Inspection on 10/11/08 for Braemar Lodge

This inspection was carried out on 10th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Braemar Lodge 16/11/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Braemar Lodge Stratford Road Salisbury Wiltshire SP1 3JH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susie Stratton     Date: 1 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Braemar Lodge Stratford Road Salisbury Wiltshire SP1 3JH 01722439700 Telephone number: Fax number: Email address: Provider web address: braemarlodge@coltencare.co.uk Name of registered provider(s): Type of registration: Number of places registered: Colten Care Limited care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodate is 55. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Braemar Lodge is a purpose built 55-bed care home with nursing for older people. The home was first registered in June 2007. Accommodation is to a high standard with a wide variety of different communal areas. The home is built into the side of the hill. The entrance area is on the ground floor, with a first floor above and a lower ground floor, which has access to an enclosed patio garden area. This is fully wheelchair accessible. There is a passenger lift between floors. All utility areas such as kitchen and laundry have separate entrances, so that supplies and items for disposal do not need to be brought through the entrance area. The home is owned by Colten Care, who own a group of care homes, mainly in the south and south west. The managers post is currently vacant. The acting manager is supported by registered nurses, care Care Homes for Older People Page 4 of 32 Over 65 55 0 Brief description of the care home assistants, ancillary, catering, administrative and activities staff. The home is visited regularly by a senior manager from Colten care. The home is situated on a road leading into the city of Salisbury. At the back the home looks over playing fields. There is car parking on site and several bus stops close by. Salisbury has a railway station, which is about 5 to 10 minutes from the home. The fee range is 695 pounds to 995 pounds per week. Additional charges are made for items such as hairdressing, chiropody and sundries like newspapers. All prospective residents are given a copy of the service users guide and a guide is also available in the front entrance hall. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection, 40 questionnaires were sent out and 3 were returned. Comments made by the people in the questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the previous inspection, on 16th November 2007 was considered. We also received an annual quality assurance assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment, the survey and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. Care Homes for Older People Page 6 of 32 As Braemar Lodge is a larger registration, the site visits took place over two days. One of the site visits was conducted by a regulatory inspector and the other by a pharmacist inspector. We refer to these persons as we throughout the report, as the report is made on behalf of the Commission for Social Care Inspection. The first site visit was on Tuesday 11th November 2008, between 8:35am and 4:15pm. The second site visit took place on Wednesday 12th November, 2008 between 9:55am and 12midday. The deputy manager was on duty both days the inspection and available for the feedback at the end of the site visits. During the site visits, we met with fourteen residents, two visitors and observed care for five residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for six residents and reviewed certain aspects of care and documentation for a further one resident, across all parts of the home. As well as meeting with residents, we met with three registered nurses, eight carers, the activities coordinator, the chef, a laundry person and two senior managers from the provider. We observed a lunch-time meal and an activities group. We reviewed systems for storage of medicines and observed a medicines administration round. A range of records were reviewed, including staff training records, four staff employment records, accident records and complaints records. What the care home does well: What has improved since the last inspection? What they could do better: Improvements are needed, to ensure safe staff recruitment and training. Where issues are identified on police checks, there must be evidence that the home has actively considered the risks (if any) for residents. There needs to be written evidence that matters in prospective members of staffs past employment have been fully explored, to ensure that they are fit to work in the home. The home needs to have documentary evidence that all professional and other staff are able to be employed in their role in the home. Individual training documentation needs improvement. Care Homes for Older People Page 8 of 32 The home should further develop its care plans and documentation, ensuring that all relevant documents are dated and signed and that all matters are fully considered in evaluations of care plans. Care plans should clearly state the interventions needed. People who are directly involved with residents should document in records, including accident records. Some equipment for the disposal of clinical waste needs to be provided and some practice in relation to used laundry could be improved. British Standard signage is needed wherever oxygen is stored or used, to fully inform all relevant persons in the event of an emergency. It is advisable that the home modernise its approach to the management of residents own moneys, to include computerised accounts and invoicing systems. