Inspection on 09/05/05 for Brambling Lodge

This inspection was carried out on 9th May 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 20/09/05

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 Unannounced 09/05/05 at 10:00am 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 V223652 090505 Stage 4.doc Version 1.20 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 Mr Kanagaratnam Rajamenon Mrs Elizabeth Abrey CRH 26 Category(ies) of DE (E) 23 OP 3 registration, with number of places Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Three people who are categorised OP and whose dates of birth are:- Date of last inspection 15th November 2004 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. 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 V223652 090505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken over a six hour period. The inspection focused on progress made by the home on a number of outstanding requirements and regulations, a reduced number of key standards were also assessed in respect of the current service offered. During the visit a tour of the premises was undertaken, and some documentation assessed. Discussions took place with 10 of the present resident group, a visitor, staff on duty and the manager. What the service does well: What has improved since the last inspection? What they could do better: The Home need to ensure that their recruitment procedure is sufficiently robust and compliant with current legislation at all times, and that resident safety is not compromised by inadequate checks on staff. An immediate Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 6 requirement was issued at this visit in respect of deficiencies within the home’s recruitment procedures. The Home need to improve planning around staff holiday and sickness cover and ensure staffing levels are maintained at all times sufficient to meet the needs of the number and dependencies of the resident group. The home needs to ensure that staffing is sufficiently flexible to cope with increasing resident numbers without compromising resident care and safety. An immediate requirement was issued at this visit in respect of shortfalls within the staffing levels. The Home are developing an activity programme but this has been slow to develop and is still inadequate for the specialist needs of this resident group who require more individualised stimulation. Please contact the provider for advice of actions taken in response to this inspection. The full 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 V223652 090505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, The Home is not routinely formalising terms and conditions arrangements on admission of new residents. The Home has made good progress in undertaking assessment of new residents prior to admission. The Home does not provide intermediate care. EVIDENCE: The Home is issuing terms and conditions statements within the service user guide information provided to prospective residents, however, of six newly admitted residents, files indicated that none had signed terms and conditions documentation in place, although two people had been in residence since February 2005. The manager confirmed that families were in receipt of this information but were still to return it, it is recommended that the Home review its current system to ensure that firmer timescales are introduced for the completion of this documentation and that all residents have agreed terms and conditions in place following confirmation of their placement or completion of trial stays and to ensure their rights are protected. The manager has made very good progress on the assessment of prospective residents, and confirmed that visits to prospective residents prior to admission is a routine feature of the Homes assessment process now. Files viewed of new Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 9 residents admitted provided evidence of the Homes assessment format and assessment dates were distinct from admission dates. The majority of residents have dementia and were unable to comment on the admission and assessment process of which they had no recollection, however, one newer resident who does not have dementia, spoke positively about the admission process, and discussions with the Home manager and the residents family in respect of the appropriateness of the home. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 The Home has made slow progress in developing and completing care plans and have not yet met an outstanding requirement. The Home are ensuring the health care needs of residents are met. The manager needs to ensure staff are fully familiar with aspects of the medication procedure EVIDENCE: The manager has worked hard to develop a very detailed and informative care plan for residents, however, files of new residents admitted indicated several care plans are still to be completed, in respect of basic daily routine information, necessary for staff to know in order to effect care in keeping with resident preferences. The facility does still not exist in care plans for residents or their representatives to sign agreement to the plan. The outstanding requirement has, therefore, only been partially met. In discussion with the manager it was apparent that the need to provide hands on support within the staffing rota is compromising her ability to update and maintain documentation appropriately. An initial desire to ensure the consistency of quality within care plans, and other staffing constraints mean that it is not possible for this to be a delegated function at this time, although consideration should be given to this in future. