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Inspection on 06/01/09 for Braemar Lodge Residential Home

Also see our care home review for Braemar Lodge Residential Home for more information

This inspection was carried out on 6th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Braemar Lodge is a small care home that has a relaxed and caring atmosphere. One relative said, "I feel very lucky to have my [relative] in a home such as Braemar Lodge. It is as near to home as you can make it, and with the 100% care the residents receive, it is a very happy place. All the staff are very caring." Someone living at the home said, "The home is excellent. I am very content with everything." People living at the home benefit from being cared for by a stable staff team, many of who have worked there for a number of years. Before moving into the home people are encouraged to visit, and staff from the home will assess their needs to make sure that Braemar Lodge will be suitable for them. Visitors are always made welcome and people appreciate the staffs` openness and helpfulness. People`s views are important to staff and management, and the home has a clear complaints procedure in place.

What has improved since the last inspection?

Since the previous inspection the manager has been registered with CSCI. They are keen for the service to continually improve, and have been working to meet the requirements that were made at our (CSCI) last visit. People are better protected as the home has improved their recruitment procedures, ensuring that staff are suitable to work with older people. Information is now available, and staff are more aware of safeguarding procedures. People have benefited from some improvements being made to the building such as redecoration and new flooring. To try and achieve better and more consistent care management a new key worker system has been introduced to provide more individual attention to things like people`s clothing. There is now a senior on duty to provide leadership on each shift.

What the care home could do better:

Although people feel that they receive good care, this should be based on robust planning so that individual needs are clearly identified. Where specific health or care needs are identified these, need to be understood and met bystaff. Some care practices need to be reviewed so that people`s sense of individuality and dignity is always maintained. Staff need to be kept up to date and better trained in some areas, particularly in dementia care. This will assist them in providing a more person centred approach in all aspects of care and social activity. To ensure that people living at the home always receive good care and support to meet all their needs, sufficient care and ancillary staff need to be provided. To achieve this, the care people need, and staffing levels required need to be kept under review. So that people always live in a safe, pleasant and hygienic home that meets their needs, the premises need to be better monitored, maintained and managed. Management must make sure that they meet Regulations and keep us (CSCI) informed of events occurring in the home.

CARE HOMES FOR OLDER PEOPLE Braemar Lodge Residential Home 481 Victoria Avenue Southend On Sea Essex SS2 6NL Lead Inspector Ms Vicky Dutton Unannounced Inspection 6th January 2009 09:00 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 Residential Home DS0000059881.V373641.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 Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Braemar Lodge Residential Home Address 481 Victoria Avenue Southend On Sea Essex SS2 6NL 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) 01702 339728 Mrs Saima Munir Raja Kirsti Linden Care Home 12 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12) of places Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th February 2008 Brief Description of the Service: Braemar Lodge is registered to provide care and accommodation for twelve older people. Braemar Lodge is also registered to provide care for people who have dementia. The home currently offers day care services for up to six people from Monday to Friday. The premises provide homely and comfortable living areas. There is a choice of communal areas including lounge, dining room and conservatorys. The accommodation is provided over two floors and consists of six single and three shared rooms. Access to the first floor is via a passenger lift. The second floor is for staff use only. There is a pleasant and secure garden and some off road parking. Braemar Lodge is in keeping with houses in the vicinity. It is situated in close proximity to Priory Park and is close to local community facilities and services. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. The last inspection report was available to people in the entrance area of the home and referred to in the Service Users Guide. The Service Users Guide dated April 2008 stated that fees range from £365.00 to £400.00 a week. There are additional charges for hairdressing, chiropodist, taxis, toiletries and newspapers. There is a flat rate charge of £40.00 per day for day care services. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key site visit. The previous inspection of the home took place on 29th February 2008. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of eight hours. A partial tour of the premises was undertaken. Care records, staff records, medication records and other documentation was selected and various elements of these looked at to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. We also spoke to three visitors during the site visit. The home’s Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was received by the due date, was fully completed, and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. Five resident and three relatives surveys were returned. No staff or visiting professionals returned surveys. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. At this site visit we left an ‘Immediate Requirement’ form. This was to let the provider know that something needed their urgent attention. We left this as we found that there was no consistent hot water supply at the home. This had implications for resident’s care, and health and hygiene in the home. The provider has since confirmed that the situation is being addressed. