CARE HOMES FOR OLDER PEOPLE
Bramblings Residential Home Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE Lead Inspector
Jo Griffiths Unannounced Inspection 11th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Bramblings Residential Home Address Bramblings Residential Home Hartley Road Longfield Kent DA3 7PE 01474 702332 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bramblings (Kent) Limited Mrs Bernadette Ramsey Care Home 26 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (25) of places Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Care for an older person with learning disabilities is restricted to 1 person whose d.o.b is 20/04/1931. 26th July 2005 Date of last inspection Brief Description of the Service: Bramblings provides residential care to older people in a large detached house in Longfield, Kent. There is currently accommodation for 26 people including 2 large lounges and a dining room. There are 2 assisted bathrooms and sufficient toilets around the home. A large building project is underway to provide more bedrooms and ensuite bathroom facilities. This is a phased project and will include upgrading areas of the existing building. The home is near to a train station and local shops and amenities. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out by Jo Griffiths on 11th November 2005 between 1pm and 5pm. A senior member of staff assisted with the inspection and the views of a number of residents were sought. Some records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 7 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, Residents have their needs fully assessed. They know that the home will be able to meet their needs before they move in. They have their needs reviewed regularly to ensure they can still be met. EVIDENCE: The manager of the home carries out assessments of residents’ needs before a place is offered to ensure that these needs can be met. This assessment covers all areas of social, physical and emotional needs. The key worker and the senior staff review residents’ needs regularly. Most residents spoken with said that they feel their needs are being well met by the home. Where residents needs can no longer be met by the home the resident is supported by the home and care manager to find a new home that can better meet their needs. Staff demonstrated their understanding of the need to manage this sensitively. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 8 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Residents have a plan of care that meets their needs. Their health needs are identified and planned for and they receive good healthcare support. Residents feel they are treated with respect and that their privacy is maintained. EVIDENCE: Residents’ care plans show that their needs have been appropriately identified and planned for. The care plans have been regularly reviewed and updated when needs have changed. Not all residents have signed to agree their care plans. The care plans also show regular input from various health professionals and arrangements have been made for one resident who wanted to be able to book their own appointments. Residents said that their health needs are well looked after and that they can talk to any staff if they feel they have a problem they are worried about. Residents can see their GP at the surgery or can receive visits at home. All the residents spoken with said that the staff are polite and respectful. This was also so seen in the interactions between staff and residents. Residents have the use of a cordless telephone for use in private and can choose to have a lock on their bedroom door if they so wish.
Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 9 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Residents are satisfied with the activities available. They enjoy a balanced diet but would benefit from clearer communication of what is available for each day. EVIDENCE: Senior staff reported that a residents meeting had been held recently to discuss the activities available. The minutes of this meeting were not available but it was stated that the residents did not want a structured programme of activities. The residents spoken with confirmed that they were happy with the activities available and that they often preferred to stay in their rooms to watch television. There were notices on the residents’ notice board informing them of planned activities for Christmas and the church services are now held weekly in response to residents’ requests. Staff are keeping better records of the activities in the home. Residents said that they enjoyed the meals. Some residents did not know what was for tea that evening, it is recommended that the choices be clearly communicated to residents each day and the choices available for breakfast be displayed on the notice board. Following a meeting with residents the menu has been reviewed by the Manager to include residents’ preferences. Records of what residents actually eat, if it differs from the menu, should also be kept.
Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 10 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected from abuse, but would benefit further from staff receiving training in protecting vulnerable adults. EVIDENCE: Staff have not completed any training in the Protection of Vulnerable Adults, but cover the whistle blowing policy as part of their induction. CRB disclosure numbers could not be accessed today, as the Manager was not on duty. These were checked last time and found to be in order. There have been no incidents of alleged adult abuse and staff were able to describe the whistle blowing procedures. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 11 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25, 26 Residents live in a safe, clean and comfortable home and have access to plenty of private and communal space. Whilst residents have access to plenty of toilets they do not have sufficient baths that meet their mobility needs. EVIDENCE: Residents live in a home that is well maintained, clean and comfortable. The current building works have been well planned to reduce any risks to residents. Residents have access to plenty of communal areas, sufficient toilets and there are 2 assisted bathrooms. It is planned that the number of bathrooms will be increased with the building project. The home is warm and risk assessments have been completed to ensure that radiators are not too hot that they present a risk of scalding. However, in one bedroom there was some exposed pipe work at floor level that was very hot. This should be covered. The new laundry facilities ensure hygienic laundering of residents’ clothes and bedding. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 12 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Residents are supported by sufficient numbers of qualified and trained staff, but will benefit from arrangements for new staff to undertake core training. They are not consistently protected by safe recruitment procedures. EVIDENCE: Staff files were inspected and most contained the required information. However, the file for a newly employed carer only contained one reference and did not contain a photograph. The application form requires minor amendment to ask applicants to detail their full employment history rather the previous 10 years. They also need to sign a health declaration. Rotas evidenced that sufficient staff are employed to meet the needs of the residents. Residents spoken with said the staff respond quickly to the call bells and they feel there are enough staff to meet their needs most of the time. There have been some difficulties with one resident who requires more supervision at the moment and this is being reviewed with the care manager. Most of the staff have completed the training they need to do their jobs effectively and training should be arranged for new staff. The deputy manager was advised that staff should not be working at night without receiving fire safety training unless they are working alongside a carer who is trained. Over 80 of the care team have achieved their NVQ award, which exceeds the minimum standards. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 13 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 Residents’ health, safety and welfare are protected. EVIDENCE: Risks to residents have been assessed and actions taken to minimise them around the home. Most staff are trained in Health and Safety and safe working practices are in place. With the exception of the pipe work raised under standard 25 there are no identified risks to residents at this time. The certificates evidencing that gas and electrical equipment have been properly checked are now available in the home. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 14 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 3 3 X X X 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 15 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) Timescale for action The registered person shall make 31/01/06 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. In that, staff should undertake training in adult protection. 2 OP25 13(4a) The registered person shall ensure that all parts of the home to which service users have access are, so far as reasonably practicable, free from hazards to their safety. In that, hot pipes in bedrooms must be covered. 3 OP29 19 (1b) The registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in schedule 2. In that, 2 written references,
Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 16 Requirement 31/12/05 31/12/05 a photograph and a declaration of fitness to work must be obtained from the applicant. The applicant form should be reviewed to request the applicant’s full employment history. 4 OP30 18(1c)(i) 23(4d) The registered person shall, having regard to the size of the care home, the Statement of purpose and the number and needs of the service users, ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. In that, training for new staff should be arranged in areas of health and safety including fire safety. 31/01/05 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 Refer to Standard OP15 Good Practice Recommendations It is recommended that residents be informed of the meal choices available each day including breakfast and that a record of meals eaten by each resident, if different form the menu, is maintained. Bramblings Residential Home DS0000023910.V264150.R01.S.doc Version 5.0 Page 17 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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