Inspection on 11/06/07 for Bramble Down Nursing Home

This inspection was carried out on 11th June 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

Bramble Down Nursing Home 11/09/06

Bramble Down Nursing Home 30/11/05

Bramble Down Nursing Home 14/04/05

Bramble Down Nursing Home 15/02/05

Bramble Down Nursing Home 14/09/04

Bramble Down Nursing Home 23/03/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOMES FOR OLDER PEOPLE Bramble Down Nursing Home Woodland Road Denbury Newton Abbot Devon TQ12 6DY Lead Inspector Doug Endean Unannounced Inspection 11th June 2007 10:00 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 Bramble Down Nursing Home DS0000058730.V335457.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. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramble Down Nursing Home Address Woodland Road Denbury Newton Abbot Devon TQ12 6DY 01803 812844 F/P 01803 812844 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) www.peninsularcarehomes.co.uk Peninsula Care Homes Ltd Vacant Care Home 40 Category(ies) of Physical disability (40), Physical disability over registration, with number 65 years of age (40) of places Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Maximum number of service users to be accommodated is 40. The categories are PD 40, PD (E) 40 11th September 2006 Date of last inspection Brief Description of the Service: Bramble Down Nursing Home is located close to the centre of the village of Denbury near the towns of Newton Abbot, Totnes and Ashburton. It is a care home with nursing that provides personal and nursing care to a maximum of 40 Residents. It can be reached by the number 176 bus from Newton Abbot that is run by a local bus service and stops outside of the home. There is also a large car park in front of the home that provides level access into the home. The home was purpose built approximately 20 years ago with care being provided on two floors. There are two passenger lifts between each level and also staircases leading up to the first floor. It also has a variety of equipment such as grab rails and ramps to ensure people living at the home are able to maintain their maximum independence. There are 23 single rooms and 8 double rooms and all have en-suite facilities, nurse call system a telephone point, radio and television. Every person living in the home has the option to bring in items from their home to personalise their room. There are several communal areas that are used for activities, dining or just relaxing. The four bathrooms are of good size and have good disabled bathing facilities that are fitted with hoists and some have shower facilities. Outside of the home at the rear there is a level garden area laid to lawn with a path surrounding it. This is surrounded by the home on three sides and there is easy access for all of the people living at the home into it. Chairs and umbrellas are provided for the comfort of those using the garden. There is always a registered nurse on duty who is supported by care assistants and the ancillary manage the catering, work in the homes laundry or carry out domestic duties keeping the home clean. The homes fees commence at £485 and increase in line with the needs of the individual. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 11th June 2007 beginning at 10:00 hours and lasting 6.5 hours. The home Manager the group Manager were at the home and they cooperated fully with the inspector at all times. The Commission for Social Care Inspection was provided with a completed Annual Quality Assurance Assessment form produced by the Manager and sent by email. In addition to this the inspector received a completed pre-inspection form with supporting evidence such as duty sheets and menu’s. The inspector also received 5 completed service users survey forms, 2 completed staff survey forms and 2 completed relatives/carers survey forms. Survey forms were sent to two local General Practitioner practices who have patients at the home and both provided responses. The inspector spent time in discussion with the Managers, made a full tour of the home looking at its facilities, and spoke to 5 residents and 1 relative. He read the files of the 5 residents as part of the case tracking process. He also spoke to 4 staff members during the course of the inspection that represented care and the ancillary services. The inspector also read 3 staff files and a sample of the maintenance documentation held at the home. What the service does well: What has improved since the last inspection? Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 6 The home has invested in the environment providing improved bathing facilities for the comfort and safety of the people who live in the home. There has been a continuing effort to improve the training of staff and address the short falls that were identified during the last inspection. What they could do better: 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. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 7 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 Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 8 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): The homes performance was assessed against standards 1 and 3. Standard 6 does not apply. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The information made available in the Statement of Purpose and Service Users Guide, plus other documents was of a good standard and should enable the reader to make an informed decision about moving to the home. The home gather a satisfactory amount of information about prospective admissions, which enables them to make a decision about the suitability of the home to meet their care needs. EVIDENCE: The inspector read the Statement of Purpose and Service Users Guide. These were available in a small seating area inside the front entrance. People living in the home, or visitors, can sit in comfort to read them along with a copy of the Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 9 last Commission for Social Care Inspection report and a company booklet laying out its aims and objectives. There is also a company website that has information about this home and others in the group. It provides information from the choice of home to how care can be funded. The Annual Quality Assurance Assessment informs the inspector that the Statement of Purpose and other information will be sent out to anyone enquiring about the home either in hard copy, large print or disc. One relative commented in a survey form that it would be good to receive a pack of information about services available at the home and they had to find out by asking. This information was found in the Statement of Purpose. In this area was a copy of the certificate of registration, public liability certificate, Registered Nursing Home Association certificate, and the complaints procedure. A complaints and compliments book was also available that had no complaints in it but did have several complimentary statements written. There was also a signing in book that meets the requirements. The Statement of Purpose and Service Users Guide were well written and informative. They were up to date apart from the details of the Manager who has only recently joined the home. The Statement of Purpose did have a full breakdown of the results of the quality assurance surveys that have been carried out during 2006. During the inspection the inspector spoke to five people living at the home. He read their files as part of the case tracking process. Each file had a completed pre-admission assessment that included a “dependency profile”. This was used to establish the level of problems that existed and provided a baseline for future care to be measured against. Some of the subjects covered were fluid and dietary needs, continence, mobility, personal care and chiropody. There were also copies of social worker assessment/care plans and hospital discharge referrals where the person had come from hospital straight to the home. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 10 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): The homes performance was assessed against standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are very comprehensive and well constructed from a wide range of information that is gathered. The people living at the home are treated with dignity and respect, and are well cared for by the staff who also access the skills of health care professionals external to the home appropriately. EVIDENCE: The inspector read a total of 5 care plans and cross-referenced the information with that obtained from the people they were about, and the staff. He found that they were an accurate representation of the care needed and that provided. The care planning process was very good with regular reassessment and care plan reviews taking place. Each plan provided photographic identification of the person it was about. There was a risk assessment for Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 11 issues such as tissue viability, the use of bed rails, etc. The later was signed by the person it was about or an advocate and reviewed at least monthly. A list of care plan reviews was seen by the inspector in the nurse’s station, which is an office that does not have open access to the public thus providing confidentiality of the records. The home uses the Malnutrition Universal Screening Tool (MUST) to identify adults at risk. Each of the people receiving care at the home have a member of staff who is identified as their key worker and their name is recorded in the persons care records. The inspector found forms in the care files that he read that recorded if a relative wished to be involved in care plan reviews, and if so how often. The relatives signed these forms. One relative however commented in the survey form that they would like to be involved in regular review meetings. During the inspectors tour of the home he noted that a variety relief equipment was in use from cushions to mattresses. In resident’s files that was read there were instructions for staff on the “advanced dynamic flotation system” that had been assessed for that person. of pressure one of the how to use as required The people living at the home have a choice of General Practitioner that they register with. One General Practitioner visited the home during the course of the inspection. Through the General Practitioner’s the Manager can obtain referrals to other health care professions who do visit the home to provide care or advice in their field of expertise. This may include District Nurses, Community Psychiatric Nurses, Continence Nurse, and Occupational Therapists. Other services such as Dentistry, Audiology and Chiropody are provided to the people living at the home as required. The Registered Nurses are responsible for all medication related activities. The administration charts provided evidence that procurement is recorded on these charts allowing the information to follow the person the chart is about. One nurse was seen during the administration round and she explained to the inspector that although a blister pack system is in use they also have medicine bottles for prescription medication that has been provided outside of the normal supply arrangements. There is a medication storage room and trolley for each floor. Both rooms provided the necessary level of security and the trolleys were purpose made and lockable. Administration records were good. One General Practitioner commented that the care service could improve further with an increased understanding of medicines. The people spoken to said that the staff treat them with dignity and respect. Personal care was provided in the privacy of the bedroom or another appropriate, area such as the bathroom. The residents looked clean and suitably dressed and wore their own clothes. Staff were seen knocking on bedroom doors before entering and when in discussion with individuals they addressed them in a respectful manner at all times. A General Practitioner Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 12 commented that people are always examined in the privacy of their own room. Rooms were only shared where there had been an agreement for this to happen. The quality assurance system recorded that the staff scored 100 for dignity and respect. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 13 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): The homes performance was assessed against standards 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. The meals that are provided are of good quality, nutritionally balanced and very well presented. The level of choice given to the people who live in the home, over a wide range of issues, is good and allows them to maintain a degree of independence. EVIDENCE: The home has employed an activities coordinator who provides a range of activities at no charge. She displays a calendar of events on notice boards in the home. The care files include a record of hobbies and interests and includes a place to record a brief family history. Some forms were only partially completed as obtaining a clear history was said to be difficult for some individuals. During the tour of the home the inspector noted that one communal area was being used as an activities room and had evidence of the craftwork that has been carried out. When speaking to the people in the home there was a mixed view about activities. Some people did not wish to attend Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 14 anything on offer and were happy to read their paper in their own room, whilst others choose to attend some events and not others. One staff survey commented that it would be good to set up visits to places outside of the home. The 5 service users survey forms recorded that 2 people always took part in the activities and 3 usually took part in the activities. Visiting can take place at any reasonable time and the inspector saw several visitors come and go during the day. The one visitor that he spoke to was very complimentary about the accommodation, the food and the care their relative receives. They also said that they chose the home and that it is easy to get there by bus. Visiting can take place anywhere in the home that the resident may choose. The home invites the people who live there to personalise their rooms with items that they wish to bring in from home. During the tour of the home the inspector saw that many people had done this to create a more comfortable environment for themselves. They also have the facilities to have their own telephone line for which they receive a bill from the phone company direct. One person who has lived in the home for several years said that the telephone helped him keep in touch with his friends who live in the district. There are also other choices that the people can make such as what they wear each day and what they wish to eat. They are asked the day before to make a choice from the menu that is then prepared for them. They can also request food that does not appear on the menu if they do not like what is planned. Breakfast is served in the person’s room and other meals are provided in the person’s room of choice such as their own room or the dining room. The cook told the inspector that she has her Intermediate Food Hygiene Certificate. The cooks are involved in how the food is prepared for the people in the home based on the results of the nutritional assessments. The inspector saw normal and pureed food that had been prepared. Pureed food is presented in the shape of the food that it was prepared from through the use of moulds. Each looked very nicely prepared and presented and the people who were eating them were very satisfied with the quality and taste. The home now operates a weekly menu rather than a four weekly rotating menu. This enables the cook to prepare a wider range of food from what is the choice of the people living at the home and what is available in the market place. The quality assurance report states 54 of people in the home felt the food was excellent and 38 felt that it was good. The 5 service users survey forms recorded a similar result with 3 saying the food was always good and 2 saying the food was usually good. The home says in the Statement of Purpose that ministers of religion can visit at any time. Mass can be said at the bedside of a person if this is their wish and a bible is available in the home. They also state that all religions and beliefs will receive the same respect and opportunity to be practiced. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 15 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): The homes performance was assessed against standards 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has satisfactory arrangements for informing people using the service and their advocates about how to make a complaint. They also have suitable arrangement for this to occur. The home has taken satisfactory steps to reduce the risk of any form of abuse through training and robust recruitment practices. EVIDENCE: The inspector saw that the home has a very comprehensive complaints procedure. This was on display in the front lobby next to the registration certificate. It included the name and address of the local Commission for Social Care Inspection office and also the contact details of the Independent External Adjudication Secretariat. Further to this the home had a copy of the procedure in both the Statement of purpose and the Service Users Guide that were also on display in the lobby. There was also a complaints and compliments book in the lobby on clear display next to the signing on book. The book had been used for compliments since the time of the last inspection in 2006. The Commission for Social Care Inspection has not investigated any complaints since the last inspection. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 16 The service users survey indicated that 3 out of five people who responded did not know how to make a complaint. Both of the relative’s survey responses indicated that they knew how to make a complaint with one saying where the complaints and compliments book could be found. The people who were spoken to by the inspector knew how to raise a complaint if they needed to. Staff from the home has attended Adult Protection training. The Annual Quality Assurance Assessment reported that this training is also ongoing. The staff handbook covers this subject and a copy of this was openly available in the staff room. There is a copy of the Alerters Guide for staff in the office. The staff records provided evidence that all staff are vetted during their application process and a POVA First plus Criminal Records Bureau are carried out. The home has robust policies and procedures for Adult Protect, disciplinary issues and whistle blowing that have recently been reviewed. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 17 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): The homes performance was assessed against standards 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides spacious, comfortable, clean, well equipped, adequately decorated, and well-proportioned accommodation that is suitable for the people who live there. The bathing facilities are of a very high standard meeting the needs of all of the people who live in the home regardless of their level of ability. EVIDENCE: Bramble Down Nursing Home is located close to the centre of the village of Denbury near the towns of Newton Abbot, Totnes and Ashburton. It is a care home with nursing that provides personal and nursing care to a maximum of Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 18 40 Residents. It can be reached by the number 176 bus from Newton Abbot that is run by a local bus service and stops outside of the home. There is also a large car park in front of the home that provides level access into the home. The inspector made a full tour of the home. The home was purpose built approximately 20 years ago with care being provided on two floors with wide corridors servicing all the bedrooms, bathrooms and communal areas. There are two passenger lifts between each level and also staircases leading up to the first floor. It also has a variety of equipment such as grab rails and ramps to ensure people living at the home are able to maintain their maximum independence. There are 23 single rooms and 8 double rooms and all have en-suite facilities, nurse call system a telephone point, radio and television. There were good levels of natural lighting and also artificial lighting in all areas of the home. Every person living in the home has the option to bring in items from their home to personalise their room. The rooms entered by the inspector were comfortably furnished to the liking of the people who lived in them. Many were provided with an adjustable height bed that made providing caring for them easier. There are several furnished communal areas that are used for activities, dining or just relaxing. They have clean comfortable seating that was suitable for the purpose that it was being used for i.e. dining or lounging in comfort. The four bathrooms are of good size and have good, high specification disabled bathing facilities that are fitted with hoists and some have shower facilities. There are electrical disinfecting sluices in central areas in the home within sluice rooms. The inspector noted that old open sluicing facilities are still in place but was assured that staff do not use them. The home was clean and clutter free during the day of the inspection. The home has a good standard of décor, furnishings and fittings, which provide a comfortable pleasing environment for residents to live in. The home has its own laundry housed in a building separate to the home. It has 2 modern washing machines, both with a sluicing cycle. There are also 2 modern commercial dryers and a separate ironing room. The home employ’s laundry staff to manage this service. Outside of the home at the rear there is a level garden area laid to lawn with a path surrounding it. Some ground floor rooms have direct access to the garden area. The garden is surrounded by the home on three sides and there is easy access for all of the people living at the home, into it. Chairs and umbrellas are provided for the comfort of those using the garden. The inspector saw evidence of the maintenance of equipment such as hoists and the shaft lift. His tour of the home showed that it was well maintained and Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 19 that the safety of the people living in it had been considered following a risk assessment of the building. The radiators were guarded and there were thermostatic mixer valves on water outlets such as sinks in en-suites and baths. The inspector saw evidence that the water supply was being managed and monitored to reduce the risk of legionella and scalding. Bramble Down Nursing Home DS0000058730.V335457.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): The homes performance was assessed against 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs staff in sufficient numbers, and with satisfactory qualifications, skills, and experience, to meet the needs of the people who live in the home. However, the number of care staff with a National Vocational Qualification in care should be addressed. The recruitment procedure and staff induction ensure a suitably prepared team cares for the residents. EVIDENCE: The home employs a large group of staff who collectively have the skills to manage both the hands on care of the people who live at the home and also that ancillary services that support that work. The home is led by a Manager who is an experienced Registered Nurse and homes manager. She has only worked in the home for less than 2 months but has already made some significant changes to improve the service. The duty sheets show that there are staff in sufficient numbers on duty by day and by night to meet the needs of the people living at the home. There have been some vacancies and regular agency staff have worked at the home to address this and also provide a degree of continuity of care. Some of the people who live at the home did Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 21 comment that the home needed more of its own staff. One General Practitioner survey response said that staff usually have the right skills to meet the needs of the people who live at the home, but some staff do not have a clear understanding of the patients needs. This was however qualified that the home does provide efficient care and liaises with relatives and doctors. The inspector spoke to 4 