Inspection on 17/09/08 for Bramble House

This inspection was carried out on 17th September 2008.

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

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

Other inspections for this house

Bramble House 17/09/09

Bramble House 20/09/07

Bramble House 13/11/06

Bramble House 19/06/06

Bramble House 25/10/05

Bramble House 25/04/05

Bramble House 26/10/04

Bramble House 02/06/04

Bramble House 16/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Bramble House 96a & 98 Stroud Road Gloucester Glos GL1 5AJ Lead Inspector Mr Adam Parker Key Unannounced Inspection 07:50 17 & 18 September 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bramble House DS0000016357.V372216.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 House DS0000016357.V372216.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramble House Address 96a & 98 Stroud Road Gloucester Glos GL1 5AJ 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) 01452 521018 marcusgreen@btconnect.com Forestglade Limited Care Home 29 Category(ies) of Dementia (29) registration, with number of places Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home providing personal care only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following category: 2. Dementia (Code DE) The maximum number of service users who can be accommodated is 29. 20th September 2007 Date of last inspection Brief Description of the Service: Bramble House is situated on the outskirts of the City of Gloucester and is within easy walking distance of a local shopping complex. A previous building project has joined the original house with an adjacent house via a link corridor. There are four assisted baths and a shower within the home and there are fourteen rooms with en-suite facilities. The home has extensive gardens at the rear of the building including an orchard. Car-parking space is at the front of the home. Information about the service including CSCI reports is made available by the provider to prospective service users through the homes’ Statement of Purpose and Service Users Guide. At the time of inspection the fees are from £333.60 for low dependency and £400.50 for high dependency. Chiropody, hairdressing and newspapers are charged extra. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One inspector carried out the inspection visit over two days in September 2008. The manager of the home and the responsible individual were present for both days of the inspection visit that consisted of a tour of the premises and examination of residents’ care files. In addition training was looked at as well as medication storage and administration and documents relating to the management and safe running of the home. Five residents were spoken to during the inspection visit as well as one visitor and two members of care staff. An Annual Quality Assurance Assessment (AQAA) form was sent to the home for completion prior to the inspection visit. This was completed by the registered manager who is no longer working at the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 6 The home had received more written information from funding authorities relating to a resident’s needs prior to admission to the home. A nutritional assessment tool has been introduced and care plans are in place for residents with pressure area care needs. The medication policy has been updated. The environment of the home has been adapted to suit the needs of residents with dementia and aid their independence. More staff training has been provided with information being kept on training completed by staff and plans made for future training. Safety checks are now being carried out on hot water temperatures and electrical appliances. 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 House DS0000016357.V372216.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 House DS0000016357.V372216.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure generally ensures that all residents are admitted to the home on the basis of a full assessment of their needs so that they can receive the care that they require. EVIDENCE: The assessment documentation for a number of residents recently admitted to the home was looked at. An assessment of the resident’s needs had been recorded on an assessment document prior to admission to the home. Although in one case the document was undated making it difficult to check when this had been completed in relation to when the resident had been admitted to the home. In all examples looked at care plans produced by funding authorities had been obtained prior to the resident moving into the home. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 9 The homes own assessment document although comprehensive should have an area added to check if a prospective resident has a history of falls. The home does not provide intermediate care and so Standard 6 does not apply Bramble House DS0000016357.V372216.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): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans must be further developed for all residents to guide staff in meeting their personal and health care needs, In addition medication administration practices need improvement to ensure that residents receive their medication when needed and that an accurate record of administration is made. EVIDENCE: Care plans looked at were brief in respect of the action required to meet needs but had been reviewed on a monthly basis. The format for the mental health care plan included an area to record whether there was involvement from a community psychiatric nurse (CPN), which is a useful method of presenting this information. However one resident’s care plan looked at did not include this information although elsewhere visits from the CPN had been recorded. The same care plan described interventions for staff to follow if the resident became aggressive however these were not detailed enough or individualised stating that staff should “divert his attention.” Exactly how this would be achieved was not recorded. