Inspection on 16/01/07 for Bramley Court

This inspection was carried out on 16th January 2007.

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

Bramley Court 22/02/10

Bramley Court 16/11/09

Bramley Court 23/03/09

Bramley Court 26/11/07

Bramley Court 02/05/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER Lead Inspector Lisa Evitts Key Unannounced Inspection 16th January 2007 09:00 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 Bramley Court DS0000066491.V326239.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. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramley Court Address 251 School Road Yardley Wood Birmingham West Midlands B14 4ER 0121 430 7707 0121 474 2944 bramleycourt@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited 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) Vacant Care Home 76 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (39) of places Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That on the ground floor the home can accommodate 37 older people for reasons of nursing care and dementia (DE (E). That on the first floor the home can accommodate 33 people over 60 for general nursing care and further 6 older people for general social care. As each of these social care beds become available they will transfer to become general nursing beds making a total of 39 general nursing beds. That the home can accommodate two named service users under the age of 65. (Registration Category 1 OP 1 DE) 2nd May 2006 3. Date of last inspection Brief Description of the Service: Bramley Court is a 76 bedded purpose built care home providing 24 hour nursing care. The ground floor is a 39 bed elderly mentally infirm nursing unit; it currently has some residential care beds. This is named Maypole unit. The first floor is a 37 bed-nursing unit, which also currently has some residential care beds. This is named Mercury unit. On both floors the residential care facility will be phased out and no further residential care admissions will be accepted. The home has level entry access and the first floor can be accessed by a passenger lift. It has wide corridors and handrails to assist residents to maintain their independence. The home has hoists and stand aids that can assist residents with decreased mobility, and pressure relieving equipment is available for residents who require this to prevent skin sores. All bedrooms have en suite toilet facilities, and there are assisted bathing facilities to meet the needs of the residents who require this assistance. The home has dining room facilities and lounge areas. On the Maypole unit a snoozelum has been created for residents to use as they choose. Kitchen and laundry facilities are located in the basement of the home. Bramley Court is situated in a suburb of Birmingham with public transport and limited amenities close by. There is limited parking available at the front of the home and a small-enclosed garden/patio area to the side of the home for residents use, weather permitting. Contact details for CSCI are displayed throughout the home. The most recent copy of the inspection report on display was from the inspection undertaken in August 2005 and this does not ensure that information is readily available for prospective residents, representatives or staff about the home. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 5 The current scale of charges for the home is £505 - £595 per week. The weekly fee payable excludes the nursing determination contribution, which is added on to the charge for the room, so for a full fee payer this can mean a cost of in excess of £680.00. These fees are reviewed annually in February. Additional charges include hairdressing, chiropodist, newspapers and personal items. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was undertaken over two days (a total of 17 hours) by two inspectors, and for part of this time by a CSCI Business Change Manager who was undertaking a short observation framework inspection (SOFI), which is an observation of residents who are unable to communicate their needs easily. The inspectors were assisted throughout by the Project Manager and recently appointed Home Manager. The Operations Manager, Operations Director and the Managing Director were present for parts of the inspection. There were 75 residents living at the home on the day of the visit and information was gathered from speaking with residents, relatives, staff, visiting healthcare professionals and from observing staff perform their duties. Care records, health and safety records and staff files were examined. The management of medication was reviewed and a partial tour of the premises was undertaken. Prior to the inspection the Project manager had completed a pre inspection questionnaire, and returned it to CSCI, and this gave some information about the home, staff and residents that was taken into consideration. Eleven comment cards were returned to the home and these were reviewed during the visit. Comments received varied about the home and staff and these are in more detail in the main body of the report. Since the last key inspection of the home in May 2006, CSCI have undertaken two random inspections of the home, one to monitor progress of the home and one to review two complaints received and these will be referred to in the main body of the report. The CSCI Pharmacy inspector had also undertaken an inspection at the home. No immediate requirements were made at the time of the visit to the home. What the service does well: The home collects good information before people are admitted into the home and this means that both the prospective resident and the staff of the home know that they can meet the assessed needs of the resident. Residents personal hygiene needs appeared to be well attended to and residents appeared to be well cared for. The medication administration is well managed and residents receive their medications as prescribed. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 7 The home is purpose built and enables residents to have space to walk; corridors are wide and enable residents who may require mobility aids to be independent. The home was clean and fresh during both days of the inspection and therefore provides a homely environment for residents to live in. Comments from residents and relatives included: “Its a very nice home” “I’m well looked after, fed well and kept clean” “Food is nice and hot” “If I had a complaint, I would talk to the nurse” “I asked for bedroom to be repainted, it was done very quickly and included a new carpet” “Changes made have been good, as the unit was looking a bit tired” “Staff look after me very well” What has improved since the last inspection? What they could do better: Previous inspection reports of the home could be made more readily available to ensure that prospective residents or staff have information about the home. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 8 Staff must have instructions on how residents can be seated comfortably to ensure that residents are safe and comfortable and that the skin does not become sore through inappropriate positions. There has been no activities coordinator at the home for a few months and residents were not being stimulated through activities and individual needs are not been met. One relative commented, “We really need someone to do activities, that’s been missing for a long time”. Choices of foods are available for residents, although not all residents are aware of the choices available and the home must make this information accessible for the residents in order for them to make an informed choice about the food they choose. One resident commented, “They used to ask every night what you wanted for dinner, but now they don’t”. ‘Grumbles’ and concerns, which are resolved at the time of being voiced, are not recorded and this does not ensure that any reoccurring trends are highlighted. The manager must ensure that faulty equipment is repaired or replaced in a timelier manner to ensure that equipment is in safe working order for staff and residents to use. Some inappropriate storage of foods and inadequate cleaning of the kitchenette area showed a lack of attention to potential infection risks and this potentially places residents at risk from harm. The garden area needs to be made more suitable and comfortable for residents and their representatives to use throughout the coming summer months. There has been a high turnover of staff at the home and this means that residents do not have continuity of care. Now that the manager has recruited new staff, the home must now work on retaining staff in order to provide consistency for the residents. Comments received included “There are lots of staff changes and the agency staff are not entirely satisfactory” and “I would like to see more regular staff”. Personal monies held on behalf of residents require auditing and documentation needs improving so that residents can be sure that their money is held safely. Fire drills for night staff must be undertaken more frequently, to ensure that staff know what to do in the event of a fire occurring in order to safeguard residents living at the home. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 9 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. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 10 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 Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have information they need to make an informed choice about where to live. Residents are issued with contracts to inform them of terms and conditions of stay at the home. Pre admission assessments are undertaken to ensure that residents can be confident that their needs can be met upon admission. EVIDENCE: A copy of the service users guide was taken for review and contained all the information about the service provided as required by the regulations. This document is available in large print and on audiocassette upon request and this enables people with sensory impairments to access the information. The most recent copy of the inspection report on display was from the inspection undertaken in August 2005 and this does not ensure that information is readily available for prospective residents, representatives or Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 12 staff about the home. It is recommended that the most recent reports are available for people to read if they choose. Residents are issued with terms and conditions of residency for their stay at the home and this includes a four-week trial period and the room number to be occupied. This ensures that residents are informed about conditions of residency at the home and gives them an opportunity to sample life at the home before making a decision to become a permanent resident. The weekly fee payable excludes the nursing determination contribution, which is added on to the charge for the room. This fee is reviewed every February, or earlier if needs change. Staff complete pre admission assessments and this enables staff to determine if they could meet the assessed needs of the prospective resident, prior to them coming to live at the home. One comment card stated “The manager visited mom in hospital to assess her”. The homes assessment information covered all the areas outlined in the standards and this means that there was enough information about resident’s health, personal care, cultural, preferred lifestyle and religious needs for care to be given in the right way. It was also pleasing to see that family members had been involved in collection of information and assessments upon admission to the home. One relative stated “Its absolutely wonderful” and a resident said, “I wouldn’t go to another place”. A comment received via the comments cards was “Its a very nice home”. