Inspection on 17/09/09 for Bramble House

This inspection was carried out on 17th September 2009.

CQC 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 17/09/08

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 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Bramble House 96a & 98 Stroud Road Gloucester Glos GL1 5AJ Lead Inspector Mr Adam Parker Key Unannounced Inspection 09:25 17 & 18th September 2009 th DS0000016357.V377850.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bramble House DS0000016357.V377850.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bramble House DS0000016357.V377850.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 Manager post vacant Care Home 29 Category(ies) of Dementia (29) registration, with number of places Bramble House DS0000016357.V377850.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. 17th September 2008 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 Inspection reports are 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 £340.00 for low dependency and £500.00 for high dependency. Chiropody, hairdressing and newspapers are charged extra. Bramble House DS0000016357.V377850.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 2009. The manager of the home, the deputy manager 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. Four residents were spoken to during the inspection visit as well as two members of care staff. An Annual Quality Assurance Assessment (AQAA) form was completed by the home and forwarded to the Commission prior to the inspection. This was completed in full and generally gave us the information we asked for. 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: The home works well with health care professionals in meeting residents’ health care needs. The home provides an excellent range of activities and helps residents to maintain links with the local community, their family and friends. There is good consultation with residents particularly around menus. The home provides a clean and well maintained environment that has been adapted to the changing needs of residents. Good quality reports continue to be produced following visits to the home by a representative of the registered provider. Bramble House DS0000016357.V377850.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is Bramble House DS0000016357.V377850.R01.S.doc Version 5.2 Page 7 taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information from funding authorities has not been obtained in a timely fashion for the home to make a full assessment of the needs of prospective residents. So that residents cannot always be sure that they will receive the care they require. EVIDENCE: The assessment documentation for three residents who had recently moved into the home was looked at. Dates on two of the assessments showed that an assessment of the resident’s needs had been recorded on an assessment document prior to them moving into the home. A third assessment document was undated. The home’s assessment document had been improved to include an area to check if a prospective resident had a history of falls. Two out of three Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 10 assessment documents looked at had not been signed by the person making the assessment. All three residents were being funded by the local authority and had been admitted to the home before the home had received a copy of the care plan from the local authority. For one of the residents a copy of the local authority’s assessment document had been obtained although it was unclear exactly when. The home does not provide intermediate care and so Standard 6 does not apply Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Attention must be given to developing care plans in a timely manner for residents that have recently moved into the home so that staff have clear instructions on how to meet their care needs. In addition medication administration practices still need improvement to ensure that residents receive their medication when needed and that an accurate record of administration is made. EVIDENCE: Care plans were looked at for a number of residents and these had improved since the previous inspection being more specific in describing what needs to be done to meet resident’s needs. Staff had received care planning training since the previous inspection. However some residents who had recently moved into the home did not have care plans prepared for some time after they moved in. One resident had moved in at the end of June 2009 and care plans had not been written until Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 12 the 25th of August 2009. Another had been in the home for seventeen days before any care plans had been written and another resident had moved in on the 24th of August and care plans were only just being prepared during the inspection visit. If information was obtained from the local authority about a resident’s needs before they move in to the home then this would increase the information available on which to base care plans at an earlier time. 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 registration, information about the CPA should be checked on admission. Risk assessments had been completed for pressure area care, falling, wandering and moving and handling. The home had been using a malnutrition assessment tool to assess residents and staff had received training in the use of this tool. Records showed that residents had been receiving input from General Practitioners (GP) and community nurses for health related needs such as medication reviews and the treatment of pressure sores. The homes AQAA document stated that the home had “built a very strong relationship” with district nurse teams. Residents had also received visits from chiropodists and an optician. The arrangements for medication storage and administration were looked at. Medication was stored securely and storage temperatures had been monitored and recorded. These showed that the temperatures in the medication storage room were on many occasions too high for most of the medication stored there From May through to September 2009 temperatures had been consistently recorded of 26 and 27° Centigrade with some as high as 29 and 30° Centigrade. This has demonstrated that arrangements must be made to store residents’ medication at the correct temperature. It was also noted that temperatures had not always been recorded daily with only two records for the whole of May 2009. Medication kept in the refrigerator was being stored within the correct temperature range according to records kept. Bottles of liquid medication and eye drops had been dated on opening as an indication of the expiry date. Controlled drugs were stored correctly with appropriate records kept. The current Medication Administration