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Although people feel that they receive good care, this should be based on robust planning so that individual needs are clearly identified. Where specific health or care needs are identified these, need to be understood and met by Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 7 staff. Some care practices need to be reviewed so that people’s sense of individuality and dignity is always maintained. Staff need to be kept up to date and better trained in some areas, particularly in dementia care. This will assist them in providing a more person centred approach in all aspects of care and social activity. To ensure that people living at the home always receive good care and support to meet all their needs, sufficient care and ancillary staff need to be provided. To achieve this, the care people need, and staffing levels required need to be kept under review. So that people always live in a safe, pleasant and hygienic home that meets their needs, the premises need to be better monitored, maintained and managed. Management must make sure that they meet Regulations and keep us (CSCI) informed of events occurring in the home. 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 Residential Home DS0000059881.V373641.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 Residential Home DS0000059881.V373641.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): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Braemar Lodge can be assured that their needs will be assessed to ensure that the home will be suitable for them. EVIDENCE: We saw that the home had a service users guide available that provided a good level of information for people. This had last been updated in April 2008. Service Users Guides were noted to be available in people’s bedrooms to provide ongoing information after they have moved into the home. On surveys everyone said that they had received enough information about the home before moving in. Many people living at Braemar Lodge had become familiar with the home before moving in, as they had been there using the day care service. Others had visited the home. People said: “As I visited many homes in the area I felt that this would be the home my relative would be happy in.” “My [relative] had been visiting Braemar Lodge for arts and crafts days at least a year before they decided to move in.” Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 10 Previous inspections had found that staff from the home always assessed people’s needs before they moved in to make sure that the home would be suitable for them, and staff able to meet their needs. We looked at the file of the person who had most recently moved into Braemar Lodge and found that a good pre-admission assessment had been undertaken. There was also information available from the discharging hospital and from the Social Services department funding the placement. Intermediate care is not provided at Braemar Lodge. Braemar Lodge Residential Home DS0000059881.V373641.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 adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to receive good care, but this may not always be based on clear and robust care planning and practice. EVIDENCE: Comments from people about the care provided were positive. On five service users surveys returned everyone said that they ‘always’ received the care and support they needed. One person said, “The staff are very good and always help me when I need it.” Relatives also felt that the care provided was good. One said, “My [relative] receives 100 care,” another felt that the care was “Exceptional.” To see how well people’s care is planned for and arranged so that staff are aware of people’s needs and meet them in an individual way we looked at four care files in detail. Each care file contained people’s personal details, the initial assessment, their current medication and any possible side effects, care plans, risk assessments, weight, fluid and bath charts, records of health appointments and daily notes. Each of the care files looked at had been reviewed on a monthly basis. The manager said that as far as possible they Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 12 try to involve people or their families in care planning. Some had been signed to show that people had been involved. Although care plans generally provided sufficient information for care to be provided, some attention to detail is needed to ensure that care provided is up to date, meets individual needs and is safe. For example one person’s care plan spoke of them having a catheter in place, when other records made it clear that this was not the case. Another person had suffered a recent bereavement. This had not been highlighted, and the care plan still spoke of contact arrangements with the person who had passed away. Basic generic risk assessments were in place relating to some aspects of care such as fire safety. One person had a risk assessment in place relating to the use of bed rails. The assessment did not highlight the reason for the use of bedrails, other options considered, or details about their safe use either on the risk assessment, or in the ‘sleep’ section of the care plan. Here the use of bed rails was not mentioned at all. The assessment had not addressed the issue of consent or been completed as part of a multidisciplinary process. The manager had completed the assessment, but confirmed that they had not undertaken any training in bed rail assessments. Some care plans would benefit from more detail being included to make them more person centred or effective. For example, one care plan recorded that a resident was unable to use their emergency call bell, but did not highlight what staff were to do about this such as extra checks. The ‘dressing’ section in care plans did not include people’s preferences or choices. Generally good daily records are maintained. However when issues were identified, such as someone being constipated, there was sometimes no follow up to show that things had been managed or resolved. It could not be demonstrated that good