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Inspection on 07/09/07 for Bramblings Residential Home

Also see our care home review for Bramblings Residential Home for more information

This inspection was carried out on 7th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People thinking about moving to Bramblings are invited to visit the home without saying when they are coming, instead of by making an appointment. This is very good idea, since it lets the person see exactly what the home is like and shows that the home manager is confident in the abilities of her staff team. The home is committed to staff training. Staff say that they are encouraged to gain new skills. The National Minimum Standards are that 50% of staff are trained to NVQ level 2. However, at Bramblings all staff are trained or are currently being trained to this level and some have gained level 4, which is the highest level. The home manager listens to her staff team and staff say that this makes them feel valued and helps them enjoy their jobs. Residents are relatives are positive about the contribution made by the care staff. "`carers...make a lot of effort to spend time individually with each resident"; "(I am ) impressed with the staff", " (I) can`t grumble".

What has improved since the last inspection?

The extension to the home, which will provide 26 additional ensuite bedrooms is now complete and is due to open shortly. Ample car parking space has been provided to the front of the building and CCTV installed. The home will benefit from a passenger lift so that clients can easily get to all floors of their home. A new call system has been installed. Some staff have completed training in dementia care and how to take a client`s blood pressure.

What the care home could do better:

There is a lack of activities to stimulate clients and this has been lacking for a long period of time. An activities organiser was employed, but they are currently unavailable due to sickness. The home manager says that a new person will be employed when the extension to the home opens. This will greatly benefit all clients. There has been slower progress than expected in updating care plans to the home`s new format. This takes into account clients health, personal and social care needs. This work started a year ago, at the last inspection. As noted in this report, one care plan that was looked at had some information missing and another had not been completed in the home`s new recommended format.

