Inspection on 28/11/08 for Brambling Lodge

This inspection was carried out on 28th November 2008.

CSCI found this care home to be providing an Good service.

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 18/12/06

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brambling Lodge 48 Eythorne Road Shepherdswell Dover Kent CT15 7PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Penny McMullan     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Brambling Lodge 48 Eythorne Road Shepherdswell Dover Kent CT15 7PG 01304830775 01304832791 blodge@1stchoicecarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Elizabeth Abrey Type of registration: Number of places registered: Mr Kanagaratnam Rajaseelan,Mr Kanagaratnam Rajamenon care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 26 Over 65 27 0 Brief description of the care home 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 £383 to £420.00 per week. There are additional charges for chiropidy, hairdressing, aromotherapy, newspapers, magazines and toiletries. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information in this report includes feedback from people who use the service, information gained from postal surveys sent to relatives, Social and Health Care Professionals and staff. The site visit includes, inspection of records, discussions with the Registered Manager, staff and various observations. The last inspection on this service was completed on 18th December 2006. The home also returned the Annual Quality Assurance Assessment (AQAA), which provides information to inform the inspection process. This did not contain all of the information required and there were also gaps in the information of what the home could do better. Improvements are therefore required when submitting the next AQQA. Care Homes for Older People Page 6 of 26 The home now has planning permission to extend the premises to provide additional bedrooms and communal space. At the time of this site visit the home does not have a date when this work will begin. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that residents receive a care needs assessment prior to moving into the home. Standard 6 is not applicable to this home. Evidence: The Registered Manager or Deputy Manager carry out a care needs assessment for each resident prior to coming to live in the home. Records viewed contained detailed information, which forms part of the care plan. However, further detail is required with regard to religion and personal preferences to ensure equality and diversity is recorded. This information is recorded in the care plans but needs to be included on the assessment form so the home is sure that it can meet individual preferences before the resident agrees to move into the home. A recommendation will be made in this report. Relatives or representatives, together with the resident are fully involved Care Homes for Older People Page 11 of 26 Evidence: in the process and sign to agree with the assessment. Joint assessments/care plans from the placing authority are also included in individual files. The Registered Manager states that the assessment form is currently being reviewed and will be amended to include the relevant information. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place to ensure that residents needs are met, however, risk assessments require further development to ensure that a safe practice of work is in place to protect residents and staff. The management and administration of medication ensures that service users health care needs are met and privacy and dignity is upheld. Evidence: A new care planning system is in the process of being introduced. This includes all aspects of health and social care and it is anticipated that each resident will have a new care plan format in place by April 2009. Not all of the care plans had been fully completed with the individuals life history. In some care plans the word assistance is used to describe the care to be given, further detail is required to clarify just what this means to the individual. The moving and handling risk assessments detailed dependency but lack information of specific manoeuvres to provide staff with clear written guidelines of how to move the person. The home needs to ensure that this is Care Homes for Older People Page 13 of 26 Evidence: recorded to ensure that residents and staff are safe when carrying out moving and handling tasks. The Registered Manager acknowledges the shortfalls in this area, therefore a requirement will not be made at this time, however a recommendation will be issued as a point of good practice. The plans are reviewed on a regular basis and there is evidence of relative and resident participation. Carers were seen throughout the day updating care plans and completing daily records. All health care needs are monitored through the care plan and there is clear evidence that the home is proactive in contacting the required agencies to ensure health care needs are met. The management of the medication is good and staff administering medication have been appropriately trained. The Medication Policy has been reviewed and there are clear individual guidelines in place for the use of as and when required medication. These include information as to how individual residents may present pain. Each resident has a chart to record the administration of creams and any changes in medication are clearly highlighted to enhance staff awareness. To ensure that residents receive their medication on time the home has purchased an additional trolley so that two staff can complete the medication round at the same time. The home has a medication room with appropriate storage for all medication needs, including cold storage. The Registered Manager and Deputy carry out spot checks and audit the medication administration sheets. Staff were observed talking to residents in a friendly supportive manner, offering choices of what they wanted to do. Care plans reflect residents preferences and detailed information as to how they can be supported whilst respecting their wishes. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provide an excellent programme of stimulating activities for service users that take account of their preferences. Visitors are welcomed in the home and residents rights and choices are promoted. The meals in this home are good, offering both choice and variety. Evidence: A full activity programme is provided for the residents, these includes a regular visit from a musician, church services, aromatherapy, reflexology, excersise, barbeques and themed parties such as halloween. Relatives are always invited and support is also given to residents who may wish to access the computer to send or receive emails. Residents are currently making personalised calendars for their family and are in the process of making Christmas wreaths. Recently several residents went to Folkestone to enjoy a visit to a pub and have a meal. In the future the home hopes to provide a greenhouse to encourage the residents to grow their own vegetables. The activity programme also includes skittles, quizzes and painting. Some of the residents pictures Care Homes for Older People Page 15 of 26 Evidence: are displayed in the corridor. There is an activity programme on display in the hallway. One resident is supported to dust while another enjoys helping with the laundry. The activities co-ordinator ensures that all residents have the opportunity to join in with the activities and if required will hold one to one to one sessions as well as group activities. Newsletters are also forwarded to relatives. Residents confirm their relatives visit and they choose where to see them. From observation at the time of the inspection all visitors were made welcome and offered refreshments. Some were able to go to the quite room or see their relative in their own room. The home does not take an appointee role with regard to any residents finances and, where an individual is not able to, someone independent of the service, such as a relative or solicitor, takes this role. Advocacy services are available and this information forms part of the assessment process and is agreed prior to admission to the home. The home support residents with their finances and has recording systems in place, together with the safe keeping of valuables. Residents were observed having access to the home and walking through the corridor between their rooms and communal areas. To ensure their preferences are upheld their wishes on getting up and retiring are recorded clearly in the care plans. Likes and dislikes are also recorded to ensure that staff have clear information to support each person. The meal serviced on the day of the site visit looked appetising, choices were available both for the main course and dessert. There were a variety of drinks available and residents were being assisted sensitively to eat their meals. Nutrition is fully assessed and recorded in the care plan and records are kept of choices and to what extent the resident has eaten their meal. Three residents said the meal was good and they enjoyed the fish pie. Each resident is asked what they would like to eat each day and if required pictures are available to help them choose. There are four weekly menus in place to ensure that residents receive a healthy diet and kitchen records are in good order. Individual dietary needs and special diets are identified in the care plan. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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. All concerns, no matter how minor, are recorded and actioned. Staff were able to demonstrate their understanding of when service users may not be happy through their behaviour or mood during the day. One resident says she does not have any complaints. There is information on the front desk, and on display, with regard to how to complain and a complaints suggestion box. Adult protection policies and procedures are in place and staff demonstrated their awareness of the procedures. All staff have received safeguarding training. 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 and robust recruitment practices ensure that residents are receiving care from appropriately vetted staff. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and pleasant environment 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: There is planned maintnenace programme in place and since the last inspection the home continues with the ongoing redecoration of the bedrooms. Carpets and bedroom furniture have been replaced where needed and the carpet in the hallway has been renewed. A new non slip flooring has been laid in the small lounge as clients were slipping on the old carpet. Worktops in the kitchen have been replaced with stainless steel. A new gas boiler has been fitted and taps in some rooms have been fitted that turn themselves off. A new hoist has been provided for the upstairs bathroom and new towels have been purchased. During the summer a new garden shed and furniture was provided and there is also cover out in the garden for residents that smoke. New conservatory blinds were also installed. The laundry room has been redecorated and new trolleys have been purchased to assist carers when they take the laundry round the home. The laundry room was in good order and all staff have received infection control training. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient staff on duty to meet the resisents needs and 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: The home is now fully staffed, however at the time of the inspection there was a member of staff on sick leave. The home ensured that care needs were being met as the activities co-ordinator was providing direct care. The Registered Manager was also assisting. Staff feedback indicates that on the whole there is sufficient staff on duty and it is only in times of sickness that they are short. The home is not fully occupied and therefore there was four care staff on duty throughout the day, two waking night staff, a cook, kitchen assistant and domestic staff. Additional flexi staff cover in busy periods, sickness and annual leave. Staffing levels should be reviewed when the home is fully occupied to ensure that care needs are met. The home needs to ensure that full names are recorded on the staff rota. Three staff files were looked at and all had the appropriate documentation in place. This included two written satisfactory references and proof of identify. The Protection Care Homes for Older People Page 20 of 26 Evidence: of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) checks have also been carried out. This ensures that residents are receiving care from staff who have been checked to provide care services. There are ten members of staff who have achieved National Vocational Qualified (NVQ) 2 or above, this is over the required 50 . There is an ongoing NVQ programme for all staff to access. The home has a training matrix, which indicates that all staff have received mandatory training. There is a traffic light system to ensure that updates in training and the provision of certificates are up to date. All staff have received dementia training and some specialist training, for example diabetes training is being provided. There is evidence of induction training on file, which includes competency tests. There is an ongoing training programme in place and copies of the training certificates are on individual staff files. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a home, which is run in their best interests, however improvements are required in the recording of the formal quality assurance programme. Resdients monies are protected by the financial systems in place. The home provides a safe environment for service users and staff. Evidence: The Registered Manager, Elizabeth Abrey, has completed the NVQ 4 in Health and Social Care with the Registered Managers Award and gained extensive knowledge and experience during her 20 year career in the private health care sector. The Deputy Manager is also has extensive experience and is trained to NVQ Level 4. The Quality Assurance questionnaire is in the process of being sent to relatives, and other stakeholders, including health care professionals. The home is developing the programme to include the analysis and action taken. There are lots of informal quality Care Homes for Older People Page 22 of 26 Evidence: assurance processes, which are not formalised in writing. For example, all aspects of the service are discussed with relatives when the home holds social events, such as the barbeques, parties and social gatherings. The home works with the relatives closely to ensure residents needs and wishes are met. This is evident by the concerns recorded in the complaints book, as every minor issue is recorded and actioned. A newsletter is sent to relatives and residents advising them of events and general news relating to the home and staff. It is the homes intention to provide additional information in the next newsletter with regard to the results of the current quality assurance questionnaire. There was a requirement to improve the quality assurance programme in the previous inspection. Although the home has developed the programme, further recording of all discussions and any action taken to improve the home needs to be evidence. This will show that the home has made changes to the service as a result of listening to the residents, relatives and other stakeholders. As the final report and analysis was not available at the time of the site visit a recommendation will be made to ensure that this is completed and available for everyone concerned. When residents move into the home it is agreed who will support them with their finances. This is usually a relative, representative and in some cases a solicitor. Advocacy services are also available. The home has a robust financial accounting system in place, which is audited on a regular basis. Receipts for all transactions are on file and copies of the accounts are sent to relatives, representatives when required. The home is providing the staff with mandatory and induction training. 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. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To ensure that religion and personal preferences are recorded on the care needs assessment form to ensure equality and diversity needs are identified prior to the person moving into the home. To ensure that all care plans have a full life history completed, clarify what assistance means to the individual and risk assessments are completed to included clear guidelines of how to move each resident. The home needs to ensure that the quality assurance programme is further developed to evidence that the residents, relatives, representatives and stakeholders are advised of the outcome of the programme and what changes have been made as a result of listening to the people. 2 7 3 33 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!