Inspection on 31/05/06 for Braemar House

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Braemar House 19/09/07

Braemar House 28/10/05

Braemar House 07/07/05

Braemar House 05/10/04

Braemar House 29/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Braemar House 38 Seaway Road Preston Paignton Devon TQ3 2NZ Lead Inspector Michelle Finniear Key Unannounced Inspection 31st May 2006 9.55 Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 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.V291459.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 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.V291459.R01.S.doc Version 5.2 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.V291459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28/10/05 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. Fees range from £306.58 to £639.94 per week. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is a summary of a cycle of Inspection activity at Braemar House since the last inspection visit. To help CSCI make decisions about what it is like to live at Braemar House the owners gave us information in writing about how the home is run; documents submitted since the last inspection were examined along with the records of what was found at the last inspection; a site visit of 7 ½ hours was carried out with no prior notice being given to the home as to the date and timing; discussions were held with the owner and staff on duty; various records were sampled, such as accident and medication records; questionnaires were sent to service users, some of which were completed with the support of an independent advocate; and a tour was made of the home and gardens. During the site visit one service user’s advocate also visited the home. In addition a sample group of service users were selected and their experience of care was ‘tracked’ and followed through records and discussions with staff and management from the early days of their admission to the current date – looking at how well the home understands and meets their needs, and the opportunities and lifestyle they experience. These service users were then spoken to, and questionnaires were sent to their relatives, general practitioners and care managers where appropriate. This approach hopes to gather as much information about what the experience of living at the home is really like, and make sure that service users’ views of the home form the basis of this report. 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’ rooms are decorated as they wish, many with en-suite facilities. There is a choice of communal space, but limited garden and outside space available. Service users spoken to were proud of their rooms and possessions. 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. 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. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 6 The owners have managed to compile in some cases really useful information about service users histories. This information helps staff and carers to understand some of the life experiences that this service user has had, and helps with the understanding of current behaviours that challenge. 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 “The staff-nice and kind, they look after me” “The food is nice, it’s lovely, it’s too much for me I need to slim down” “It’s a happy place” “Cara, Rian and Anna put 100 of their time and love into Braemar, anyone of them are always available for the clients and staff” “xxxxxx is loved; he is not just a client” What has improved since the last inspection? What they could do better: Any significant incidents and any allegations concerning a staff member or the registered person must be reported to CSCI without delay. This is to ensure that any incidents or allegations can be investigated appropriately, and in accordance with the local Adult protection policy and procedures as necessary. The home manager should provide an assessment of the risks from legionella, which is a bacteria which may be found in water systems. This is to ensure Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 7 service users, visitors and staff are protected from any risks of Legionella infection. The home manager should seek information on the local palliative and end of life care protocols. This is to ensure that service users with a life limiting or deteriorating illness and their supporters can plan and make decisions with medical support about their future care. 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.V291459.R01.S.doc Version 5.2 Page 8 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.V291459.R01.S.doc Version 5.2 Page 9 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, 4, 5 Quality in these outcome areas was good. 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 discussed on the site visit, and were as previously seen. Braemar House’s statement of purpose and service user guide gives service users and prospective service users 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. This is an excellent document, personalised with photographs and symbols. Records seen on the site visit indicated that service users and their supporters have had this document explained fully to them, and they had signed it to confirm they agreed with the contents. This helps to ensure that all the information provided is understood. Files for three service users were seen on the site visit. These were selected to ensure a range of needs could be seen. Service user information was split into Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 10 two files, a current person centred file, and a file for admission information and assessments, historical information and financial records. This ensures that current information on service users is always to hand. Person centred plans are written using the service users input as the starting point. This helps to ensure that service users care is delivered in the way that they would wish, and that they are able to make their own lifestyle choices with support. No new service user has been admitted to the home since the last inspection cycle. Discussion was held with the owner on the admission process that has been followed previously and this was related to the service user files selected. The 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 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.V291459.R01.S.doc Version 5.2 Page 11 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, 9 Quality in these outcome areas is good. 