staff during the course of the inspection that have different roles in the care team. Each person was happy working at the home and felt that the new manager was making a positive difference to the home. Only 2 staff returned the care workers survey forms. The general responses were hopeful that the change in management would bring with it a motivating approach that “encourages staff to provide the best possible care”. The 5 service users responses said that the staff listen and act on what they say and 4 said that the staff are usually available when they need them. One said that the staff are always available when they need them. One person wrote that staff were “not always will to spend time with them”. A member of staff filled in this form on the resident’s behalf. The pre-inspection form indicates that just 25 of the care staff employed by the home has a National Vocational Qualification at level 2 or above. On of the care staff that was spoken to said that she has worked at the home for less than a year. She completed a full induction program and this was verified when her file was read. She said that her induction included working with someone who had a National Vocational Qualification at level 3 in care. She also said that she had applied to do her National Vocational Qualification at level 2 in care. One Registered Nurse told the inspector that she went through the application and interview process and had a Criminal Records Bureau check. She also worked alongside another Registered Nurse for 4 days and completed an induction pack before taking charge of a shift herself. She said that she loved the work and finds it less stressful than he role in the National Health Service. The cook provided information about her work and felt that her skills were appreciated in that she takes part in the planning of meals to meet individual residents needs. The laundry lady showed the inspector around the laundry and provided an insight into how the laundry service is managed. The inspector looked at 3 staff files. They provided evidence that the home has followed its recruitment procedure and obtained the required information about staff that is required by the schedules. Files included completed application forms, photographic identification, Criminal Records Bureau and POVA First results, 2 references and evidence of the training that individuals have been involved in. Staff files are kept in a secure place. Bramble Down Nursing Home DS0000058730.V335457.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): The homes performance was assessed against standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is good and this has resulted in good standards of care in a well-presented and safe environment. The homes quality assurance measures are good, and the results easy to understand. EVIDENCE: The home has employed an experienced Registered Nurse as the Manager. She has only worked at the home for less than two months but comes with the Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 23 experience of managing a nursing home for some time before moving to Devon. The documentation that she prepared for the Commission for Social Care Inspection, Annual Quality Assurance Assessment, has been presented in a professional and informative format using her computer skills. This has demonstrated her management ability and knowledge of the role she has accepted. The staff that work at the home have paid her compliments saying that she has provided them with the motivation they need. She is supported by the Group Manager who also took a positive part in this inspection. The Statement of Purpose did have a full breakdown of the results of the quality assurance surveys that have been carried out during 2006. This showed that staff scored 100 for dignity and respect whilst food scored 54 excellent and 38 good but 100 for meals being served at the right time. It also had comments on the improvements and changes such as the nurse’s station being moved to a better location and the refurbishment of the bathrooms. The Group Manager told the inspector that there is further quality assurance taking place for 2007 and the staff files have been reviewed by the Administrator who has now left the homes employment. The home does not manage the affairs of any of the people living in the home. Any fee’s charged that are outside of the contractual arrangement are invoiced to the individual managing a residents finances. Records, survey responses from staff and discussion with the staff confirmed that they receive regular supervision and have daily report sessions each day. The home is managed with the needs, and safety of the people living in it, as the priority. Staff have received adequate training and the home has been maintained to a good standard. There have been measures taken to provide a safe environment such as radiator covers and thermostatic mixer valves to reduce the risk of burns and scalds. The home has invested in standing and moving aids and bathrooms have been refurbished with the provision of some new baths that have integral hoists. Policies and procedures have been reviewed and are up to date. Accidents are appropriately recorded and care plans regularly reviewed to enable the correct care to be provided. Bramble Down Nursing Home DS0000058730.V335457.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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 4 X 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO 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 Refer to Standard OP28 OP26 Good Practice Recommendations The home should work towards training 50 of care staff to National Vocational Qualification level 2 in care. Old sluicing facilities that are in several places around the home should be removed to reduce the risk of use, and therefore improve infection control arrangements by reducing the risk from standing water in the pipes leading to them. Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Bramble Down Nursing Home DS0000058730.V335457.R01.S.doc Version 5.2 Page 27 - 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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