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 13 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are met by the care staff who use care plans, which contain sufficient information to meet the residents needs. The medication administration is well managed and this ensures that residents receive their medication as prescribed. EVIDENCE: Each resident has a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from the staff in order for the residents to maintain their needs. Since the last visit to the home, the care plans had improved, information was easy to retrieve and care plans and risk assessments were not excessive. Monthly assessments for nutritional requirements, falls risk and assessments of the risk of sore skin are undertaken and this ensures that staff can take preventative action as indicated. Moving and handling plans identified the type of hoist and size of sling to use and this ensures that staff have guidelines to follow and ensures the safety of both the staff and the resident. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 14 A client review had been held for one resident with the resident’s daughter and it was pleasing to see that the staff had implemented actions to concerns voiced about weight loss during the review. There was evidence that the GP had been involved in the care and supplement drinks had been prescribed. It was also pleasing to see that family members had been involved in collection of information and assessments upon admission to the home. Personal hygiene care plans require detail as generally stated “offer bath or shower once a week”. No personal preferences were recorded or choice about how often to have a bath or shower. Some care plans had good details recorded such as “likes putting on make up and brushing hair” “female carers only” “leave the door open” “prefers to sleep with the light off” and this ensures that residents can maintain their personal preferences. Core care plans (these are plans that give the same instructions for all residents) had been used for residents who woke during the early hours and this does not ensure that the plans account for resident’s individual health or personal care difficulties. One resident had two infections, however no care plan showing how this was to be managed was available on the day of the inspection. Daily records stated “infection control measures were maintained” but there was nothing to say what these measures were and therefore there were no guidelines for staff to follow. It is recommended that staff use appropriate terminology for the age group whom they provide care for in order to promote the dignity of the residents, as one care plan stated that a “nappy would be appropriate” and another to “make him sit in a supervised area”. One care file stated that a relative was not to be allowed into the home, however no details were recorded as to whether this was the residents personal choice or if the relative posed a risk to the resident. This did not ensure that staff were given instructions what to do if the relative came to the home, in order to safeguard the resident and potentially staff from harm. There was evidence that residents are seen by external healthcare professionals such as general practitioners, chiropodists, psychiatrists, dentists, social workers and opticians as required and this ensures advice is sought from the relevant professional. A complaint received by CSCI was pertaining to knowledge of catheter care and documentation of diet and fluids taken by the residents, requirements were made regarding these and staff have received training in catheter care and one relative commented “they keep a chart of what he eats and drinks”. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 15 Senior mangers of the home undertake care plan audits and this ensures that any missing information is highlighted. This is good practice because it ensures records remain correct and ensures that needs are met and documented as appropriate. Comments from residents and relatives included: “He has been looked after really well” “On the whole personal care is pretty good” “He is clean and shaved” “Well looked after” “He is always neat and tidy” “I’m well looked after, fed well and kept clean” Residents personal hygiene needs appeared to be met and residents appeared well cared for. Residents were dressed appropriately in clothing, which reflected personal choices and preferences depending on their age, gender, and culture. One care plan stated to “position in chair correctly” but gave no further instructions on how to achieve this. A comment from a relative was “Staff don’t seem to know how to make a resident comfortable if they slide out of the sitting position” Staff must review this as part of the moving and handling assessment, as soreness of skin may occur if the residents are inappropriately seated. An hour and a half was spent observing the care given to a small group of people in the lounge of the unit offering care to people with dementia. This observation took place mid morning. Most of the time there were ten residents in this lounge and usually at least one member of staff. One resident who was seated in a hard chair appeared uncomfortable. Although the carer in the room did not initially respond to this she immediately