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 11 Another resident had a care plan for breathing with the statement “Ensure she does not over exert herself.” another care plan stated that the resident should be prompted “to go to the toilet at regular intervals.” Care plans needed more specific information as to how the individual residents needs would be met. A daily report had been completed for residents, this included indications that checks had been made on continence and pressure areas. Appropriate pressure area risk assessments had been completed and these included a note of any equipment in use such as a pressure relieving cushion. Examples looked at also recorded personal care such as when a resident had taken a bath of if a bath had been offered and refused. Risk assessments had been completed for pressure area care, falling, wandering and moving and handling. A good example of risk assessment for wandering was looked at and this had been completed using specific information regarding the individual resident and the local area. The home had been using a malnutrition assessment tool to assess residents and staff had received training in the use of this tool. One resident had been receiving input from mental health services. There was no documentation on file relating to the Care Programme Approach (CPA) to check if the resident’s care plan was in line with this. The home should find out if arrangements are in place under the CPA and if so request a copy of related documents and request involvement in any future review meetings. Considering the homes change in registration and the admission of residents in the future that may have involvement with mental health services, information about the CPA should be checked on admission. The arrangements for medication storage and administration were looked at. Medication is stored securely although storage temperatures had not been monitored and recorded for the medication storage room and there was no record of storage temperatures for medication kept in the refrigerator. The homes’ policy on medication states, “the temperature of the drug cupboard will be checked and recorded daily”. Containers of liquid medication and eye drops had been dated on opening as an indication of the expiry date. Medication administration records (MAR) had photographs of residents as an aid to identification and included information on health problems and medication to be given on an ‘as required’ basis. One resident’s MAR also included a pain management chart. The MAR showed that handwritten directions had not been signed or dated and there was no evidence of any checks being made on these entries. One resident had directions for giving medication changed with handwritten entries added to the MAR. One of these entries had been written in pencil and there was no signature of the person making the changes or evidence that it had been checked by another member of staff. Staff had not followed the homes medication policy in relation to handwritten directions. Examination of the MAR for the same resident showed that an omission code had been used. On further examination the code used had not been clarified at Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 12 the foot of the MAR. Through discussions with the acting manager and the responsible individual it became evident that a new supply of the medication had not been ordered in a timely fashion and so had not been available to give to the resident for over a week. This is of concern as the medication prescribed was a regular dose given for the treatment of dementia. Contact was made by telephone by the acting manager with a member of staff responsible for medication. It was evident that the use of omission codes where medication was not given had not been fully understood in this case. Another resident had been prescribed an anti-depressant medication. The MAR showed that this had not been signed as being given for the 9/09/08 and the 11/09/08. Also on the 8/09/08 an omission code had been used although the reason for this had not been clarified. A third resident had been prescribed ear drops but there were two occasions where the MAR had not been signed to indicate if these had been administered. As at the previous inspection it was strongly recommended that weekly audits were made on medication administration as a check that people living in the home receive their medicines correctly. It was reported by the acting manager that medication audits had been carried out by the previous registered manager although a written record of these could not be found during the inspection visit. There were no residents administering their own medication at the time of the inspection visit. Following a recommendation at the previous inspection there had been a review of the medication policy. Staff were observed treating residents with respect and up-holding their privacy. Residents confirmed that staff knocked on doors before entering and were polite to them. Bramble House DS0000016357.V372216.