ongoing care such as regular baths had been undertaken. For a person who moved into the home in August no baths had been recorded. For another the ‘bathing/weight record’ was also blank. For other people last recorded baths had been 22/11/08 and 02/09/08. This may be caused by an ongoing situation relating to the homes hot water supply. (See also under the ‘environment’ section of this report.) On one occasion a member of staff had recorded, “No baths done as no hot water as usual.” On surveys people were happy with the level of healthcare they received. A relative said “Whenever my [relative] has needed medical help they have always received it. I have also been kept informed of their care.” Records showed that people access regular chiropody, GP services, and eye care. One person’s care plan said, “Arrangements to be made for [resident] to visit the dentist regularly.” Although they had lived at the home for some time, the manager acknowledged that they had not seen a dentist, and said that people living in the home do not currently have access to dental/oral care. The manager undertook to look into this. Care planning could be improved to support people’s ongoing healthcare. For example some people came out as ‘at risk’ on pressure sore assessments, but this information, and any remedial actions, had not been highlighted in care Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 13 planning. Some people had potential side effects or consequences from medications they were taking such as warfarin. Again this had not been highlighted in their care plan. We looked at medication systems and records to see how this aspect of people’s care is managed. People can feel confident that their medications are managed safely. Since the previous inspection protocols have been put in place for medicines that are prescribed to be taken on an as and when required basis, (PRN.) This will help to ensure that such medicines are used correctly and consistently. Training certificates and discussion with the manager confirmed that staff administering medication have received recent training. Some practice issues were highlighted to the manager. This was to ensure that there is available a list of staff who are trained and authorised to administer medication, along with a sample of their signature/initials for audit purposes, and dating boxed/bottled medication when it is commenced, again to provide a good audit trail. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. There were some indications that staff do not always maintain practices that support individual dignity. In a downstairs toilet there was a bag of mixed communal stockings/pop socks. A member of staff was observed to get a slightly miss-matched pair to put on a resident. In this toilet there was also a container containing a number of combs, brushes and razors. In the upstairs bathroom there were three washing puffs hung together. These things suggest that items are used communally, which is not good practice. A relative also raised an issue that clothing is often put away incorrectly and said, “My [relative] has not got their own clothes on again today but what can you do.” The manager agreed that this can be an issue as staff do not always put things away in the right place. Braemar Lodge Residential Home DS0000059881.V373641.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 a visit to this service. People have some opportunities to enjoy a fulfilling lifestyle, and enjoy wholesome home cooked food. EVIDENCE: People spoken with during the site visit who were able to comment seemed to be happy with the level of activity and stimulation available. During the inspection people were happy, laughing and talking with each other and staff. On surveys one person said that there were ‘usually’ activities available that they could take part in and two said that there ‘sometimes’ were. Comments from relatives were, “[Relative] is able to sing along but is unable to do very much at all. She likes to listen to [specific programmes and music]. There are activities at the home but sadly my [relative] is unable to join in,” “They keep the residents happy and entertained.” Activities are an area where the home is trying to improve. The AQAA said that in the previous year more activities equipment had been provided and they were trying to provide “More group activities and a client based approach.” People’s preferences with regard to activity and occupation are recorded to a degree in care planning. From observations and comments more could perhaps be done to assess and provide for the stimulation needs of people who have a Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 15 more severe level of dementia or other disabilities. As the manager and staff have not had a good level of dementia care training this may be difficult. An activities co-ordinator works for two days each week, and other members of the staff team have set time for activities during the afternoons on other days. We noted that activities provided were concentrated in one of the home’s two lounges where people attending for day care, and some of the home’s more able residents sit. In the other lounge people who were frailer had music or the television on. The manager said that normally staff would spend one to one time with people. Some people have opportunities to attend activities outside of the home such as, ‘Tea and Talk’ a local social club. People’s religious/spiritual preferences are recorded in care planning. People living at Braemar Lodge are able to have visitors at any time. During the site visit when visitors came they were made welcome by staff. Visitors said that staff were always helpful. Staff were respectful of peoples wishes and they were able to go where they wished in the home. Daily living preferences such as rising and retiring times were recorded in care plans. Details of advocacy services were on display so that people know where they can go for independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. On surveys four people ticked that they ‘always’ enjoyed the meals provided and one that they ‘usually’ did. People spoken with over the lunchtime period said, “You certainly can’t complain about the food,” and, “the food is always very good.” People said that they did not have a choice of main meal, although staff said that choice was available. A relative said, “The food is very good and if I am at the home at a meal time I feed my [relative] and they always enjoys the meal.” The home works to a rotating four weekly menu. When viewed these showed that a good range of foods are offered. We saw that where people needed help to eat, this was done in a caring and sensitive manner. Braemar Lodge Residential Home DS0000059881.V373641.