went to the resident’s aid when the person started to slip towards the floor. Likewise when people called out for help or sought attention there was generally a positive staff response. The pharmacy inspector visited the home in August 2006 and reported that the management of medication had remained at a good standard. During this visit to the home five residents medications were reviewed and all balances were found to be correct. Medication was signed for upon receipt and photocopies of prescriptions were kept so that staff could check they had received the correct drug. Controlled drugs were recorded appropriately and medication was signed for when administered and this ensures that residents are receiving their medication as prescribed. On the Maypole unit a tracking form had been introduced which gave details of new medications started or drugs that had been discontinued and this is commendable as means that staff know what current medication the residents are prescribed. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 16 On the Maypole unit, the fridge thermometer was out of order. Medication had been placed in the fridge on the nursing unit to ensure that it was stored appropriately. The home manager must ensure that a new thermometer is purchased for the maypole unit drug fridge. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is limited opportunity for stimulation through leisure and recreational activities in the home, so residents are not able to engage in activities that meet their needs or wishes. Residents receive a wholesome and varied diet, which meets any specific dietary or cultural needs. EVIDENCE: There has been no activities coordinator employed at the home since October 2006. A new activity coordinator has been appointed and the home manager was waiting all relevant checks to be returned before a start date could be given, to ensure the residents were protected from harm. The hairdresser visits twice a week and the home has a catholic priest visit each month and a Baptist church visit every two weeks to enable residents to be able to continue to be involved with their religious choices. The home manager stated that three entertainers had come to the home over the Christmas period and the home had held a Christmas party for residents and relatives were invited to join in the festive celebrations. The manager stated that a family had brought in a crib for the nativity scene and the catholic priest Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 18 had come into the home to bless this, and this assists residents to continue to follow their religion. Residents can order newspapers if they choose which can be delivered to the home upon request and two residents are currently using this facility. A number of comments were received from residents, relatives, staff and via comment cards, which included: “There are no activities on offer” “I bring my own games and puzzles in to do with him” “We really need someone to do activities, that’s been missing for a long time” “Not a lot of activities, we chat where we can and play music” “More could be arranged” “I would like to see more 1-1 activities” Observations of the Maypole unit found that although some warm exchanges took place between staff and some residents, some sat for long periods of time with no one to talk to and nothing to do. There did not appear to be any undue restrictions in people visiting the home and one relative commented “I’m very well looked after also” Residents are able to go out with family and friends as they choose, some residents go out for Sunday lunch and one resident goes out to the pub, which ensures that residents are able to exercise choice over their lives and continue with their individual interests. One resident was hoping to be able to go on holiday later in the year with friends, and this maintains independence. A snoozelum had been created, with soft music and fibre optic lights on the dementia unit and a resident appeared to be enjoying this facility. The menus provided by the home were good and varied and comprised of a four week rolling menu. Two choices of meal are available at lunch and suppertime and a cooked breakfast is available on a Saturday for any resident who chooses this option. There are snacks available throughout the day, which consist of assorted sandwiches, fruit, cereals, biscuits or yoghurts. There are no menus placed on tables in the dining rooms and some residents commented that they did not know what options were available. During observation a resident who asked what was for lunch was told, “it’s a surprise”. It is strongly advised that staff know what is on the menu so that they can talk about food and respond properly to such questions. It is important that these smaller details of resident’s lives are discussed to keep residents feeling of being given choices and active involvement in their life. Softer options are available for residents who have swallowing difficulties. On Maypole unit, staff were recording the option and amount of food that residents were eating but this was not been done consistently and some days nothing had been recorded. The Mercury unit was only keeping a record of food for residents who were experiencing difficulties with nutrition, however it Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 19 is required that a record is kept for all residents in the home. The deputy manager is in the process of devising picture menus for residents on the dementia unit and this will assist residents to identify with their choice of foods. One relative raised concerns that food was food was left for residents and that it was cold before anyone went back to help them to eat