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): 12,13,14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home continues to provide a varied activities programme through consultation with residents and in line with their individual abilities. This provides an excellent degree of social contact. In addition residents individual preferences are catered for in the meals provided in the home. EVIDENCE: The home has an activities coordinator working generally on weekdays, when spoken to she explained how she had made changes to some of the activities provided in the home in line with the change in the homes registration to include dementia. She had used information available on the internet and was clearly up to date with current thinking on this subject. Since the previous inspection new activities introduced to the home have included seated Tai Chi exercises, reflexology and aromatherapy. The activities for the week are planned through consultation with the residents and a weekly activities notice is produced. Trips out of the home have been organised with destinations such as local shops and a trip to the seaside. More informal outings have also started for residents with individuals joining staff on Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 14 shopping trips to buy items for the home. Residents have activities care plans and a life history record is made including any interests or significant events. In addition a risk assessment for activities has also been completed. The activities organiser has undertaken a training course in providing activities in care homes. Three residents spoken to commented positively on activities provided and described some that they had taken part in. Some activities are provided in the evening such as the ‘takeaway evening’, which it was reported has been a great success. A newsletter has been produced giving information about planned activities and other news items about the home. This has included a number of contributions from residents. The overall impression was of a home with a lively and varied activities programme with plenty of consultation with residents. There are close links with the local church that is situated directly opposite to the home. Residents visit the church hall for coffee mornings and regularly attend Holy Communion. One resident also attends a local Baptist church every Sunday and another has visits from a Roman Catholic priest. There are also residents who attend the local Ukrainian club and the local Afro-Caribbean club with another working one day a week in a charity shop. The home has a policy of open visiting and one visitor was spoken to during the inspection visit, she visited weekly and described how she was welcomed by the staff and offered a drink. The home has recently obtained a computer and has plans to use this to help some of the residents contact relatives abroad. The home has information about local advocacy services available and had cause to make use of an advocate for a resident in the past. Residents can bring in their own furniture and electrical equipment to the home and evidence of this was seen during a tour of the premises. The home had a menu that changed every four weeks through consultation with residents. The menu only included one choice of main dish although it was stated “Alternatives are available on request.” This was confirmed by the cook who stated that the home could provide a vegetarian diet if this was requested. However there were no special diets being provided at the time of the inspection visit. The serving of lunch was observed on one day of the inspection visit. Some residents were eating at dining tables and others in their chairs with small individual tables. Serving dishes were in use on tables as a way of encouraging a degree of independence. Staff were attentive to residents needs during lunch offering drinks and maintaining an appropriate level of contact. One resident was very positive about the meals provided stating that he “ Hadn’t sent one back yet.” Another resident said that they were “ Quite pleased.” with the meals. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 15 Water coolers have been provided in the lounge and dining room, a breakfast bar is set up for residents to help themselves, and fruit and biscuits are now kept in the lounges. Both cooks had completed an NVQ in professional cookery. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies on complaints and preventing abuse should protect service users from harm although staff training when completed would be of additional benefit in protecting people who use the service. EVIDENCE: The home has a complaints procedure provided to residents and their relatives in the service users guide. In addition a copy of the procedure was prominently displayed in the entrance hall of the home. A complaint was received by us and passed to the home in December 2007. This was appropriately investigated and we were supplied with a copy of the home’s findings. In relation to resident’s legal rights, the home has information available on the Mental Capacity Act 2005. The home has a policy on adult protection and has copies of the Alerter’s guide produced by the local authority adult protection unit. Since the previous inspection the home has been trying to arrange adult protection training for staff. This has been cancelled on a number of occasions due to sickness of the trainer. Since the inspection visit the home and the trainer have both provided evidence to us regarding the current position with this training. There have been no reported incidents of abuse at the home. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 17 Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a carefully adapted environment suitable to their needs that also promotes their independence. EVIDENCE: There have been a number of improvements to the environment of the home in line with the change in the homes’ registration to provide care to people with dementia, including dividing it loosely into four distinct areas, each with its own décor theme and name selected by its occupants. The gardens have been greatly improved by the removal of some overhanging branches that restricted light. The garden has been fitted with more secure fencing so that residents have more privacy and can access the grounds independently and safely. CCTV cameras were in use for security purposes covering entrance areas. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 19 All communal areas have been redecorated in a style likely to promote independence for people with dementia, with plenty of useful signs. The signs were designed using guidance from the Alzheimer’s society. Toilets have been fitted with black seats to increase contrast, and bathrooms and toilets have been painted in ways that will help people to use them independently. This also included the use of pictorial signs on doors. Almost all bedrooms had been redecorated. All bedrooms are now fitted with digital TV aerials, and all basins are fitted with hot water regulator valves. The gardens have been greatly improved by the removal of some overhanging branches that restricted light. Strip lighting is being replaced gradually with domestic-style lighting. The laundry was looked at and was in need of cleaning in a number of areas particularly behind the machines. In addition an amount of objects had accumulated in the laundry that would not ease the process of keeping the area clean. Wall surfaces were also in need of attention to ensure that a cleanable surface is maintained. Considering the state of the laundry the home must ensure that any staff member with responsibility for working there must receive infection control training. The home was noted to be free from any odours and this was also commented on by the one visitor spoken to. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices need improvement to ensure that residents are protected. In addition the lack of staff training in some areas may affect the ability of the home to meet the needs of people using the service. EVIDENCE: Staffing in the home consists of the manager with five carers in the morning with a minimum of four carers in the afternoon. In addition the activities coordinator works each weekday. At night there are two carers in the home. Ancillary staff consisted of a laundry assistant, two cleaners, a cook and a handy man. The home had not used any agency staff and it was reported that staffing levels are based on 27 residents and can be reviewed if dependency levels or numbers of residents increased. The homes’ AQAA document stated that two out of twenty one staff had achieved an NVQ with five others working towards this. Although an improvement on the situation at the previous inspection, the home should continue to work towards a higher ratio of staff trained to NVQ so that residents can be cared for by a competent staff group. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 21 Records for four recently recruited members of staff were examined. Three members of staff had been employed without all of the required checks and information being obtained. One member of staff had been employed without giving the reasons for leaving twelve previous posts in care settings and there was no evidence of any proof of identity being obtained. A second member of staff had been employed with only one reference and another with no reference from the previous employer. One person had been employed with two references that although they related to previous employment came from a manager who left both services some time ago and not from the employer themselves. The registered provider should consider the validity of such references if received in future. Some staff had been employed through a recruitment agency although their practice failed to meet the regulations and has potentially put residents at risk. The home’s AQAA document stated that staff induction training met the national minimum standards. However there was no evidence that new staff had received induction training in line with the nationally specified Common Induction Standards. Information on staff training has now been compiled and was available at the inspection visit. Staff training has been provided in dementia in line with the change in the homes registration. Staff spoken to confirmed the training provided and in particular the dementia training and how this had helped in caring for residents with such needs. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite the recent loss of the registered manager the acting manager has guided the home through a number of changes. There is good consultation with residents about the service although further staff training is needed in a number of areas to ensure residents safety and well being. EVIDENCE: The previous registered manager had been dismissed from the home in August 2008. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 23 At the time of the inspection visit the home had employed a temporary manager while they were seeking a replacement for the previous registered manager. The temporary manager had a background in social care. A regular resident’s forum is held in the home where various issues are discussed. Minutes of the August meeting showed that there had been discussions around food and menus, forthcoming events and seating arrangements. Residents had given their views about a recent takeaway evening and the choice of drinks available in the evening. This is a useful way of keeping in touch with the views of residents. Visits had been made and reports compiled by the registered provider as required under the Care Homes regulations 2001. On examination these reports were of a high standard. The report for May 2008 showed how outstanding issues in the home were being checked and how improvements in the service were being made. A suggestion box has also been made available in the home. The home had plans for developing its quality assurance systems with the use of audits. Consideration should also be given to the use of surveys to gain the views of those with an interest in the home such as visitors and health and social care professionals. The home provides secure facilities for resident’s money. The amount held for one resident was checked against records and was found to be correct. The majority of staff had received training in safe working in infection control and control of hazardous substances. However moving and handling and first aid training dated back to 2005 and fire safety to 2006. The