Inspection on 02/03/06 for Brambles Care Home Limited

This inspection was carried out on 2nd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Brambles Care Home Limited 09/04/08

Brambles Care Home Limited 26/04/07

Brambles Care Home Limited 30/06/06

Brambles Care Home Limited 06/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brambles Care Home Limited 22 Cliff Road Leigh On Sea Essex SS9 1HJ Lead Inspector Ron Reeves Unannounced Inspection 10:00 2 March 2006 nd 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 Brambles Care Home Limited DS0000063786.V286123.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. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brambles Care Home Limited Address 22 Cliff Road Leigh On Sea Essex SS9 1HJ 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) 01702 472417 01702 472417 Brambles Care Home Ltd Manager post vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration:None. Date of last inspection 6th May 2005 Brief Description of the Service: The Brambles provides care and accommodation for up to twenty two older people. Generally residents have low to medium dependency needs. The home does not provide nursing care and does not cater for people with a diagnosis of dementia. The Brambles is a large, extended and converted house situated in a residential area. Accommodation at present is provided on three floors in fourteen single and four double rooms. All rooms have en-suite facilities. The ground and first floor are accessed via a shaft lift and the lower ground floor rooms by stair lifts. The communal areas include an open plan lounge and dining area. There is also a conservatory and a raised decking area. The homes gardens are very well maintained and include an ornamental pond. There is limited parking at the front of the building. The Brambles is close to a mainline station and bus route Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection which took place during the day of the 2nd March 2006 and lasted six and a half hours. The inspection process included discussions with the new manager who had been in post since 20th February, two staff, four residents, two visiting relatives and a district nurse. A tour of the building took place and a sample of policies, procedures and records examined. The manager, staff and residents were most helpful during the inspection, which was greatly appreciated. What the service does well: What has improved since the last inspection? A new enthusiastic experienced manager has been appointed. Although only in post for two weeks has addressed some of the requirements identified at the previous inspection. A single and double bedroom has been added to increase the home’s registration to 22 beds. New carpet has been fitted to the stairs and landing. Additional staff have been employed to improve care staffing levels and to ensure that cooking and domestic staff are employed for 7 days a week. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, 5 The home provides sufficient written and verbal information to prospective residents and their families in order for them to make an informed choice. However the home’s assessment process is inadequate to ensure the home can meet prospective residents’ needs. The home provides a caring, friendly environment where visitors are made welcome. EVIDENCE: The home has an appropriate Statement of Purpose and Service Users Guide. Discussions took place with the manager regarding making the Service Users Guide more user friendly. The home’s assessment and care planning system remains unchanged. The new manager is aware of the lack of information in the assessments and the lack of direction in the care plans for staff to meet residents’ needs. Prospective residents and their families are invited to visit the home as many times as they like before making a decision. A visiting relative said she visited 104 homes before finding a home that could fully meet her resident’s needs. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Significant improvements are needed to the home’s care planning and medication administration procedures. The new manager is aware of the shortfalls and of the improvements required. EVIDENCE: The new manager is aware of the shortfalls in the home’s assessment and care planning processes. She is preparing to review these procedures and introduce care plans based on Person Centred Planning. Residents’ health care needs were being met and recorded in the care plans. A visiting district nurse commented that she is very happy with the care provided to the residents that she treats. She has trained staff to measure glucose levels or a resident with diabetes. She said she is always made welcome and kept up to date. Concerns raised at the previous inspection regarding the administration of medication have not been addressed. It was noted that medication is not booked in and bottled medication was not market with date of opening. There were no protocols in place for the medication prescribed “as and when Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 10 required” and for the procedures regarding the staff support for a resident who self injects insulin. The new manager has arranged with the home’s pharmacist to introduce a new system for the administration of medication. This will be introduced at the end of the current 28 day cycle of medication. She was reminded to ensure that all staff administering medication are fully trained on the new system by the pharmacist. Residents spoken with expressed their satisfaction with the way they were cared for by the staff. The home has comprehensive policies and procedures for managing people who are terminally ill. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The range of activities and meaningful pastimes still require improvement. Links with families are good. Food provided to residents has improved. EVIDENCE: Activities are still organised on an ad hoc basis. The manager informed that she is investigating employing additional staff to ensure daily activities take place every day. Visitors are encouraged at all times. The manager informed that most residents receive regular visitors. Two visiting relatives said they were always made welcome and appreciated the care their relatives received. Residents spoken with felt that generally they had choices over their daily routines. From observations throughout the day it was clear that residents could choose to spend time in the communal areas or in their own rooms. The home operates a four week rotating menu for the provision of meals. Menus contained a wide range of meals, which appeared nourishing, although there was no choice of the menu meal of the day. However alternatives are available on request. A wide selection of food is on offer at breakfast and tea. Staff asked residents every day whether they would like an alternative from the main meal of the day. Residents spoken with were generally satisfied with Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 12 the food provided. The manager informed that the cook would be attending the next residents’ meeting to discuss menus. Record of food eaten by residents requires developing to ensure all food eaten by residents is recorded. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 The home has appropriate policies, procedures and practices in place to manage residents’ concerns and protecting them from abuse. EVIDENCE: No complaints have been received by the home since the previous inspection. All residents are included in the local voters register where appropriate. The home has an appropriate Adult Abuse Policy. Most staff have received training for the protection of vulnerable adults. The manager is reviewing the home’s training programmes and is considering including managing challenging behaviour and depression. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The Brambles provides the residents with a comfortable and homely environment. Hazards identified at the previous inspection and this inspection must be addressed. EVIDENCE: The Brambles is a large detached house, which has been extended to provide a high standard of accommodation for the residents. Two bedrooms have been added to the lower ground floor, which are accessed by stairs which are fitted with stair lifts, and have direct access to the garden. There is raised decking area with steep steps to the garden. Staff spoken with said they do encourage and assist residents to access the garden during fine weather. However there are some areas of the garden that need a general tidying to make it safer for residents. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 15 All bedrooms have en-suite facilities. There are three bathrooms. Only one has an assisted bath and one is shared by the hairdresser. The need to upgrade at least one of the other bathrooms was a requirement made at the previous inspection, but no action as yet has been taken. Bedrooms seen were well decorated and furnished. Secondary free standing heating was observed in a few of the bedrooms inspected. These must be risk assessed to ensure the safety of the residents. Residents spoken with said they were very pleased with their bedrooms, some have views over the estuary. The communal space consists of a lounge, dining area, and an attractive conservatory area. Most of the residents spend their day in the lounge with the television on all day. Residents spoken with in the lounge said they don’t really watch the television and no-one was able to change the channels if they wanted to. The home has twisting narrow corridors, which can cause problems to manoeuvring wheelchairs. This was particularly noticeable to the access to the communal toilet, close to the lounge, which is in use all day. Temperature control valves are fitted to all hot water taps accessed by residents. Regular checks were seen to be in place to ensure water temperatures are maintained at appropriate levels. Checks had been carried out for legionella and certificate issued. The home’s laundry is located in the basement and has direct access to the garden. New carpets have been fitted to the staircase and laundry. The home was clean, tidy and odour free. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 16 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): 27-30 Staffing levels have improved since the last inspection. The new manager is aware that it is still many areas of the home’s staffing situation that need further development. EVIDENCE: Staff rotas indicated staffing levels have been increased arising from comments from the previous inspection. At the time of the inspection care staff have been increased to 4 per shift. Domestic hours now cover 7 days a week and a kitchen assistant employed from 2.00 pm to 6.00 pm 7 days a week. In addition the home employs a handyperson for 20 hours a week and a laundry person 25 hours per week. During the night 2 waking care staff are on duty. The manager informed that she would be further reviewing the home’s staffing requirements with the proprietor in the near future. The manager has commenced reviewing all the home’s staff files to ensure they evidence a thorough recruitment process. The home’s induction programme does not meet the “skills for care” standard. The manager informed that she is aware of the need to review the staff induction programme. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 17 Training records evidenced that all staff have received foundation training. Staff spoken with demonstrated a sound knowledge of the residents’ care needs and were seen throughout the day to care for the residents in a sensitive and unhurried manner. Residents spoke positively about the staff and the care they received. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 18 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): 31,32,35-37. The new manager is fully aware of the problems experienced by the home and is attempting to introduce improvements in a planned manner. EVIDENCE: The manager has been in post since 20th February 2006. She stated she would be applying for registration on completion of her probation period. She has over 12 years experience in the care business with 2½ years as a manager. She is at present studying for her NVQ Level 4 in care. A member of staff commented that the new manager is easy to approach and although new in post, thinks she will be able to carry out the changes required. The home looks after small amounts of money for residents’ day to day expenses. A random check revealed appropriate receipts have been received and records of money balanced with the cash in the safe. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 19 The manager reported that she is aware of the lack of one to one staff supervision and has plans to commence regular staff supervision by the end of March. The manager has started to review all the home’s policies and procedures and records. These will be fully reviewed at the next inspection. The home has current safety certificates for services and equipment and regular checks are now maintained for the home’s fire protection equipment and hot water temperatures. Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 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. 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 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 2 2 X 3 3 2 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 2 3 Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement The needs of prospective residents must be assessed by a suitably qualified or trained person prior to admission and the home must confirm in writing that they are able to meet the resident’s needs in respect of their health and welfare. The Registered Person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. (Previous timescale of 01.01.05 not met) The Registered Person must consult with residents about their interests and provide a programme of activities and provide facilities for fitness and recreation. The Registered Person must provide sufficient numbers of suitable baths to meet the needs of the residents. The Registered Provider must ensure that all parts of the home are as far as reasonably DS0000063786.V286123.R01.S.doc Timescale for action 01/05/06 2. OP9 13(2) 01/03/06 3. OP12 16(2) 01/07/06 4. OP21 23(2) 01/05/06 5. OP25 13(4) 01/04/06 Brambles Care Home Limited Version 5.1 Page 22 6. OP29 17(2) Schedule 2 practicable free from hazards and that unnecessary risks to residents are identified and as far as possible eliminated. Hazards and risks identified at this inspection are: Risk of falls from the decking and garden. Freestanding radiators which may have hot surfaces. The Registered Person must ensure that robust recruitment procedures are in place, and applied consistently. Records required by regulation in respect of staff recruitment must be obtained prior to a staff starting work. 01/04/06 7. OP30 18(1) The Registered Person must 01/04/06 ensure that staff receive training appropriate to the work that they perform. This refers to the need for robust induction processes to be in place for new staff. (Previous timescale of 01/03/05 not met) The Registered Person must ensure that persons working in the home are appropriately supervised (Previous timescale of 01/03/05 not met) 01/04/06 8. OP36 18(2) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Residents should be given a choice at mealtimes DS0000063786.V286123.R01.S.doc Version 5.1 Page 23 Brambles Care Home Limited 2. 3. 4. OP28 OP33 OP36 At least 50 of care staff should have NVQ 2 in Care or equivalent. (Not inspected) Policies and procedures in the home should be reviewed and updated. Care staff should have formal supervision at least six times a year) Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Brambles Care Home Limited DS0000063786.V286123.R01.S.doc Version 5.1 Page 25 - 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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