Inspection on 18/12/06 for Brambling Lodge

This inspection was carried out on 18th 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 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

Brambling Lodge 28/11/08

Brambling Lodge 20/09/05

Brambling Lodge 09/05/05

Brambling Lodge 15/11/04

Brambling Lodge 11/05/04

Brambling Lodge 04/11/03

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

CARE HOMES FOR OLDER PEOPLE Brambling Lodge 48 Eythorne Road Shepherdswell Dover Kent CT15 7PG Lead Inspector Mrs Penny McMullan Unannounced Inspection 18 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 Lodge DS0000042604.V306723.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 Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brambling Lodge Address 48 Eythorne Road Shepherdswell Dover Kent CT15 7PG 01304 830775 01304 832791 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 Mrs Elizabeth Abrey Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two (2) service user`s whose DOB are 02/01/1918 and 17/02/1919 are categorised as OP. 20th September 2005 Date of last inspection Brief Description of the Service: Brambling Lodge is an extended detached property, located on the main road running through the village of Shepherdswell. The Home is set back from the road and accessed by an ascending drive, this levels out into a car parking area to the side of the property. The local area is served by a limited public bus service, but the village has a train station with direct mainline access. The Home provides residential care for up to 26 older people with dementia. Accommodation is arranged over two floors accessed by two staircases and a shaft lift. There are 24 single rooms, 11 of which are en-suite and 1 shared room with an en-suite. Each bedroom has a private wash-hand basin and call bell, many of the rooms also have televisions in-situ for residents use. Coin box telephones are available for use on both floors. The Home benefits from a large conservatory to the side of the house next to the entrance. The garden to the rear of the property has been landscaped and leveled off to provide a secure and safe area comprising patio with tables and chairs, and a large expanse of lawn, for residents to use in good weather. The current fees for the service at the time of the visit are £367.82 to £420.00 per week. There are additional charges for chiropidy, hairdressing, aromotherapy, newspapers, magazines 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. The email adress for the service is: bramblinglodge@firstchoicehomes.co.uk Brambling Lodge DS0000042604.V306723.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 9 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 home has plans to extend the home at the side of the premises to give service users additional dinning room and lounge space. What the service does well: What has improved since the last inspection? Some bedrooms have had new carpets and a two-seat sofa and armchair have been purchased for the conservatory. All bedrooms doors are in the process of being painted white with identification for individual rooms. The home has introduced a daily allocation of staff, recording and evidencing night checks and quick reference guides to service user daily needs. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 6 New locks on service users rooms are being fitted to ensure privacy for service users. 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 Lodge DS0000042604.V306723.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 Lodge DS0000042604.V306723.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): 2,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A Contract or Statement of Terms and Conditions are in place for each service user. Arrangements are in place to carry out a detailed and through assessments of needs of service users prior to admission to the home. Standard 6 is not applicable to this home. EVIDENCE: Each service user has a written contract/statement of terms and condition, which has been signed by the service user or relative. The Registered Manager also signs and dates the document. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 9 Three service users files were looked at and contained 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. One service user said that her daughter had visited the home before she came to live here. Service user comments on their postal survey indicate that a contract had been received. Standard 6 is not applicable to this home. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10,11 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 health and social care needs. There are shortfalls in the medication policy with regard to the administration of covert 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. The moving and handling risk assessments need to include further information to provide staff with clear guidelines to carry out the identified safe practice of work. A recommendation has been made in this report. A GP comment card indicates that the staff Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 11 understands the needs of the service users and relatives comment they are kept informed of important matters affecting their relative. Health care needs are monitored and recorded in the service user plan. GP visits and hospital appointments together with optician, dentist and chiropody appointments are also recorded. A visiting health professional indicated the home responded well to service users health care needs and was proactive in reporting any areas of concern. Service user comments on their postal survey indicate they always receive appropriate medical support. A relative says ‘my mother has always received good medical support and they always keep me informed’. Senior Staff administer the medication and they have all received appropriate training. The Deputy Manager observes staff administering the medication to ensure they are competent to do so. The MAR sheets (Medication Administration Sheets) are in good order and there is a system in place to record medication errors. The Deputy Manager audits all documentation each week. The storage of medication is satisfactory. The home needs to review the medication policy to include the administration of covert medication and ensure that staff have clear guidelines to follow. A requirement has been made in this report. Feedback from service users and their relatives express overall satisfaction at the care and support offered. From observation and discussion it is apparent that service users have their preferences taken into consideration with regard to their daily lives. Staff demonstrated their patience and understanding of the service users needs. One-service users receives telephone calls and emails from her relatives in Australia. One service user says the staff maintains her privacy and dignity and is good when providing personal care. The home is in the process of changing locks for service users rooms to ensure privacy. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 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 an excellent programme of stimulating 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 provides a programme of varied interesting activities. Service users have made calendars with their individual photographs on to send to their relatives. They also made their own Christmas cards, tree baubles and decorations. Scrapbooks of personal details have been completed together with individual photo albums. There is also reflexology and aromatherapy. Service users were enjoying a card game at the time of the visit and were clearly enjoying the participation. The activities carer ensured each service Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 13 user was able to win and enjoy the game. The activities programme is varied pottery; mask making and painting, painting, playing different card games, bingo, and cake decorating. Service users confirm that they are able to go to a local hotel for lunch and one visits her husband on a regular basis. Another was going out with her partner for a short while. Service users surveys indicate there are always suitable activities in the home. One service user says ‘there is always something to do’. This standard has been scored as 4 which is commendable and the home has exceeded the expectation of the standard. Visitors are welcome at all times in the home and service users can see them in private if they wish. One visitor, a friend of a service user says the home is very good and she is always welcomed. Service users confirmed that family visit them and sometimes they also go out with them for a few hours. Relative’s surveys indicate that they visit their relative in private. Service users relatives, representative, or solicitor together with the home support them with their finances. Advocacy services are n place for three service users. Information on advocacy is included in the care plans. There is a four weekly menu in place in the home and staff ensure that service users are offered choice by monitoring meals given to the service users. One visitor confirmed that her friend is always offered a choice of meal. There are two folders of pictorial meals for service users to promote choice. Preferences are also recorded in service user plans. Service users feedback verbally and comment cards indicate the meals are good and they enjoy the food. There are varied soft drinks available throughout the day and coffee and biscuits are served on the trolley in the morning and afternoon. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 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: There have been no complaints since the last inspection. Staff were able to demonstrate their understanding of when service users may not be happy through their behaviour or mood during the day. Relatives and service users spoken to said they did not have any complaints. There is information on the front desk and on display with regard to how to complain. Adult protection policies and procedures are in place and staff demonstrated their awareness of the procedures. 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 Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 the following standard(s): 19,26 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 good standard. Laundry facilities are satisfactory and policies and procedures are in place to control the risk of infection. EVIDENCE: A new call bell has been fitted in the lounge to ensure that staff can hear this in any part of the home. Service users spoken to say staff are responsive to their calls. There is a maintenance and development plan in place. The home is in the process of installing a new fire system on the first floor and there is ongoing redecoration. Service users doors to the bedroom are in the process Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 16 of being painted for clearer identification. The garden is well maintained and rooms are checked on a regular basis. There are areas of the home, which are in need of redecoration, and the home is working towards completion. New washing machines and tumbles driers have been installed. The laundry room is in need of painting and this is in the maintenance book job list to be completed. The premises are clean and tidy and feedback from a visitor confirms that the home is always cleaned to a high standard. Staff have received training in infection control and are aware of laundry procedures. Feedback from service users indicates the home is clean and tidy and free from offensive odours. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 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 staff on duty to meet service users needs. Arrangements are in place for the safe recruitment of staff. A programme of training is in place to ensure service users receive care and support by trained staff. EVIDENCE: There was five care staff on duty throughout the day, which includes the Deputy Manager, Team Leader, Senior Carer and two carers. In addition there is a Cook, kitchen assistant, and domestic staff. The home has a dedicated Activities Co ordinator and two waking night staff. Flexi staff covers for sickness and annual leave. Relative and service user feedback indicates that there is sufficient staff on duty to meet the needs of the service users. Three staff files were viewed and contained POVA checks and Criminal Record Bureau checks. Two references together with appropriate application forms and interview notes are also on file. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 18 An ongoing programme of training is in place, to ensure staff have achieved mandatory and NVQ training, in addition to more specialised courses. The home is currently maintaining the 50 level of NVQ 2 or above trained staff. Mandatory training is ongoing and there are also more specialised courses provided. Staff confirmed induction training has taken place. The home has introduced a new programme in line with Skills for Care. Staff spoken to confirm they have attended training courses in the last year. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 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): 31,32,35,38 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. There are shortfalls in the quality assurance system as there is no evidence of how feedback is influential in the development of the service. The Home has implemented systems to ensure service users financial interests are protected. Supervision of staff is in place The home provides a safe environment for service users and staff. EVIDENCE: Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 20 The Registered Manager has been in post for two years and demonstrated her knowledge of service users, staff and the day- to- day management of the home. Staff and services users say they feel supported by her and the home is relaxed, comfortable and homely. Staff morale is high resulting in an organised staff team benefiting the daily lives of the service users. A visitor commented on how hard the Manager and staff work to ensure the service users have a good quality of life. A staff member commented ‘I feel I am a valued member of staff’. The home has provided quality assurance questionnaires to service users and relatives however further consultation, with users and other stakeholders is not in place. There is no resulting development plan to evidence service users/relatives/representatives views are taking place. A requirement has been made in this report. The home produces a newsletter for relatives/representatives to keep up to date with news in the home. The Registered Providers are in the process of developing this programme. Service Users finances are dealt with by relatives their representatives and solicitors. Arrangements are place for service users to receive their personal allowance and all personal belongings are recorded appropriately. All staff have received supervision. This is recorded and agreed with individual staff members. The Registered Manager and Deputy Manager carry out the supervision and training needs are also identified and recorded through supervision. Mandatory training is ongoing and the relevant safety checks in the home have been carried out. The fire book is in good order with evidence of tests and drills taking place. Environmental risk assessments are also in place and accidents were tracked though to service user plans, recorded and appropriate action taken. Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 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 3 3 2 x 3 3 x 3 Brambling Lodge DS0000042604.V306723.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 Requirement Timescale for action 31/01/07 2 OP33 24 To review the administration of covert medication, amend medication policy to ensure there are clear guidelines for staff The home is still to consult more 31/01/07 widely with stakeholders, and produce and publish an annual report of service user feedback, to evidence how user consultation is influential in service development. 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 add further detail to the moving and handling risk assessments to clarify the safe practice of work Brambling Lodge DS0000042604.V306723.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 Lodge DS0000042604.V306723.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. 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