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their supporters will be assured that people have full assessments of need prior to admission, order to meet their diverse needs. Evidence: During the inspection, we met with a range of people, some of whom had been admitted recently. One person reported that they were admitted for a trial period and decided to stay, because they liked it. Another person who had been admitted recently reported that they thought they had been in the home for some time and reported that they felt quite settled and another person reported Im quite happy so far. One person reported that they had decided on this home because a close relative had been cared for at Braemar Lodge and that they had been impressed with how the home had looked after this relative. Some of the people met with were too frail to remember much about the pre-admission process. One person reported that a family member had come and seen round the home on their behalf, another reported that they Care Homes for Older People Page 11 of 32 Evidence: thought a member of staff had come and visited them in their flat before admission. A review of records showed that all residents have a clear and detailed assessment of need prior to admission. The assessment includes areas relating to different peoples diverse needs, such as social care and mental health care needs. The providers use a standard assessment tool, which includes a wide range of areas and directs staff on the areas where care plans need to be developed after admission. The home reported in their annual quality assessment that they have further developed their assessment methodology during the past year. The assessments seen reflected what residents told us, what we observed and what staff told us. Staff reported that they were informed in writing and verbally when a person was due to be admitted, so that they could prepare to meet the persons needs. Where additional assessments were needed, for example from the Macmillan Nurses, these were also obtained and taken into account when planning care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents diverse nursing and care needs will be met by the home, with full care plans, which are regularly evaluated, to direct staff on how their individual needs are to be met. People are protected by the homes procedures for the safe handling of medicine. People are well supported to manage their own medication, however this must be reflected in the records. Evidence: During the inspection, we met with a range of residents who had different levels of dependency, and some visitors. One visitor reported that I cannot think of a thing to criticise about the care. Another visitor reported on how well the home had looked after their relative when they were unwell. A resident reported theres always someone to help you if you need it and another all the girls are very good to me. Nursing and care staff spoken with showed a good knowledge of the nursing and care needs of individual residents. All residents have full assessments of need, which are regularly reviewed. Where a Care Homes for Older People Page 13 of 32 Evidence: need or a risk, for example risk of pressure damage, risk of falling or manual handling need, is identified, care plans are put in place to direct staff on how the need is to be met or risk reduced. As at the last inspection, some care plans would benefit from more precision and words such as pads, cream or laxatives should be avoided and the actual type of pad, topical cream or aperient needed should be described. This will more accurately direct staff and enable effective evaluation of the intervention. As much as possible, residents are involved with developing their care plans. One resident knew about how staff planned to meet their complex breathing needs and another how their mobility and manual handling needs were to be met, reporting they hoist me to bed. Most care plans reviewed had been regularly evaluated, including if the persons condition changed. Where a resident had needs relating to bowel care, whilst care plans had been reviewed, it appeared that the daily bowel care record had not been taken into account in all cases during the evaluation. As issues relating to bowel management can cause difficulties for elderly people, all evaluations need to include a full review of what is documented in the daily bowel record. At present only registered nurses write in the daily record about a residents condition. As much of the care is provided by the carers, it would be preferable if they reported directly in writing on the persons daily condition, rather than reporting it verbally to another person, who writes it down, as this involves a risk that not all matters may be included or be accurately documented. Some of the residents in the home are very frail. Where a resident is not able to move their position independently or give themselves meals or drinks, the home uses monitoring charts to ensure that such frail people have their care needs met. A review of these records throughout the inspection showed that these records were individually maintained, in full, at the time care was given. Some people had additional directives in their room to direct staff on certain aspects of care. Where this is the case, while some records were dated and signed, not all were, and this is needed to ensure timely evaluation. Some residents had complex medical needs. Where this was the case, there were clear care plans to direct staff on actions to take. For example one person who was an insulin dependant diabetic had a clear and measurable plan of care directing staff on how their individual needs were to be met. Another person who had breathing difficulties had a clear care plan about their breathing needs. One person had a stoma and their care plans directed staff on actions to take to meet their needs. Reviews of records showed that the home contacted residents GPs when needed. Other healthcare professionals were also contacted. One persons records provided Care Homes for Older People Page 14 of 32 Evidence: evidence of visits from the speech and language therapist and another the dietitian. The Parkinsons specialist nurse was visiting the home to meet with certain residents on the day of the first site visit. All personal care was provided behind closed doors. Staff at all levels, including the laundry staff and domestic staff, were observed to knock on residents bedroom doors and await a reply, prior to entering the residents room. Some residents reported in questionnaires that there had been problems with the return of laundry, however it appeared from talking to residents currently in the home that this had now been