Inspection on 26/04/05 for Bramble Lodge Care Home

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 23/08/05

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 Lead Inspector Jackie Herring Unannounced 26 April 2005 10:00 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Bramble Lodge Care Home Address Delemere Road Park End Middlesbrough 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection NA 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection, which took place over two inspection days, nine hours of inspection time in total. Five residents, two relatives, six staff members of varying grades and the manager were interviewed or 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 two days. What the service does well: What has improved since the last inspection? What they could do better: The templates for the residents assessment and care needs records are comprehensive, however the completed records were in need of further development and detail and must include a comprehensive mental health assessment. There was also the need to include details of individual preferences, decision making and lifestyle habits ensuring all residents had the same level of choice. Bramble Lodge Care Home Version 1.10 Page 6 The menu needs to be developed further to include a choice of meals or list of alternative meal options. One resident said, “I accept what I am given” rather than choosing what they wanted. Some of the staff records were in need of further information, confirming the correct checks had been carried out. The frequency of formal supervision of staff needed to be increased. There was also the need for some staff to have further awareness of resident’s dignity needs. A garden, which is safe and accessible to residents’, is in need of development. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bramble Lodge Care Home Version 1.10 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 Version 1.10 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 does not assess resident’s needs in enough detail to ensure their needs can be met. EVIDENCE: Three sets of resident’s records were examined during the inspection all of which contained a copy of the pre admission assessment. The assessment is based predominantly on the activities of daily living. The records also contained copies of the care management assessment, where appropriate. Whilst the template for the documentation was comprehensive, the pre assessment documentation did not contain sufficient information to show that judgement had been made about the home being able or suitable to meet individual residents needs. In a number of the assessment boxes, there were comments such as “no problem” and where there was additional narrative, this did not give details as to why nursing home care was required. The pre assessment documentation also contained very little detail of residents mental health needs. Bramble Lodge Care Home Version 1.10 Page 9 Residents and relatives spoken to during the inspection were clear about the category of care within Bramble Lodge and were in the main satisfied that the home could meet their needs. Bramble Lodge Care Home Version 1.10 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 standard(s) 7,8,9,10 The assessment and care plans did not contain sufficient detail to ensure that health, personal and social care needs are fully met. Whilst residents who were able to discuss life in the home believed they were treated with respect, this was not fully demonstrated for more confused residents. EVIDENCE: Three sets of residents records were examined during the inspection, all of which contained assessment documentation, risk assessments, care plans, health and social care assessments and daily records of care. Within all of the files, there were records for GP, district nurses, chiropody, optician and social work involvement as well as any other health care professional. The assessments of health, personal and social needs as well as additional assessment tools did not contain sufficient individual information for detailed plans of care to be developed. Examples of this included two residents who potentially had nutritional problems did not have their likes/dislikes and preferences recorded, the nutritional assessment had not been fully completed and there were no weights recorded. The initial assessment for one of the residents stated “eating and drinking – no problems”, despite being on specific medication for this. Bramble Lodge Care Home Version 1.10 Page 11 It was also identified that the mental health needs of residents had not been assessed and there were no specific care plans in place despite there being needs which were identified through the care management assessment and through discussion with the resident. Residents who were interviewed stated that they were treated with respect by the staff team. Residents who were able to discuss life in the home in the main believed their needs were being fully met by the home. They spoke well of how their privacy and dignity needs were met, and described staff knocking on the bedroom and bathroom doors, and how sensitively personal care needs were handled. On the first day of the inspection, however, the inspector observed two staff members displaying a disrespectful attitude to residents. This was reported to the manager who took immediate action to remedy the situation. Also on the first day of the inspection, a shaving regime was observed which was not acceptable in that resident’s shaves were taking place in a toilet area near the lounge. The manager informed the inspector that this was not the normal practise, however it was agreed that there would be discussion with the staff team regarding individual choice, preferences and lifestyle decisions. Bramble Lodge Care Home Version 1.10 Page 12 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) 13,14,15 Residents are able to maintain relationships with their friends and families and are able to take where possible certain levels of control over their lives. Residents are generally happy with the meal provision, however choice and alternatives were not available. EVIDENCE: The inspector was informed that an activities person had been appointed for 16-20 hours per week. Staff spoke positively about this appointment and said that the residents were now going out of the home more. One resident described going to the local shops and having a cup of tea and cake and said that they really enjoyed this. On the first day of the inspection, the inspector observed that the activity person took two of the residents out and the manager also discussed how one of the residents went swimming. Relatives were observed to be visiting on both of the inspection days. One resident stated, “I go out for lunch and my relatives are able to visit when they want to”. Residents, who were spoken to said they had a level of control over their lives and could make a range of decision about daily life such as when to get up, go to bed and how to spend their day. Staff said that they encouraged residents to make decisions and life in Bramble Lodge was flexible. Bramble Lodge Care Home Version 1.10 Page 13 The menu was examined and did not demonstrate there was