Inspection on 20/09/05 for Brambling Lodge

This inspection was carried out on 20th September 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 Lodge 28/11/08

Brambling Lodge 18/12/06

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 Michele Etherton Announced 20/09/05 at 9:30 am 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 Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Brambling Lodge Address 48 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 830775 01304 832791 info@1stchoicecarehomes Mr Kanagaratnam Rajamenon Mrs Elizabeth Abrey Registered Care Home 26 Category(ies) of Dementia- over 65 registration, with number of places Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9/5/05 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. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector carried out an Announced inspection visit to assess those key standards not inspected previously and to check on progress made by the home on addressing outstanding requirements and recommendations highlighted by the previous unannounced inspection. The inspection was undertaken between 9.30 a.m. and 4. 59 p.m. During this time the inspector toured the building, viewing all communal spaces and those user bedrooms currently in use (with service users permission where this could be obtained) and all other areas of the home. The inspector spent time chatting with more than half the current service user group both in communal spaces and in their own bedrooms. The service users appeared relaxed and settled. The hairdresser was present in the home during the morning and in the afternoon some of the service users were doing crosswords and puzzles with staff support. A lunchtime medication round was also assessed during the visit. In addition to the manager and a provider the inspector was also able to speak with five staff, three of whom were care staff and included the deputy manager, and two staff from the domestic team. Staff generally expressed support for the current management of the home and spoke positively about improvements and developments in the home that had been put in place. Service users were complimentary of the staff support they received and expressed a good level of satisfaction in the service they received, comment cards received from relatives and representatives supported an overall satisfaction although some newer relatives felt it was still too early to form opinions, and those relatives of longer term service users were supportive of what they saw as clear improvements in the service provided by the home. A range of documentation was reviewed including four service user files comprising assessment and care plan information, terms and conditions documentation, risk assessments and medication information. Other documentation viewed included three staff files, Medication administration sheets, staff meeting minutes, staff rotas and training information, activities information, the fire risk assessment, the medication procedure, and the repairs and maintenance book. What the service does well: The Home provides a comfortable, pleasant environment for service users in a relaxed and homely atmosphere. An ongoing programme of maintenance and upgrading is in evidence. Prospective service users are clearly assessed prior to admission, and the Home is willing to work with service users who may have posed a challenge to some other services. The Home is evolving a stimulating Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 6 and fun programme of activities, strongly influenced by responses and preferences indicated by the service users. The home ensures service users are accompanied to all hospital and routine health appointments if family members are unable to accompany them. What has improved since the last inspection? What they could do better: The home management team need to ensure that terms and conditions documentation and the necessary consents to care plans, behaviour management strategies and medication administration are in place, and that they actively seek the participation of relatives and representatives in achieving this. Risk assessments for individuals need to be more detailed and the actions taken need to be relevant to the identified risk. The management team need to ensure that risks are reviewed frequently and feature strongly in the day to day functioning of the home as a reflection of the more vulnerable and needy category of service users to the general older person population. Although willing to address identified shortfalls within the service, the home management team and the providers need to be more actively auditing their own service and identifying areas for improvement and acting upon them. Staffing levels need to be constantly reviewed to ensure that adequate levels of stimulation and support can be offered to an increasing number and dependency of this service user group. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 7 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 H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 8 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 Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 9 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) 2 & 3 Although contracts are issued on admission, service users rights could be compromised by a failure to ensure these are signed by relevant parties and therefore legally binding. The home is undertaking assessment of all prospective service users prior to admission. EVIDENCE: Progress on addressing this outstanding recommendation was re-assessed at this visit. Four new service user files were viewed, two had signed contracts in place, the manager advised a third was in the post. Whilst there had been some success in this area, it was noted that one service user, has been in placement for approximately four months and was still lacking a signed contract. Clearly, it is acknowledged that representatives have a role to play in ensuring they return contracts signed in a timely manner, however, the home will need to review its current arrangements and timescales for ensuring these are returned, and this remains an outstanding recommendation. Four new service user files assessed on this visit provided evidence of assessment prior to admission. Discussion with the deputy manager responsible for assessment of one of the newer service users, indicated that contributions from existing care workers, family representatives and care Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 10 managers contributed to the completion of the assessment process and documentation wherever possible. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 11 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) 7,8,9 & 10 The Home has made good progress in the development, content and updating of care plans, but need to evidence more clearly that service users or their representatives are involved, consulted about and endorse the plan in use. The Home promotes and maintains service users health and facilitates access to health care appointments. Further improvements are required in the management and administration of medication to ensure service users are not placed at risk of harm. Service users are supported in a respectful and sensitive manner that allows them to exert their rights and make choices in their daily routines. EVIDENCE: Progress in achieving a previous requirement in respect of care plans was assessed through the review of four care plans. The Home has worked hard to develop their current care plans and there has been a marked improvement in the content of users personal preferences around daily routines. Risk assessments are linked to areas highlighted in the care plan but are inadequately detailed. The Home has failed to fully achieve the requirement as care plans’ are still not being routinely signed by representatives, where clearly a service user’ lacks the capacity to endorse the plan of their care. Concern was expressed that the use of pressure mats in respect of managing two Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 12 service users’ behaviour and alerting staff to their movements, had not been thought through as a strategy, and had not been written into a behaviour management programme for either service user. The home were unable to evidence that discussion with service user representatives and their approval of such measures had been undertaken, the home are required to address these issues. The home has addressed a previous recommendation in respect of the weighing of service users, the frequency of weighing has been standardised, the home has a set of chair scales that enable non-weight bearing service users to be weighed. The home is now routinely weighing new service users on admission. Service user files viewed indicated access to routine health care appointments and more specialised health appointments. The Home has made improvements to its administration of medication. Discussion with two staff members in respect of a previous recommendation in respect of disposal of spoiled medication was answered in keeping with the homes policy on disposal of medication. It is recommended that the disposal of spoiled medication needs further separate clarification within the home’s disposal of medication procedure. The home has taken steps to address issues previously identified around homely remedies, medication consents are still not routinely in place and this is now required for all service users. A medication round was observed during the inspection, and highlighted the following required actions, the home are required to develop individual user guidelines for staff in the use of PRN medications, reductions of prescribed medications at the request of a G.P must be clearly evidenced within the care plan and where possible signed by the GP, timescales for implementing changes to dosage must be closely monitored and reviewed with the GP as agreed. The following good practice guidelines were also suggested as a result of observed practice, medication spoons for the administration of medications must be used only once on each medication round and then washed before use on the next medication round, instead of the use of disinfectant wipes. The MDS cards in use would benefit from photographs of service users to match with those on the MAR sheets, MAR sheets viewed were satisfactorily completed. Liquid medications are to be dated upon opening and to be included in daily audits of administration. as required medication to be included in daily administration audits. Service users spoken with confirmed that they can choose to participate in activities or not, many were observed moving between their bedrooms and communal spaces throughout the day, and some of those spoken with stated that they preferred to keep to their own rooms. Although several users spoken with had stained clothing, further discussion revealed that they had fresh clothing on that day but spillages had occurred, staff had not had time to help them change or notice that this was needed, in another instance a service user was unshaven, the home has implemented a personal hygiene checklist to ensure all aspects of personal care are addressed routinely by staff, several Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 13 files viewed however, indicated that in some instances this is not being filled in and may indicate some personal care has not been given, staff spoken with felt that they are pushed to achieve all tasks at peak times of the day as many service users require support and supervision, failures to undertake these matters fully is a reflection on staffing levels and is addressed further on in this report. All of those service users spoken with expressed complimentary and positive comments about the staff who they found friendly, and helpful, one user stating ‘they should all get a medal’. Another service user who is currently unwell was very positive about the care and support they had been receiving during their illness. Another new service user was able to make clear comparisons between how they had been treated elsewhere to this home and were very positive about the attitude of staff. Feedback from relatives was mixed with new relatives feeling they are unable to make a knowledgeable comment because of not knowing the home for that long, more longstanding relatives were more positive about the improvements in the home and expressed general satisfaction with current arrangements. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 14 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 & 15 The Home continue to make progress in the development of a stimulating and meaningful activities programme for service users. Service users are provided with a wholesome and nutritionally balanced menu, but its development must be influenced by their personal preferences EVIDENCE: The Home has achieved an outstanding requirement and have reviewed the activities programme. The Home currently provides a musical entertainment and a morning session with a Reflexologist and an Aromatherapist on a monthly basis, although in the case of the two latter activities service users can pay privately for extra sessions if they wish. The home also now provides an art and craft session twice per week, and records of this were noted during the visit, the hairdresser also visits weekly. Staff have introduced a number of other activities onto the afternoon sessions which enable service users to participate on an individual and team level, service users spoken with confirmed these activities are taking place but they themselves do not always choose to participate. The manager advised that when staff are available some service users are taken out to the village shop, etc, the home now has access to a minibus and this will enable additional trips to be taken away from the home if sufficient staff are in place. One service user indicated a desire for raised flower beds so they could participate in some planting activities, the home have undertaken this activity with service users filling pots for the patio, Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 15 however, raised flower beds are currently not a feature in the garden and need to be considered, particularly for those in wheelchairs, and this is a recommendation. The improvements in the activities programme are heavily reliant on the input of staff, and as a consequence staffing levels will need to amply reflect this if the home is to maintain and build on the good progress made to date, particularly as service user numbers increase. A new oven has been fitted and consultation with the cook confirmed this and other equipment within the kitchen was working satisfactorily, the cook is responsible for the ordering of food and is satisfied with the quality of goods ordered on a weekly basis, the cook was clear about the rotation of food to ensure foods did not run out of date. All food is freshly cooked. Menus viewed were varied and wholesome, however, feedback indicated that although menus are frequently reviewed to provide variety, some dishes are not favoured by service users but appear again on the menu, clearly user preferences must be taken account of in the production of menus and this is a recommendation. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 16 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) 18 The Home has taken steps to ensure the implementation of good practice protects service users from financial abuse, and has identified where further improvements can be made to improve staff awareness and protect service users from harm. EVIDENCE: The home have implemented measures in respect of outstanding recommendations to ensure that service users money and possessions are appropriately recorded and receipted at all times. Staff have received some training in the management of aggression in relation to service users through dementia training, however, the home management feel that the appropriate management of aggression was inadequately addressed within general dementia training and that the staff team need additional and specific training to ensure they have a consistent strategy in place which is in line with best practice. As a consequence they are currently investigating training courses that are in keeping with the homes ethos of using non physical interventions to diffuse potentially aggressive situations. It is a recommendation that the home pursue this training for staff particularly in view of the increasing number of service users some of whom may have behaviour that challenges staff. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 17 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 & 26 The Home provides a comfortable and pleasant environment for service users to live in which is maintained to a good standard of repair and cleanliness, Some service users may experience a reduced quality of support from carers due to inappropriate call bell arrangements. EVIDENCE: The Home is maintained to a good standard with bedrooms offering attractive personalised accommodation and communal spaces providing a homely and comfortable environment, service users have the use of a lounge and conservatory, and a separate dining room, that are situated to the front of the building and receive a great deal of sunlight, a further quiet lounge is available, but service users appear to prefer the brighter communal spaces than the quiet area, which is sometimes used by visitors. Concern was expressed that in two cases call bells had been replaced by pressure mats and service users had to get up and go to the wall point to gain staff attention in their bedrooms, the call point being unable to cope with a pressure mat and a call bell lead (the appropriate use of pressure mats has already been addressed at standard 7). One service user indicated they had been trying to get staff attention for some time that morning, another service Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 18 user’s call bell was not within reach whilst they were in their bedroom during the day, although they confirmed that they are given the call bell at night when they are in bed, and they are able to mobilise themselves in their wheelchair during the day. Call bells were in evidence in other bedrooms and service users confirmed they use them if they need attention, and that staff are responsive. Whilst the inspection did not indicate any intent on the part of staff to deprive particular service users access to bells, The Home will need to review current arrangements to ensure that the use of the call bell system for other things does not deprive service users of the ability to gain staff attention when needed and this is a recommendation on this occasion and will continue to be monitored for improvement. A repairs and maintenance book is in use and staff are recording repairs needed, timescales for achieving minor repairs appear satisfactory. The Home environment continues to maintained to a good standard of cleanliness and cleaning schedules are in place, including a schedule for the cleansing of showerheads for prevention of Legionella. Domestic staff were observed undertaking domestic duties during the course of the visit. The laundry area was viewed on a tour of the premises and the laundress confirmed that the over use of red bags for all clothing had been clarified with staff and this was now limited to soiled laundry only. With the change in category of service user there had already been an increase in the amount of incontinent laundry and consequently an increase in service user numbers will mean the current laundry provision will be inadequate, this is an area that is already under discussion within the home and it is therefore a recommendation at this stage that the laundry provision is reviewed and additional equipment provided to cope with increased soiled laundry. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 19 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 & 29, 30 The quality of support offered to this vulnerable service user group may be compromised by a failure to ensure that realistic staffing levels match increasing numbers and dependencies of service users. Good progress has been made by the home to implement measures for the improvement of the staff recruitment process and the protection this affords to service users as a consequence. A programme of training is in place to ensure service users are supported appropriately by trained staff. EVIDENCE: An immediate requirement issued at the last inspection for an increase in staffing levels was addressed, however, the increase in numbers of service users and their dependencies is placing a strain on the current staffing levels and is impacting on their capacity to address all personal hygiene tasks for service users, the improvement in the stimulation and activity of service users has also been influenced strongly by the availability of staff, this will be severely compromised by increases in service user numbers without this being appropriately reflected in additional staffing hours. Discussion with staff and service users indicated that there are some difficulties around peak times of the day, usually mornings between 8 –10 a.m. and evenings between 5-8pm, when staff are particularly pressed to attend to personal hygiene routines of service users, and this was evident in the observation of one service user and a review of documentation recording personal hygiene tasks undertaken, four of the present user group have a need for two carers with their personal care routines. It is a requirement that the home review the current staffing levels to Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 20 alleviate current pressures around the identified peak times, and that staffing levels are kept under constant review to ensure that the home can appropriately support service users with dementia many of whom have high dependency needs. The Home has made significant progress in addressing a previous requirement to improve its recruitment procedure, new staff files were viewed, and evidence of POVA, CRB disclosure requests, references and appropriate application and interview processes were noted. Files viewed contained evidence of ID, although several still need current photos, and the home manager is taking steps to address this. It is a recommendation that staff files are reviewed to ensure all documentation in line with schedule 2 of the Care Homes Regulations is in place, and omissions are addressed. An ongoing programme of training is in place, to ensure staff have achieved mandatory and NVQ training, in addition to more specialised courses. A number of staff are still to achieve all their mandatory core skills training, although the home were able to evidence training is being booked on a rolling programme. The home is supportive of staff participating in NVQ training and the home is on track to achieve a 50 trained staff target by the end of 2005. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 21 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) 32, 33, 35, 36, 38 Service users benefit from improvements to the management structure and improved staff dynamics and leadership. Some progress has been made in seeking the views of service users and their representatives and improving consultation, but need to evidence how feedback is influential in the development of the service. The Home has implemented systems to ensure service users financial interests are protected. Service users care and support may be compromised by a failure to evidence adequate formal supervision of staff. In seeking to promote the health, safety and welfare of service users the home must actively risk assess in response to changes in the environment. EVIDENCE: The manager has been influential in introducing an improved atmosphere to the home, service users and staff appeared relaxed and happy. Staff spoken with felt that the manager was supportive and felt there had been a general improvement in the staff dynamics, and that they worked more as a team. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 22 The home has made some progress in addressing an outstanding recommendation for improved consultation, with users and other stakeholders. The manager has held a relatives meeting and used this as an opportunity for relatives to review their family members care plan, in addition to addressing any issues or concerns. A newsletter has also been developed. Two day staff meetings have been held and one for night carers. Although the home has made some progress in developing consultation with stakeholders, it is unable to evidence at this time how such consultation influences the development of the service and improves the service quality. Staff confirmed that informal competency monitoring of some tasks such as medication administration are happening, but no records of this or outcomes are maintained, the development of a room monitoring audit in response to some internally identified poor practice issues has been undertaken, the home is still to develop a consistent programme of internal audit to inform service improvement, and to publish a report of the outcomes of consultation and user feedback and this is a recommendation. The home has advised that service users’ savings are managed solely by their representatives including family and solicitors. The home is aware of five service users who are subject to power of attorney, personal allowance money is retained on users behalf by the home, and a balance of each is maintained. The balances of three service users