it, another relative said that staff had to stand up to feed residents and this did not promote dignity. This practice was not observed on the day of the inspection but was discussed with the project manager and will need to be monitored. During the morning observation it was evident that some staff knew the residents well but they had limited time, as they were busy bringing residents in from breakfast and working in other areas. A delay with the tea trolley that morning meant that although residents were frequently offered a cup of tea “in a minute”; this had still not appeared well after midday. Staff did seek to get cold drinks for some residents although not everyone was offered these and the manager must ensure that residents are assisted to maintain their fluid intake. Comments received from residents and relatives included: “I often don’t get a drink at night” “Fishcakes are very nice” “They used to ask every night what you wanted for dinner, but now they don’t” “Food looks reasonably well prepared and the quality is ok” “Dinner is really good, but the evening meal is a mess” “Need more nourishment at nighttimes” “Food is nice and hot” “I love my cooked dinner” Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and accessible to residents and their representatives should they need to make a complaint. The home does not always record concerns that are resolved on the day and this does not ensure that any trends are identified. The home has an adult protection procedure, which should safeguard residents from harm if followed without delay. EVIDENCE: The home has a comprehensive complaints procedure in place and this is available to residents and representatives of the home. There have been a number of complaints made to the home, which covered areas such as poor communication, change of staff, management, fees for the home, staff not following instructions, and standards of care such as wound care, resident falls, catheter care and personal appearance of residents. CSCI have received two complaints and two concerns about the home since the last key inspection and these were reviewed throughout a random inspection at the home. The areas of concern were pertaining to personal care, medication, staff knowledge and attitude, and numbers of staff available. Some elements of the complaints were upheld and requirements were made to ensure that resident’s care was appropriately delivered and recorded. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 21 Formal complaints are recorded and outcomes and responses were available for review. The home does not record ‘grumbles’ (less formal concerns) raised, and any concerns that are raised and resolved at the time are not recorded. This means that the home loses valuable information about concerns, some of which when grouped together may show that the home are failing to meet the needs of the residents and that residents or relatives expectations of the home are not being met. Any concerns raised should also form part of the quality assurance programme and annual development report. One resident commented, “If I had a complaint, I would talk to the nurse” and a relative said “Yes, complaints are dealt with straight away”. This perhaps shows that some relatives think they are raising complaints. The home had leaflets on display, which gave details of an advocacy service, which could be accessed by residents if they required this assistance. The home has a copy of the Multi Agency Guidelines and the adult protection policy has been amended and is in line with the Department of Health’s “No Secrets” and this ensures that staff have guidelines to follow to respond to any allegations of abuse appropriately. Since the last key inspection of the home in May 2006 there have been four incidents of adult protection reported by the home. The incidents were appropriately reported to CSCI and to Social Care and Health who are the lead authority. These incidents have now been resolved and the cases closed. It was of concern that the day after the fieldwork was completed, the project manager reported an allegation of adult protection nature to CSCI that had been identified on the previous day, when two inspectors were at the home until 6pm. The inspectors were not informed of this incident at the time and this does not meet the regulation to inform CSCI without delay. The training statistics for the home were reviewed and indicated that 89 of staff had received training in abuse and protection of vulnerable adults to ensure that they have the knowledge to act appropriately to safeguard residents in the event of an allegation of abuse. This training was confirmed on the training matrix and on staff files reviewed. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 22 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): 19,20,21,22,24,25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of improvements have been made to the environment so the home provides a clean, homely and comfortable environment for residents to live in. Faulty equipment must be repaired in a timelier manner to ensure that it is available for residents to use. EVIDENCE: On both days of the visit to the home, the home was found to be clean and fresh with no offensive odours. The lounge area was comfortably warm, bright and pleasant. The atmosphere in the home was calm, relaxed and pleasant. Since the last visit to the home the first floor corridors had been redecorated and a new carpet laid throughout. A number of changes had been made to the Maypole unit and there were pictures painted on the walls. A snoozelum had been created, with soft music and fibre optic lights and one resident was observed to be seated in this area and