Inspection on 30/01/09 for Bramber Nursing Home

This inspection was carried out on 30th January 2009.

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

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

Bramber Nursing Home 11/01/07

Bramber Nursing Home 06/12/05

Bramber Nursing Home 24/06/05

Bramber Nursing Home 28/01/05

Bramber Nursing Home 23/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bramber Nursing Home 1 Bramber Avenue Peacehaven East Sussex BN10 8LR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathy Flynn     Date: 3 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Bramber Nursing Home 1 Bramber Avenue Peacehaven East Sussex BN10 8LR 01273584594 01273584594 wolfblass17@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Bramber Nursing Home Limited Name of registered manager (if applicable) Mr Peter John Stapleton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 21 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia DE Date of last inspection Brief description of the care home Bramber Nursing Home is privately owned by Mr and Mrs Stapleton. Mr Stapleton is the registered manager and Mrs Stapleton works as a senior carer in the home taking responsibility for the homes administration and catering services. The home can accommodate up to 21 service users with a dementia type illness who need nursing or personal care. The home is registered for service users aged 60 years and over. The home is a converted private home and now provides 21 single rooms on two floors Care Homes for Older People Page 4 of 24 care home 21 Over 65 0 21 Brief description of the care home and has a shaft lift available to ensure all service users have access to all areas of the home. The home is located in Peacehaven near the sea front and is a short walk to local amenities. Bramber Nursing Home was first registered on the 1st January 1993. The home provides care and support to residents who are both privately funded and those who are funded by Social Services. The homes fees at the time of the inspection ranged from 550 to 680 pounds per person per week depending on the funding arrangements. Additional costs are charged for chiropody hairdressing, newspapers and specific toiletries at cost. The homes literature states that the objective of the home is to provide care to all residents to a standard of excellence which embraces fundamental principles of good care practice, and that this may be witnessed and evaluated through the practice, conduct and control of quality care in the home. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Bramber Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home by the inspector and an expert by experience. An Expert by Experience is a person who, because of their shared experience of using services, and/or ways of communicating Care Homes for Older People Page 6 of 24 joined residents for the religious service, the activity and lunch on the day of the inspection. A tour of the premises was undertaken and a range of documentation was reviewed including duty rotas, recruitment files, care plans and the menus. The manager, care staff, housekeeping staff, activity coordinator and cook were happy to discuss the support they provide. They were very positive and felt they could meet the residents needs. The Annual Quality Assurance Assessment (AQAA) was completed by the manager, within the required timescale, and identified areas where improvements have been made, and where others are planned for the benefit of residents. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessments are completed, with the prospective resident and representatives, before a room is offered to ensure that the home can meet their individual needs. Evidence: The manager confirmed that the statement of purpose and service users guide now contain information regarding fire precautions, terms and conditions of residency and a copy of the complaints procedure. A copy is kept in the office and is accessible on request. Three pre-admission assessments were viewed. The manager advised that they are completed with the involvement of the prospective residents and their representatives before they are offered a place at the home. A letter is then sent to the prospective Care Homes for Older People Page 10 of 24 Evidence: resident and their representative confirming that the home can meet their needs and that a place is available. Intermediate care is not offered or provided at Bramber Nursing Home. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system enables staff to offer appropriate support and care to residents. Policies and procedures are in place with regard to medication to protect residents. Evidence: Three individual care plans were viewed and found to contain information about the support needs of residents including relevant risk assessments including mobility, pressure areas, moving and handling and nutritional status. Specific information about residents behaviour, for example at meal times, and triggers that may cause difficulties should be included in the care plan so that staff can refer to them if necessary. Life histories are gradually being introduced and the one available gave clear information about the residents life, interests and family involvement in the care provided. Care Homes for Older People Page 12 of 24 Evidence: There is evidence that the care plans are reviewed regularly and that relatives and representatives can be involved if they wish. The feedback from visitors was positive the staff are very good and know how to look after the residents. They all appreciate the care provided, although particularly at lunchtime, when a number need assistance. The concern identified at the last inspection regarding the use of wheelchairs and removal of footplates was discussed with the manager. Footplates have been removed because residents have been injured when these were used. A risk assessment has now been completed for each resident, and advice for staff in transferring residents has been recorded in the care plans. The registered nurses are responsible for the ordering, storage and administration of medicines, and there are policies and procedures in place to ensure residents are protected. The manager explained that with the support of GPs medication is kept to a minimum. This has reduced the risk of falls and encouraged residents to be independent and mobile, following risk assessments. It was noted that residents were treated with respect and staff had good rapport with residents and visitors. One relative said staff are excellent and can manage residents even if they are not having a good day. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided, approximately one hour each day, for residents if they wish to join in. The meals are good, residents are offered choices and staff assist when required. Evidence: On the day of the inspection a church group provided prayers and singing and many of the residents joined in. The residents then played a word game with the activity organiser, and they clearly enjoyed it. The activity organiser has attended a training course, and this has given her a better idea about what are the most appropriate activities for the residents. She has developed a programme for one hour a day that includes group and individual activities, depending on what the residents prefer. Volunteers also assist her, when they are able, so that she is able to spend more time with residents who remain in their rooms. The care staff when asked said they were unable to provide additional activities for residents because they do not have the time, although they would like to spend more Care Homes for Older People Page 14 of 24 Evidence: quality time with them. The concern that one hour would offer activities only for some residents was discussed with the manager. Visitors said they were made to feel very welcome and they are encouraged to be involved in decisions about the support offered at the home. A number visit daily and some choose to assist residents with meals. The manager and staff said the relatives are a valuable resource particularly when residents are unable to communicate their wishes or choices, and they aim to work with them when making decisions about the services provided at the home. One of the care staff offers hairdressing, and a number of residents took advantage of this on the morning of the inspection. The meal eaten with residents was attractive, appetising and enjoyed by the residents. A number needed assistance, family members and staff provided this depending on the preferences of the individual residents, and a relative joined his wife for lunch. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place with regard to complaints, training in supporting vulnerable adults is provided for staff to protect residents. Evidence: The home has a clear complaints procedure, which is incorporated into the Services Users Guide, for residents and their representatives to refer to. The manager advised that a complaint raised by the local authority has been addressed and resolved. Feedback on the day of this inspection was very positive, we have nothing to complain about although they do know who to talk to and what action to take if they did. Policies and procedures for Safeguarding Adults are in place, and staff spoken with had a good understanding of abuse and what action to take if they have any concerns. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within this home is good providing residents with a homely and comfortable place to live. All parts of the home are accessible and infection control systems are in place to protect residents, visitors and staff. Evidence: Bramber Nursing Home is a converted property that has been adapted for its current use, and provides residents with a homely and comfortable environment. They are able to bring some of their own possessions with them and many have decorated their rooms with ornaments and pictures. During the tour of the home it was noted that it was clean and staff cleaned up after the hairdresser and any spills from lunch quickly. Hand washing facilities are in place, staff have attended infection control training and are aware of the correct use of gloves and aprons. A number of bed tables and aids were noted to be rusty or chipped, the manager advised that these will be replaced as part of the ongoing maintenance programme for the home. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff morale is high resulting in an enthusiastic workforce that works positively with residents and their relatives to improve their whole quality of life. Recruitment procedures are robust and protect residents. Evidence: Staffing levels seen confirmed that there are sufficient numbers to meet the personal and nursing care needs of residents. However as already noted the demands on staff are such that they have little time to sit and chat, or spend additional time with residents. A registered nurse is on duty at all times and the manager and his wife live close by, and are available at any time. The staff were very positive about the home and felt they could offer the support and care residents need and want. A number have worked there for several years, and there is a low turnover of staff. The visitors spoken with said the staff are very good, they know exactly what each resident needs and visitors are always welcome. The recruitment procedures are appropriate and the staff records reviewed were satisfactory and included the necessary POVA and CRB checks. Care Homes for Older People Page 18 of 24 Evidence: All new staff are required to work through the induction programme, which is in line with Skills for Care, and the expectation is that they will continue with National Vocational Qualifications when this is completed. The staff spoken demonstrated that they have attended the mandatory training, in addition to in-house training specific to the needs of the residents. They felt that they have an understanding of the residents support needs and are able to offer them a good service. A training matrix is used to identify which members of staff have yet to attend or require updates. The manager advised that they have exceeded the required 50 of staff with, or working towards, NVQ level 2 or equivalent. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides clear leadership and is supported well by staff who can demonstrate an awareness of their roles and responsibilities. Systems are in place to ensure the health, safety and welfare or residents and staff. Evidence: The manager and his wife are also owners of the home and are clearly involved in all aspects of this service. Feedback from visitors was very positive they said that the home is run very well and everything is done for the benefit of the residents, some of which are very frail and vulnerable. There are no resitrictions on visiting, relatives and friends can be involved in providing support if they want to, and it feels like a family. Observations during the inspection supported this. It was clear that the excellent relationship they have with residents, visitors and staff is relaxed and friendly, and encourages them to participate in decisions about the care the residents receive. Staff were quite clear about their responsibilities and said they can raise any issues Care Homes for Older People Page 20 of 24 Evidence: with colleagues, including the manager, as he is open to discussions about anything. Questionnaires are used to monitor the care provided in the home and any suggestions are acted upon if they are assessed as safe. The feedback is also included in the Statement of Purpose and is available on request. The manager confirmed that the relevant certificates relating to Health and Safety in the home are up to date and systems are in place to protect the residents, visitors and staff. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!