Inspection on 12/12/06 for Brambling House

This inspection was carried out on 12th December 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

Brambling House 10/12/08

Brambling House 17/10/05

Brambling House 21/04/05

Brambling House 02/11/04

Brambling House 17/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Brambling House 46 Eythorne Road Shepherdswell Dover Kent CT15 7PG Lead Inspector Mrs Penny McMullan Unannounced Inspection 12 December 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 Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brambling House Address 46 Eythorne Road Shepherdswell Dover Kent CT15 7PG 01304 830276 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) Mr Kanagaratnam Rajaseelan Mr Kanagaratnam Rajamenon Vacant Care Home 20 Category(ies) of Past or present alcohol dependence (1), Old registration, with number age, not falling within any other category (19) of places Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) person with a past dependency on alcohol/drugs whose date of birth is 11.02.1937 17th October 2005 Date of last inspection Brief Description of the Service: Brambling House is an extended detached property set back from the main road above a grassed bank and accessed by a steep drive. Car parking is available off road in a small car park at the rear of the premises. The Home is located off the main road through the quiet and rural village of Shepherdswell. There is a limited public bus service, but the village has a train station with direct mainline access. The house provides residential care for up to 20 older people ( 1 bed is currently allocated to a person with alcohol dependency needs). Accommodation comprises of 16 single rooms, seven being located downstairs, with a further 9 single rooms and 2 shared rooms situated on the first floor. The Home benefits from having three communal spaces for Service Users downstairs, in the form of one small lounge, a lounge/diner and a large conservatory area. All parts of the Home are accessible to Service Users via a shaft lift. Each bedroom has a private wash-hand basin and call bell, a telephone is available for Service Users to use. Service Users have access to a garden with a patio area which is located to the side and rear of the property. The current fees for the service at the time of the visit are £303 to £350 per week. There are additional charges for chiriopdy, hairdressig, aromotherpay, newspapers and toiletries. Information on the homes services and the CSCI reports for prospective service users/relatives will be referred to in the Service User Guide. A copy of the report is also availabe in the home on the desk by the front door. The email adress for the service is: bramblinghouse@firstchoicehomes.co.uk Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on evidence gained from a pre-inspection questionnaire completed by the home; comment cards received from service users, families, and visiting professionals; and a site visit of 8 hours to the home. The site visit includes talking to service users, staff, the proposed Registered Manager; a partial tour of the building; inspection of records; and various observations. The proposed Registered Manager has been in post since August and has applied to the Commission to become the Registered Manager. She has previously worked in the home in a senior position and is familiar with the running the home, service users and relatives. What the service does well: All of the service users comments received indicate that overall they are happy with the care being provided. A Health and Social Care professional commented that it was a very positive experience for a service user who was thinking of moving into the home. Comment Cards from two other health care professionals indicate they are overall happy with services being provided. Relative’s comments: ‘The staff are always helpful and polite, always ask if you would like tea or coffee. The home always smells fresh and the service users seem happy and warm’. My relative’s care in the home is much better and she feels more settled in herself’. ‘All of my family feel my relative is very well cared for in a safe environment’. ‘Since we have had a new manager the service users enjoy more activities and family and friends are encouraged to participate, which means so much to the clients’. Feedback from service users is very positive and all postal surveys received say that overall they are satisfied with the service being provided. Staff say they are supported by the Manager and work well as a team. Another staff member says ‘The home is very friendly, warm and comfortable and service users are well looked after’. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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 Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to carry out a detailed and through assessments of needs of service users prior to admission to the home. EVIDENCE: Three service users files were looked at and all had a care needs assessment together with a care plan or joint assessment from the placing authority. This information is part of the care plan to ensure service users needs are met. A prospective service was visiting the home at the time of the site visit. Another service user said that her relative had received all of the information on the home. Standard 6 does not apply to this home. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care planning system is consistent to provide staff with the information they need to meet service users needs health and social care needs. Services users are protected by the home’s policies and procedures for dealing with their medication, however there are minor shortfalls in the storage of medication. The home promotes service users rights and choices. EVIDENCE: Three care plans were looked at and contained detailed information in all aspects of health and social care. The service user and/or their relative/representative sign the plans. Comment Cards from relatives confirm they are consulted about their relatives care. The plans are reviewed on monthly basis but it was not clear in some of the sections if this had been completed. The moving and handling risk assessments need to include further Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 10 information to provide staff with clear guidelines to carry out the identified safe practice of work. A recommendation has been made in this report. Staff should also take more care when recording sensitive information on the daily record sheets. Health care needs are monitored in the service user plan, clearly recording health checks and appointments in addition to