CARE HOMES FOR OLDER PEOPLE Bramblings Residential Home Bramblings Residential Home Bramblefield Close Hartley Road Longfield Kent DA3 7PE Lead Inspector Nicki Dawson Key Unannounced Inspection 10:00 7 September 2007 th 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.V348336.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramblings Residential Home Address Bramblings Residential Home Bramblefield Close 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.V348336.R01.S.doc Version 5.2 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. 9th August 2006 Date of last inspection Brief Description of the Service: Bramblings Residential Home provides accommodation and care for up to 22 older people. The registration is for up to 26 persons, but it is the policy of the home to provide single bedrooms and double rooms for couples who wish to share. This policy is in line with good care practices. The home has been extended and is due to open shortly. When fully open, the home will provide accommodation for up to 46 older people. The bedrooms in the extended part of the home are all en-suite. There are plans to redecorate and upgrade the original part of the home, which has only one bedroom that is en-suite. Clients’ bedrooms are situated on ground and first floors. A passenger lift has been installed and will shortly be in use. There are several areas where visitors are able to meet residents in private. Bramblings is situated in a quiet close, within walking distance of the village of Longfield. Public transport is available nearby. The home is surrounded by the gardens. There are car-parking facilities on site. Weekly fees are £303-£382. In some cases, the home levies a top-up charge of £20 per week that must be paid by service users. There are additional charges for chiropody (£7), hairdressing (£7-£23), newspapers and magazines ordered by service users, toiletries and personal phone costs. Prospective service users are able to obtain full information about services and facilities by asking for a copy of the home’s Service User’s Guide. New service users are given a copy of a personal contract that outlines the rights and responsibilities of both parties. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced, which means that the clients, staff and home manager did not know that the inspector was calling at the home. The inspection started at 10am and took 6 hours. Discussion took place with clients, staff and the home manager, to gain their views and knowledge of the level of care, provided by the service. The shared areas of the home and a number of clients’ bedrooms were entered. A number of records to do with resident’s care and safety were looked at. Survey questionnaires “Have Your Say About...” were sent by the CSCI to residents and relatives before the inspection visit. Comments made were mostly positive about the level of care provided at Bramblings. The people who live at Bramblings are referred to as ‘clients’ throughout this report since this is what the care staff team calls them. What the service does well: What has improved since the last inspection? The extension to the home, which will provide 26 additional ensuite bedrooms is now complete and is due to open shortly. Ample car parking space has been provided to the front of the building and CCTV installed. The home will benefit from a passenger lift so that clients can easily get to all floors of their home. A new call system has been installed. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 6 Some staff have completed training in dementia care and how to take a client’s blood pressure. 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. The summary of this inspection report can be made available in other formats on request. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Before new clients move into the home, their needs are assessed and they have enough information to decide whether it is the right home for them. EVIDENCE: The home manager has produced a ‘statement of purpose’ that sets out the aims, objectives and philosophy of the home, together with the services and facilities provided for residents. A copy of the ‘service user’s guide’ is to be given to new clients and placed in each client’s bedroom. This sets out for the people who live in the home, the services and facilities that they can expect if they move to the home. Clients commented that they received enough information about Bramblings before they moved in, to help them decide if it was the right place for them to live. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 9 Clients said that they have a written contract detailing the terms and conditions of their stay at the home. The home manager said that it is written in line with the recommendations made by the Office of Fair Trading. This is good practice. The home manager explained that before a new client moves into Bramblings, a senior member of the care team undertakes a full assessment of their needs. This is to make sure that the home can meet the prospective client’s needs. The home obtains and checks the validity of assessments carried out by other professionals. This is good practice. Clients and their families are encouraged to visit the home without making and appointment, before deciding whether to move into the home. The home manager believes that this gives people a true picture of what the home is like. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are being developed to ensure that they include all clients’ health, social and personal care needs. Staff support clients’ to access healthcare services. The home’s procedures for recording the administration of medication are being reviewed to make sure that safer practices are in place for the recording of changes in clients’ medications. EVIDENCE: The way that clients’ care plans are written is currently being changed, to make sure that they includes all the clients’ health, personal and social care needs. Care plans clearly record the support needs of clients and the staff support that is needed to meet these needs. One care plan that was being updated had part of the old assessment removed and the new one had not yet Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 11 been completed. Therefore, the plan of care did not contain important information about the care needs of that client. The home manager said that she would ensure that the care plan was completed on her next working day. Staff said that care plans are easy to use and understand. “If you read the care plan, you know the client” said one member of staff. Clients commented that they usually receive the support and care that they need. Care staff said that they know whom to contact to get the appropriate health care support for the clients that live at the home. All health care appointments are highlighted in clients’ care notes. Care staff said that this makes it easier for them to monitor client’s health care needs. One relative commented positively on the care provided to their relative, “‘as mum’s condition has deteriorated the carers are spending more time with her”. Clients may have responsibility for keeping their own medication subject to a recorded risk assessment. Staff who give out medication are trained to do so. Clear records are kept of medicines that are given to clients. Two changes to medication practices were recommended. Firstly, that two staff check and sign the medication administration sheet when entries are hand written. Secondly, that if a GP changes the dosage, or frequency that a medication is to be given, then this change should be checked by two staff and signed. This is to make it safer for clients. The home manager said that she understood the importance of these measures and would put them into practice. Staff described how they maintained clients’ dignity and respect whilst undertaking personal care tasks. We try to, “treat people here as if you would like to be treated”, said a member of the care staff team. Other staff made similar comments. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Clients do not currently benefit from the stimulation that an activities organiser would provide. Clients are able to make choices and maintain contact with their family and friends. A balanced diet is provided. EVIDENCE: Most clients commented that there were never any activities on offer that they could take part in. One client said, “myself and the other residents are bored stiff”. At the last inspection the home manager said that there were plans to increase the level of activities provided for residents, that an activities organiser would be employed for 30 hours per week and that the home would benefit from the day centre being built in the home’s grounds. This has not Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 13 occurred, although an activities organiser was in post for a short time period. The home manager said that the lack of activities currently in the home, “is our biggest downfall”. She said that currently there are visiting entertainers and that an activities organiser would definitely be in post when the extension opened. It is intended that the activities organiser would arrange group and individual activities and develop a personal profile of each client. The home recently had a summer fete and clients said that they enjoyed this very much. Clients said that their visitors are welcome at all reasonable times. Clients are able to make choices in many areas of their lives. They decide on routines that suit them. They can call for assistance by using call bells at any time. They are encouraged to choose their own clothes Clients commented that they usually like the meals that are provided. One client enthusiastically described the day’s meal as, “lovely dinner, pastry was super”. Clients explained that if they do not like the main meal that is offered, they can choose an alternative. Clients can choose whether to eat their meals in the dinning room or their own bedrooms. A cook is employed every day to cook the main meal. She said that there is always enough food available to cook what is on the menu. The menu provides a balanced diet for clients. Clients’ nutritional needs are monitored. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The comments and view of clients and their representatives are listened to and acted upon. Clients living at the home feel safe and protected. EVIDENCE: No complaints about the home have been received by the home or by the commission, since the last inspection. All clients who completed comment cards said that they knew how to make a complaint. The majority said that their comments were listened to and acted on by staff. Staff demonstrated that they knew what to do if a client made a compliant. The home manager has attended a trainer’s training course on safeguarding vulnerable adults. She provides all members of staff with information about the concept of protection of vulnerable adults. Staff are encouraged to report any issues that they are concerned about. There is a separate form in each client’s care plan to record any areas of concern. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Plans are in place to improve the environment for clients. EVIDENCE: The home environment is currently changing. An extension to the side of the home provides 26 additional ensuite bedrooms. There has been some delay in opening the extended part of the home, but it is due to open shortly. The existing home environment does not meet the same high standards. The home manager said that there are plans to decorate and upgrade the existing part of the home. Clients can choose whether to move to the new part of the home when it opens. Clients’ bedrooms are in need of redecorated, but are comfortable and clients are able to personalise them according to their individual tastes. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 16 Most clients said that the home was usually fresh and clean. One described it as, “spotless”. Staff follow the home’s procedures to minimise the spread of infection in the home. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Clients are in the care of a group of staff that are trained to meet their care and support needs. EVIDENCE: The home manager said that staffing levels are based on the identified needs and dependency levels of clients. Care staff said that there were sufficient numbers of them on duty to carry out their care tasks. There are four care staff on duty in the morning, three in the afternoon and two at night. All care staff are trained to or are working towards NVQ level 2 or above. This award is useful because it helps staff develop good care practices and skills in working with people who live in a residential care home. In addition 4 staff hold level 4 NVQ. This is good practice and shows the home’s commitment towards training care staff to a high standard. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 18 Before new members of staff are employed at the home, the home manager carries out a number of checks to make sure that all members of staff working at the home are suitable to care for vulnerable residents. All new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. The home manager said that staff are trained in the essential areas that they need to be able to care for the people in their care. This includes training in first aid, moving and handling, food hygiene, adult protection and health and safety. Attention needs to be given to the dates when this training took place to make sure that the training is current. In addition, some staff are trained to take clients’ blood pressure and others to care for people with dementia. . Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Clients benefit from living in a home that is well managed. EVIDENCE: The home manager, Bernadette Ramsey has 15 years experience of managing residential care homes. She is a Registered Nurse and holds the Registered Managers Award. This is a formal qualification recognised by the Commission to be useful because it helps to make sure that people who manage residential care services have the competencies that are necessary to do so. The home manager is trainer in safeguarding vulnerable adults and the deputy manager is a moving and handling assessor. Both are NVQ assessors. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 20 The home manager has a clear understanding of the aims and purpose of the home. Staff said that she is approachable and listens and acts upon any comments that they make to improve the service. Clients’ and relatives’ views about the quality of the service are sought every year. Clients’ meetings are held twice a year and relatives and clients are informed about what is going on in the home through a regular newsletter. Where the home is responsible for monies held on behalf of a client, clear records are kept of all financial transactions The home manager said that all items of equipment in use in the home remain in good working order and she has provided the dates on which they have been serviced. As stated at the last inspection, the home manager is reviewing the training status of all members of staff. This is to make sure that all staff have the skills to care for older people who live in residential care. Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 4 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations When medicines are hand written on the medication administration record, the accuracy of the record should be checked and signed by an additional member of staff. This is to make sure that clients receive the correct medication. When a GP changes the dosage or frequency that a medication is to be given, the written amendment on the MAR sheet should be made by the GP. In the absence of the GP, the change should be checked and signed by two members of staff to ensure accuracy. This is to make sure clients receive the correct medication. 2 OP9 Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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 Bramblings Residential Home DS0000023910.V348336.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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