personal allowance monies were checked randomly and found to be accurate and in keeping with the records in place. A receipt book is in use. Possessions are recorded in the possessions book, small items of jewellery handed over for safe keeping are recorded in care plans, and representatives are asked to sign for their return. The home has made slow progress in the implementation of regular formal supervision for staff, although there was evidence that the majority of staff had now received at least one session, and in order to try to ensure frequencies of supervision are maintained the home manager now shares the responsibility for undertaking sessions with the deputy manager and a senior night carer. Lack of formal supervision opportunities for staff if not maintained could place the care and support of service users at risk, if the assessment and performance of staff is not routinely monitored. Progress on addressing an outstanding recommendation was assessed on this visit. The Home has implemented additional fire safety measures in compliance with the fire officer and these works are still underway, the home is also installing stair gates to both staircases. This has been discussed with the fire officer but an updated fire risk assessment must reflect these changes and be forwarded to the fire service for comment, this remains an outstanding recommendation. The fire book indicated that fire alarm and equipments tests and checks are being undertaken in keeping with expected frequencies. Staff Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 23 fire drills are happening and it is recommended that the home ensures that all staff including night staff participate in fire drills a minimum of twice annually. During the visit there was evidence of works being carried out by a workman and staff were vigilant in ensuring that doors were closed to protect service users, however, it was noted that tools were strewn across a large area of an upstairs hallway, where the works were being carried out and posed a hazard to service users some of whom were still upstairs, on pointing this out this was cleared away immediately, and further works will be carried on external to the building or in a more controlled manner, it is the responsibility of the home manager and staff to ensure that maintenance and repair work is carried out in a manner least likely to cause distress or harm to service users and in keeping with the homes own very detailed policy and that appropriate risk assessments are in place for each activity and not a general risk assessment, and this is a recommendation, on this occasion. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 24 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 2 3 x x N/A 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 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 2 2 x 3 2 x 3 Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 25 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 7 Regulation 15 Requirement 1)Home to evidence that consultation with users and representatives in respect of care plans is routinely undertaken and care plans are endorsed by them(previous timescale not met). 2)Improved detail and thought to be given to the content of risk assessments with care plans. 3)Restrictions put in place by the home in respect of behaviour management must be clearly detailed within an individuals behaviour management programme, must form part of the care plan and must be consulted about with other stakeholders who must endorse the management strategy. 1)Signed consents to medication must be in place for service users who lack capacity to do so for themselves themselves. 2)Individual user guidelines for the use of PRN medication must be in place on each user file.3)Changes to prescribed dosages or medication regimes ordered by GPs must be documented with clear review Timescale for action 31.12.05 2. 9 13(2) 31.12.05 Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 26 3. 27 18 dates, where possible GPs should endorse changes even where temporary. Home to undertake a review of staffing levels and initiate an increase around peak times of the day to ensure service users receive a good level of support and stimulation, levels to be reviewed constantly to reflect increasing numbers and dependencies of users 30.11.05 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 3 9 Good Practice Recommendations All service user contracts/terms and conditions are to be routinely signed by service users representatives where the service user lacks capacity. The procedure for handling spoiled medications as opposed to general disposal needs to be clearly specified in medication procedure, photos to be added to MDS sytem. Medication spoons to be used only once per service user on each medication round and all spoons to be washed after each round, Liquid medications to be dated upon opening and to be included in daily audits of administration. as required medication to be included in daily administration audits. Expressed user preferences to be incorporated in the development of menus Staff to receive specific training in the management of aggression with specific reference to service users with dementia. Use of call bell system to be reviewed Laundry provision to be reviewed with a view to future workload and increased soiled laundry Home to review staff files to ensure all documentation is in line with schedule 2 of the Care Homes regulations 2001 and to address any omissions. Quality assurance system to be developed further, to implement internal audit systems and draw those already in place into a quality assurance policy and procedure. H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 27 3. 4. 5. 6. 7. 8. 15 18 19 26 29 33 Brambling Lodge 9. 10. 36 38 Home to publish a report on the outcome of feedback from service users and other stakeholders. Home to maintain frequencies of formal staff supervision Manager to review fire risk assessment in respect of installation of magnetic door closures, and the installation of stair gates. Manager to ensure risk assessments are in place for contractors and maintenance staff undertaking repairs, upgrading and routine maintenance works. Brambling Lodge H56-H05 S42604 Brambling Lodge V243650 200905 Stage 4.doc Version 1.40 Page 28 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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