home must check when updates are required in these areas of training and plan to provide training both to new staff and those in need of updating. Although kitchen staff had received training in food hygiene, the home should also check if other staff require this training. Heating and electrical systems and appliances had been serviced and maintained. The electrical wiring had been checked and a certificate issued in March 2008. Portable electrical appliances had been checked with records kept, which was a great improvement from the situation found at the previous inspection. The central heating had been serviced in April 2008. The storage of cleaning materials was looked at and there was no decanting of substances from one container to another with substances kept in appropriately labelled containers. The storage cupboard was checked and this was locked. Hot water temperatures were being checked and recorded on a monthly basis. Servicing had been carried out on hoists and bath lists. However on inspection a plastic seat on one bath hoist had split. This could have caused an injury to anyone using it. When pointed out to the management, this was immediately taken out of use and the service engineer called in to replace the seat. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 24 Although a number of security measures are in place it is recommended that a security risk assessment be carried out with regard to the security of the premises. A recent environmental health inspection of the kitchen upgraded the service from two-star to four-star. One accident book was in use as opposed to the two at the previous inspection. In one resident’s records it had been recorded that there had been a visit to hospital following the resident complaining of pain to their left hand. Another resident had been admitted to hospital with an illness in August 2008.These were reportable to us under regulation 37 although we received no reports. The home must check on notifiable incidents and report them without delay. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 X X 3 3 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement When medication is administered to people who live in the home it must always be clearly and accurately recorded and given in accordance with the doctor’s directions. This is to make sure people receive the correct levels of medication. This requirement has been repeated from the previous inspection. Where any directions are hand written in medication administration charts these must be signed and dated by the staff member making the entry and checked and signed by another staff member to ensure accuracy. In order to provide safeguards for residents, all staff in the home must receive training on adult protection. This requirement has been repeated from previous inspections. In the interests of infection control measures must be taken to ensure that the laundry can DS0000016357.V372216.R01.S.doc Timescale for action 30/11/08 2. OP9 13 (2) 30/11/08 3. OP18 13 (6) 31/03/09 4. OP26 13 (3) 31/12/08 Bramble House Version 5.2 Page 27 5. OP26 13 (3) 6. OP29 19 (1) (b) Schedule 2 7. OP38 23 (4) (d) 8. OP38 13 (4) 9. OP38 13 (5) 10. OP38 37 be kept in a clean and hygienic state. Any staff member with responsibility for working in the laundry must receive training in infection control practices in order to protect residents from any possible cross infection. Before a person starts work in the home, all the information and documents specified in Schedule 2 of the Care Homes Regulations must be obtained to ensure that residents are protected through robust recruitment procedures. Staff must receive training and updates in fire safety in order to protect residents in the event of a fire. Staff must receive training and updates in first aid in order to deal with any accidents or health emergencies to residents. Staff must receive training in moving and handling to ensure the safety of residents in any situation where they may need assistance. The registered person must give notice to the Commission without delay of the occurrence of any event in the care home specified under regulation 37. 31/01/09 30/11/08 31/12/08 31/01/09 31/01/09 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The pre admission assessment document should include an area for checking if any prospective resident has a DS0000016357.V372216.R01.S.doc Version 5.2 Page 28 Bramble House 2. OP7 3. 4. 5. 5. 6. 7. 8. 9. OP7 OP9 OP9 OP9 OP9 OP33 OP38 OP38 history of falls. The home should check if arrangements are in place under the Care Programme Approach for any residents and if so obtain a copy of related documents and request involvement in any future review meetings. Care plans should be more individualised and describe in more detail the actions that staff need to take to ensure that resident’s needs are met. Weekly audits and check counts of a random sample of medicines are strongly recommended to demonstrate that people living in the home receive their medicines correctly. The temperature in the medication storage cupboard should be monitored and recorded to check that residents’ medication is being kept at the correct temperature. A record should be kept of the medication storage temperatures in the refrigerator. Staff should read and follow the homes “Policy and procedures for ordering, receiving, storage and administration of medicines.” Give consideration to the use of surveys to gain the views of those with an interest in the service such as visitors and health and social care professionals. Consideration should be given to training other staff in food hygiene if their role involves preparing or handling food. A risk assessment should be completed regarding the security of the premises. Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bramble House DS0000016357.V372216.R01.S.doc Version 5.2 Page 30 - 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!