Inspection on 16/11/07 for Braemar Lodge

This inspection was carried out on 16th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Braemar Lodge 10/11/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Braemar Lodge Stratford Road Salisbury Wiltshire SP1 3JH Lead Inspector Susie Stratton Key Unannounced Inspection 08:40 16 , 20 and 23rd November 2007 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braemar Lodge Address Stratford Road Salisbury Wiltshire SP1 3JH 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) 01722 439700 braemarlodge@coltencare.co.uk www.coltencare.co.uk Colten Care Limited Mrs Irene Doris Gray Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55) of places Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 55. N/A – newly registered service Date of last inspection Brief Description of the Service: Braemar Lodge is a purpose built 55-bed care home with nursing for older people. The home was first registered in June 2007. The home has gradually been admitting residents, on a planned basis. At the time of the inspection, there were 32 people resident. 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 home is managed by Mrs Irene Gray. She is supported by a head of care, registered nurses, care 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 to £990 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. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 40 questionnaires were sent out to residents and their relatives. Only three were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. The report by our central registration team, when the home was registered, was considered. An annual quality assurance assessment was submitted by the home prior to this inspection. This document provided information to support the inspection. The site visits took place over three days, on Friday 16th November 2007 between 8:40am and 10:30am, on Tuesday 20th November 2007 between 8:45am and 2:30pm and on Friday 23rd November 2007 between 8:40am and 9:45am. The registered manager, Mrs Irene Gray was on duty for the first two site visits. The area manager and head of care were present for feedback at the end of the inspection. During the site visits, we met with ten residents and observed care for five residents for whom communication was difficult. We reviewed care provision and documentation in detail for six residents, one of whom had been admitted recently. As well as meeting with residents and visitors, we met with two registered nurses, four carers, a laundry worker, the activities coordinator and the chef. We toured all the building, observed a lunch-time meal and an activities session. We observed systems for administration of medicines. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Braemar Lodge was purpose built to a high specification, with the current client group in mind. All rooms are large, corridors are wide enough to allow for two wheelchairs to pass, there are a wide range of different communal areas and attractive, wheelchair accessible gardens. All equipment is new. A wide range of different equipment is provided to meet the needs of people with disability or complex nursing needs. The furnishings and fittings are domestic in style, giving the home a non-institutional appearance. The manger and her deputy are experienced in the field and have successfully recruited staff, supporting them in developing as a team, since the home opened. The home offers a range of activities to meet the diverse needs of people. A wide range of meals are offered, with a flexible meals service. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 6 Residents and their supporters expressed their appreciation of the home. One reported “It is a great pity that there are not more homes like Braemar Lodge”, another “I really can’t think of anything I would wish to alter” and another “I’m very satisfied”. People also expressed their appreciation of the staff, one said “They’re wonderful here, so caring”, and another “I can’t say enough for them”. People expressed their appreciation of the activities, one reported “Braemar Lodge offers a wide variety of activities, a gym, a computer room and regular social/activity sessions morning and afternoon” and the meals, one reported “Easily the best for food” and another “Absolute choice”. One person summed the home up, stating “The place itself is lovely, the food, the cleaning everyone is very kind.” What has improved since the last inspection? What they could do better: No requirements were made at this inspection. Eleven good practice recommendations were made. Where a resident is prescribed or needs to have topical applications, all care plans should direct actions to take. Care plans should state the precise actions to be taken and avoid the use of generalistic words such as “assist” or “regularly”. The audit system for care plans should include regular reviews of frequent care charts, to ensure that residents are being assisted with activities of daily living at the frequency that they need and all fluid charts should be totalled once every 24 hours. The medicines trolley should always be locked when it is out of the direct line of vision of the registered nurse administering medication. Where a person is prescribed medication on “as required” basis or drugs which may affect their activities of daily living, such as pain killers, mood altering drugs or aperients, all care plans should specify the drug to be used and the indicators for its use. Where medicines instructions are hand written or changes are made to medicines instructions, these should always be signed and counter signed by a second person. A health status questionnaire should be developed and all prospective staff requested to complete, prior to employment, to assess their fitness for their role. An agency induction checklist should be developed, to support the home and agency staff. This should be signed by the inductor and inductee. The home should keep a copy of all receipts when items of value are taken in or handed out to residents or their relatives, to ensure a full audit trail. An audit system should be put in place to ensure that all staff comply with principals of prevention of spread of infection. A copy of guidelines from the Health and Safety Executive relating to bed safety rails and lap belts should be obtained and considered when drawing up individual risk assessments. