Inspection on 07/07/09 for Bramble Lodge Care Home

This inspection was carried out on 7th July 2009.

CQC found this care home to be providing an Good service.

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 22/04/08

Bramble Lodge Care Home 17/04/07

Bramble Lodge Care Home 24/04/06

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 12/10/2009.

Key inspection report Care homes for older people Name: Address: Bramble Lodge Care Home Delamere Road Park End Middlesbrough TS3 7EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Bassett     Date: 0 7 0 7 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 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. 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 Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Bramble Lodge Care Home Delamere Road Park End Middlesbrough TS3 7EB 01642322802 01642322803 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bramble Care Homes Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the followjng category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia Code DE, maximum number of places: 23 Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 23 Date of last inspection Brief description of the care home Bramble Lodge is a two storey purpose built 41 bedded care home with nursing which operates two separate units for different categories of care. One unit is for people with a mental disorder and the other unit is for people with dementia. All 41 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. Care Homes for Older People Page 4 of 25 Over 65 0 0 23 18 Brief description of the care home Bramble Lodge is located close to shops, public houses and transport. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was a key inspection. As a key inspection, all of the key standards were looked at or discussed. This was to check that the home meets the standards that the Care Quality Commission ( CQC) say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 6 of 25 The visit was unannounced. The inspection visit lasted six and a half hours. During this time the inspector looked at a range of documentation including, the files of people who live at the home and staff who work there. The inspector spoke to six people who live at the home, one family member, a visitor, three staff members, the deputy manager and the manager. The manager of the home completed an Annual Quality Assurance Assessment (AQAA). At the time of the inspection the home was providing services to 39 people. The last key inspection took place on 22/04/08. Care Homes for Older People Page 7 of 25 What the care home does well: 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 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. Care Homes for Older People Page 8 of 25 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures that should ensure that prospective service users have their needs assessed and those needs can be met . Evidence: During the visit the inspector examined the files of two people who have recently been admitted to the home. Both contained a pre admission assessment carried out by qualified nursing staff from the home prior to that persons admission. Files also contained other information gathered from the persons care manager and other health professionals. The AQAA returned to CQC detailed the pre admission assessment process. The deputy manager told the inspector that care staff are now being involved in pre admission visits and assessments. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs that people receive is generally based on their individual needs, however documentation does not always reflect this. The principles of respect, dignity and privacy are put into practice. Evidence: During the visit the inspector examined the files of five people who live at the home. Each was found to contain a range of assessments and risk assessments in relation to the persons physical and mental health needs. These were seen to be reviewed and evaluated on a regular basis. The content of the reviews have been developed since the last inspection to be more detailed. The five files examined each contained plans of care in relation to needs identified in the assessment documentation. It was seen work has commenced to develop the care plans to reflect how the needs are to be met in a person centered way. However the level of detail in plans of care varied. For example plans of care in relation to personal hygiene state assist with but give no detail of how this is to be done. Other plans in relation to continence varied in detail of what specific aids were to be used. Further development is required to ensure all plans reflect the persons abilities and Care Homes for Older People Page 12 of 25 Evidence: preferences, and details of how staff are to give assistance. Plans of care were seen to be reviewed and evaluated on a regular basis. Records are kept of daily interactions and interventions. Information in the files indicate people have access to GPs and other health professional as required. People who spent time with the inspector confirmed this. The home operates a named nurse and key worker system. The deputy manager told the inspector the key workers are to become more involved in the review process and it is hoped they will participate in review meetings. Both the manager and the deputy told the inspector where possible people who live at the home or their representatives are involved in the care planning process and agreements are sought. Staff who spent time with the inspector were able to demonstrate through response to questions a good knowledge of peoples needs and how these are met. Staff spoke of promoting individuals privacy, dignity and independence. The inspector observed good interaction between staff and the people who live at the home. The inspector was not able to communicate