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 a visit to this service. People are cared for safely through suitable procedures and practice. EVIDENCE: There was a clear complaints process in place that was on display for people and available as part of the Service Users Guide. On surveys everyone said that they knew who to talk to if they were not happy with anything, and knew how to make a complaint. A relative said, “Staff will resolve any problem.” Since the previous inspection no complaints have been recorded by the home. One person raised some concerns with us (CSCI.) The issues raised were discussed with the manager. We saw that there were up to date local authority guidelines, and local procedures available to give staff understanding and guide their practice in relation to safeguarding. Training records viewed, and staff spoken with confirmed that training in safeguarding had been undertaken and that staff understood actions to be taken. Care plans viewed showed that where people’s behaviour may be challenging this is identified and advice given to staff. Neither the manager or staff have undertaken any training in managing challenging behaviour, and only limited training in dementia care, which may assist the process of assessing and understanding behaviours. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 17 Braemar Lodge Residential Home DS0000059881.V373641.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, 21, 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely environment, but cannot always expect that the home will be adequately clean. EVIDENCE: Braemar Lodge generally provides a comfortable and homely place for people to live. Some areas are looking tired and would benefit from redecoration. A relative said that the home was “long overdue for decoration I believe. I do understand how difficult this would be with Braemar always full.” People spoken with were happy with the accommodation provided. People using shared rooms did not seem to mind this. One person said, “No I don’t mind it at all as I get on very well with the person I share with.” The AQAA identified a number of improvements that have taken place since the previous inspection such as a new shower, new flooring in some areas and the hallway being decorated. It also identified that further works are planned. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 19 The previous inspection identified that only one assisted bath was available for people as another bathroom was out of order. As identified above a new shower has been fitted in this area to provide additional facilities, but this has not worked since its installation. The manager said that this was due to be rectified. When we looked at the premises we saw that there were a number of other areas where improvements are still needed. Some furnishings and fittings need improvement or replacement. For example curtains in some rooms were very thin and not hung properly, a commode was in poor condition, a ‘kylie’ bed protector was in very poor condition, as were some pillow protectors which were hard plastic that could be uncomfortable to sleep on. Toilet roll holders were missing or broken. This could be potentially hazardous if people are having to reach behind them or elsewhere for toilet paper. There seems to be inadequate storage facilities available. This leads to some areas looking cluttered. For example bedding stored in an upstairs shower tray, dirty mops and buckets in a downstairs residents toilet area. Braemar Lodge is registered to provide care for people who have dementia. This needs consideration to ensure that things such as signage, lighting and storage facilities are suitable to meet people’s needs and keep them safe. One person on a survey felt that the home was not always kept warm enough for the people living there. The day of inspection was a very cold one, and additional small heaters were being used to ensure that the building remained warm and comfortable for people. At lunchtime some people were feeling the cold in the conservatory area where they were eating. There have been problems with the consistent supply of hot water at the home. This has the potential to impact on people’s choices in relation to bathing and washing, and the maintenance of good infection control procedures. On the day of the site visit the best that could be achieved in any area tested at different times of the day was luke warm water. The flow of water was also poor in a number of areas. From discussion and records these problems have been ongoing for some time and have not been properly addressed. An immediate requirement was made to ensure that the provider dealt with the issue in a timely manner. Following the inspection the manager and provider confirmed what actions were being taken. On surveys two people felt that the home was ‘always’ kept fresh and clean, and two that it ‘usually’ was. One person said, “The home is always clean and tidy and has a very home like feeling and always smells very fresh which is not always easy.” On the day of the site visit morning odours were dealt with, but there were isolated areas where odours remained after cleaning. No cleaning staff are employed. Night staff clean communal areas and day staff clean people’s rooms. There is no rotational approach, or cleaning schedules in place to ensure that all areas are deep cleaned on a regular basis. This showed, and a number of areas such as en suites were not properly clean. The lack of hot water also has the potential to have a major impact on hygiene and cleanliness The manager said that from the following week a member of Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 20 staff is to have two hours a week for dedicated deep cleaning of people’s bedrooms. Although it was confirmed that staff have undertaken training in infection control, a number of poor practices were observed during the day. Some beds had been stripped back with covers put on the floor, dirty linen had been left on the floor in a corridor, a used commode was uncovered in a shared room, in two downstairs toilets there was a terry towel for communal use rather than paper towels. Although the homes laundry had an alcohol gel dispenser there were no hand washing facilities at the sink, and no protective clothing readily available in the area. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. People receive care from staff who know them well, but who may not always be up to date in their skills and knowledge. EVIDENCE: People living at Braemar Lodge benefit from having a stable staff team. Staff turnover is low, and agency staff are not used. Since the previous inspection rotas have been organised so that there is always a senior member of staff on duty. A relative said, “Having a senior member of staff in place to look for the welfare of all the residents and to look for ways to improve their outlook is so good to see for visiting families.” We received other positive feedback about staff such as, “The manager and staff here are all very nice,” “The staff are very much on hand to listen and help whenever needed,” and “Staff skills are excellent.” During the week up to six extra people are accommodated during the day. From rotas viewed staffing levels vary. During the week in the day there is the manager/senior and two care staff available. In addition a cook is provided each day and an activity co-ordinator works on two days each week. During the evenings two staff are available. At night there is one awake and one sleeping in member of staff. During the weekends however there is only a senior and one member of care staff on duty during the day and evening. The manager said that three people need the assistance of two staff with daily living tasks and three people need assistance to eat and drink. Staff also have Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 22 to carry out cleaning and laundry tasks. Since the laundry area is accessed externally there could be occasions when only one member of staff is available in the building. On surveys four out of five people felt that staff were ‘always’ available to them. Although they appeared adequate during the time of the site visit, staffing levels provided are not based on any form assessment tool to assess people’s dependency levels and subsequent staffing levels required. Management therefore risk people not being supported in the way that they need by having the correct number of staff always on duty. This is particularly so when factoring in the needs of day care clients. Also, with only two staff on duty at weekends, people’s holistic needs including engagement and activity may not be met. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. At Braemar Lodge it was confirmed with the manager that out of 10 care staff, two have already achieved an NVQ, and a further four staff are working towards this. We looked at the files of two members of staff who had been most recently recruited to ensure that recruitment procedures protect people living in the home. Staff files were well organised. Good records were in place to show that appropriate checks such as taking up references, checking identification and carrying out Criminal Records Bureau (CRB) checks had taken place. For one member of staff the references given on the application did not match those taken up, and neither was from a recent employer. This situation was explained but had not been recorded as would be good practice. For one member of staff there was a basic four day induction program in place that had been properly signed off. Although this member of staff is carrying out care tasks, there was nothing to show that a programme based on Skills for Care standards had been commenced. For the other member of staff there was no basic induction on file to show that they had been advised of fire procedures and other introductory matters. The manager said that this member of staff had started a Skills for Care Programme, but that the folder was not available. In speaking to staff they said that they had completed a range of training over time. However some areas of training were lacking. The manager said that although some video training was available for core areas, no staff had completed comprehensive training in dementia care for which the home is registered. This has the potential to mean that although kind and caring, staff may lack the skills and up to date knowledge to offer a proactive service to people, helping them to maintain their abilities for as long as possible. The manager themselves had a certificate on file for an ‘Introduction to Dementia’ course that was undertaken in March 2004. In spite of this the homes Service Users Guide says, “The staff are highly trained with a vast knowledge of dementia in order to care for such clients.” On a training matrix it was stated that dementia care training was ‘planned’ although no dates are currently set. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 23 Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 24 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 adequate. This judgement has been made using available evidence including a visit to this service. People can expect the home to be run in their best interests, but management may not always be robust and timely in addressing important issues that might affect people’s health and welfare. EVIDENCE: The manager at Braemar Lodge was registered with CSCI last year. The manager is very experienced and holds NVQ at level three in care. They are planning to undertake the current recognised qualification, ‘Leadership and Management’ to enhance their skills. In discussion with the manager it was clear that they are committed to providing people with a caring and improving service. Since the previous inspection they have been working hard to meet the requirements that were made at that time. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 25 We saw that regular resident and staff meetings take place to offer people the opportunity to express their views. The provider had completed the AQAA for this year and this gave us a useful picture of the home. The provider is on the rota as being in the home on four mornings each week, and undertakes sleeping in duties. They also undertake the regular monthly visit that is required by Regulation to ensure that the home is being properly run. The manager said that they have in the past undertaken surveys with people as a quality exercise. Now they have a chat with families about what is good and so on. This process is verbal and not recorded. The home therefore has no formal quality assurance process in place as would be good practice. People can feel confident that if they or their families ask the home to help them look after their personal monies that this will be done in a way that safeguards their interests. Monies checked were correct. Generally good records were maintained, but receipts need to be held for all transactions so that a good audit trail is maintained. At the moment the hairdresser is not providing receipts. The manager undertook to address this. Since the previous inspection work has been carried out to address fire safety issues in the home. A new fire escape has been installed and a fire risk assessment is in place. During the morning it was noticed that some fire doors were wedged open with items such as a soft toy. The manager was advised that if doors need to be open that a safer way of achieving this is looked into. Satisfactory fire records were maintained, and we saw that most staff have now undertaken regular drills. When we looked at the accident records maintained at the home, we noted that management had not been keeping us adequately informed of events occurring at the home, such as people sustaining fractures. Responsibilities under Regulation 37 were briefly explained to the manager, and they were advised to visit our website for further information and documentation. A training matrix indicated that staff have undertaken video training in some core areas such as control of hazardous substances (COSHH). However the manager confirmed that health and safety training had not been undertaken for a while. Although we saw that training was now planned to take place imminently, staff had not been kept up to date in moving and handling practice. This has the potential to put people at risk. The manager said that it “had been a while” since staff last did this training, and the manager last completed moving and handling training in March 2005. We have previously identified that the homes water system had not been maintained so that it was fit for purpose. We also noted that the homes certificate of electrical safety had expired in August 2008, and had not yet been renewed. The manager said that when the electrician came it had been too cold to carry out the work, as it would involve turning off the power. This needs to be addressed as soon as possible. Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 26 Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 Requirement The premises and services must be properly maintained and fit for purpose in meeting people’s needs. This refers to the issues identified in the report such as items of equipment being in poor condition. 2. OP21 23 (2) (j) There must be sufficient numbers of bathing facilities in good working order to ensure that the needs of residents are met. This is a repeat requirement with a previous compliance date of 01/06/08. 3. OP26 13 People must be protected by robust procedures being in place to prevent the spread of infection. This refers to the issues identified in the report including: • Poor staff practices • Lack of paper towels in key areas (This was a previous requirement, with a DS0000059881.V373641.R01.S.doc Timescale for action 01/07/09 01/03/09 01/02/09 Braemar Lodge Residential Home Version 5.2 Page 29 • • 4. OP30 18 compliance date of 01/05/08) Lack of hot water to ensure hygiene and good cleaning. Lack of deep cleaning regimes. 01/07/09 So that people are cared for by skilled and well trained staff appropriate training must be provided. This refers to the need for staff to have good quality training in dementia care for which the home is registered. 5. OP38 18 So that people are looked after safely and staff protected a good level of core training and update training must be provided. This includes areas such as moving and handling and health and safety. The home must be well maintained and safe for people to live in. The homes electrical certificate must be renewed at the earliest opportunity and a copy of the certificate sent in to CSCI. 01/07/09 6. OP38 23 14/01/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations So that people living in the home receive good care based on their individual needs and preferences, care plans DS0000059881.V373641.R01.S.doc Version 5.2 Page 30 Braemar Lodge Residential Home should continue to be developed to provide a person centred and holistic approach. 2. OP10 Care practices should be monitored to ensure that they support an individual approach to care that supports people’s dignity. As the home is registered to provide care for people with dementia care needs, the premises should be reviewed to ensure that it is safe and suitable in meeting people’s assessed needs. Things such as signage, lighting, orientation aids and decoration should be considered. To keep the home clean and fresh for residents the employment of dedicated cleaning staff should be considered. Staffing levels should be kept under review to ensure that they are at all times sufficient to meet people’s holistic needs. 50 of the homes care staff should be trained to NVQ level two or above so that people receive care from well trained staff. There should be in place a robust quality assurance system in place based on seeking the views of people involved with the service. 3. OP19 4. OP26 5. OP27 6. OP28 7. OP33 Braemar Lodge Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Residential Home DS0000059881.V373641.R01.S.doc Version 5.2 Page 32 - 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. 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