appeared very relaxed. An old car had Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 23 been purchased; a telephone box; and a dodgem car had been purchased to place in the ‘garage area’ and these items may assist residents to recognise or remember things from their past. A sitting room area had also been created which some residents were using to have their afternoon tea. The dining room and lounge areas had been changed so that two lounges were opposite each other on the ground floor, and this meant that residents could wander safely between the two lounge areas. The home is purpose built and has wide corridors with handrails which enables residents to have space to walk and is suitable for disabled people that need equipment to assist them to maintain their needs. There is level entry access to the home and the first floor can be accessed by a passenger lift. Entrance to the building is via a keypad and the number had recently been changed after a comment was received from a relative that this had not been changed since July 2006, and this ensures the security of the home and for the residents. The home has assisted bathing facilities, however it was of concern that the bath on the nursing floor had been out of order for a number of weeks and the home were waiting for parts to be delivered. Residents had been offered showers or use of the bath on the ground floor. It was also of concern that a number of hoists had not been in working order and one comment card stated, “hoists have been out of order – waiting for days”. The home manager must try to resolve problems with equipment in a timelier manner to ensure that equipment is safe and in working order for both staff and residents. It was recommended that ‘stoppers’ are purchased to fill the gaps in the shower chairs to prevent any accidental injury occurring to residents. During one of the random inspections it was identified that a resident was unable to have a bath, as the safety of the resident could not be assured with the homes available equipment. During this visit to the home, the manager stated that equipment was on order to facilitate this residents needs, half had been delivered and the home was awaiting delivery of the other half of the equipment. All toilets have frames to assist residents and since the last inspection of the home appropriate signage has been added to doors so that residents can identify the facilities. Bedrooms seen were personalised and all rooms have a door lock, which ensures that residents are comfortable in their own environment and can maintain their privacy as they choose. One resident had a remote control, which enabled him to change TV channels and turn off the lighting in his room independently. One relative raised a concern that the call bell in the bedroom was not long enough for the resident to reach when she was sitting in her chair and the manager advised that a longer cord had been ordered to meet this need. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 24 During the tour a number of small repairs were noted: a washer was not working on a tap; one bedroom door handle fell off; one toilet light was not working and the manager requested that the handyman rectified these. In the kitchenette area on the Mercury unit, cereals were found in open packets in drawers, opened bread was not dated, handles were missing from the cupboards, the microwave and fridge was dirty and the worktop needed replacing. The Operations Manager informed inspectors on the second day of the visit that a deep cleaning plan had been devised and the area had been cleaned, however the manager must continue to monitor the cleanliness of this area as it poses a potential risk of infection. Positive comments about the environment were received from relatives, with the exception of the garden area and included: “New bedding has been purchased and some residents have had new beds” “Changes made have been good, as the unit was looking a bit tired” “I asked for bedroom to be repainted, it was done very quickly and included a new carpet” “The outside fabric needs tidying up and something needs to be done with the gardens” “Garden chairs are plastic and the gardens are tatty” It is accepted that the garden areas become untidy during the winter months, however the manager must plan how the home can make the garden area more suitable to meet resident’s needs for the coming summer months. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 25 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not receive care from a stable workforce and this does not ensure that they receive continuity of care. Shortfalls in the recruitment process may potentially place residents at risk. EVIDENCE: Laundry, kitchen, domestic and maintenance staff are employed in addition to nursing and care staff. Two nurses and six care staff are on duty throughout the day, on Mercury unit. Two nurses and seven carers are on duty throughout the morning and two nurses and five carers in the afternoon on Maypole unit. One nurse and three carers are on duty throughout the night on both units. Since the last inspection at the home, there has been a high staff turnover, and the home have been using agency staff, which does not ensure continuity of care for residents. An up to date staff list was reviewed and showed that there had been at least 23 new staff employed at the home since the last key inspection of May 2006. The home has almost completed the recruitment phase and therefore it is anticipated that the use of agency will reduce and that residents will receive care from a stable workforce, this will continue to be monitored through statutory inspections of the home. Comments from residents and