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Inspection on 14/04/05 for Bramble Down Nursing Home

Also see our care home review for Bramble Down Nursing Home for more information

This inspection was carried out on 14th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

Brambledown Nursing Home provides a very good level of Nursing and Personal care. A dedicated well qualified staff group ensure that Residents have all their needs met and ensure residents access a full variety of services. The routines within the home are flexible depending on the choice of the residents. Residents and their families are given information and opportunities to visit the home prior to making a decision to move into the home, and residents and their families confirmed that this good communication continued after admission. Staff communicate well with Service Users and their families and provide opportunities on a formal and informal basis to ensure their voices are heard and requests acted on. The Manager and staff within the home listen to suggestions and act on requirements set by the Commission for Social Care Inspection in a prompt and efficient manner. Residents spoken to were very happy living at the home and were full of praise for all staff within the home. The staff group are keen to maintain the high standard of care and enjoy a good team morale. Residents and staff enjoy a genuinely caring relationship, with frequent bursts of humour.Staff have a good understanding of the needs of Residents and importance of choice and respect. The residents enjoy the well balanced, nicely presented meals which are served in attractive surroundings. The staff team organise the activities programme and encourage residents to maintain contact with friends, family and the local community. The home is well maintained and equipped to ensures Residents are helped to maintain independence.

What has improved since the last inspection?

Residents, staff and Relatives are happier with the improvement in standards since the arrival of the Manager and deputy Manager. The Manager has introduced many changes which have been gratefully received by Residents, staff and relatives. Staff benefit from a clear direction of leadership from the Manager and Deputy and are respected for their `hands on` approach. Morale of the residents, staff and relatives have improved since the last inspection. Residents, Staff and relatives feel confident that ideas will be listened to and changes made. Care Plans have been changed to provide an improved way of planning and delivering care and new policies and procedures have been introduced so staff are able to ensure care given is done so in a safe manner. A review of the medication system now ensures residents safety is protected. The experience of mealtimes has been improved by the Manager who has adapted one of the communal areas into a dinning area. Relatives and staff commented on this attractive setting and said that the change ensures that the meals are hot when dished up.

What the care home could do better:

At the time of inspection Penninsular Care homes were in the process of changing some corporate documents and procedures. These changes must include a formal induction and training process, which will help ensure staff work safely and reduce risk to the residents. Training must be completed to ensure there is a qualified first aider on duty at all times. Staff must know what to do if abuse is suspected within the hometraining needs to be completed to make sure this happens.To protect residents, staff must have had the necessary checks and references performed before working at the home.

CARE HOMES FOR OLDER PEOPLE Bramble Down Nursing Home Woodland Road Denbury Newton Abbot TQ12 6DY Lead Inspector Clare Medlock Announced 14 April 2005 th 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 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 D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Bramble Down Nursing Home Address Woodland Road, Denbury, Newton Abbot, Devon, TQ12 6DY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 812844 01803 812854 brambledown12@btinternet.com Peninsula Care Homes Ltd Elaine Sampson Care Home with Nursing 36 Category(ies) of Physical disability (36), Physical disability over registration, with number 65 years of age (36), Terminally ill (36), of places Terminally ill over 65 years of age (36) Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Care Home Providing Nursing to 36 Service Users. Providing Care to a maximum of 36 Service Users who have Physical disability, Terminal Care to a maximum of 36 Service Users, and Terminal Care to a maximum of 36 Service Users who are above the age of 65 years of age. Date of last inspection 15 February 2005 Brief Description of the Service: Brambledown is a care home which provides personal and nursing care to a maximum of 36 Residents. The home is a purpose built care home which has two floors. The home has a passenger lift and variety of equipment, adaptions, grab rails and ramps to ensure Residents are able to maintain independence. The home have 20 single rooms and 8 double rooms. All rooms have ensuite, telephone point, radio and television and residents have an option to bring in items from home to personalise their room. There is a registered nurse on duty at all times and the home have a call bell system. There are two communal lounge areas, a conservatory and newly appointed separate dining room. There are four bathrooms which are fitted with hoists. Residents have their clothes laundered in the on site laundry. There is an activities programme which Residents are able to access if they choose. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and took place over seven hours on Thursday 14 April 2005. The Inspection found that the majority of the standards were met and the overall quality of care was very good. The home have been subject to many changes in the last two years which have consisted of change of ownership and two changes of management. This inspection consisted of speaking with Service Users (Who have requested to be called Residents), family and friends, staff and management within the home. A full tour of the premises was conducted. Care records, staff files, policies and procedures and other records were inspected. Seven of the 32 Residents, one relative, and five staff were spoken to. Not all standards were inspected on this occasion, therefore it is recommended that previous reports are obtained to gain a broader picture of events within the home. What the service does well: Brambledown Nursing Home provides a very good level of Nursing and Personal care. A dedicated well qualified staff group ensure that Residents have all their needs met and ensure residents access a full variety of services. The routines within the home are flexible depending on the choice of the residents. Residents and their families are given information and opportunities to visit the home prior to making a decision to move into the home, and residents and their families confirmed that this good communication continued after admission. Staff communicate well with Service Users and their families and provide opportunities on a formal and informal basis to ensure their voices are heard and requests acted on. The Manager and staff within the home listen to suggestions and act on requirements set by the Commission for Social Care Inspection in a prompt and efficient manner. Residents spoken to were very happy living at the home and were full of praise for all staff within the home. The staff group are keen to maintain the high standard of care and enjoy a good team morale. Residents and staff enjoy a genuinely caring relationship, with frequent bursts of humour. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 6 Staff have a good understanding of the needs of Residents and importance of choice and respect. The residents enjoy the well balanced, nicely presented meals which are served in attractive surroundings. The staff team organise the activities programme and encourage residents to maintain contact with friends, family and the local community. The home is well maintained and equipped to ensures Residents are helped to maintain independence. What has improved since the last inspection? What they could do better: At the time of inspection Penninsular Care homes were in the process of changing some corporate documents and procedures. These changes must include a formal induction and training process, which will help ensure staff work safely and reduce risk to the residents. Training must be completed to ensure there is a qualified first aider on duty at all times. Staff must know what to do if abuse is suspected within the hometraining needs to be completed to make sure this happens. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 7 To protect residents, staff must have had the necessary checks and references performed before working at the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5. Standard 6 Not applicable Residents and their families are given useful information and are made to feel welcome prior to moving in. Residents are thoroughly assessed prior to admission which ensures the home is the right place for them to be. Residents are cared for by a skilled team of staff. EVIDENCE: Brambledown Care Home have a Statement of Purpose and Service User Guide which the manager explained were in the process of having minor updates to include the recent staff changes. Both documents were comprehensive and well written providing all the information that is required. Once Residents are admitted to the home they have a settling in period and can give a months notice if the home is unsuitable. Residents all have contracts whether they are funded privately or by a third party. Contracts seen were all signed and included rooms to be occupied and terms and conditions of residency. Residents spoken to said they knew that visits could be made prior to admission but that family had done this as they were in hospital. Discussion with the Manager and records confirmed that there is a registered nurse on duty at all times and that the staff have a variety of skills and special Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 10 interests to meet the needs of the Residents. One Care Assistant spoke of a special interest in Parkinson’s disease. Posters and records confirmed that staff access a wide range of specialist training. Examples included: Speech and Language therapist, wound Care, catheter care, skin care, optician and stroke awareness training. Discussion with staff and Residents confirmed that the existing Manager has introduced a ‘key worker system’. Residents stated that they found this useful as there was a named person that they could ask to sort out problems. Staff stated that they enjoyed this responsibility and it gave them more job satisfaction. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and10 A newly introduced clear and consistent care planning system is outstanding which means that the health and social needs of Residents are fully planned. Staff communicate well with the multi disciplinary team and provide effective systems for the management of medications in place, which safeguards Residents. There is an ethos within the home that promotes the privacy and dignity of Residents at all times. EVIDENCE: Five Care Plans were inspected on this occasion which clearly demonstrated that Residents have all their needs met and staff are aware of all aspects of the care. All Care Plans seen were up to date, well written and complete. A new system of care planning and recording has been introduced by the Manager which staff said was easy to use and follow. Records confirmed that any changes in the general or specific needs of the Residents are identified and trends monitored. Observation confirmed these documents were ‘working documents’ and reflected the high standard of personal care given. Two Residents stated that they were aware that staff had records of their care but that they were not interested in seeing them. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 12 All 32 Residents seen on the day of inspection looked very well cared for with the finer details of care attended to. Examples included nail, hair and eye care. Records and discussion with Residents confirmed that NHS services are accessed and that staff contact the General Practitioner and other multi disciplinary health care professionals promptly. All five Residents spoken to confirmed that they think that the care they receive is very good and has greatly improved since the arrival of the new manager and deputy manager. Two Residents and One Relative stated that had been tempted to leave the home and had even started looking around for alternative homes but that the care has ‘improved greatly since the arrival of the new Manager and her deputy’. Residents said that staff are very kind, sensitive and respectful. Observation confirmed that staff knock on Residents doors prior to entering and prevent entry when care was being given to protect their privacy. Residents said this was normal practice. Residents spoken to said that generally they do not have to wait long for the call bell, and staff always explain the reason if there is a delay. Observation confirmed that Residents are able to receive visitors in private and use the telephone in private. Staff spoken to said they felt the standard of care given was good within the home and has improved since the arrival of the new manager. Staff stated that if they had more staff they felt it would be good to take more time with the residents. Observation confirmed that the staff use safe systems for the ordering, receipt, storage, administration and recording of medication. A tour of the building confirmed that Residents only have creams and lotions that are prescribed to them and each jar had the date of opening written on. Observation confirmed the medication sheets are completed correctly with omissions being recorded correctly. Inspection of the controlled cupboard confirmed a correct balance. Residents spoken to confirmed that staff give their medications on time and that the staff seek advice from the General Practitioner regarding medication. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15. Social activities are creative, well managed and varied. Residents have choice and control over their lives whilst living at the home and enjoy the improvements in the meals that are provided. EVIDENCE: Residents spoken to said the staff within the home ‘bend over backwards to ensure they are happy’ and that staff understand if they want a lie in or to get up early and staff will make sure this happens. Residents said they have a set day for a bath but this is changed if they wanted. Staff spoken to said some residents are bathed once a week whilst others enjoy more frequent baths. Staff spoken to said that if residents requested daily baths this will be organised. Residents stated that there is a range of activities organised by the home and that it is OK to join in or opt out as much as they choose. Examples of activities given include: musicians, tranquil moments (poetry recital and reminiscing) painting, and visits by family and friends. Photographs confirmed that residents had enjoyed a recent activity of decorating and eating cakes. Discussion with Staff confirmed that a new session of activities is being arranged which will include bingo, arts, board games and flower arranging. Residents spoken to confirmed that a local minister comes in once a month to hold a communion service and the home’s diary confirmed that 1:1 religious Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 14 services are organised. Residents spoken to said they have also enjoyed visits where staff have bought in their pets and children. Observation of the visitors book confirmed that friends and family have access to the home at any reasonable time and observation of specific events confirmed that residents are able to maintain links with the community. A tour of the home confirmed that Residents rooms are personalised by bringing in personal possessions with them to the home. On the day of inspection one room was being painted prior to the new Resident’s admission. The colour had been chosen by the resident. Discussion with the Manager confirmed that Penninsular Care Homes do not handle the financial affairs of Residents and that this is done by family or advocates. Relatives spoken to said a small amount of cash is given to the administrator to pay for sundries such as hairdressers and that they are given receipts and shown records. Records for these ‘pocket monies’ were inspected and found to be correct. Discussion with the Manager confirmed the home have a four week menu plan which appeared to be well balanced and nutritious. Residents spoken to said there has been an issue with the food in the last few months but that this has improved. One resident stated that the food had been ‘ghastly’ and she stopped eating it and went out as much as she could but that food is now back on track and that she now regularly enjoys ‘seconds’. Residents stated that there are three meals a day with biscuits served mid morning and home made cakes in the afternoon. Residents stated that are told the day before what is for lunch and if they wish they can ask for an alternative. Observation confirmed that the menu is displayed on a blackboard in the dining area should residents forget. Observation confirmed that the food is hot when it is served. Residents said this was always the case and there was plenty of it to allow for ‘seconds’ which was a popular choice. Observation confirmed that on the day of inspection a main meal of cottage pie, and fresh vegetables followed by chocolate sponge and chocolate sauce was enjoyed. Liquefied meals were served in an attractive manner and assistance was given in a calm unhurried manner. Residents spoken to confirmed that this was normal practice within the home. Staff stated that the manager has transformed one of the lounge areas into a dining area. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18. Brambledown’s complaints procedure allows Residents and Relatives to be confident that their concerns are listened to, taken seriously or acted upon. Staff are aware of adult protection issues and how to report any allegations, however the training is incomplete and all done at the home which potentially could place Residents at risk. Staff would benefit from attending adult protection training with staff from other agencies. EVIDENCE: Brambledown’s complaint procedure is displayed within the Statement of Purpose and Service User Guide. The document contains all information required which includes timescales and how residents and their families are able to contact the Commission for Social Care Inspection. One Resident stated that she knew this ‘official way’ was available but a minor issue had been ‘sorted out straight away by the staff’. One relative stated that life had improved since the Manager and deputy had arrived and that complaints had been made but have now been sorted. Specific examples included footrests on wheelchairs and the food. One Resident stated ‘there was nothing to complain about’ and that ‘life was very good’ at Brambledown. Discussion with Residents and the Manager confirmed that systems are in place for Residents to participate in the local and parliamentary elections. The Manager stated that an electoral register is completed and postal votes arranged for those who are unable to go to the polling station. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 16 Discussion with staff confirmed that the issue of adult abuse is taken seriously and the company have a clear line of management to whom allegations can be reported to. Staff spoken to knew the correct reporting procedure. Records and discussion confirmed that training comprises of a video and discussion and that not all staff have completed this training. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,and 26. Brambledown is a purpose built and provides a safe comfortable home in which Residents are able to stay as independent as possible. The home has a good standard of décor, furnishings and fittings which provide a comfortable pleasing environment for residents to live in. EVIDENCE: Brambledown is a two story purpose built Care Home which has adaptations and equipment to ensure Residents needs are fully met. A tour of the building confirmed that the home employ a maintenance man who was observed to carry out routine and ad hoc repairs. On the day of inspection this included decorating a bedroom and mowing the lawn areas. A tour of the building confirmed that the home has separate communal areas each fitted with domestic furnishings and ornaments to promote a homely environment. On the ground floor are two lounge areas, a conservatory and separate dedicated dining area which has been introduced in the last year. Residents spoken to said they liked this arrangement. On the first floor there are no lounge areas, however one very wide corridor provides seating for Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 18 Residents who could opt to watch the ‘comings and goings.’ Residents spoken to said they preferred going down to the lounge or spending time in their rooms and were able to decide which to do. A tour of the building confirmed that all rooms have ensuite bathrooms. In addition to this the home have additional large bathrooms with adapted baths and showers. The home have an additional two sluices and additional storage cupboards. Residents rooms were all seen to be comfortable and provided evidence that Residents are able to bring their own possessions with them if they so choose. The home have eight shared rooms. These rooms have screening and the Manager confirmed that Residents make a choice whether they share or not. A tour of the building confirmed that all rooms had central heating and the temperature was comfortable. All radiators seen were guarded and windows on the first floor were restricted in order to safeguard Residents. Records of steps taken to prevent the spread of legionella were seen. The company employ a contractor to perform this task. The home was clean, tidy and free from offensive odour on the day of inspection. A tour of the building confirmed that the home have a well equipped laundry, with washing machines that have cycles to ensure foul linen is washed in a way that prevents infection to other Residents and staff. The Manager stated that she had identified a risk with the laundry where both clean and foul laundry was transported in the same trolley and as a result has purchased a new clean laundry trolley to prevent the spread of infection. The laundry was equipped with separate hand washing facilities, gloves and aprons to protect staff and Residents from infection. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 There is a stable staff group at the home who meet the needs of the residents. The staff files, recruitment procedures and induction records are poor. This means that staff rely on memory and communication which has a potential to place Residents at risk. EVIDENCE: Off Duty records confirm that the Manager provides a stable staff group with a skill mix that ensure Residents needs are met and that the home is well maintained and a safe and comfortable place to live. Staff and Residents spoken to stated that there had been a turnover of staff prior to the present manager arriving which resulted in a drop in standards but that this has now improved again. Residents stated that they feel there are enough staff generally but sometimes holidays and sickness affect this. One member of staff said they thought the care is good but could be better if they had more time to spend with each resident. Discussion with the Manager and records confirmed that the induction process is being addressed and at present relies on communication and memory which has the potential to place Residents at risk. The Manager stated that new staff are given emergency information, a layout of the building, and a list of residents and their whereabouts. Following this they are shown the fire video, and manual handling video prior to shadowing an experienced care staff. During their induction they work with the trained nurse and are given information including code of conduct, confidentiality, privacy and dignity. There were no records to confirm this process occurred but the Manager has collated some information including check lists for new staff. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 20 Discussion with staff and the Manager confirmed that of the 16 Whole time equivalent care staff 9 have NVQ 2 training with some staff having level 3. The Manager and staff gave examples of extra training which has been arranged. This included speech and language therapist, skin care, continence care and Parkinson’s disease courses. Inspection of seven staff files took place. This confirmed that not all staff had evidence of all required checks taking place. Recently appointed staff files contained evidence that satisfactory checks had been carried out. Two overseas files contained all information required, including home office information. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 The new Manager has a good understanding of the importance of developing a good relationship with Residents, relatives, which has resulted in a better standard of care and staff morale. The manager is supported well by staff within the home with all staff demonstrating an awareness of their roles and responsibilities. The home is well managed and provides a safe place to live. EVIDENCE: Brambledown Care Home is one of five owned by Penninsular Care Homes. The organisation has clear lines of accountability. The new Manager for Brambledown is an experienced Registered General Nurse and has managed Nursing Homes since 1999. She is in the process of doing the Registered Managers award and keeps herself updated though courses, reflective practice and reading journals and information relevant to the Residents care needs. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 22 The Manager stated that she is aware of her learning needs and has identified budget control as one of these. There is currently no Manager’s job description so the Commission for Social Care inspection is unclear as to the extent of the Managers role within this home. Staff spoken to all agreed that there was a great deal of respect for the Manager and deputy as they have come to the home and worked with staff to improve standards. One member of staff stated that the Manager and deputy ‘immediately rolled their sleeves up and worked with us and this stopped me from leaving.’ Another member of staff said the morale has increased since the new Manager has been here. During the inspection laughter was heard which was shared with Residents. Residents said it was always like this and it was fun. Discussion with the Manager confirmed that quality assurance was performed in a variety of ways and this included: speaking with Residents and their families, questionnaires, residents meetings, and Regulation 26 visits where the area manager for the company visits the home on an unannounced basis. One Resident said she has had a few minor issues sorted out straight away and staff always ask what I want. Another Relative stated that life has improved since the Manager has been in post and requests to improve the security, food and use of wheelchair foot rests were listened to and acted upon. Observation confirmed that the home do not have a recognised audit tool and do not send summaries of audits and questionnaires to the Commission for Social Care Inspection. Discussion with Residents and Relatives confirmed that the home do not manage the financial affairs of the Residents and that this is done by the Residents, their families or a solicitor. Residents and Relatives stated that the home hold ‘an envelope’ which contains a small amount of petty cash which is used for events such as hair dressing. One Relative stated that the administrator shows receipts for the service that has been provided. Inspection confirmed the balance of two of these monies was correct. Discussion with The Manager, nursing staff and care staff confirm that staff supervision occurs as part of the normal management process where staff are supervised and given clear direction and support. Documents seen within the home are used for this purpose. The Manager has also highlighted the importance for Nursing staff to receive clinical supervision in addition to appraisals. Staff spoken to have found this useful. Training records within the home confirmed that staff had received mandatory training in respect of fire safety, manual handling, food safety and some infection control. Records confirmed that the first aid training was not up to Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 23 date which results in there not being a first aider on duty at all times. New first aid boxes have been introduced since the last inspection. Records confirm the home maintain equipment. Service Records were seen for Legionella prevention, Fire safety checks, Lift services, Electrical PAT testing, Sluice maintenance, Hoist maintenance and gas boiler services. Generally the records seen within the home were well maintained. Accident books allow for the reporting of dangerous incidents to RIDDOR and allow follow up and action. All records seen were secure and stored in a safe manner. A tour of the building confirmed that the staff within the home maintain a safe environment for the Residents. Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 1 3 3 2 x 3 3 3 2 Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 25 No Are there any outstanding requirements from the last inspection? 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. 2. Standard OP18 OP29 Regulation 13 (6) 19(4) Requirement The Manager must ensure that the adult protection training is complete The Manager must ensure that staff files all contain the information listed in schedule 2 prior to employment. The Manager must ensure the induction process is formalised with records kept. The Manager must take steps to ensure that there is a qualified first aider on duty at all times. Timescale for action 01/01/06 01/01/06 3. 4. OP30 OP38 18 (1c) 13(4) 01/01/06 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP18 OP29 OP31 OP33 Good Practice Recommendations The Manager should consider accessing the external adult protection training provided by the local multidisciplinary adult protection team. The Manager should consider adapting the excisting application form to contain more specific information from applicants The Manager should have a written job description The summary of quality assurance audits and Resident D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 26 Bramble Down Nursing Home 5. 6. 7. OP35 questionaires should be sent to the Commission for Social Care Inspection The Manager should obtain two signatures when adding and taking money from the residents pocket money envelopes Bramble Down Nursing Home D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 27 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 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 D54-D07 S58730 Brambledown V210891 140405 Stage 4.doc Version 1.20 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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