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 on the site visit, which were linked to the assessments seen. Service user plans are drawn up with the full involvement of the service user and/or their supporter and advocate 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, observations and discussions. The plans were found to be an accurate reflection of the care and support needed or given, and service users activities seen were reflected in their daily plans. One file also contained Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 12 information which had been compiled from old hospital records. This is commendable as this information helps staff and carers to understand some of the life experiences that this service use has had, and helps with the understanding of current behaviours that challenge. Other files contained some life history work, and information that has been gathered from relatives, which is also of great significance to the service user, particularly those who have communication difficulties themselves. Service users rooms showed evidence of person centred planning with individualised pictorial representations of people of significance and support to them. 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 taking is important in ensuring the full development and potential of the service user. As an example one service user who is quite frail is going on holiday with all the service user group to France. The home owners feel strongly that this service user will benefit from being with their friends and the experience, and have spent time ensuring that the environment and equipment needed will be available abroad. 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. These are detailed in their service user plans, and discussions with service user confirmed these were things they enjoyed. In the completed questionnaires one service user indicated that sometimes they “have to do things” like attend day centres, another said that sometimes they stayed at home “to help”, sometimes they went shopping, to the theatre, pub meals and day activities. Other opportunities available include a music workshop, exercise sessions, massage, pool, play station and computer, karaoke, arts and crafts, board games etc. None of the service users spoken to on the visit wished to attend religious services, but this would be accessed if wished. During the inspection site visit service users not out of the home were colouring, reading, preparing to go out shopping, watching television, putting away laundry and talking to visitors. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 13 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): 12, 13, 15, 16, 17 Quality in this outcome area is good. Service users follow full and active lives, and receive a varied diet. EVIDENCE: Files for three service users were inspected in detail and reference was made to other files to see opportunities available to them for interesting and enjoyable activities. During the site visit many service users were out at various day placements and a local centre which provides activities for people with learning disabilities. Discussions with these service users on their return indicated that they had been taking part in a variety of activity, particularly Art and craft works on that day. Service users were able to discuss their forthcoming holiday and the preparations they were making, and their attendance at local clubs including one with a planned curry night. The evening before the site visit two service users had been out to the cinema and then had a takeaway curry on their return. Another service user had been visited by family, and they had all sat down to watch the England football match and enjoy a glass of beer. These activities were all in accordance with service users interests and expressed choices, and the service user being able to offer hospitality to his relations underlines how the home ensures service users treat Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 14 the home as their own. During the site visit a service user’s advocate visited the home with their family. It was clear that the service users were all acquainted with the small children and the advocate themselves, who had bought ice creams for everyone in the house, including staff. This encourages a family like domestic feel to the home, and service users could be seen showing genuine regard for each other during the visit. Service users are encouraged to access all community services and facilities as well as those which are specially to meet the needs of people with learning disabilities. This includes for example the use of local pubs and cafes, healthcare facilities and shops. This helps service users feel a part of the community in which they live. Service users are encouraged to continue and develop valued relationships, be those with family, friends or advocates. One service user spoke movingly about the recent loss of a partner who had passed away, and of other significant losses in their life. Attendance at local centres enables links with other people with learning disabilities in the area, but service users contacts are encouraged throughout the community. The home owners have an understanding of the social model of disability, which suggests that it is society and the way it is constructed that ‘disables’ people not any differences they may have. For service users this means that the home has an expectation that they have the right to take part in any activity within the community and the responsibility is the communities to make adaptations to allow that to happen. Contact with family is enabled and service users spoke of the pleasure they had from receiving telephone calls and visits from family members. Evidence of this could be seen in daily logs and in service user activity plans. Discussions were held with staff on duty and management concerning the balancing of service users dietary needs and healthy eating principles with the choices that service users may make for options which may not be so nutritious. On the day of the site visit the home had prepared a packed lunch for service users out of the home, and those at the home had sandwiches. For the evening meal staff cooked Fish Provencal, which was a recipe service users had chosen from a new cookery book. One service user had written in their questionnaire that they wished to lose weight, and this was discussed with them. Staff confirmed that they had in fact lost some weight and were being careful about what they ate. The home has a menu plan which is drawn up in conjunction with service users. One service user at the home has 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. As an example when all the service users were eating ice-creams, a low sugar version was made available for this Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 15 service user. This helps them to not feel different or excluded from certain foods. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 16 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): 18, 19, 20, 21 Quality in these outcome areas was good. Service users receive the help they need to manage their healthcare. EVIDENCE: Service users’ healthcare needs were being addressed well. The home has plans and regular internal audits to ensure that service users receive the regular routine health checks to which they are entitled, as well as specialist checks for hearing and vision. Evidence was also seen for some service users of routine preventative healthcare such as mammography screening. Service users and staff confirmed service users are supported to attend medical and hospital appointments, and these were recorded in service user files. One service user has become increasingly frail, and discussion was held with the home on considering with the service user, medical staff and advocate what interventions would be appropriate in the case of future deterioration. Agreeing these end of life care issues in advance means there is more chance for the service user or their advocate to make their wishes known than in a potential crises. The home’s systems for managing medication were also seen on the visit. The home has a medication policy and procedure and uses a monitored dosage system which means that medication is blister packed by the supplying Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 17 pharmacist. This system reduces the risks of errors and makes it easier to check if medication has been given on a particular occasion. The medication cupboard was clean and clear of excessive stock, and all records seen were recorded appropriately. The home has a dedicated lockable refrigerator for medication such as unused insulin and eye drops. The home’s storage and policy on administration is checked regularly by the supplying pharmacist. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 18 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): Procedures for managing complaints and adult protection issues are satisfactory. EVIDENCE: Braemar House has a clear complaints procedure. Service users interviewed and who responded in a questionnaire indicated that they knew who they could go to with any concerns and be confident that it would be dealt with. One service user who commented through an advocate wrote “I made a complaint we gave it to Rian, she done something about it. I was pleased”. Others, when asked how to make a complaint said they would “tell the staff –Rian or Cara”. As an example one person had made a complaint about their trousers being left inside out when they had been ironed. This was fully detailed in the complaints book, along with the action that had been taken by the homes management to resolve the concern. This demonstrates that service users are aware of the home’s complaints procedures, and have faith in using them. The home has clear information available for staff on Adult protection procedures, which has been backed up by training, documentation for which was seen. A recent issue was raised by a service user at a local day centre. It is understood that this has been investigated by Social Services. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area was good. Braemar provides a comfortable, homely, clean and safe environment in an accessible location for people wishing to enjoy an active life. EVIDENCE: On this unannounced visit to Braemar House, all areas of the home seen were clean, warm and comfortable. All service user bedrooms were seen, one was shown by the service user themselves, and two others discussed their rooms during the visit. 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 en-suite facilities, and one room currently still registered for shared occupation, but being used as a single room. 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, these are now all fitted with water temperature regulators where service users would be bathing or showering, and this is to be extended to all basins in the near Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 20 future. This is to ensure no service user can suffer a scald as a result of coming into contact with hot water. Plans are in hand for further redecoration and renovation as a part of the home’s development plan. The roof is to be replaced and a service user’s room redecorated while all the service users are away on holiday in France. 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. The home has limited outdoor/garden space, but there are seating areas outside and the home is within 100 yards of a beach, promenade and green space. There is parking for several cars on the home’s forecourt, and on street parking nearby, although this may be limited in the summer months. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 21 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): 32, 34, 35 Quality in this outcome area is good. The home has clear procedures for the recruitment, training and retention of staff. EVIDENCE: Braemar House has clear processes for the recruitment, selection and retention of staff, which offers a good protection for residents. Three staff files were selected at random for inspection on the site visit, and anonymous questionnaires had previously been sent to staff members. Files contained all required information and demonstrated that all of the required checks, such as a criminal records bureau checks and references were taken up on appointment. These checks are important as they help to protect service users from being cleared for by staff who may be unsuitable to be working with vulnerable people. The home has procedures for equality and diversity monitoring in their employment, and has sets of standard questions as an example for use whilst interviewing to ensure that all applicants receive the same interview processes. Job descriptions are available