more specialised hospital appointments. Service users confirm that the home calls the GP when required and there is evidence on file with regard to visiting professionals. Service users also say they attend hospital appointments and the Optician, Chiropodist and a Dentist visit the home. Senior Staff administer the medication and they have all received appropriate training. Weekly audits are carried out and the MAR sheets (Medication Administration Sheets) are in good order and any errors are recorded and appropriate action taken. The protocols for as and when required (PRN) medication have been implemented and there are guidelines for staff. The storage of medication needs to be reviewed in line with Royal Pharmaceutical Guidelines. The storage of the trolley restricts access to the medication fridge and the area would benefit from a complete refurbishment. A recommendation has been made in this report. Feedback from service users and their relatives express overall satisfaction at the care and support offered. There were minor comments made with regard to the lack of experience of junior staff. The Manager is aware of these comments and is working with the staff to ensure the needs of the service users are met. Service users feedback indicates their preferences are taken into consideration with regard to their daily lives. Staff demonstrated their understanding of the service users needs and the importance of treating them with respect whilst maintaining privacy and dignity. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is providing a programme of activities for service users that take account of their preferences. Visitors are welcomed in the home. Arrangements are in place to ensure service users rights and choices are promoted. The meals in this home are good offering both choice and variety. EVIDENCE: The home has responded to a previous recommendation to develop the activities programme. They have appointed an Activity Co-ordinator and each service user has a detailed sheet of activities undertaken. Communion was taking place at the time of the site visit and service users confirm this was a regular monthly visit. Feedback from service users spoken with confirm that there is bingo, communion, music man, children singing, and animal therapy. The home is in the process of completing a life history on all service users to Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 12 encourage individual activities to be identified. One relative says that the home tries hard to motivate the service users. Service users confirm that their relatives visit them. Surveys from relatives indicate that they visit their family in private and are consulted about their care and feel welcomed in the home. Relatives and service users say the staff is friendly and always make tea or coffee. There are some service users who receive a visitor every day and relatives’ feedback indicates they have an active role in the daily life in the home. Service users choice is promoted in all aspects of their lives. Service users have personalised rooms with some of their own furniture. Service users comments. ‘I get up and go to bed when I like, ‘I like to stay in my room to watch television’. The home does not handle any finances for service users as relatives deal with their finances. The home operates a four weekly menu and service users are asked each day if they want the dish on the menu or an alternative. All service users spoken to say the food is good and they enjoy the meals. The meal time was unhurried and service users are able to choose where they eat, the dining room, lounge or their own room. All the necessary checks and cleaning schedules are in place and the home has two cooks. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident complaints will be listened to and dealt with appropriately. Arrangements are in place to ensure service users are protected from abuse. EVIDENCE: The home has a detailed /concerns log in place and records appropriate action taken. The home is also in the process of implementing a new complaints recording format. Relatives spoken to said they did not have any complaints and raised any concerns with the home who have always been proactive in addressing any small issues. Service users spoken to say they have no complaints but would raise their concerns with the staff if they had any issues. There are polices and procedures in pace with regard to Adult Protection. The home is fully aware of adult protection protocols and training of staff is ongoing. The home has a system in place to record and action any verbal aggression. Arrangements are in place for the protection of service users finances. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 19,21,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and pleasant environment for service users to live in which is maintained to a satisfactory standard. Laundry facilities are satisfactory and policies and procedures are in place to control the risk of infection. EVIDENCE: There is a planned programme of routine maintenance and a daily log of jobs, which need completing. The walls in the corridors and some bedrooms have been painted but require further work. There are still areas of paintwork, which require attention, and the outside of the home would benefit from redecoration. Some carpets or vinyl have been replaced in service users rooms but there are some rooms where the carpets are old and in need of Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 15 replacement. The home is in the process of receiving quotes for this work. recommendation has been made in this report. A A recommendation was made in the last inspection report to lob the trees at the side of the house. The home has had one tree cut down in the front garden but there does not seem to be any progress made with regard to pruning the other trees. As it is winter it is difficult to tell if the trees restrict the light in service users room. The home needs to review this situation in the Spring to ensure the light in service users rooms is not restricted. A recommendation has been made in this report. A review of bathroom facilities is an outstanding recommendation and will need to be addressed within the upgrade of the premises. One of the bathrooms has been partly decorated but this work has not been completed. Although there are two bathrooms in the home only one is used and this restricts client choice in bathing. This is partly due to the size of the upstairs bathroom and the electric hoist. Some service users do not feel the design of the hoist in the upstairs bathroom is as good as the one downstairs and therefore prefer to use the one downstairs. The home needs to further review bathing facilities and a recommendation has been made in the report. The home is clean and pleasant and they have now employed a domestic for seven days a week. Laundry facilities are in place and service users confirm that the service is good. The home has implemented a schedule of cleaning me to control infection and odours within the home. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient well trained staff on duty to support and promote the needs and welfare of service users. Arrangements are in place to ensure that residents are supported and protected by the homes recruitment policies. A training and induction programme is in place to ensure staff have the skills to meet the needs of the service users. EVIDENCE: There are three members of staff on duty from 8 am to 8 pm and two waking night staff. In addition there is one cook and one domestic plus the proposed Registered Manager. Service users say they feel there is enough staff on duty. Relative feedback indicates that the staffing levels have improved. There are busy times during the day and evening when there is only two staff on duty and the home should consider reviewing this situation to cover with three staff at core times of getting up and going to bed. A recommendation has been made in this report. There is an established staff group in the home resulting in low sickness rates and reliable staff. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 17 The home has a planned NVQ programme with the majority of staff participating in the award. As a result the home has more than 50 of staff that have completed or are undergoing NVQ training at this time. Arrangements are in place for the recruitment of staff with evidence of POVA and CRB checks and two written references in place for new staff. Staff files also contained certificates for a range of training they had attended recently including manual handling, first aid, fire, health and safety and medication. A staff-training matrix is in place, and a number of courses booked to ensure that all staff achieves training in mandatory core skills, and more specialised training. An advanced food hygiene course is also planned for the Cook. Induction training is provided and signed off by senior staff and a new format is being introduced in line with Skills for Care. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. Improvements and development is required to ensure service users views are influential in the development of the service. The Home has implemented systems to ensure service users financial interests are protected. The home is providing a safe environment for service users and staff. EVIDENCE: Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 19 Mrs L. Kumar, the Manager has worked in the home for approximately three years and was appointed to the post of Manager in August 2006. An application to become the Registered Manger is in process. Relatives, staff and service users say the home has improved since she took over. She has completed her Registered Manager Award and previously worked in the home as a Senior Carer. She is therefore familiar with the day to day running of the home and staff group. Mrs Kumar demonstrated her knowledge of the service users and her commitment to providing a high standard of care. A quality assurance questionnaire was sent out to service users and relatives in November and the Area Manager is in the process of summarising the results for publication. The home is still not consulting more widely with stakeholders, and will need to address this issue to ensure these views are included. There is no evidence that the views of service users, relatives, representatives and other stakeholders are included in a development plan for the home and any further plans to improve the service. A requirement has been brought forward in this report. Service users monies are managed and controlled by relatives and representatives. The home manager and senior staff look after personal allowance monies and ensure that the relevant records are in place. Records were viewed and were found to be accurate. Receipts are in place and service user sign for any monies issued. Mandatory training is in place and appropriate safety checks have been carried out. The accident book was accurately completed and tracked through to the individual service user plan where appropriate action had been taken. Falls are monitored through the accident recording and when required a falls prevention plan is implemented. Environmental risk assessments are in place and the fire risk assessment is being reviewed in January. The fire book was in good order with evidence of tests and drills taking place. Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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 OP33 Regulation 24 Requirement The home is still to consult more widely with stakeholders, and produce and publish an annual report of service user feedback, to evidence how user consultation is influential in service development. The home to produce an annual development plan, draw together current audits and checks into a system for self monitoring using a verifiable method at least on an annual basis. This requirement has been brought forward from the last inspection timescale 1/4/06. Timescale for action 31/01/07 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 OP7 Good Practice Recommendations To ensure that the monthly review is clearly and consistently recorded. DS0000042612.V306720.R01.S.doc Version 5.2 Page 22 Brambling House 2 OP9 3 OP19 To add further detail to the moving and handling risk assessments to clarify the safe practice of work The storage of medication needs to be reviewed in line with Royal Pharmaceutical Guidelines. The storage of the trolley restricts access to the medication fridge and the area would benefit from a complete refurbishment. To complete the redecoration inside and paint the outside of the home. To continue with the refurbishment of bedrooms and complete the decoration of the bathroom The home is needs to review the lobbing of the trees at the side of the premises in the Spring to ensure the light in service users rooms is not restricted A review and upgrade of bathroom facilities is needed to provide improved choice of bathing options to service users, this recommendation has been brought forward from the last inspection To review staffing levels at core times during the day 4 OP21 5 OP27 Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Brambling House DS0000042612.V306720.R01.S.doc Version 5.2 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. You have been warned!