a choice of main meals. Residents described choice at breakfast and the manager stated that alternatives were available. One resident said they were unaware of alternatives and choices and stated, “I accept what I am given”. It was agreed with the manager that the choice and alternatives option should be more widely known and written into the actual menu. The inspector joined resident’s for lunch, which was well presented and very tasty. Bramble Lodge Care Home Version 1.10 Page 14 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) 18 The residents are generally protected, however further staff training is needed. EVIDENCE: Residents said that they felt safe and if they did have any concerns they would speak to the manager about them. Staff who were interviewed were able to discuss abuse, however there was limited knowledge about Protection of Vulnerable Adults and No Secrets. Bramble Lodge Care Home Version 1.10 Page 15 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) 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: Whilst walking around the home on both of the inspection days, it was observed to be clean, well maintained and odour free. Residents and relatives who were interviewed said that the home was always kept very clean and that it was a very pleasing environment. There was some discussion with a member of housekeeping staff who informed the inspector that there was always a sufficient amount of equipment and products. One resident said, “the home is beautiful, it is well decorated and all of the furnishings are so comfortable”. Bramble Lodge Care Home Version 1.10 Page 16 The rear garden has not been developed as such was not accessible for use by the residents, who require a safe area for use. There was much discussion with the manager about this and access to it during the inspection. The front of the home had a pleasant open plan garden, which had been laid to lawn and also had flowerbeds. Bramble Lodge Care Home Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Resident’s needs were generally being met, however not necessarily at times of their choice. There was lack of evidence of sufficient recruitment checks being undertaken to ensure the protection of residents. It was unclear if the staff had the training and competencies to meet the needs of the residents. EVIDENCE: An examination of the duty rota and through discussions with some of the staff, it was identified that there had been a number of occasions when there were insufficient staff on duty. On example being that one recent weekend, there had been three care assistants on duty rather than the five for which no regulation 37 notification had been received. Staff said that on these occasions, they were not able to deliver the level of care they usually would. The manager and staff informed the inspector that the shortages were as a result of staff sickness, quite a lot of which occurred over the weekends. The manager informed the inspector that action was being taken and that further recruitment would be taking place and that systems were in the process of being implemented to manage staff sickness. Four staff files were examined during the inspection, which contained the majority of the information required. In three of the files, no actual CRB/POVA disclosures were available; there was a logbook, which had been completed by the manager that contained the CRB number and date. Also, induction records were not available in all four of the records examined. Bramble Lodge Care Home Version 1.10 Page 18 During discussion with the manager and through an examination of the activities person’s file, it was unclear what training had been implemented to ensure that this person had the necessary skills and was competent in this role. This particularly related to taking residents out of the home with no other staff member, where there were no risk assessments, emergency or contingency plans and support systems ensuring protection of the residents and staff member should a problem occur. The manager informed the inspector that this had been a gradual process and there had been some shadowing in place to ensure safety for all parties, however this could not be evidenced and had not been recorded. Staff and residents were however, very positive about the role of the activity worker. Bramble Lodge Care Home Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36 Bramble Lodge is a well managed home however a number of the systems and processes were not robust enough to fully demonstrate staff were appropriately supervised through their job roles. EVIDENCE: Residents, relatives and staff who were interviewed described a well run home, with the manager being extremely supportive, approachable and down to earth. During an examination of staff files, supervision records and up to date appraisal records could not be evidenced. The manager informed the inspector that the system had been developed and was about to be introduced and implemented. Bramble Lodge Care Home Version 1.10 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score N/A N/A 2 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 2 COMPLAINTS AND PROTECTION x 2 x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x x x x 1 x x Bramble Lodge Care Home Version 1.10 Page 21 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 pre admission assessment must be developed further to fully deail individual care and mental health needs and to evidence that individual residents needs can be met. There must be a fully completed assessment and detailed care plans, which 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/ represntatives involvment. Assessment must include details of health care 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. Staff must be fully trained to ensure they treat residetns with dignity and respect. The morning personal care routine must be reviewed to ensure individualised care is Version 1.10 Timescale for action 1 August 2005 2. OP7 14 1 August 2005 3. OP8 14 1 August 2005 4. OP9 13 31 June 2005 Immediate Immediate 5. 6. OP10 OP10 12 12 Bramble Lodge Care Home Page 22 7. 8. 9. OP20 OP27 OP28/29 23 17 19 provided and delivered with dignity. A garden which is accessible and safe for resident use must be developed. The required number of staff must be on duty at all times, ensuring resident needs are met. The manager must be in receipt of satisfactory CRB/POVA checks for all staff prior to commencecment of employment, which is able to be evidenced. 1 August 2005 Immediate Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 15 18 30 36 Good Practice Recommendations The menu should be developed further to show all available choices alternatives. Further training in rgard to Protection of Vulnerable Adutls should be provided to all staff. Evidence should be contained within individual staff files demonstatiing their ability, skill and experience for the role in which they are employed. All staff should receive formal supervision six times per year. Bramble Lodge Care Home Version 1.10 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Bramble Lodge Care Home Version 1.10 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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