local authority to ensure clarity. Adult protection training is important as it clarifies staff actions to be taken in the case of suspected abuse.
Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 16 Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29,30 Braemar provides a comfortable, homely, clean and safe environment in an accessible location for people wishing to enjoy an active life. EVIDENCE: On this announced visit to Braemar house, all areas of the home seen were clean, warm and comfortable. All service user bedrooms were seen, some were showed by the service user themselves, who expressed pride and satisfaction with the accommodation. One service user specifically requested that the report note how clean and tidy their room was. All service user bedrooms are individual and attractive, showing evidence of their personal interests and tastes in colours and styles of furnishing. There are ten single bedrooms, mainly with ensuite facilities, and one room currently still registered for shared occupation, but being used as a single room. This will be re-registered as a single room in the near future. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 18 The home has a suitable number of baths and a wheel-in shower facility on the ground floor. Risk assessments have been undertaken for water outlets, and this should be re-examined again to ensure service user safety from scalding. Plans are in hand for further redecoration and renovation as a part of the homes development plan. Service users will be consulted throughout the decision making on décor. One service users room ceiling had been damaged by a small plumbing problem, which will be remedied. The home has a specialist washing machine, capable of achieving a full sluicing cycle, which means that it is capable of ensuring total infection control of any contaminated linen or clothing. Appropriate arrangements are in place to dispose of clinical waste, which ensures service users are protected from any risks of odour or cross infection. There is a large open plan lounge/diner, and a visitor’s room/computer room for service users. This means service users have somewhere they can take relatives rather than have to sit in the communal lounge or their rooms. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 35 Braemar house has carried out a full process of recruitment and vetting of staff ensuring service users are protected. EVIDENCE: Only two employed members of staff work at Braemar house with the rest of the staffing made up by family members. It is planned that this will be supplemented by another recently recruited member of full time staff, releasing the owners from some direct care time with service users. The home has job descriptions for all staff employed. Discussion was held on training that has been undertaken since the last inspection. This has included an assessment of overall staff training needs, and additional training has been planned as a result. Additional training is to include infection control, moving and handling updates, epilepsy awareness, first aid, total communication and for the owners the completion of their Registered Managers Awards. The registered managers award is a specialist award and qualification in relation to managing a care home. The home currently has 50 of the staff having achieved an NVQ level 2 or above. Two other staff are working towards the award or a higher qualification. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 Braemar House is a well managed care home. Some attention is required to health and safety issues. EVIDENCE: Braemar house is a family run home, with the registered manager being Ms Rhian Hill. Ms Hill has worked at the home for 9 years, and so has extensive experience of working with the service users. She is currently completing her Registered managers award. Risk assessments have been undertaken for water outlets, and this should be re-examined again to ensure service user safety from scalding. Several water temperature outlets at wash hand basins were noted to be delivering water at 60 degrees centigrade. In general, where there is full immersion the home has fitted automatic water temperature regulation. Additional discussion needs to be held with a plumber in relation to an upstairs bathroom where water temperature is delivered at 62.4 degrees centigrade. The owner expressed concern that as this is a cast iron bath which cools water on filling; if the water temperature is regulated at below this temperature then the water in the bath
Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 21 will be cooled excessively by the bath and make the bath too cool to use. This is to ensure that service users are not put at risk from scalding. Other areas of health and safety inspected were satisfactory, with staff training and updates in food hygiene, infection control, first aid, fire and moving and handling planned. This will ensure that everyone who works at the home has up to date training in these areas, helping to protect service users. Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x x x Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Braemar House Score 3 x x 2 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x DS0000058135.V264699.R01.S.doc Version 5.0 Page 23 NO 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 YA42 Regulation 13 Requirement The owner must reassess the risks presented by water temperatures being delivered at over 60 degrees centigrade to some wash hand basins, and the water temperature to the bath on the first floor. Advice should be taken from the Environmental Health department of the local council. A moving and handling plan and risk assessment must be provided for service users with moving and handling needs associated with a life limiting illness Timescale for action 30/11/05 2 YA21 13 30/12/05 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 YA23 Good Practice Recommendations Minor amendments are required to the homes policy on adult protection to ensure it is fully compliant with local policy and procedures.
DS0000058135.V264699.R01.S.doc Version 5.0 Page 24 Braemar House Braemar House DS0000058135.V264699.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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