CARE HOMES FOR OLDER PEOPLE
Bramcote House Care Home Town Street Bramcote Nottingham NG9 3DP Lead Inspector
Keith Charlton Unannounced Inspection 7th February 2006 09:55 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 Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 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. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Bramcote House Care Home Address Town Street Bramcote Nottingham NG9 3DP 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) 01159257316 0115 9257316 Bramcote Nursing Home Limited Ms Azza Hebeshaw, Mr Mahmood Saba Mrs Ann Elizabeth Warner Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22), Terminally ill (1) of places Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd September 2005 Brief Description of the Service: The home is situated 5 miles from the city of Nottingham, within the village of Bramcote. It is close to public transport and local amenities. Both residential and nursing care is provided to older people. There is a choice of sitting areas, 12 single and 5 double bedrooms, though some double rooms are used as single, and a passenger lift gives access to all floors. The entrance to the building and the gardens are accessible to wheelchair users Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service user and their views of the service provided… The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection. The Registered Manager was on duty and assisted the inspector. Planning for the Inspection included looking at the service history - notifications of significant events sent to the Commission for Social Care Inspection etc and looking at the Requirements from the previous Inspection Report. There have been no complaints regarding the service in the last twelve months. The Inspection took place between 9.55 and 14.15 and included a tour of the building, inspection of records and direct and indirect observation of care practices. The Inspector spoke to nine residents, two members of staff, a relative and the Registered Manager. What the service does well: What has improved since the last inspection?
Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 6 The menu is displayed to service users and shows an alternative choice for main meals. The Registered Manager has organised staff records and the visitors book was available to sign in for fire precautionary purposes. 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. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 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 Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 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 the following standard(s): Please refer to the last Inspection Report. EVIDENCE: Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 9 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): 7,10 Service users are treated with respect and have Care Plans that detail the care needs of service users. EVIDENCE: The Care Plans of two service users were seen with areas of need identified during assessment were addressed. Care plans contained appropriate risk assessments for falls, continence, skin condition manual handling and nutrition. All plans are evaluated on a monthly basis and updated as necessary. From speaking to nine service users and observing staff practice it was evident that service users feel that staff show respect, friendliness and affection towards them, and staff were highly praised by service users. A relative spoken to said that staff could not be friendlier to her husband and that the home was run on the basis of close relationships between staff and service users and she couldn’t fault them for anything. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 10 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): 13,14 Service users have choice over their lives and visitors are encouraged by the service. EVIDENCE: Service users said that their routines were respected by staff and the staff asked said that there were no rules – service users could have a lie in and go to bed when they wanted and they could spend time in their rooms or the lounge as they wished and service users can go out in the village if able. One service user said staff helped her increase her independence with her mobility. A visitor was present during the inspection and said that staff always welcomed her and her family and provided a meal if she wanted one and she could stay as long as she wanted. Service users also said their visitors were always made welcome. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 11 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): 16,18 Service users and relatives have information regarding making complaints. A relevant procedure needs to be are in place to fully protect service users from abuse. EVIDENCE: Service users said they were confident that if they had a complaint that it would be properly looked into by the Registered Manager. There is a complaints book to record this. There has not been a recorded complaint for over a year. The complaints procedure was displayed in the entrance hall. This needs amendment so that the complainant can go to the Commission for Social Care Inspection first if they choose as, at present, they are only directed to the home. Staff were asked as to the adult protection procedure and found to have a good general knowledge though one staff was unsure of which Agencies to approach if Management did not deal properly with the concern. The Registered Manager said that she would compile a short procedure and discuss this with staff to ensure all staff were aware of the full steps to take. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 12 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): 19,26 Service users live in a safe, homely environment with comfortable bedrooms. Some attention is needed to damaged paintwork and stained flooring. All areas are kept clean and hygienic. EVIDENCE: Service users said that they liked their bedrooms. Individual bedrooms were personalised and generally well decorated, apart from one double bedroom on the second floor, and a spacious homely environment is provided. A heavily stained carpet was found on the first floor corridor, which needed replacement. Because of wheelchair damage there was paintwork to doors and skirting that was damaged. Paint was also seen to be flaking off external wooden window frames, which was identified in the last Inspection Report. There is currently free access to the home during the day – the Registered Manager said security would be reviewed and a coding lock installed to protect service users and staff. The home was found generally very clean with no malodours. A domestic person is employed to do the laundry. Service users said the home was kept clean and there was a good laundry service.
Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 13 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, 29 Sufficient staff are provided to meet service users needs. Recruitment practices need to be reviewed to fully protect service users. EVIDENCE: Service users said that there always appeared to have enough staff on duty and staff said there was time to sit and speak to service users, especially in the afternoon. The rota showed there was always at least one trained nurse on duty with three to four care assistants during the day and one at night. This was sufficient to meet the needs of the current service users. Catering and domestic staff are employed in addition. Staffing records showed that generally appropriate documents are collated and the Registered Manager said new staff were checked against the Protection of Vulnerable Adults list before commencing employment, though there needs to be written evidence of this in the files. Written references are needed before staff commence employment, one of which needs to be from the last employer. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 14 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): 35,37 The organisation of essential records was satisfactorily kept. EVIDENCE: Following on from the last inspection, the Registered Manager said that all service users money was looked after by relatives etc so the she was no longer involved in transactions. Staffing records are now better organised in separate folders. The visitors’ book was present to record all visitors to the home. Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 15 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 4 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X 3 X Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 16 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. 2. 3 Standard OP18 OP19 OP29 Regulation 18 23 19 Requirement All staff need to be fully aware of the Adult Protection procedure. A number of facilities issues need attention. Some aspects of recruitment practices need to be tightened. Timescale for action 07/04/06 07/05/06 07/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bramcote House Care Home DS0000026420.V272334.R01.S.doc Version 5.1 Page 17 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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