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 11 Resident files viewed provided evidence of skin integrity and nutritional assessments being undertaken, the frequency of weighing of residents is not consistent and needs reviewing, the home should also consider the weighing of new residents upon admission and these are recommendations. Files indicated hospital and routine health screening appointments are happening and two residents and a visitor confirmed access to appointments. One resident indicated that communication could be improved at times in respect of the outcomes of routine appointments and the receipt of glasses or teeth as a result but otherwise felt satisfied that they received access to optician and dental services on a regular basis, both residents spoke about recent health issues and access to health professionals as a consequence. The medication standard was not fully assessed, however, observation of a medication round highlighted a need for administering staff to be fully familiar with the Homes own medication procedure, with particular regard to the handling of spoiled medication, although this was dealt with responsibly during the medication round it was not in keeping with home procedure, and there is a danger that spoiled medication could be inappropriately stored. The inspection also highlighted the presence of homely remedy medication in a resident bedroom who is not self medicating, this has been brought in by a relative and clearly the manager will need to discuss with the resident and their family this arrangement and liaise with the GP to ensure this medication will not impact on prescribed medication. The manager and staff must ensure that all approved homely remedies are clearly indicated on resident files and raise with relatives the issue of bringing in covert medication to the home and this is a recommendation. Where medication arrangements and consents are not clearly stated within the care plan, consents must be obtained in respect of medication administration and this is a recommendation. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The Home has made slow progress in introducing a meaningful and stimulating activities programme for residents and are still to meet this requirement. The Home has an open and flexible visitors policy. The Home has implemented a previous recommendation to ensure advocacy information is available. Residents are generally satisfied with the quality, quantity and variety of food provided for them. EVIDENCE: The manager advised that a craft session is organised weekly, with a monthly aromatherapy session. The activities book indicated that the hairdresser and vicar visit also on a regular basis, however, there is little stimulation other than this. The majority of residents had little insight into whether they would want other activities, although it was observed that when offered one to one attention by staff with an activity e.g. colouring they enjoyed this. Staffing levels do not currently lend themselves to staff having sufficient time to provide this level of input. The manager is aware of the need to develop a stimulating programme of activities and is currently discussing with providers the recruitment of an activities organiser with specific reference to people with dementia. The provision of activities remains an outstanding requirement. Visitors were observed coming and going and some residents were able to discuss visiting arrangements, two service users and a visitor confirmed flexible visiting arrangements and that staff were welcoming and friendly. The Home has addressed a previous recommendation to make advocacy Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 13 information available by including this within service user guide information. Residents were observed moving freely around the home, and choosing where they wished to be, and what they wanted to do. Two residents have regular arrangements in place for going out, some residents choose to eat on their own others eat as a group in the dining area, routines are flexible and the atmosphere relaxed. Most residents spoken with were complimentary about the food provided in the home, although the home is currently coping without an oven whilst awaiting the fitting of a new one which is already in the home, interim menus have had to reflect this limitation, and the range that can currently be offered, only one resident indicated a less than satisfactory view of the current menu arrangements, but also stated that the Home provided `too much food’, this was a personal preference and other residents were observed as having very good appetites and no difficulties in eating their meals, during the meal residents with dementia spoke positively about it, but had little insight into an overall view of the menu, but were able to speak about personal food preferences, discussion with the cook indicated these are taken note of and alternatives provided where necessary. A menu was not available for residents to view although a new menu board for the residents is now on order. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, & 18 The Home are actively recording and addressing complaints made to them. The Home has made good progress in raising staff awareness in respect of adult protection, but still needs to fully address outstanding recommendations. EVIDENCE: The complaints procedure is openly displayed. The Home has received two complaints since the last inspection and the complaints book provided evidence that these had been actively investigated and resolved. The Home has made good progress in ensuring that staff are made aware of adult protection issues and procedures and have received training. A staff member spoken with confirmed attendance on Adult protection training and was able to distinguish differences between whistle-blowing, confidentiality and adult protection procedures, a staff training matrix confirmed that the majority of staff had now undertaken adult protection training. The Home has introduced a book for the recording of personal possessions, and the manager indicated that a receipt had been given in respect of an item of value, held for safe keeping, this was discussed and agreed that this should feature as standard practice within the home and it is a recommendation that this is implemented. In response to a previous recommendation the home has reviewed its Whistle-blowing procedure to make minimal reference to the DOH guidance `NO secrets’. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,22,24,25 &26 The Home has made good progress in developing an attractive, clean and safe environment for residents, and has met an outstanding requirement in respect of infection control standards. The Home has also made very good progress in addressing outstanding recommendations in respect of standards 21, 22, 24,& 25 EVIDENCE: The Home is undertaking a programme of upgrading within the home, that involves the redecoration of communal areas and bedrooms. This has been undertaken sensitively and with reference to the needs and vulnerability of the residents. The rear garden has also been landscaped and residents spoken with spoke positively about using the garden and a desire to do some gardening e.g. potting plants and flowers; in discussion with the manager this is an area she is hoping to develop for residents and will be looking at ways to take this forward. Locks are still to be fitted to garden gates and are due to be fitted shortly, within the maintenance programme. Progress made by the home on outstanding recommendations in respect of standards 21, 22, 24 and 25 Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 16 were assessed during this visit and have all’ been satisfactorily addressed by the Home manager. An outstanding requirement in respect of standard 26 has also now been addressed. The Home environment is maintained to a good standard of cleanliness, no unpleasant odours were detected on the visit. Discussion with staff around the management of laundry highlighted some confusion about the use of red bags, which staff were observed using for all laundry whether soiled or not, this was discussed with the manager and it was recommended laundry arrangements are clarified with care and laundry staff to ensure consistency, the main washing machine was being repaired at the time of the visit, although a back up machine was available for use, as an interim measure. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, The Home have failed to ensure that adequate staffing levels are maintained in respect of the dependency and number of residents, and in ensuring a robust recruitment procedure is maintained for their protection and safety. The Home has invested heavily in the training of staff and has made good progress in ensuring a broad range of mandatory, specialist and NVQ training is available to staff. EVIDENCE: The visit highlighted slippage in the maintenance of appropriate staffing levels for the number and dependency of Dementia residents, this was particularly disappointing as assurances that higher staffing levels would be maintained were an important factor in agreeing to the change of category for the home from OP (E) to DE (E). There is an over reliance on the managers availability to provide on hands support which is unrealistic given her commitments to assessments, meetings, work pattern etc. Two residents require 2:1 support and this was observed in one case to take a long time, the manager was elsewhere in the building seeing visitors, workmen etc. and it was necessary to call for back up from the next door home, this is an impractical and unacceptable staffing arrangement, and allows no flexibility or facility within the staffing levels to facilitate activities with residents, accompany residents to hospital if required, provide flexible support as and when required, or to take on additional residents if need be. An immediate requirement has been issued in respect of staffing levels. Three new staff have been employed since the last inspection, although the home have undertaken CRB checks and are Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 18 awaiting outcomes of these, POVA first checks had not been made on two at all and only on a third post employment, this is in breach of legislation and the home has only partially addressed an outstanding requirement. New staff files also highlighted inadequate references and a lack of required information in compliance with Schedule 2 of the care Homes regulations (2001). An immediate requirement has been issued in respect of the recruitment procedure, and an outstanding requirement remains unmet. Staff spoken with confirmed that an intense programme of training has been ongoing in the Home, they were positive about the outcomes of the training but felt that its intensity had taken away some of the opportunities to reflect on what they had learned before going onto the next course. A staff training matrix indicates that eights care staff have achieved or are currently undertaking training for NVQ2 and above, meaning that the home is on target to achieve more than 50 trained staff by the year end. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,36,38 The new manager’s approach has improved staff dynamics and morale and improved the atmosphere within the home. Some initial progress on developing systems for engaging and communicating with stakeholders, has been made. The Home has made limited progress in developing a formal programme of staff supervision. Outstanding recommendations in respect of health & safety have been addressed, and progress made in providing a safe and secure environment for residents, including increased staff awareness of health & safety issues. EVIDENCE: Staff spoken with found the new managers approach open, staff felt that morale had improved and were relaxed and confident in speaking about aspects of their work practice. Staff confirmed a staff meeting had been held with the new manager, but were unclear of the frequency of meetings, a staff member spoken with was positive about the benefits of staff meetings in allowing staff an opportunity to discuss issues. Further discussion with the manager confirmed that meetings would be more regular, once much of the training commitments were out of the way. Relatives and residents meetings Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 20 have not been held regularly, and the manager will need to decide whether future meetings should jointly involve residents and their relatives, a newsletter has been produced and this has been made available to residents and relatives, further letters are planned. It is a recommendation that the home initiate strategies for consultation with staff, relatives and residents, in respect of service development. Staff spoken with including the manager confirmed regular formal supervisions are not routinely happening for all staff, although the manager has indicated that she has now commenced the process with some. It is a recommendation that formal supervision sessions are made available for all care staff and that formal supervision is provided for the manager. Two outstanding recommendations in respect of standard 38 have been addressed, documentation viewed indicated staff are actively identifying health & safety issues, actively reporting faults, fault repair is being undertaken in reasonable timescales and is having minimal impact on residents, however, where this involves an outside contractor, delays are extended and the home have been successful in minimising the effects on residents to date. A fire training session was taking place for staff at the time of the inspection, this was undertaken sensitively and in a manner which would cause least distress and disturbance to residents. A recent visit by the fire safety officer indicated a failure by the home to address an outstanding issue in respect of magnetic door closures, this has now been addressed, but it is recommended that the manager review the fire risk assessment as a result of these changes, and the proposed installation of stair gates, following further consultation with the fire officer. The accident book was reviewed and indicated that 21 accidents had occurred since the last inspection, none requiring A & E hospital admission, it was noted that 9 of these accidents related to one individual who is no longer at the Home, therefore a relatively low level of accidents are occurring amongst the general resident population. Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 x x 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 2 x x x 2 x 3 Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement Care plans to provide accurate, up to date and detailed information regarding residents, their routines and preferences. Risk assessments are to link to care plans, service users or their representatives are to agree and sign plans (prevous timescale partially met) Develop an activities programme for residents to provide stimulation, recreation and fitness, that is appropriate to the capacities and preferences of the resident group( previous timescale partially met) Staffing levels to be reviewed and increased in keeping with the number and dependencies of the resident group. CRBs of existing staff are processed by the Home as a matter of priority, and that reference to POVA is made in respect of new staff as part of recruitment procedure(previous timescale of 31.12.04 partially met) Timescale for action 1.6.05 2. 12 16(20(n) 1.6.05 3. 29 19 immediate 4. 29 19 immediate Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 9 7 8 9 Good Practice Recommendations Home to ensure that terms and conditions documents are in place for all residents following confirmation of placement or completion of trial stay. The manager should consider the completion of care plans becoming a delegated function amongst other members of the staff team. Home to review the frequency of resident weighing, and to consider the weighing of residents upon initial entry to the Home Home to ensure that administering staff are fully familiar with the Homes medication procedure, particularly in the management of spoiled medication.Home manager to make clear to relatives the homes policy around the covert provision of homely remedies for those not self medicating, and to ensure that all homely remedies are cleared with respective GPs to ensure they do not impact on prescribed meds. Care plans must also contain medication consents for individual residents whether self administering or not, if this is not clearly stated within the care plan. Manager to ensure receipts are routinely issued for valuables accepted for safe keeping on behalf of residents, and that these are also recorded in the possessions book. Home manager to clarify with care, and domestic staff the laundry arrangements for the management of soiled laundry and non soiled laundry. Home to explore possibility of main clinical waste bin having a lock staff, residents and relatives to be kept informed through meetings, newsletters etc of changes in staff, management etc that have occurred and of future plans and developments. Formal recorded supervision sessions to be provided to manager and care staff a minimum of six times annually. Manager to review fire risk assessment in respect of installation of magnetic door closures, open bedroom doors, and installtion of stair gates. 5. 6. 18 26 7. 32 8. 9. 36 38 Brambling Lodge H56-H05 S42604 Brambling Lodge V223652 090505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 11th Floor, International House, Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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