Records (MAR) were looked at. Where medication had been stopped and handwritten directions added to the MAR these had been dated and signed by two members of staff indicating that checks had been made on handwritten directions. However when the MAR from Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 13 the previous month was looked at some handwritten directions had no signatures or dates against them showing inconsistent practice. One resident had been prescribed a short course of medication which had been handwritten on the MAR with no signatures or dates; the course started towards the end of one months MAR and would have continued on the following month. However on examination it was found that the directions had not been carried over and so the resident had not been given their full course. This is an example of where a lack of care in preparing new MAR charts has resulted in a resident not receiving prescribed treatment. It is assumed that all of the residents medication that was not taken by them was returned to the supplying pharmacist although records of returned medication were not sufficiently detailed enough to clarify this. There was also some inconsistent practice with recording whether medication was given or omitted. Although staff initials had been used in most cases to indicate where medication had been given, some gaps in recording were found. One example looked at was a resident who had been prescribed medication for epilepsy to be taken twice a day. On one day there were no signatures to indicate if this had been given. A check on the amount of tablets remaining showed that the resident had in fact not received one dose of the medication. Other examples of where staff had not signed for medication given were found and discussed with the management of the home during the inspection visit. Where medication had been omitted a system of codes was in use, generally these were being used correctly and the home had further developed this practice on more recent MAR where a new code was in use to indicate where medication prescribed on an ‘as required’ basis was not required by the resident at a particular time. One resident’s medication for improving their bowel action had only been given once a day instead of twice a day. The reasons for not giving this for two days had been clearly recorded and where appropriate. However it was unclear why it had not been given for over three weeks following this. If this was due to the original reason then this would have warranted the attention of the resident’s GP. Where medication had been prescribed on an ‘as required’ basis there were no plans or protocols in place to guide staff on when to give this. This was apart from one plan that had been supplied to the home by a resident’s Community Psychiatric Nurse (CPN). One resident had been prescribed medication for anxiety to be given on an ‘as required’ basis. The manager reported that staff would use their judgement on when to give this. As well as there being no protocol in place there were no care plans yet completed for this resident and so staff had no point of reference for their decisions when deciding if this resident should be offered the medication or not. The home had a new medication policy and it was reported that staff with responsibility for giving medication to residents had read this as well as being given medication training. Audits of medication administration recording were in place in the home although given the above evidence these were clearly not providing a reliable Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 14 check on practice and this was discussed with the management of the home during the inspection visit. 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. One resident commented that the staff treated them “well”. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of 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 activities coordinator had recently left her post and a new coordinator had been recruited although had not yet started work at the home. The activities for the week are planned through consultation with the residents and a weekly activities notice is produced. Trips out of the home had been organised with local destinations such as shops and other trips outside of Gloucester such as a recent trip to Tewkesbury Abbey to view paintings that residents had completed which were on display there. Since the previous inspection a ‘people carrier’ has been purchased making trips out easier to organise. Residents have activities care plans and a life history record is made including any interests or significant events. In addition risk assessments for activities had also been completed. Activities were planned with the abilities and needs Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 16 of individual residents in mind, taking into account the home’s registration category. One resident spoken to chose not to take part in organised activities and trips out of the home but was happy to enjoy the freedom to spend their time as they wished including walks to a local shop. The overall impression was of a home that had a varied activities programme with plenty of consultation with residents. The home had maintained close links with the local church that is situated directly opposite. Residents had visited the church hall for coffee mornings and regularly attend Holy Communion. There are also two residents who attend a local black elders club. One resident had been helping with work on the home’s new sensory garden. The home had a policy of welcoming visitors at all reasonable times and a quiet room was available that residents could use with their visitors. The home had obtained a computer and this had been used by some residents to maintain contact with relatives who did not live locally. 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 three weeks and had been drawn up through consultation with residents at monthly meetings. In addition menu suggestion forms have been used and the home’s AQAA document stated that these had led to two choices of main dish every mealtime. A cooked breakfast was available twice a week. 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. Staff were noted to be wearing blue plastic aprons over their uniforms during the meal time. Some residents were eating at dining tables and others in their chairs with small individual tables while others ate in their rooms. Staff were attentive to residents needs during lunch checking if residents wanted sauce on the fish and serving drinks. One resident who declined their meal due to feeling unwell was offered a sandwich instead. One resident commented that they “couldn’t fault” the meals provided and another resident described the meals as “alright”. A third resident stated that they had enjoyed an “Excellent lunch” although commented that they felt that cooked breakfasts were usually only being provided once a week. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s policies on complaints and preventing abuse should protect residents from harm despite this a previous allegation was not promptly reported. However the improvement in staff training in this area should protect 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. In the twelve months prior to the completion of the AQAA document the home had received no complaints. Since the previous inspection the home had introduced a new complaint monitoring form. In relation to residents legal rights the manager and a senior carer had received training in the Mental Capacity Act 2005. With the manager also having completed training in the Deprivation of Liberty Safeguards (DOLS). The home had a policy for adult protection as well as a ‘whistle blowing’ policy to guide staff in voicing serious concerns. The specific contact details for relevant agencies should be updated and added to the adult protection policy. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 18 All staff had received training in protecting vulnerable adults. Information from the Gloucestershire County Council in the form of their Alerters Guide was not on display in the home as it had been at the previous inspection. This had apparently been removed during redecoration. All staff had received training in adult protection and some staff had completed local authority ‘alerter’s’ training. One member of staff spoken to was able to recall what had been covered during the ‘alerter’s’ training. One incident of alleged restraint was reported to us by the home in February 2009. This was reported to us some weeks after the event and original information was lacking in detail. This was taken up with the manager of the home at the time and we were then given more information. A referral was then made to the local authority adult protection team. The home took appropriate action regarding the member of staff concerned given the circumstances. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of 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 had been ongoing improvements to the environment of the home since the previous inspection. Work had continued on the garden to make it an area that can be used by residents. The previously overgrown orchard was in the process of being developed as a sensory garden suitable for residents with dementia. 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 had been fitted with black seats to increase contrast, and bathrooms and toilets had Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 20 been painted in ways that would help people to use them independently. This also included the use of pictorial signs on doors. Grab rails had been installed in some of the corridors since the previous inspection. Redecoration of bedrooms had continued and it was reported that nearly all of these had been completed. Bedrooms looked at during a tour of the premises had been completed to a high standard including new floor coverings and furniture. Residents were still able to use their own furniture where this had been brought into the home. The laundry was looked at and was much improved since the previous inspection. It was cleaner, tidier and with accessible hand washing facilities. Wall and floor surfaces were readily cleanable. The home was noted to be fresh and free from any odours. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are deployed and there has been some progress with training although recruitment practices need some further improvement to ensure that residents are fully protected. EVIDENCE: Staffing in the home consists of the manager with four carers in the morning with a minimum of four carers in the afternoon. At night there are two carers in the home with plans to increase this to three in the future. Ancillary staff consisted of a laundry assistant, two cleaners, a cook and a handy man. It was reported that staffing levels had recently been reviewed in relation to the dependency of residents. It was reported that the home had eleven out of seventeen permanent care staff with an NVQ at level 2 or above which is a great improvement on the situation at the previous inspection. Records for four recently recruited members of staff were examined as well as one in the process of being recruited. Two of the four had been recruited with all the correct documentation and information obtained prior to employment in the home. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 22 A third member of staff had been employed without a risk assessment being carried out regarding information on their Criminal Records Bureau Disclosure. Such risk assessments must form part of the recruitment procedure in the interests of protecting residents. A fourth member of staff had provided an employment history although this contained a gap in the employment history and some employment dates were only in years despite months being requested on the home’s application form. There was no evidence that gaps in employment had been explored with the applicant at interview. The documentation obtained so far for the member of staff in the process of being recruited showed that gaps in the employment history had not been explained. This would need further investigation and was discussed with the manager during the inspection visit. Some of the record keeping around recruitment should improve. One staff member had two dates recorded for when they had started work in the home neither of which was accurate and the correct information was only found after checking the staff rota. A record should also be kept of the dates that references are received by the home as a clear indication that the correct sequence of recruitment procedures has been followed. However there was still no evidence that new staff had received induction training in line with the nationally specified Common Induction Standards. New staff are given an induction into the working of the home. Staff spoken to confirmed the training that they had received and noted the improvement in training in the home over recent years. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there is good consultation with residents about the service and staff training has improved, the development of reliable and robust auditing will ensure that the home is more effectively managed in the interests of residents’ safety and welfare. EVIDENCE: Since the previous inspection the home had appointed a new manager. She is a registered mental health nurse with the registered managers’ award and has had previous experience in managing a care home for older people. She was in the process of making an application for registration with the Commission. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 24 Since the previous inspection some work has been done on quality assurance with the use of surveys from residents, their representatives and staff. Although it was reported that low numbers of these had been returned, the process of using information on surveys, reaching a conclusion about this in relation to the service provided and taking any necessary action had been established. A monthly resident’s meeting is held in the home where various issues are discussed. In addition to this menu suggestion forms have also been used giving residents a say in what they would like on the menus. The home had plans for further developing its quality assurance systems with the use of audits. These are planned for such areas as accidents and residents money. As mentioned previously the medication audit in use was not considered reliable enough to detect a number of shortfalls in practice. Visits had been made and reports compiled by the registered provider as required under the Care Homes Regulations 2001. On examination these reports were as found at the previous inspection of a high standard. Reports looked at clearly showed where residents had been consulted about their views on the service provided in the home. The home provides secure facilities for resident’s money. The amount held for two residents was checked against records and was found to be correct. No money held on behalf of residents is paid into a bank account used by the home. However a ring was being held on behalf of one resident with no separate record kept. The ring was also being kept in the drug cupboard although it was reported that this was at the request of the resident’s relatives and was stored there for ease of collection later in the day. Staff had received training in infection control, fire safety, first aid and moving and handling and food hygiene. 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. The central heating had been serviced in May 2009. 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. Hot water temperatures were being checked and recorded on a monthly basis. Some had been found to be slightly low but remedial action had been taken. Work had also been carried out to reduce the risk of Legionella in the home. Servicing had been carried out on hoists and bath lifts. Although a number of security measures are in place it is recommended that a security risk assessment is carried out with regard to the security of the premises. Window restrictors are in place in the home although those on the first floor of the ‘Squirrel Corner’ area of the home could easily be removed from a Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 25 functioning position. In the short term residents in these rooms should be risk assessed to check if such windows present any possible risk to them. The responsible individual described work that was to be carried out on these windows which would also involve replacing the restrictors with a more suitable design. A recent environmental health inspection of the kitchen upgraded the service from a two-star to four-star. It was reported that a fire risk assessment was being prepared for the home by an outside consultant. Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 26 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 2 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 3 X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 27 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 OP3 Regulation 14 (1) (b) Requirement Where a prospective resident is funded by a local authority, the home must receive a copy of the care plan before the resident is admitted to the home. This is so that the home has enough information to determine if it can meet the needs of any prospective resident. After a resident has moved into the home written care plans must be prepared without delay so that staff have information on how to meet the resident’s needs. 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 previous inspections. Arrangements must be made to store residents’ medication at the correct temperature. This is DS0000016357.V377850.R01.S.doc Timescale for action 30/11/09 2. OP7 15 (1) 30/11/09 3. OP9 13 (2) 31/12/09 4. OP9 13 (2) 31/12/09 Bramble House Version 5.3 Page 28 5. OP9 13 (2) 6. OP29 19 (1) (b)Schedu le 2 7. OP29 12 (1) (a) 8. OP30 18 (1) (c) 9. OP35 17 (2) Schedule 4 to ensure that the potency of residents’ medication is not adversely affected by storage temperatures that are too high. When medicines are prescribed to be administered as required make sure that there are clear written guidelines to staff on how to reach decisions about the administration of such medication. This will help to make sure people receive the correct amounts of medication in a consistent way. 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. This requirement has been repeated from the previous inspection. A risk assessment must be completed regarding any information on an applicants Criminal Records Bureau disclosure in relation to suitability for employment. Induction training must be provided for new staff in line with the Common Induction Standards. This is so that staff can be looked after by competent staff. Where valuables are held on behalf of residents a record must be made as specified in Schedule 4. This is so that there is an accurate record of any valuable items held in safekeeping for residents. 31/12/09 30/11/09 30/11/09 31/01/10 30/11/09 Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 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. The auditing of medication administration and recording needs to be more reliable. All handwritten directions on the medication administration records should be signed and dated by the staff member making the entry and checked and signed by another staff member. Records of medication returned to the supplying pharmacy should be more accurate in terms of the amounts returned. Where medication prescribed to be given on a regular basis is omitted then the reason for this must be clearly recorded on each occasion. Update the adult protection policy to include the specific contact details for relevant agencies. Record keeping around recruitment should improve with accurate records kept including a record of when written employment references are received by the home. A risk assessment should be completed regarding the security of the premises. Risk assessments should be carried out with regard to the residents on the first floor of ‘Squirrel Corner’ and the type of window restrictor in use in these rooms. 2. 3. OP9 OP9 4. 5. 6. 7. 9. 10. OP9 OP9 OP18 OP29 OP38 OP38 Bramble House DS0000016357.V377850.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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