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not admit for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The needs of prospective residents are assessed in detail, so they and their supporters know that the home can meet their needs. EVIDENCE: All prospective residents have a full assessment of need completed prior to admission. This assessment is completed by the manager or her deputy, both of whom are registered nurses. Residents spoken with reported that they had been given opportunity to visit the home before admission, some reported that they had been too unwell to do this and that family members had visited on their behalf, others said that they had been able to see round the home and choose their own room. Assessments seen were completed in detail and provided a clear basis for provision of nursing and care, until the home’s detailed assessments were completed. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 10 Residents and their supporters commented favourably on the admission process. One said “Braemar Lodge has offered all the information we require” another “We visited numerous homes and this one is bright and fresh compared to others” and another “Braemar Lodge has given support and care which exceeds our expectations”. One person who said that they had been admitted regularly for respite care to a range of homes in the area said that in their opinion it was the best in the area and that they would return to it whenever they could. In their annual quality assurance report, the home stated that admissions were a smooth process, with no evidence of abrupt discharges soon after admission and that people admitted for respite care returned to the home. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People are supported by the home’s systems for providing health and personal care. EVIDENCE: All residents have a full care plan drawn up to direct staff on how their needs are to be met. All residents have assessments for risk, including pressure damage and manual handling. Where a risk is identified a care plan is drawn up to direct staff on how risk is to be reduced. Care plans reviewed were generally clear and reflected what residents and staff reported. Discussions with staff indicated that they are informed of residents’ needs at report at the start of their shift and that they can readily access care plans to further direct them on how to meet residents’ needs. The home has a system for regular audit of care plans. It is advisable that clear, measurable language is used in care plans and words like “assist” and “regularly” are avoided. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 12 Some residents were prescribed topical applications and others needed them due to their condition. Some residents had very clear instructions relating to this, however others did not, so staff unfamiliar with their needs, such as agency staff, would not have the information that they needed to direct them on which applications were to be used and where. The home cares for people with a range of needs; some people are quite independent but a few need regular interventions to meet their complex needs. Two of the residents had recently been commenced on monitoring charts to ensure that they were given regular fluids and their positions changed, to prevent pressure damage. The charts in use are not totalled every 24 hours and this is advisable to assess if the resident is developing a risk of dehydration. One of the charts had not been completed regularly; however the person had only recently been commenced on the chart. The other person had been turned regularly but not at the frequency specified in their care plan. As these records can be important in preventing risk to individuals, they need to be included in the regular audit and monitoring systems and action taken, to ensure that documentation supports evidence that frail residents are receiving the care that they need. None of the residents had pressure damage and there was clear evidence that for one person who had been admitted with pressure damage, their condition was now much improved and the wound fully healed. Where the resident had a wound, there were clear directions on actions to take, with monitoring systems in place so that the home can assess the progress of the wound. It was noted as good practice that the home tries to manage resident needs without the use of urinary catheters. Only one resident had a urinary catheter and the home were developing plans to remove it for a trial period. Where a resident had more complex needs such as diabetes, care plans were drawn up to direct staff on how the individual’s needs were to be met. The home has established a good working links with the local palliative care team. The home has two areas for the storage of medicines. All medicines were safely stored and there was a full audit trail of medicines received into the home, administered to residents and disposed of from the home. We observed medicines rounds and the registered nurse was observed to carefully review instructions prior to administration and to support residents when taking medication, giving them time to take the medication. We observed that the registered nurse left the trolley open when giving out medication in the dining room. There was no evidence that any of the residents in the home experienced complex restless behaviours, however it would be better practice for the registered nurse to lock the trolley while assisting a resident to take their medication if the trolley is out of her line of vision. Where medicines administration charts had been completed by hand, some had been signed and countersigned, but others had not and this is advised, so that staff can ensure that instructions are correct. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 13 Some residents were prescribed drugs on an “as required” basis and others had been prescribed drugs which can affect their daily lives, such as painkillers, mood altering drugs and aperients. Some of these residents had care plans relating to this, directing staff on the type of drug and indicators for use, however others did not and this is regarded as good practice so that registered nurses and other people, such as GPs, can be full advised of the effectiveness of prescribed treatments. All care was provided behind closed doors. Staff at all levels were observed to knock and await a reply before entering a resident’s room. Residents who were frail had their hair nicely brushed and their fingernails and mouths were clean. Staff observed for small but significant changes in resident’s conditions. For example one daily record showed that a person had noted that a resident was not themselves on a certain day. This had been looked into and it was identified that their hearing aid was to functioning correctly. Action was taken and by the next report, the person was back to their usual self. One relative reported “I am particularly impressed with the way in which the staff treat the residents”. A resident reported “I have to drink a lot, so I’m out 2 or 3 times in the night and need help, staff are very good then”. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported to exercise choice in their daily lives, recreational activities and meals. EVIDENCE: Breamar Lodge employs an activities coordinator. An activities programme is displayed and all residents are given a copy of the programme. All residents have a clear social profile drawn up; this is added to as staff find out about additional matters relating to a resident. The activities coordinator runs large group, small group and individual activities. One person reported that they appreciated how the “Activities coordinator goes round and gives me a list of what he is doing and he explains what’s on the list.” Another resident reported on how the activities coordinator “works very hard trying to keep us motivated” and one relative reported “I would imagine that the service is well able to cater for active/extrovert and more sedentary/introverted residents.” As well as an activities coordinator, one of the carers works as a social carer on a rotational basis. This person will also do individual room visits, support residents in 1:1 activities and when going out of the home. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 15 Braemar Lodge has a minibus and is able to take people out regularly, including wheelchair users. During the inspection, a trip was taking place to a local shopping centre. One resident described a recent trip and lunch out. Other residents reported that they went out regularly with family members. All people commented that their visitors could come at any time. One resident reported “I can see my visitors when I like”. Relatives also felt that the home maintained good liaison with them. One reported “I am confident that information would be provided where necessary.” Communion is offered twice a month and the activities coordinator was aware of how to make contact with other religious groups, if people were admitted with different Christian or other faiths. Most residents felt that they were able to choose how they spent their lives. One reported “Up to me how I spend my day”, a frailer person reported “I like to get up for lunch and staff know this” and another “I can have my meal in the dining room or my room”. One relative commented “Braemar Lodge fulfils my relative’s physical requirements but also offers the stimulation of interacting with a number of people, and while [my relative] is not able to participate in much activity, just being a part of a participating group gives [my relative] interest. As a consequence, [my relative] is sleeping much less in the daytime and [my relative’s] speech is no longer slurred.” Braemar Lodge has a large dining room on the ground floor, which is attractively laid out, with cloth tablecloths and napkins. A large proportion of residents choose to eat there at lunch-time, some eat there in the evening and a few eat their breakfast there. Staff are available to support residents at lunchtime. Two very frail residents were assisted to eat by staff. One member of staff always remains in the dining room to assist and support residents and answer their queries. All aids to independent eating are provided. Residents are offered a choice of fluids, including a range of soft drinks, wine and sherry. The chef showed an awareness of the importance of diet to elderly people. He meets with all residents on admission and if requested, meets with them afterwards. He showed an awareness of a range of diets and knew how to obtain more information on more complex diets. There is at least one choice at the main meal and sometimes there are three or more. Residents can also ask for something else if they wish. During the inspection, one resident had asked for a salad instead of the choices on the menu and this was provided. As would be expected in a larger home, a range of comments were made about the meals, they ranged from “I don’t like the meals” through “The food is very good – most of it”, “The food offered is attractively presented and nutritious” to “The food is marvellous”. When the kitchen is closed, staff can also prepare small snacks such as sandwiches, cakes and biscuits for residents who feel hungry late at night or early in the morning. Residents’ visitors can have a meal with them if they choose and one relative described how much their resident valued this. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are protected by the home’s complaints procedure and systems for safeguarding vulnerable persons. EVIDENCE: Braemar Lodge has a complaints procedure, which is available in the service users’ guide and is displayed in the main entrance hall. The manager maintains a complaints log and it was noted that if a complaint is made, that she follows company policy and procedure. It was also noted as good practice that verbal concerns are logged and taken notice of, not just written complaints. No complaints have been reported to us since the home was opened. The manager or her deputy visit all residents every morning and are able to listen to issues which the person may wish to raise, this ensures that their concerns are addressed. Nearly all residents felt that they were able to bring up issues of concern. One reported “I speak my mind”, another “I told Matron and staff got told” and a relative commented “Any queries/comments/complaints dealt with promptly and sympathetically”. Staff spoken with were aware of their responsibilities for passing issues of concern on. One recently employed care assistant reported that senior staff always listened when they had concerns about any resident. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 17 Staff at all levels reported that they had been advised of their responsibilities relating to safeguarding vulnerable adults. Records showed that all staff had been trained in this area during induction. All staff have been given a copy of the “No Secrets” policy. No reports relating to safeguarding people have been made since the home opened. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. People are cared for in a modern, homely environment, which is well maintained and clean. EVIDENCE: Braemar Lodge was purpose built as a residential and nursing home, to a high specification. Accommodation is provided on three floors, lower ground (built into the side of the hill), ground and first with a passenger lift in-between. Corridors are wide enough for two wheelchairs to pass at the same time and all doors are wheelchair accessible. The décor is attractive and homely in tone. All parts of the home were well maintained. One person reported “It’s better because of the building” and another “This is better than any other place I’ve been in”. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 19 There is a large paved patio garden area, which is wheelchair accessible from the lower ground floor, to the rear of the home. There are a range of sitting rooms on each floor, each is attractively furnished and are homely in tone. On the first floor there is an activities room and there is also a computer room for residents to use. As well as sitting rooms, there is a hair dressing room on the ground floor. The front entrance hall is large and can be used as a sitting area by residents or by relatives waiting for a resident or a member of staff. All rooms are built to a high specification and much exceed minimum standards for room size. This means that there can be space for staff to access both sides of the bed. Residents can bring in their own items if they wish and some rooms were highly personal, reflecting each person’s likes and preferences. All rooms are en-suite and some have showering facilities. There are assisted bathrooms on each floor, with a variety of different types of bath to meet the needs of people with a range of disability. All bathrooms and assisted WCs are large enough for staff to use hoists when assisting residents with complex manual handling needs. The home has a range of equipment to meet residents’ different needs. All residents with more complex needs were nursed in profiling beds. All residents who were assessed as being at risk of pressure damage were provided with appropriate pressure relieving equipment. A range of hoists to aid manual handling were provided and staff were observed to use them appropriately. Where residents were assessed as being at high risk of falls, they had been provided with a mobile alarm system, so that they could alert staff. The call bell system was clear, letting staff know exactly which bell had been used. There is a full monitoring system for when residents use call bells. This is reviewed on a daily basis. The home was clean throughout. A domestic was observed performing their role and they were noted to be careful, commencing cleaning each en-suite, using the same method, starting on one side and working their way round methodically to the next side. When cleaning communal rooms, they moved chairs out of the way, rather than cleaning round them. The laundry worker reported that they had all equipment that they needed. They also reported that all staff complied with company policy on the separation of different types of laundry. There were clear systems for separation of potentially infected laundry and management of clinical waste. Registered nurses reported that they had a good supply of sterile gloves for performing aseptic dressings. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will be supported by the numbers and skill mix of staff, who are appropriately recruited and supported by the company’s training policies. EVIDENCE: Breamar Lodge has a full range of staff employed. There are at least two registered nurses on duty during day shifts and one on night shifts. The registered nurse is supported by care staff who have a range of skills and experience. In addition there are a team of catering and domestic staff. Laundry, maintenance, administrative and activities people are also employed. While a few residents considered that there were not enough staff on duty other did not, such a variance is always to be anticipated in a larger home. Comments ranged from “If I ring my bell the staff come, they are a bit pushed for time”, through “Varied help from the carers” to “They’re wonderful here, so caring”. Since the home opened, they have had to rely on some agency staff but records showed that this was reducing. Where agency staff are used, the same agency is contacted and generally the same people used. The home supports training. All staff spoken with commented on the effective induction programme when the home opened. All staff were given a two week induction before any residents were admitted. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 21 One experienced registered nurse commented on how useful this period had been, partly to make them into a team, partly to inform them of company policies and procedures and partly to reinforce areas she had already known about. One more recently employed care assistant reported that they had been given a full induction and had shadowed for a period before working more independently. Records relating to inductions were maintained in full and complied with current guidelines. It was discussed that a written induction is not given to agency staff and it is advisable that this takes place, with the agency person and inductor signing as separate areas are covered. Training, including NVQs are supported by the parent company and all training is in company time, so attendance is high. Now that the home is opened, they are developing further areas and planning to cover areas relating to resident care. For example