for all levels of staff within the home. Discussions and records showed that the home had recently had to dismiss a staff member. This had been managed well and in the best interests of the service users. Two staff involved with service user care have achieved their NVQ level 2, and two are still working towards the qualification. Discussion was held with the staff on duty, one of whom is working on the award and aims to finish by Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 22 Christmas 2006, another is not interested in pursuing this at present. The NVQ award is a national qualification recording the competencies of staff, and should ensure service users receive a consistently good service. Training records were also seen on the site visit. The induction systems for new staff are being updated to incorporate the new sector skills standards for staff working with service users with a learning disability, but older systems could be seen to have been completed for the current staff. Staff questionnaires confirmed they had received an induction on employment. Residents spoken to during the site visit interacted with staff in an informal and clearly affectionate manner, and were supported by them well in the observations undertaken. This was also the case with service users with communication difficulties. Staffing levels seen were flexible to meet the changing daily needs of residents and additional staff are on duty at times of greatest activity. This means service users should not be disadvantaged and restricted from attendance at events or activities of their choice by the staffing levels. Some service users are out of the building for much of the day, so evenings and mornings can be times of most activity and interaction. A staff training and development programme was seen on the site visit. This demonstrated staff attendance at core training updates as well as resident specific or developmental topics. The staff-training programme is comprehensive and means service users will be supported by well-trained staff, who are able to understand their needs and deliver their care appropriately. In addition, staff files showed evidence of formal supervision on a regular basis. Supervision is a system of staff appraisal and development planning. Appropriate supervision will ensure staff are working at their optimum level and providing consistent care for service users. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 23 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, 39, 42 Quality in these outcome areas was good. The home is well managed; Policies and procedures, including the arrangements for Health and safety, protect residents and staff from foreseeable risks. There are good systems for quality audit and management. EVIDENCE: Braemar house is a family run home, with the registered manager being Ms Rian Hill. Ms Hill has worked at the home for 9 years, and so has extensive experience of working with the service users. Rian Hill divides her day-to-day management responsibilities with her sister, Cara Hill, which works well for them both and the home, but with Rian carrying the overall responsibility. Rian and Cara could demonstrate they have clear systems for monitoring and managing the quality of the care provided at the home. There are regular audit systems which ensure for example that all care plans are kept up to date, that service users receive regular healthcare checks and that standards in the home environment are kept up. Questionnaires could be seen to have been Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 24 completed by relatives, staff, the visiting podiatrist, music teacher, optometrist, hairdresser, staff at centres that service users attend in the day, solicitors, care managers, social services, general practitioners and dentists. These questionnaires help the management to improve the home or ensure that the care delivered to service users is of a good quality. Discussion was held on Health and safety at the home. The home has had a full Asbestos survey done since the last inspection, and has plans to complete a Legionella risk assessment. Regular fire checks are carried out, as one service user confirmed, and on the day of the site visit electrical safety checks were being carried out on all portable appliances. Also on the day of the site visit the owners were receiving a health and safety visit from a specialist company with whom they have contracted to provide advice and record keeping systems. This will include standardised risk and environmental assessments. Since the last inspection all areas where service users have a bath or shower have regulated temperatures so that no service user can scald themselves from hot water. Radiators are protected to ensure service users would not be able to injure themselves from coming into contact with a hot surface. Window openings are restricted or are top opening according to the manager, so no service user could be accidentally injured falling from a window. Accident records seen showed only one accident since the last inspection which had involved a service user cutting their finger on a glass which had broken while they were washing it. The record also showed that appropriate first aid and medical support had been provided, which shows that service users are supported by staff who understand First Aid practices. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 25 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 Standard No Score 1 3 2 3 3 3 4 3 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 26 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 YA23 Regulation 37 Requirement Any significant incidents at the home and any allegations concerning a staff member or the registered person must be reported to CSCI without delay. Timescale for action 31/05/06 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 2 Refer to Standard YA42 YA21 Good Practice Recommendations The home manager should provide an assessment of the risks from legionella in the home. The home manager should seek information on the local palliative and end of life care protocols. Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 27 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 © 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 Braemar House DS0000058135.V291459.R01.S.doc Version 5.2 Page 28 - 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. 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