resolved. One person described the laundry service as excellent, another Im very pleased with the laundry and another said that the laundry was marvelous, you just put in a thing and its back next day all done and lovely. Our Pharmacist Inspector looked at all the arrangements for medicines in the home. All medicines are stored appropriately and securely, however the controlled drugs cupboard must be fitted with the correct bolts to ensure that it complies with the current legislation. All suitable records are kept by the nursing and care staff, including separate records of creams and lotions. There are clear care plans for the use of medicines prescribed as required. Some people are supported to manage their own medicines. One person we spoke to said that they were pleased to maintain some independence but the nurses always help if I need it. All people who manage their own medicines have a care plan and risk assessment, however we found two risk assessments that were not fully completed and one that did not reflect how the person stored the medicines in their room. During the inspection, we observed that whilst some registered nurses performed safe administration of medicines, others needed to ensure that they complied with the homes policies on administration, in that one registered nurse signed the medicines administration record before they had observed the resident taking their medication. There was evidence that this matter had been dealt with in full by the time of the second site visit. The acting manager has put in place safe procedures for dealing with changes to medication and all input from healthcare professionals and changes to doses or medicines were clearly recorded and acted upon. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported in their diverse social and recreational needs and mealtimes are regarded as an important area of service provision. Evidence: The home employs an activities coordinator and a carer is also provided to support residents on individual activities in their rooms. The activities coordinator gives each resident a list of activities for the coming week and residents can chose how they want to participate. One resident reported activities, Ive got a list weve quite a nice thing this afternoon - we all like that, another theres painting this to-day and you can just watch if you want to and another I went to the wiggly feet thing. The activities person reported that they try to do a lot of word games to support people who have mental frailty. External people also come into the home, including a reflexologist and EXTEND exercise class provided by a qualified EXTEND teacher. The activities coordinator reported that they also have access to transport and are able to take people on shorter or longer trips out. Where people were not able or willing to leave their room, they or the social carer visit to give 1:1 support. One person reported, the girls have said if I feel lonely just ring the bell and someone will be with you. Care Homes for Older People Page 16 of 32 Evidence: Residents have pen pictures, detailing their past lives and preferences. Not all of these had been completed for every resident. All residents have a care plan relating to social needs and the activities person documents attendance and outcomes in the residents daily record. Care plans include significant individual matters, such as the importance of practice of a faith for a person. For example, one person met with originally came from aboard and their notes reflected the fact that they did not wish to practice the religion they were born into in their country of origin. The activities person reported that a church service, including Holy Communion takes place one a fortnight and that the Roman Catholic priest will visit individually if requested. One person reported that they regularly returned to their own church for services and attended a lunch club, so that they could still meet old friends. Residents reported that they could chose how to spend their days. One person reported, I prefer to stay in my room. I prefer to be quiet, another they come and fetch me for the day room when I want, its up to me what I do, another I can do what I like here. Another person reported that they did not like to go out of their room but I do go to Holy Communion once a fortnight. However a person did comment they always try to get me into bed before I want to. As would be anticipated in a larger care home, there were a range of opinions about the meals. Comments varied from the foods well cooked, not very exciting, the foods a bit variable to the food heres excellent and the food heres all I could possibly desire. One person who reported that they appreciated being able to ask for an omelette when they wanted. During the inspection, we observed a lunch time meal. Residents could come to the dining room or eat in their room if they preferred. The system was well organised and ensured that people got the meal that they had ordered. The meals were observed to be served hot. Residents had a choice of drinks at mealtimes and could have wine or beer if they wished. Where residents needed support to eat their meals, staff sat with them, supporting and encouraging them to eat. As much as possible frail people were encouraged to assist themselves to eat and appropriate aids were given to them to assist them in doing this. We met with the chef, who reported that he liked to meet with residents to receive their comments. We observed that he was meeting with a resident during the inspection. He showed a clear knowledge of individual residents likes and dislikes. He reported that the parent company provided him with supports for menu development but that he could change items on the menu, when needed, to ensure that residents preferences could be met. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following recent management changes, residents will have their complaints listened to and action will be taken if indicated and vulnerable adults will be safeguarded. Evidence: The home has a complaints procedure, which is displayed and is available in the service users guide. Evidence from the home indicated that since the last inspection, compliance with the providers complaints procedure has been an area which has needed development. The deputy manager reported that since she came in post, she had identified that the previous manager had not followed the companys complaints procedure and some matters had not been raised or acted upon. The deputy manger has worked hard to ensure that the providers complaints procedure is followed and she now documents all matters, including verbal complaints and matters of concern. We have not had any complaints made to us since the last inspection. There was evidence that following complaints, one area the deputy manager has worked on, is response times when the nurse call bell is used and ensuring that all residents are left with access to their call bell. The site visit showed that more work is needed in this area. Three residents were observed to have been left without access to their call bell and on two occasions, it took over three minutes for staff to respond when a call bell was activated. One resident reported it depends how fast they come, sometimes they take more than half an hour and occasionally more than that and Care Homes for Older People Page 19 of 32 Evidence: another they dont always come when you ring the bell, however another person reported its not difficult to get a member of staff when you use the bell. Records showed, and the deputy manager reported that she had had a range of matters raised about call bells and has worked with staff to ensure that residents are always left with access to their call bells and that staff respond promptly when they are used. In order to ensure that this matter is resolved, she has ordered more pagers and they should be delivered to the home shortly. This is also an area where she reports she is planning to concentrate on, once the new manager is in post. Residents commented on how they would raise issues of concern. Some issues related to the previous management. One person reported Ive told them for a long time but nothing happened. Some people felt that they could talk to management now. One person said I have talked to the manager when Im not happy, Ive told them all sorts of things. People who had been admitted since the management changes felt that the home did take effective action. One person reported that they felt an agency nurse had been rude to them one night, they had told one of the homes staff and that the agency nurse had not come back. Another person reported that the night staff had not left them with their call bell, so they had told the [deputy manager] and she got it put right. The deputy manager is aware of how to ensure that vulnerable people are safeguarded, including an awareness of the local procedures for supporting vulnerable persons. Two referrals have been made by the home since the deputy manager came in post. These have been in support of vulnerable persons. One matter was investigated by the local adult protection team and relevant action was taken by the appropriate external authorities. The other matter was passed back to the home, who investigated the allegation and took appropriate action, including disciplinary action against person(s) involved. During the inspection, we spoke to a range of staff about safeguarding vulnerable adults. Staff we spoke to showed an awareness of the area and were able to give examples of how people could be at risk and be protected from this risk. The home has recently ensured that staff are trained in safeguarding vulnerable adults by an external agency. The deputy manager is working towards ensuring that records of training in safeguarding adults are fully up to date. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will benefit from an environment which meets their needs, which is well maintained and where there are generally systems in place to prevent risks of crossinfection. Evidence: Braemar Lodge was purpose-built as a care home and all rooms and areas exceed National Minimum Standards. Accommodation is provided over three floors, with a passenger lift in between. There are a range of different communal rooms for residents to sit in, if they chose. Facilities, including assisted baths, showers and wcs are provided for people with a disability. A wide range of relevant equipment is provided, including hoists, pressure relieving mattresses and profiling beds, to meet the needs of very frail people. All equipment was new on purchase and is regularly maintained. All parts of the home were in a good state of decorative repair. People commented on the home facilities. One person reported that when they had initially come to see the home, they had been shown all over the home. They had seen their room and thought, thats the one. One person who spent most of their time in bed reported that they appreciated being able to see the view out of their window whilst they were in bed and another person reported my family chose this room for me because of its very nice view2. One person described their room as fun another Care Homes for Older People Page 21 of 32 Evidence: person said, my bed is comfortable and another its comfortable and warm here. Several of the people had brought a range of their personal possessions into the home and their rooms were highly individual, reflecting their likes and preferences. During the inspection, we observed a domestic performing their role. This person worked carefully, cleaning under items as well as on top and cleaning high and low surfaces. All of the home was clean and smelt fresh. The home has sluice rooms for cleansing sanitary items. All of the clinical waste bins in these rooms had their foot pedals broken, so bins would need to be opened by hand. As peoples hands can become contaminated when clinical waste is put in bins, leading to a risk of cross infection, all clinical waste bins need to be foot pedal operated. The providers reported in their annual quality assessment that they plan in the next year to develop an infection control link nurse role. There was a good supply of gloves and aprons and we observed staff using them. We visited the laundry and noted that all areas were clean and dust-free, including the areas behind the machines and dryers. The laundry person reported that staff consistently placed potentially infected and infected laundry in correct bags, in accordance with company policy. It was observed that for lower risk items, they were placed in containers and then re-sorted in the laundry. Current good practice advise is that all laundry should be separated and source, rather than being re-sorted in the laundry. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will not have been supported by a continuity of staff, who have been fully trained in their roles in the recent past, however actions taken by management will ensure that this is an area which will be rectified in the near future. Some deficiencies in recruitment practice mean that residents could be put at risk, as not all areas relating to employment have been fully considered. Evidence: Many residents reported on their opinion of staffing of the home. One person said I dont like the agency nurses and they are here quite a lot, another that they had been assured there would be sufficient staff on duty at all times which has since proved to be incorrect, another agency staff not very good or not interested and another staff under too much pressure. Discussions with staff echoed this. Several carers commented on how difficult it was to work with agency carers, as they had to supervise them all the time, as well as doing their own work. Carers also felt that some registered nurses spent too much time away from the residents and did not come out onto the floors enough to identify what was happening, this was particularly the case when carers felt they were spending much time supervising agency staff. Some carers felt that their experience and skills were not considered and wanted to take on more complex roles, to reflect the training they had undertaken. Some staff did not appear to have a full understanding of the carers role, particularly of how Care Homes for Older People Page 23 of 32 Evidence: central the role of the key worker could be. One registered nurse did feel that carers ought to be encouraged to take on more complex areas, to improve their job satisfaction. Braemar Lodge has recently undergone a period of significant change, with reported low morale amongst some staff, increased staff turnover and a high use of agency staff. Following action by the provider, this situation should be resolved shortly and reliance on agency staff should be reduced or ceased all together. The deputy manager reported that once a new manager was in post, they would then be able to concentrate on reviewing practice in the home, ensuring that staff properly performed their roles and that staff who wished it, could be more developed in their roles. The deputy manager reported that since she had come into post, she had identified that there had been deficiencies in the previous managements approach to recruitment of staff. She had ensured that all people now had police checks. There was evidence that more than one person who had taken up employment prior to the deputy manger coming into post did not have fully satisfactory police checks. She was advised that, in such cases, although the persons had been in post for a period of time, risk assessments need to be completed, together with the employee, to ensure that any potential risks to residents were identified and reduced if indicated. Two of the people who had been taken on since the new deputy manager came in post did not have clear employment histories and there was no evidence that this had been probed at interview. Files also did not clarify reasons for leaving their most recent post, including where one individuals file indicated that they may have had issues relating to a higher than anticipated sickness rate. One registered nurse did not have evidence of their current registration with the Nursing and Midwifery Council on file and written evidence of this is needed, to ensure that the person can practice as a registered nurse. The file of a person from aboard did not clarify if they could work in this country. The deputy manager reported that this had been discussed with the providers human resources department who had clarified that the individual could work, however there was no written evidence for this on the persons file. The deputy manager reported that when they came in post, records of training, including induction had not been kept in an orderly manner. They had worked through records, up-dating them, to identify mandatory training which needed up-dating and had developed an action plan to ensure that all people were trained. The deputy manger agreed that work was still needed in this area, as not all files were up to date and general records of training were not reflected on individual staff records. They anticipated that once the new manager came in post, this would be an area which they could concentrate on. We discussed that some carers were undertaking more Care Homes for Older People Page 24 of 32 Evidence: advanced roles, for example appliance of stoma bags or minor dressings. The deputy manager reported that carers were trained before undertaking such roles. This needs to be supported by documentation, so that only carers who have been trained to, undertake such roles. During the inspection, we met with an external training provider who was supervising two members of the night care team, who were undertaking National Vocational Qualifications (NVQs). Both members of staff had stayed on after their night shift to meet with their tutor. Both reported that they were enjoying undertaking NVQs and that they appreciated being able to undertake them at their own pace. Later on, we observed the training provider supporting one of the day carers in NVQs. The carer showed interest in developing their role and had produced an informative document on how they would promote equality and diversity for residents. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by some of the management systems for the home and once the new home manager is in post, this is an area which will be further developed. Evidence: Braemar Lodge has undergone a period of considerable management change since the last inspection. The previous deputy manager moved on to another home within the group in 2007 and the current deputy manager was appointed, taking up post in the spring of 2008. Almost immediately after her appointment, the previous manager went on sick leave and then later on, left her role. This meant that the deputy manager, had to act into the managers role until a new appointment was made. It was reported that a new person has been appointed to the managers role and that this person will take up post in December 2008. At the same time the operations director for the home left. The new operations director took up post recently. The deputy manager reported that she had been supported by the provider in a variety Care Homes for Older People Page 26 of 32 Evidence: of ways since she has acted into the managers role. Currently she was being supported by the deputy manger from another home within the group. She was also visited regularly by a senior manager from the provider. The new operations director happened to be visiting the home on the day of the site visit. The deputy manager reported that she had identified a range of deficiencies since she came into post including staff recruitment practice, staff supervision and responses to complaints. She had started to address these areas, but was confident of more development once a permanent manager was in post, when she would be able to fully concentrate on being the head of care. Considering the areas which did need to be addressed, the deputy manager has made a very successful start in addressing matters in a range of areas. The provider has a standard system for assessing quality of service provision. This means that they have been able to identify areas for development in the home and support the deputy manager in ensuring that service delivery was improved during the past few months. They submitted a comprehensive annual quality assessment to us before the inspection. During the inspection, an internal audit into residents moneys was taking place by a senior manager from the company. It is advised that the company consider fully modernising it approach to handling individual residents moneys and introduce a computerised accounting and invoicing system, to reduce to its lowest level the actual amount of moneys held in the home on behalf of residents. As the home was only recently built, some parts are still under guarantee. Other equipment and services are regularly maintained. As noted in Standard 30 above, the deputy manager has identified that training records need improvement and is working her way through them, so that the home can show that all staff have been regularly trained in mandatory areas relating to health and safety such as manual handling and first aid. We observed that the home were not using British Standard signage on room doors where oxygen was in use of stored. I order to ensure the safety of all persons in the event of a major crisis, such as fire, British Standard signage must always be used where indicated. The home maintains clear records of accidents, these are monitored by the provider. As care or other staff are often the first people to find a resident after they have had an accident, to it is recommended that they document what they found in the first instance, rather than the registered nurse documenting what was reported to them. This is to ensure that a contemporaneous record is maintained. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The controlled drug 31/12/2008 cupboard must be fitted with rag or rawl bolts. This is to ensure that it complies with The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. 2 26 13 Where clinical waste needs 31/12/2008 to be disposed of, foot-pedal operated bins should always be provided. Staff hands can easily become contaminated when handling clinical waste, therefore hands-free disposal bins need to be provided to prevent risks to cross-infection. 3 29 19 Staff files must always include all relevant evidence that the person is able to practice and/or work in this country. 15/12/2008 Care Homes for Older People Page 29 of 32 The home must be able to evidence that all staff are able to be employed by the home. 4 29 19 Where a member of staff 15/12/2008 has issues identified relating to police checks, a written assessment of their fitness for their role must always be performed. The home must be able to demostrate that all people employed by the home are fit to work in a care home environment. 5 29 19 Where records relating to employment history are not clear, there must always be evidence that this has been considered, prior to employment The home ensure that all people employed are fit to work in a care home environment, taking into account their previous employment history. 6 38 13 British Standard signage must always be used on the doors of rooms where oxygen is stored or in use. In the event of a major crisis, such as a fire, all members of the emergency services will need full notification of the risks presented by the home environment. 15/12/2008 15/12/2008 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 7 7 7 Carers should be supported and encouraged to write in residents daily record when they have provided care. Evaluations of care plans relating to bowel care should take into account the persons daily bowel record. Care plans should clearly state the type of interventions to be used and avoid general terms such as pads, cream or laxatives. All signs in residents rooms relating to meeting specific care needs should be dated and signed. All risk assessments for self medication must be fully completed and contain all relevant information. Laundry should be separated at source and not re-sorted in the laundry. Where carers are performing extended roles, there should always be written evidence that carers have been trained in this role. Individual staff records should be fully up-dated, to reflect general training records. The home should modernise its approach to management of residents moneys by introducing computerised account and involving systems. The person who witnessed an accident should always be the person who documents what they observed. 4 5 6 7 7 9 26 30 8 9 30 36 10 37 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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