Inspection on 24/04/06 for Bramble Lodge Care Home

This inspection was carried out on 24th April 2006.

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 23/08/05

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 Key Unannounced Inspection 25th April 2006 09:30 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 Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 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 Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 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 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) 01642 322802 01642 322803 Grant Williamson Mr Kenneth Walton Care Home 35 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (15) Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate three named individuals who are under 65 years of age. To accommodate three individuals who are over the age of 50 years. Date of last inspection 23rd August 2005 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 wash hand basin and the rooms meet the required size. There are a number of bathrooms and showers as well as a variety of lounge areas. 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 DS0000061455.V290979.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and was conducted in two inspection days, ten inspection hours in total. As a key inspection, all of the key standards were examined, which included an examination of residents records, social activity arrangements, medication records, a tour of the home, health and safety records, staff records and training and discussion with residents and staff. Four residents and one relative were involved in discussion about life within Bramble Lodge and staff were interviewed and there was also informal discussion. In direct observation also took place, as a number of residents were not able to engage in informed discussion about life in Bramble Lodge due to their communication and cognitive needs. What the service does well: What has improved since the last inspection? Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 6 An accessible and safe garden has been developed since the last inspection and there is furniture available for use when the weather improves. Improvements have been made to the level of recreation and activities provided for the residents. Residents are now aware of alternative menu choices should they want them. Progress has been made in regard to NVQ training and 48 are now qualified to level 2 or above. Some additional quality assurance has commenced, as has formal staff supervision. What they could do better: The assessment and care documentation continues to be in need of further development as they do not contain sufficient information about the individual residents including their background, history and lifestyle; their individual needs are or how these needs are being met by the staff within Bramble Lodge. This is also the same for risk assessments. Whilst a number of staff have been trained in the topic of abuse and protection of vulnerable adults, the actual action taken following a recent incident is a cause for concern as there was a lack of recording, a delay in reporting and inappropriate action taken at the time of the incident. Further staff training is required for those staff not already trained and more in depth training for others. Whilst some additional quality assurance has commenced, this needs to be built upon further. This is also the same for formal staff supervision in that some has taken place, however this is not been carried out at the frequency needed. It is also recommended that further client specific training takes place and when this happens should be fully recorded. The actual medication systems were good, however there continues to be occasions when medication is out of stock or there is a delay in obtaining medication, which delays required treatment to residents. Consideration should also be given to increasing the lounge areas within the first floor unit, as this is a little small. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 7 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 DS0000061455.V290979.R01.S.doc Version 5.1 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 Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Whilst pre admission assessments are in place, the home has not been assessing resident’s needs adequately to ensure their needs can be met. EVIDENCE: Samples of resident’s records were examined during this inspection and pre admission assessments were available and had been completed. There does, however, continue to be the need to increase the information about individual assessment of needs, particularly in relation to their mental health needs. This had also been identified by the Operations Manager during quality audit visits. Bramble Lodge does not provide intermediate care. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Whilst care records are in place for the residents, the assessments, risk assessments and care plans are not adequate and do not set out fully resident’s health, personal and social care needs. Residents spoken to have their privacy needs and rights upheld and are treated with dignity. The medication systems are in the main robust however two areas needed some further action. EVIDENCE: Four sets of resident’s records were examined during this inspection, two residents who had not lived at Bramble Lodge for long and two who had lived there for some time. It was identified that there continues to be work do to, to ensure that detailed information is in place, as they do not contain sufficient information about the individual residents including their background, history and lifestyle; their individual needs or how these needs are being met by the staff within Bramble Lodge. During discussion with the manager, it was agreed that the care management assessments contained detailed and valuable information that the staff could use in their own assessments and subsequent plans of care. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 11 This is also the same for risk assessments in that some of the risk assessments did not detail the action to be taken although the document allows for this and on some occasions although there were risks identified within care management assessments, these risks had not been fully assessed by the home with supporting plans of care. Examples of this included risks of medication hoarding and going out of the home unescorted. It was also identified that where risks had been identified by the home, the supporting plan of care had not been developed, an example of this being a resident who was a risk of tissue damage, there was no supporting care plan. The daily statement of care were also in need of more information as they did not contained any real information about the care given, by whom and about the resident in general. During discussion with the manager, it was identified that there was still more development work to do and staff training was continuing to take place to improve the detail and quality of individual residents care plans. It was confirmed that training was planned for the qualified nurse team and was due to be delivered very soon. During discussion with staff, they confirmed that they could access the residents records if they wanted to, however there was no specific keyworker systems, care workers were not involved in reviews of the residents and there were two separate handovers, care workers to care workers and qualified staff to qualified. There was also little evidence that the assessments and plan of care had been discussed with residents or their relatives, which the manager agreed to take forward. Details for GP, District Nurse, Optician and CPN visits were available within all of the files examined. The medication systems were examined during the inspection and the storage, recording and administration of medications was in the main robust. There had been a recent inspection by the pharmacy advisor who made a small number of recommendations. It was identified that there was the need to record the temperature of the medication cupboards to ensure that they did not become too hot. It was also identified that the medication records did not contain photographs of the residents and it would be good practise to do this. During discussion with relatives and a staff member, it was identified that there had been occasion when medication was out of stock or there had been a delay in obtaining it, this is of particular concern in respect of antibiotics when there has been a delay in commencing this treatment. It was confirmed through discussion with a qualified member of staff that this situation was being addressed with the supplying pharmacist. