Inspection on 21/04/05 for Brambling House

This inspection was carried out on 21st 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 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 12/12/06

Brambling House 17/10/05

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 Michele Etherton Unannounced 21/04/05 at 9:30am 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. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brambling House Address 46 Eythorne Road, Shepherdswell, Dover, Kent, CT15 7PG 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) 01304 830276 Mr Kanagaratnam Rajamenon Mrs Lynn Catherine Kent Care Home only 20 Category(ies) of Older People x 19; Alcohol Dependency Past or registration, with number Present x 1 of places Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2004 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 that is mainly laid to lawn, and is located to the side and rear of the property. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection during which a tour of the premises was undertaken. The providers, manager, and three staff were spoken with in addition to one relative and 11 of the 14 people currently resident in the Home. Two residents were in hospital at the time of the visit. A range of documentation was viewed and the Homes progress in addressing outstanding requirements also checked. What the service does well: What has improved since the last inspection? The Home has made significant progress in addressing outstanding requirements and recommendations. There has been a significant improvement in the appearance, content and updating of required documentation within the Home. The providers have actively recruited to the vacant manager post and a new manager has now been registered by CSCI. Discussion with staff during inspection indicated a generally positive view of the new manager by staff and in the future of the Home. Staff stated they felt better supported and listened to. The providers have invested heavily in the training of staff at the Home, and a rolling programme of mandatory, qualification and special training is now in place. The Home has improved its resident assessment and admission processes. The Home has improved its recruitment procedures. The manager has re-located the dining area to one of the smaller lounges to create a more intimate and homely setting. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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 Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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 and 4 The Home has made good progress in achieving the standard for assessment of service users and ensuring staff are appropriately trained to meet the needs of residents. EVIDENCE: A previous recommendation in respect of the homes assessment process has been addressed. Documentation on new residents admitted to the home since the last inspection supported information provided by the manager regarding the current assessment process. The manager confirmed that she is undertaking assessment visits to prospective residents prior to admission and completing assessment information, supporting information is also provided where available from care management. New residents spoken with were unclear about how they had come to be at the home and were unable to support or deny they had received assessment visits. An outstanding requirement from several previous inspections has now been addressed satisfactorily. A comprehensive training programme has been underway for some time to ensure all care staff can understand and Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 9 appropriately meet the needs of the resident group, discussion with staff, residents, a relative, and the district nurse gave no indications that resident care needs are not being satisfactorily met at this time, as long as levels of staffing appropriate to the number, needs and dependency of residents are maintained to ensure daily routines are not compromised. Residents spoken with indicated that routine bathing arrangements’ and activities’ had been affected by current staffing reductions (see standard 27). Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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 The home has made good progress in the development of resident care plans. The home has made progress in actively identifying and promoting health and care needs of residents. EVIDENCE: The manager has implemented detailed care plans that provide a comprehensive range of both personal and care need information to inform staff. It has been pointed out that in order to ensure staff familiarity with and reference to care plans as a working tool, the responsibilities for updating care plans should not rest with the manager alone, and the manager has agreed to share this responsibility with staff. Care plans viewed, showed evidence of updating and were signed by residents, residents spoken with were unclear about whether they had seen care plans or not although they had signed them. In view of the level of confusion amongst many of the residents it is recommended that care plans’ are routinely viewed by relatives or care managers at review as well as the resident and with their permission, to ensure the homes plan of care is supported. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 11 The Home has addressed a previous requirement issued at the last inspection. A water machine has been introduced into the conservatory for residents to help themselves to cold water, staff’, were also observed offering drinks to residents. Resident files provided evidence of nutritional, continence, falls and skin integrity assessments, falls monitoring was also noted on files. Resident weights are being routinely recorded. The district nurse present during the inspection confirmed that there had been improvement in the management of healthcare issues within the Home, although two small issues were raised and these were discussed with the manager at the time of inspection. Routine health appointments for residents were noted on those resident files viewed. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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) 12, 13,15 The Home has made progress to address previous inspection recommendations in respect of advocacy and menu’s, however, progress has been slower in providing a range of meaningful and stimulating activities relevant to the individual needs and interests of residents. EVIDENCE: The manager and providers are conscious of the need to provide activities within the Home and have introduced some monthly activities i.e. The music man, and an aromatherapy session, they also provide a weekly, craft session on one afternoon. Discussion with a relative indicated that whilst generally satisfied with the care and environment, there were concerns at the lack of stimulation and that the home was not adhering to its own user guide, in that exercise sessions are not currently provided, also that activities provided should take account of the additional disabilities of those with sight or hearing impairments. The manager and providers indicated that exercise sessions offered were not supported by residents and were discontinued. Staff indicated that they do not currently have capacity to spend quality time with residents or to initiate activities like Bingo etc. The providers have indicated they will be actively seeking to address this issue and will be recruiting an activities organiser to devise activity programmes within their homes. Discussion with residents indicated visiting arrangements are flexible and this was confirmed in discussion with a relative spoken with at inspection. In response to previous Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 13 recommendations the home has displayed advocacy information in the main entrance area. Menu’s are written on a board daily in the dining area, these were noted during inspection, residents were complimentary about the food e.g “its very good, but too much”. The manager indicated that they are trying to involve users in the development of the menu by letting them all have a chance to select their favourite meal and this will be provided on a Thursday each week. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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) 16 The Home have improved the system for recording of concerns and complaints. EVIDENCE: The Home displays its complaints procedure. Residents spoken with said they did not have anything to complain about and were quite happy at this time. They indicated that if they had a concern or complaint they would seek out a member of staff to tell. The manager has acted upon a previous requirement to record complaints and concerns expressed to the manager, new complaints and their outcomes were viewed at inspection Discussion with one relative at inspection and another prior to inspection, indicated specific concerns in relation to staffing levels and activities but these had not been discussed with the manager. This indicated that relatives still lack confidence in using the complaints, concerns and suggestions process and that the Home still needs to work with relatives and residents to make it familiar and accessible. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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) 19,21,26 The Home has made good progress towards partially addressing an outstanding requirement in respect of the garden, and has implemented interim arrangements to meet an outstanding requirement in respect of infection control. The premises would benefit from upgrading. EVIDENCE: A fence has been erected in the garden to prevent residents accessing a side alley and steep bank from the rear garden. An environmental risk assessment has been produced which incorporates the steep bank but does not address this specifically, Further work is planned to re develop the Garden and make it a safer and more secure environment, and this should commence shortly. The manager has re-organised furniture within the communal lounges to create a smaller and more homely dining area. Decoration in hallways, staircases and communal bathrooms and toilets is very tired looking and in need of upgrading. The providers and manager have indicated that Brambling House will be upgraded in the near future, and that upgrading may entail the change of use of an upstairs bathroom to a walk-in shower in line with expressed user preferences, it is a recommendation that bathroom provision is reviewed in Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 16 keeping with user preferences and to provide residents with more choice of bathing arrangements, and accessible facilities. The Home has adequate numbers of bathing facilities and despite the recent upgrade of an upstairs bathroom, with a mobile electric hoist, both upstairs bathrooms are currently underused by residents who prefer the downstairs bathroom with hoist facility. The Home has addressed an outstanding requirement in respect of the emptying and cleansing of commodes, but point out these are interim arrangements, which may be improved upon if further structural changes within the Home are approved. It was recommended the Home request a locked clinical waste bin from their waste collector in keeping with Infection control standards Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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 The Home has not maintained progress in providing adequate staffing levels to ensure daily routines of service users are maintained. The Home has made good progress in the numbers of NVQ qualified care staff within the home. The Home has satisfactorily improved its recruitment procedure to meet an outstanding requirement. EVIDENCE: The Home has recently lost two care staff’ and had not made adequate provision for their immediate replacement. Staffing levels were therefore reduced at the time of inspection. Two care staff and one manager is not adequate to ensure residents routines are maintained, discussion with residents indicated a reduction in the number of baths provided and less contact with staff throughout the day. The manager is not available every day owing to commitments for meetings, assessments, documentation etc, the manager also does not work on shift until 8p.m, this leaves only two staff to help residents to bed, one of whom requires two staff to help,and this was confirmed in discussion with the district nurse. Staffing is, therefore, currently inadequate to ensure the safety of other residents elsewhere in the building. The Home have taken steps to recruit and have appointed one new staff member subject to references and checks. It is a requirement that a safe level of staffing is provided which can meet the needs and dependencies of residents and does not compromise daily routines. At he time of inspection there were 11 care staff on the roster of whom 6 staff are currently undertaking NVQII & III qualifications, the new member of staff if appointed has NVQII The Home is on track for achieving this standard. The manager advised all staff have now had a CRB, new staff are receiving POVA checks and only one staff member has been appointed since the last inspection. A random sampling of two staff Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 18 files indicated the Home has improved content and met the outstanding requirement. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 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) 31,36,38 The Home has benefited from the appointment and registration of a registered manager, whose has made a noticeable effort to address outstanding requirements and recommendations. The Home has made limited progress however, in providing staff with formal supervision. The Home promotes the health, safety and welfare of staff and service users but needs to strengthen systems for recording this. EVIDENCE: The home has appointed a manager who has been registered by CSCI. The manager has an HNC qualification in care and management and is seeking clarification as to what if any further modules may be required to achieve the Registered Managers Award, and it is a recommendation that this is undertaken. The manager updates her practice by attending periodic training, and could evidence five training sessions attended within a six month period. Staff spoken with indicated that there had been an improvement in staff morale, and that they felt the manager listened to them and also explained things to staff, and was very supportive. Staff confirmed access to supervision sessions, however, the current system for supervision is more akin to an Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 20 induction checklist and from discussion with the manager and staff did not afford sufficient opportunity to have a flexible agenda and focus on the topics of supervision highlighted within the standard, this was fully discussed at inspection and the manager was in agreement with changing the format. Servicing invoices for equipment and services within the home were available and in date. The fire book indicated that tests and checks of fire fighting and fire detection equipment and systems are happening regularly, however, staff have not received regular fire drills although staff have received fire safety training. The Home were unable to evidence that this incorporated fire drills. It is a requirement that all staff receive a minimum of two fire drills annually. Safety notices were noted around the Home but were not overly intrusive. The accident book viewed at inspection indicated a low level of accidents overall, however, concern was expressed that of 15 accidents ten had occurred during the night shift , the manager was recommended to investigate the reasons as to why this may be occurring particularly as the home provides two waking night staff to every night shift. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 3 x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x x 3 x 2 Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 22 yes 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 19 Regulation 13(4)(a,b, c) Requirement Timescale for action 30.6.05 2. 27 18(1)(a) 3. 32 16(2)(m)( n)&24(1& 3) 4. 38 23(4)(e) Action plan to detail how the garden is to be made secure for servicd users to use safely and in what timescale.(timescale of 30.6.04 partially met).Environmental risk assessment in respect of steep bank to front of Home (timescale of 30.10.03 partially met) Staffing levels to be provided at 30.5.05 a level in keeping with the number, needs and dependencies of residents, and are sufficient to ensure daily routines are not compromised The provider to evidence 30.6.05 opportunities for service users and their relatives to be consulted and informed and to give feedback in respect of service delivery.(timescale of 15.12.03 only partially met) systems to be implemented to 30.5.05 ensure all staff receive a minimum of two fire drills annually 5. Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 23 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. Refer to Standard 1 9 Good Practice Recommendations Provision of daycare and respite services should be highlighted within the statement of purpose if these are to feature within the overall service to be provided Home to record minor medication errors in an incident book and notify the CSCI of more serious incidence in compliance with Regulation 37 of the CHR 2001. Administering staff to be made familiar with the medication procedure. Home to purchase an updated BNF. cincerns regarding competency of individual staff members need to be assessed and evaluated as to likely risks to residents, with appropriate actions taken to minimise. Home to look at the development of individual activity programmes for service users that also incorporate communal activities provided. with resident approval care plans to be discussed with relatives and supporters, Home to update fire risk assessment for the Home with reference to current resident dependencies, open bedroom doors, and forward to fire officer for comment. Home to review bathroom facilities to provide greater choice to residents. Occupational therapist assessment of the premises via e.g. occupational therapy bureau Home to explore with clinical waste collection service provision of lockable waste bin manager to evidence current qulification is equal to NVQ4 in care/management or take steps to achieve this standard Home to develop policy and procedure for quality assurance. Home to develop strategies for engaging with service users, staff relatives and other professionals to gain views about the service. manager to implement a new staff supervision format manager to review causes of increased of nightime accidents, and to take steps to minimise 3. 4. 5. 6. 7. 8. 9. 10. 12 16 19 21 22 26 31 33 11. 12. 36 38 Brambling House H56 H05 S42612 Brambling House V221974 220405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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. 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