Inspection on 23/08/05 for Bramble Lodge Care Home

This inspection was carried out on 23rd August 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 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 Lodge Care Home 07/07/09

Bramble Lodge Care Home 22/04/08

Bramble Lodge Care Home 17/04/07

Bramble Lodge Care Home 24/04/06

Bramble Lodge Care Home 26/04/05

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

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

CARE HOMES FOR OLDER PEOPLE Bramble Lodge Care Home Delemere Road Park End Middlesbrough TS3 7EB Lead Inspector Jackie Herring Announced 23 August 2005 9:30 am 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 Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bramble Lodge Care Home Address Delemere Road Park End Middlesbrough TS3 7EB 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) 01642 322802 01642 322803 Grant Williamson Mr Kenneth Walton Care Home 35 Category(ies) of MD(E) - Mental Disorder - over 65 (15) registration, with number DE(E) - Dementia - over 65 (20) of places Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26/4/05 Brief Description of the Service: Bramble Lodge is a two storey purpose built 35 bedded care home with nursing which operates two separate units for different categories of care. One unit is for older people with a mental disorder and the other unit is for older people with dementia. All 35 bedrooms are single rooms with ensuite facilities containing a toilet and washhand basin and the rooms meet the required size. There are a number of bathrooms and showers as well as a variety of lounge areas and . The home is set in its own grounds, with car parking.Bramble Lodge is located close to shops, public houses and transport. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced inspection, which took place over one inspection day, six hours of inspection time in total. Five residents, four relatives, three staff members of varying grades, the manager and regional manager were involved in discussions during the inspection process. A range of documentation was also examined; including resident’s records, staff rotas and staff records, there was also informal discussion and indirect observations across the day. This was a good inspection, with any good practice suggestions improvement being well received by the manager and regional manager. for What the service does well: What has improved since the last inspection? Some development has taken place with regard to producing new more detailed assessment documentation, although this now needs to be introduced. The menus have been developed further to show a list of alternatives to the menu. Staff files now contain the required information such as details of Criminal Records Bureau checks. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 6 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. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The home has not been assessing resident’s needs in enough detail to ensure their needs can be met. EVIDENCE: Four sets of resident’s records were made available for examination during the inspection. After examining two of the four records and having had discussion with the manager and regional manager, it was agreed that there continued to be the need to develop the pre assessment documentation as it did not contain sufficient information to show that judgement had been made about the home being able or suitable to meet individual residents care and mental health needs. A new assessment document had been developed and this contained much more detail including lifestyle habits and also a separate mental health assessment. During discussion with the manager and regional manager, it was confirmed that the new documentation would be put into immediate use. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 9 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 The assessment and care plans did not contain sufficient detail to ensure that health, personal and social care needs are fully met. The medication systems are in the main in order; some additional action was needed to ensure additional robustness. EVIDENCE: Four sets of resident’s records were made available for examination during the inspection. After examining two of the four records and having had discussion with the manager and regional manager, it was agreed that although some progress had been made, there continued to be the need to further develop the full assessment documentation, risk assessments and care planning records. These did not contain sufficient individual detail and the actual interventions needed more specific direction. One resident’s assessment, care plan and supporting documentation was discussed in substantial detail and it was agreed, particularly around the risk assessed areas that further detail and direction was needed. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 10 The home operates a named nurse and keyworker system, however when this was discussed with residents and relatives, they were unaware of the name of their named nurse or keyworker or what this role entailed. During these discussions they could not recall the assessment of need and care plan had having been discussed them and this could not be evidenced within the files examined. One relative said, “they are well able to care for my mum, she is receiving the care that she needs, they keep me informed of any changes and always have time for me”. The medication systems were examined and found that medication storage was appropriate. The administration of medicines was in need of review as there were some medications not being administered and in another medication was out of stock. The system for recording what has been ordered and what has been received was in need of review to ensure that the appropriate amounts are obtained. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 11 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, 15 Activities were in need of further development, ensuring social, recreational and spiritual needs are provided for. EVIDENCE: During discussion with residents and staff, they confirmed that some level of activities take place, however there was a general consensus that the social, recreational and religious aspects of care could be improved and developed further. One resident said due to the location, “It’s awkward for me to get to the Methodist Church”; “I used to go to the bowls at St Paul’s Road, very little opportunity to get there now”. Other residents say that they had received Holy Communion within Bramble Lodge. One resident said, “need more socialisation, it would be nice to have some-one popping in more often for a few minutes chat”. It was confirmed at the last inspection that an activities person had been appointed for 16-20 hours per week, however this person was currently only working 8 hours. There was also some suggestion that the residents on the ground floor benefited more from the activities person’s input rather than those on the first floor. Relatives were unaware of any recreational and social activities that had taken place. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 12 Staff did describe skittles, painting; board games and going out for walks and that on special occasion such as Christmas and Easter there were entertainers and raffles. During discussion, there was no actual activities/recreational/social activity programme, the regional manager said that it would be beneficial to have this type of programme and agreed that this needed to be developed further. A copy of the menu was made available with the pre inspection questionnaire and although it did not contain an actual choice of meal, it now contained a list of alternatives. There was discussion about how residents were actually consulted about their choice of meal and it was agreed that this could be positively improved upon by ensuring they were consulted and asked. Resident were satisfied with the meals provided and said, “quite satisfied, very good food, choices now and again”. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 13 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, 18 The residents are generally protected, however, further staff training is needed. EVIDENCE: During discussions with residents and relatives they said they were aware of the complaints procedure and residents said that they felt safe and if they did have any concerns they would speak to the manager about them. During the inspection, two relatives raised some concerns about small issues, however these were discussed with the manager and regional manager during the inspection and the relatives were satisfied that these matters were being addressed. Residents said that they felt safe and if they did have any concerns they would speak to the manager about them. Relatives also had no concerns and were satisfied with how their loved ones were being cared for. During discussion with the manager he said that he had recently attended a very informative training day regarding Protection of Vulnerable Adults (POVA), which he had discussed with some of the staff. He said that not all staff had received training in regard to POVA, however this training had been planned with a training agency and they were waiting for some dates. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 14 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, 26 The internal environment at Bramble Lodge is clean and well maintained and conducive for the residents needs. The garden currently is not a safe and suitable environment for the residents to use. EVIDENCE: On the day of the inspection, the lift was not working and had been out of operation for four days. Risk assessments and contingency plans for taking meals and hot drinks upstairs had been implemented. The lift was in full working order prior to the end of the inspection. Whilst walking around the home on both of the inspection days, it was observed to be clean, well maintained and odour free. The manager informed the inspector that they had tried to develop the rear garden for use by residents, however this had not worked out, due to the inappropriate behaviour of the local neighbours who properties back on to Bramble Lodge. Further plans are underway to develop an area at the front of the home. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 15 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, 29 The procedures for the recruitment of staff are generally robust offering protection to residents. EVIDENCE: The manager confirmed that the agreed staffing levels were being achieved and that there had been little staff turnover and very little use of agency staff. He also confirmed that there was very good qualified staff cover with all of the duties being covered by the home’s own permanent qualified staff team. Copies of the Criminal Records Bureau disclosures were available for examination. There was the need to increase the information regarding POVA First, particularly in the event that a member of staff’s employment was commenced prior to the CRB being returned. One relative said, “the attitude and manner of the staff is always the same, friendly, polite and respectful”. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 16 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) 33, 36, 38 Bramble Lodge is a well run home. The staff supervision system needs to be fully introduced to ensure all staff receives regular supervision. Quality assurance systems have not been fully implemented and do not demonstrated that the home is run is the best interest of the residents. EVIDENCE: Relative described a well run, open and friendly environment at Bramble Lodge, they said, “We see this as a well run home, the staff are very nice, everyone is very welcoming”. One resident said, “It’s great here, I am more than happy, I have no worries or concern”. The pre inspection questionnaire confirmed that recent fire drills had taken place for both day and night staff, that weekly fire alarm checks take place and that staff had received fire training in July 2005. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 17 A training programme was also made available and was being rolled out from 12/8/05 to 17/1/05 and included the following topics, Health and Safety Awareness; Appointed Person’s First Aid; Moving and Handling, Fire Safety Awareness; Basic Food Hygiene and Infection Control. During discussion with the manager he confirmed that the maintenance worker completed regular environmental checks such as water temperature checks and fire checks. During informal discussion with staff, they confirmed that they had received supervision; they were however unaware of how often this should be carried out. Supervision records were made available for examination and they demonstrated that the system had now been implemented. The manager confirmed that he was in the process of ensuring that all staff receive supervision on a regular basis. Quality assurance was discussed with the manager who said that he had received very little response to questionnaires that had been sent to GP’s and Social Workers. He said that he tended to receive more informal verbal feedback about the services and care at Bramble Lodge. It was agreed that the system would develop from further development, to formalise it more and to ensure that the views of residents and relatives are obtained and the information analysed with findings and outcomes made available to all. Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 2 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x x 2 x 3 Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 19 Yes 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. Standard OP3 Regulation 14 Requirement The new pre admission assessment documenation must be introduced to fully detail individual care and mental health needs and to evidence that individual residents needs can be met. Individual assessments, risk assessments and detailed care plans must continue to be developed further and includes preferences, likes, dislikes and also mental health needs. The additional assessment documenation must be fully completed and there should be evidence of service user/ representatives involvment. Assessment must include details of health care, both physical and mental needs and there must be detailed care plans demonstrating how these needs are met. The medication systems must continue to be reveiwed to ensure effective systems are in place for obtaining medication and recording what has been ordered and obtained. The planned POVA training must B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Timescale for action 1 December 2005 2. OP7 14 1 December 2005 3. OP8 14 1 December 4. OP9 13 Immediate 5. OP18 13 1 October Page 20 Bramble Lodge Care Home Version 1.40 6. OP20 23 take place and ensure that all staff have received this training. The plans for developing the front garden into an areas that is safe and accessible to residents must be completed. 2005 1 October 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. Refer to Standard OP15 OP18 OP33 Good Practice Recommendations Steps should be taken to ensure that menu choices are proactively given to the residents. The recreation/social activities programme should be developed further and steps should be taken to ensure residents spiritual needs are me. The quality assurance systems should be further developed to include additional customer satisfaction questionnaires and to make the results of any questionnaires available to relatives and residents. The planned programme for staff to receive formal supervision six times per year must take place for all staff. 4. OP36 Bramble Lodge Care Home B51-B01 S61455 Bramble Lodge V233563 230805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale Stockton-on-Tees TS17 6QX 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. 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