many of the registered nurses are planned to attend a catheterisation course. Relatives commented that they considered that staff were able to undertake their roles. One reported “From observation of them at work, the staff at Braemar Lodge certainly appear to have the right skills and experience to enable them to look after people properly” and another “Braemar Lodge has given support and care which exceeds our expectations”. A review of employment records showed that all required pre-employment checks take place, including police checks, a full past working history and two references obtained prior to employment. All staff sign a health disclaimer. It is advisable that a pre-employment health status questionnaire be developed and all staff asked to complete it prior to employment. All staff are interviewed and an interview assessment record completed. All staff are given a job description and terms and conditions of employment. All staff receive supervision one month after employment. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are fully supported by the home’s management systems. EVIDENCE: Braemar Lodge is managed by an experienced manager and registered nurse. She has obtained the manager’s award and also holds a university degree. The manager has worked in other homes within the group and is fully aware of company polices and procedures. She is supported by a head of care, who is also an experienced registered nurse. One person reported “I can always see the manager”, another “I see the manger, she walks around” and another “The matron is excellent and so is the under matron”. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 23 Braemar Lodge has a system for regular audit of nursing and care provision. A senior manager visits the home on a monthly basis and makes a report. These reports are balanced in tone and document areas to be addressed and progress, as well as good points. Now that the home has been opened for nearly six months, a customer satisfaction audit is to take place. Other audits include an audit of accidents, responses to call bells and care plans. The home looks after some moneys on behalf of residents. Three accounts were checked at random and all found to be correct. Copies of invoices are maintained and all credits and debits include two signatures. Reviews of records and discussions indicated that at times items are handed in for safekeeping or handed back to residents or their supporters. When this happens, receipts are given to the resident or their supporters but a copy s not retained by the home and this should take place so that there is a full written audit of all items handed in or back to the resident or their supporter. The home has a clear training matrix, so that it is clear that all staff have been trained in matters relating to health and safety, such as manual handling or food handling and when the next training is due. Staff were observed to undertake safe practice in nearly all areas. One area needs more attention to certain detail and should be audited more often. This relates to prevention of spread of infection. In one bathroom during two days of the inspection, three tablets of soap were observed on the bath or wash hand basin. Communal use of soap is a risk to cross infection. This was not observed in any of the other communal bathrooms or WCs. In the laundry, three items of laundry were observed on the floor and on the floors, one linen bag was noted to be over spilling onto the floor. All of this can also increase risks of cross infection and staff need to be advised of the importance of the detail of practice in the area. All equipment was new and was still under guarantee. It was observed that safety rails were used on some beds and it was reported that lap belts could be used on occasion to maintain resident safety. Where this is the case, risk assessments are drawn up, these are regularly reviewed. The assessments do not conform in full to advice from the Health and Safety Executive and it is advised that the assessment documents in place are reviewed to conform to this advice. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Where a service user is prescribed or needs to have topical applications, care plans should direct actions to take for all service users. Care plans should state the precise actions to be taken and avoid the use of generalistic words such as “assist” or “regularly”. The audit system for care plans should include regular reviews of frequent care charts, to ensure that service users are being assisted with activities of daily living at the frequency that they need and all fluid charts should be totalled once every 24 hours. The medicines trolley should always be locked when it is out of the direct line of vision of the registered nurse administering medication. Where a person is prescribed medication on “as required” basis or drugs which may affect their activities of daily living, such as pain killers, mood altering drugs or DS0000070222.V349111.R01.S.doc Version 5.2 Page 26 4. 5. OP9 OP9 Braemar Lodge 6. 7. 8. 9. 10. 11. OP9 OP29 OP30 OP35 OP38 OP38 aperients, all care plans should specify the drug to be used and the indicators for its use. Where medicines instructions are hand written or changes are made to medicines instructions, these should always be signed and counter signed by a second person. A health status questionnaire should be developed and all prospective staff requested to complete, prior to employment. An agency induction checklist should be developed, this should be signed by the inductor and inductee. The home should keep a copy of all receipts when items of value are taken in or handed out to service users or their relatives. An audit system should be put in place to ensure that all staff comply with principals of prevention of spread of infection. A copy of guidelines from the Health and Safety Executive relating to bed safety rails and lap belts should be obtained and considered when drawing up individual risk assessments. Braemar Lodge DS0000070222.V349111.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © 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 Lodge DS0000070222.V349111.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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