with all the people who live at the home due to their frailty and capacity. However people who spent time with the inspector expressed satisfaction with the care that they receive. Comments received by the inspector included i am looked after well,i am well taken care of and staff understand my needs. A family member who talked to the inspector said she was happy with the care her relative receives. Information contained in the AQAA returned to CQC indicated the home has a policy and procedure in relation to the safe handling of medications. The inspector was informed all medications are administered by qualified nursing staff. The manager told the inspector annual competency assessments take place. A sample audit of storage and administration of medication found no major concerns, however a sample audit of medication documentation identified an incorrect recording for one controlled medication. A number of open eye drops and tubes of ointments were found not to have a date of opening. Medication audits are in place, the manager told the inspector these are being developed further to be more comprehensive in content. It was recommended that the temperature of the first floor medication room be monitored, as additional ventilation may be needed. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are enabled to make choices about their lifestyles. Social and recreational activities meet individuals expectations. Evidence: Two of the five files examined by the inspector were for people who had lived at the home for sometime, these were seen to contain brief information in relation to that persons social and family history. The other three files contained no specific information, however documentation was in place to record that persons life history. The manager explained to the inspector this documentation had just been introduced and staff are to complete it. All the files contained information about that persons likes and dislikes in relation to food. The home employs two part time activities coordinators who set an activities programme and document the activities people participate in. Those people who were able to communicate with the inspector expressed satisfaction with their lifestyles within the home and said that the activities provided met their needs. People spoke of walks out to local shops, cafes and the local park. One person said how much he had enjoyed a recent trip to Redcar and others spoke of going swimming. Other people spoke of regularly attending groups such as MIND. Care Homes for Older People Page 14 of 25 Evidence: Comments received by the inspector included i can do what you want, its home from home and there is a relaxed atmosphere. Staff told the inspector the mobile library has recently started to visit the home on a regular basis. A visitor told the inspector that she always noticed how staff treat people with compassion and respect, she also spoke of staff meeting peoples spiritual needs as well as their physical needs. A family member said they were always made to feel welcome and could visit when they wished. At the last inspection it was identified that the mealtime experience for people who lived within the first floor unit could be improved. The inspector spent time observing lunch. It was seen that action had been taken to improve the experience for people who live there. The meal was seen to be unhurried and at the pace of the individuals. Tables were set with tablecloths, napkins, appropriate cutlery, and condiments. Staff were available to give assistance as required, and the inspector observed good interaction. Staff who spoke to the inspector said meal times were staggered to allow staff time to give people individual attention. People were given choice as to the meal and beverage and records kept of what diet was taken. People who spoke to the inspector told her they enjoyed the meals and there was always a choice available. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are enabled to express their concerns and have access to a complaints procedure. Staff have an understanding in relation to prevention of abuse and reporting concerns Evidence: Information contained in the AQAA returned to CQC indicated the home has policies and procedures in relation to handling complaints and prevention of abuse. Further information indicated the home has received 4 complaints and dealt with 2 safeguarding referrals in the last 12 months. Complaints were seen to recorded appropriately. People who were able to spend some time with the inspector said they felt comfortable at the home and were aware of how to raise any issues. People confirmed they are listened to and action is taken. One person who spoke to the inspector said people are treated with respect another said i am listened to, i have no complaints. Staff who spent time with the inspector were able to demonstrate through response to questions the action they would take if they became aware of any concerns. Staff records seen by the inspector did not contain any evidence of recent training in relation to prevention of abuse and the no secrets guidance. However a training plan seen indicated some training is to take place by end of July 2009. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment that is appropriate to the specific needs of the people who live there. People are able to personalise their bedrooms and the home is warm, clean and comfortable. Evidence: Bramble Lodge Care Home provides care for people with dementia and mental health needs across two units. It is a spacious home with a good amount of communal rooms, suitably located throughout the home. These include a coffee lounge and sensory room. On the day of inspection the home was found to be clean, warm and comfortable for people. There was evidence of personalisation of peoples own rooms, with people having family photographs, and other personal belongings. People who were spoken to said they were very satisfied with their rooms. All bedrooms are single rooms with ensuite facilities. The garden is accessible to people who want to use it and is a safe environment. Furnishings are of a good standard. The walls to the first floor corridor have recently been repaired and decorated and are awaiting the replacement of pictures and displays. Audits and checks are in place to ensure that Bramble Lodge is a safe place for people to live, this includes the monitoring of water temperatures. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained and in sufficient numbers to meet the needs of the people living there. However further training would enhance the care people receive. People are protected by the homes recruitment procedures. Evidence: During the visit the inspector examined the files of two people recently employed as care assistants. These were found to contain application forms, interview records, two references and evidence of CRB (Criminal Record Bureau)check and PoVA first (Protection of Vulnerable Adults) check obtained prior to employment commencing. Records of CRB and PoVA first would benefit from further development to include the level of check and the signature of the person confirming the check is satisfactory. The manager told the inspector no qualified staff have recently been employed. The manager carries out an annual PIN (Professional Identification Number) check for all qualified nursing staff to confirm continuing eligibility to practice. Information contained in the AQAA returned to CQC and records seen by the inspector indicated staff have received training in relation to health & safety, fire safety, moving & handling, food safety, nutrition, and infection control. Eight staff participated in dementia awareness training that took place on the day of inspection. A training plan seen by the inspector indicated further training is to take place regarding prevention of abuse, challenging behavior, health & safety, nutrition and infection control. Information in the AQAA indicated 75 of the care staff have achieved NVQ at level 2 Care Homes for Older People Page 18 of 25 Evidence: or above. Staff who spoke to the inspector confirmed training had taken place. On the day of inspection there home was providing a service to 39 people. A staffing rota seen by the inspector indicated there were usually 5 or 6 care assistants and 2 qualified staff on duty during the day, and 3 or 4 care assistants and 1 qualified staff overnight. People who spoke to the inspector said there were sufficient staff to meet needs. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and generally run in the best interests of the people who use the service. The health, safety and welfare of people who live at the home and staff was promoted and protected Evidence: The manager of Bramble Lodge is a Registered Mental Nurse, who has the relevant experience, knowledge and skill to manager the home. He has been in post for a number of years. People who spoke to the inspector told her there was an open door policy and communication was good. A family member confirmed they were always kept up to date with any changes in their relatives circumstances. One person who spoke to the inspector said they were well taken care of, another said the staff are good, it is alright here. Staff told the inspector they received good support from the manager, and everyone worked as a team. Staff confirmed they receive regular supervision. A range of audits take place within home to ensure that the home was operating at a Care Homes for Older People Page 20 of 25 Evidence: good level and areas for improvement could be identified. These include Regulation 26 visit reports, and audits of care plans, the medication system and the environment. In terms of quality assurance, surveys had been sent to people who live at the home, their relatives and health professionals who visit the home with some limited response. There is also a comments box available to people. Accidents were seen to recorded appropriately and analysis takes place. Fire alarm systems are tested on a weekly basis and there are regular fire drills. Information contained in the AQAA returned to CQC indicated equipment used within the home is serviced as required. A sample audit of monies held by the home on behalf of people who live there found no discrepancies between amounts recorded and money held. Records seen contained two signatures and evidence of a regular external audit. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 The registered person must ensure staff follow the policies and procedures in relation to the administration of medications. To promote the safety and welbeing of the people living at the home 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Plans of care should be developed further to include details of the persons abilities and preferences in relation to the identified need and how this is to be met. The date of opening of medicines with a limited use, should be recorded to make sure that medicines are not used beyond the date recommended by the manufacturer. Work should take place to record the life stories of the people living at the home. All staff should receive training in relation to safeguarding vulnerable adults and the no secrets guidance. Page 23 of 25 2 9 3 4 12 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 5 29 Records of CRB and PoVA first would benefit from further development to include the level of check and the signature of the person confirming the check is satisfactory. The manager should ensure the planned training takes places and involves all staff. 6 30 Care Homes for Older People Page 24 of 25 Helpline: 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. 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