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 12 During discussion with residents they said that they were able to make their own decisions about daily life within Bramble Lodge and said good things about the home and the staff. One residents said, “I am well looked after, the carers are good and you can have a good talk with them”, “You are asked if you want a lie in, they come in and say good morning then they visit again a 9.00 am to check if everything is OK”. Staff spoken to confirmed that residents were given choices and encouraged to live as independent a life as possible. One staff member said, “Life for the residents is flexible, independence and choice is encouraged even down to basic things such as offering drinks”. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Activities are in the main well managed for residents ensuring social, religious and recreational needs are provided for, these could be linked to a more detailed social and lifestyle assessment. Residents where possible are able to control aspects of their lives, their independence and make choices. Meals are provided to a good standard within a suitable environment. EVIDENCE: A copy of the daily activity programme was enclosed with the pre inspection documentation. It detailed a programme taking place seven days per week on a four week rotational programme and the staff list also demonstrated that two staff were employed in the capacity of activities co-ordinators. Details of activities included, trips out of the home, bingo, watching DVD’s, crafts and chats and potting plants, which was evidenced during the inspection. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 14 Residents said that there were activities taking place if you wanted to participate, some of the residents spoken to preferred to stay in their rooms. One resident said, “There is lots to do to help pass the time away and I have visitors now and again, I rarely go out but can do if I want to”. Another resident said, “I have visitors now and again and I go out to one of the local churches”. On speaking with another resident and their relative, they were unclear about the activities and were unsure how the programme linked with individual lifestyle choices and hobbies and one lady spoke of feeling a little lonely. Social assessments were contained within the resident’s records and as identified previously these were in need of more personal details regarding lifestyles, interests and hobbies, which should be completed in detail regardless of cognitive difficulties and confusion. Residents spoken to were very satisfied with the meals provided and said, “The food is good and there is plenty of it”, “The meals are very nice, they are traditional home cooked meals”. A copy of a two week menu was made available and detailed choice of a cooked breakfast along with cereal and toast, a main meal at lunch time with a list of alternatives if required, a lighter meal early evening and sandwiches along with hot drinks at supper time. A discussion took place with one of the cooks and it was confirmed that there was always sufficient resources. Access to food is available 24 hours per day with items such as cereal, toast, eggs and sandwich fillings available through the night if needed. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Effective systems are in place for managing complaints. Key staff recently potentially failed to adequately safeguard and protect residents within Bramble Lodge by not following correct procedures despite procedures being in place. EVIDENCE: Residents who were spoken to said, “I have no grumbles or complaints about life within Bramble Lodge”; they said that if they did they would speak with the manager about it. One resident said, “If I had a complaints, I would go to Kenny, he will sort them out”. Copies of the service users guide was available and contained details on how to make a complaint should it be necessary. There had been two complaints within the last twelve months, which had been addressed by the home. A requirement from the previous inspection relating to Protection of Vulnerable Adults training and the need to ensure that all staff had received the appropriate training. Of the four staff spoken to during the inspection, two had not received training since employment with Bramble Lodge, one had received training elsewhere. The manager confirmed that training had taken place and provided copies of certificates to the inspection. The training records provided to the inspector demonstrated that twenty-four of the forty-two staff had received this training and although the certificates stated POVA training they did not detail the specific course content. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 16 It is of concern that a recent incident, a possible allegation of abuse, was not appropriately responded to by key staff within the home. This matter is currently under investigation. Concern has also been raised regarding the recording of such incidents within the home. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Residents continue to benefit from a very attractive, clean, homely and wellmaintained environment offering spacious bedrooms with comfortable and well-decorated communal areas. EVIDENCE: A tour of Bramble Lodge took place and it was observed to be clean, well maintained, spacious and airy and odour free. It continues to be well decorated and is a safe environment for the residents to live. A random number of bedrooms were visited, some of which were more personalised than others, which the manager said was down to individual choice and preferences. Residents who were spoken to said, “It’s very comfortable here”; “I have a nice bed, a nice room with a lovely ensuite”. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 18 The upstairs lounge overflows into the central area where the lift is housed and further chairs overflow into the corridor. During discussion with staff comments were made about the size of the smoking lounge, which is only used by a very small number of residents. There had been some suggestion that the lounge could be extended into the smoking lounge to create more space. This was also discussed with a senior staff member within the organisation who is clearly aware of the matter and is presently exploring options for improvements. Since the last inspection, a safe garden area has been developed which is accessible to residents. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The deployment and number and skill of staff on all shifts is generally appropriate to ensure that at all times residents are supported by an experienced, well trained team of staff. The procedures for the recruitment of staff are in the main robust offering protection to residents, however additional information is needed when staff commence employment with a POVA First check only. EVIDENCE: The duty rota was examined during the inspection and detailed that throughout the day time, two qualified nurses were on duty, one of which was nearly always an Registered Mental Nurse (RMN), when this was not the case, it was an Registered General Nurse (RGN) who had worked for the organisation for a substantial number of years and was deemed to have the required knowledge, skill and experience. In addition, there were also five care assistants on duty although there had been occasions when this had been down to four, which is in the process of being addressed. Night duty is covered by one RMN and three care assistants. There is a current vacancy for a deputy manager and the manager is currently covering some of the actual nursing care time along with occasion bank nurse. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 20 The pre-inspection questionnaire detailed that 48 of care staff are qualified to NVQ level 2 or above and the manager also confirmed that four of the care staff had attained level 3 with a further four already underway. Four staff files were examined during the inspection, two new staff and two randomly selected, all of which contained the required information such as application form, appropriate references and Criminal Records Bureau checks. During an examination of these records, it was identified that some staff had commenced employment prior to the returns of the CRB although the home had received information to commence following the receipt at head office of a POVA First check. This was discussed with the manager as there was not information to support that on these occasion, that the new staff were working under supervision at all times and what these arrangements were. Staff who were spoken to said that they enjoyed their jobs and talked of the training they had completed which included all of the mandatory training as well as Dementia Care Awareness. It was identified that it would be useful to have more client specific training such as challenging behaviour. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 Bramble Lodge is generally 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: The manager of the home is registered with CSCI and he is a Registered Mental Nurse who has the required qualifications and experience to manager Bramble Lodge. Residents who were spoken to said, “I have always been settled here, it is a very comfortable home”, another residents said, “It is very pleasant here, very nice and you are well cared for”, a further resident said, “It is better for me now, I have no qualms, it is a good place where you are looked after and the carers are good”. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 22 One of the relative surveys received stated, “The home is lovely, clean and tidy, very good care, staff are caring and kind. Manager is approachable and does very hard work in sometimes difficult circumstances”. Quality assurance systems was discussed with the manager who said that a relative survey had recently been implemented, so far five survey have been returned out of thirty five sent out and the outcome report was yet to be produced. Regular visits take place from Senior staff within the organisation and reports produced. The manager confirmed that further quality assurance systems were being implemented such as care plan audits. Up to date service records were not available within the home during the inspection, however the pre inspection questionnaire detailed that equipment such as fire equipment, emergency lighting, lift, gas installations were all up to date. In house records relating to weekly fire checks and water temperatures were available. It was identified that it was nearly six months since the last fire drill, the manager confirmed that these were being carried out in six monthly batches and they were planned to take place in the very near future. The system for formally supervising staff was discussed with the manager, as this was an outstanding recommendation from the previous inspection. The manager confirmed that work had commenced for which there was evidence, however these continue not to be taking place at the required frequency. There was some discussion about the possibility of cascading these to other key staff members; the manager said that there had been some difficulty due to the deputy manager leaving. Good systems are in place within the organisation to ensure the ongoing delivery of mandatory training including health and safety, fire, infection control, first aid and moving and handling, which are all well recorded. Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 23 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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 24 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 Requirement Timescale for action 01/08/06 2. OP7 14 3. OP8 14 4. OP9 13 The pre admission assessment documentation must continue to fully detail individual care and mental health needs and to evidence that individual resident’s needs can be met. (This has been ongoing since 1 August 2005) 01/08/06 Individual assessments, risk assessments must continue to be developed further and must be supported by detailed plans of care which include preferences, likes, dislikes and also mental health needs. There should be evidence of service user/ representative’s involvement. (This has been ongoing since 1 August 2005) Assessment must continue to be 01/08/06 developed to include details of health care, both physical and mental needs and there must be detailed care plans demonstrating how these needs are met. (This has been ongoing since 1 August 2005) The system for ensuring that 10/05/06 DS0000061455.V290979.R01.S.doc Version 5.1 Bramble Lodge Care Home Page 25 4. OP18 13 5. OP29 18 medication remains in stock and for ensuring that medication is obtained in a timely way must be reviewed to ensure that residents receive their prescribed medication. POVA training must continue to 01/07/06 take place and ensure that all staff have received this training. Key staff must receive additional training in the reporting and recording of such incidents. In the event that staff 10/05/06 commence employment prior to CRB and on a POVA First, details of how they are being fully supervised must be recorded, as should details of the POVA FIRST. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP9 OP21 OP18 OP30 OP33 Good Practice Recommendations The medication records should contain an up to date photograph of each resident. Consideration should be given to increasing the amount of accessible communal space within the first floor unit. The recreation/social activities programme should be developed in accordance with detailed social and lifestyle assessments. Client specific training should be developed to increase the awareness of individual conditions and this training should be recorded within the home. 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. 6. OP36 Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Tees Valley Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Bramble Lodge Care Home DS0000061455.V290979.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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