relatives included: “Its all agency staff” Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 26 “There are lots of staff changes and the agency staff are not entirely satisfactory” “Carers have been really good” “Staff are very good but there is never enough” “Staff look after me very well” “A few more settled carers would be good” “I would like to see more regular staff” A member of staff commented that there had been a huge turnover of staff and it was hard, as they just got them trained and then they left. The home currently has 48 of staff who hold an NVQ qualification in care and the manager stated that once all the newly recruited staff had started work this would increase above the recommended 50 of staff who hold this qualification which ensures that staff are trained and skilled to care for residents individually and collectively. Seven staff files were reviewed and the following concerns were found: • Two staff files had no evidence of POVA first checks (Protection Of Vulnerable Adults) prior to commencing employment, • One file had only one reference, • One file did not have any explanation of a three-year gap in work history documented, • One file had a work permit, however the second page of the permit, which covered working conditions, was missing and therefore it could not be determined if this person should be working at the home. These shortfalls in the recruitment process may potentially place residents at risk and the home must ensure that all recruitment checks are in place prior to the staff commencing employment. There was evidence that staff were receiving training and the induction booklet was seen. One member of staff has taken on the role of the ‘in house trainer’ and every Friday is designated to training. The training packs have been devised by the organisations trainer and are delivered by the in house trainers. Whilst the trainer has a number of years of experience in care, it is of concern that they do not have any formal qualifications in care or teaching and this must be reviewed, in order to ensure that the trainer has the skills necessary to train other staff. The home has a designated fire trainer and a member of staff has recently completed a course to become a moving and handling trainer, which ensures that staff at the home are trained in these areas and can minimise any risks to residents. Other training has included health & safety, customer care, abuse, catheter care, nutrition, safe use of bed rails, infection control, COSHH (Control Of Substances Hazardous to Health), challenging behaviour and dementia training. The dementia training is delivered by the Deputy Manager who has been trained to deliver the Yesterday, Today, Tomorrow training, a member of Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 27 staff spoken with felt that further training in this area was required and this was brought to the attention of the managers. Observations of staff and residents found that some staff clearly knew residents well. Others did not and their responses to some situations indicated a lack of training, for example in defusing situations where residents upset each other or in responding appropriately to a resident’s questions. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 28 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): 31,32,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home now has a full complement of staff and requires time to provide stability and a consistent service, which meets the needs of the residents. The home routinely undertakes health and safety checks, which ensures that residents are living in a safe environment. Fire drills undertaken must be successful to ensure that staff can safeguard residents in the event of a fire. EVIDENCE: A project manager has managed the home for approximately six months. A new home manager has been appointed and had been working at the home for one week at the time of the inspection. The home manager has previous experience of working in a care home and community experience. It is the Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 29 intention of the organisation that the project manager will remain at the home for at least three months until the new manager has completed her induction programme. One relative commented, “We are concerned what will be happening with the new manager, Dianne intends to stay to supervise”. Management of the home will continue to be monitored throughout the inspection process, as the management of the home has undergone several changes over the last few years, which has caused problems in ensuring consistent good practice, and quality of service is provided to meet the needs of the residents. A health professional attending the home thought that the care provided and the management had improved substantially. She stated that the project manager had worked very hard and that the home was “better and much calmer”. She stated that she had seen 80 of the relatives on the nursing floor who were “all more than happy” with the service provided. Positive comments were received about the Deputy Manager of the home and dementia unit from relatives who appeared to be happy with the changes being made. Comments included: “He keeps the staff together and is very caring” “His standards are very high in care and communication” “Hands on man to be recommended” The Operations Manager visits the home at least twice a week and the Operations Director visits the home on a weekly basis. The Operations Manager completes a Regulation 26 visit report and a copy of this is sent to CSCI for information. Night spot checks have been undertaken by senior managers of the home to ensure that staff are competent and performing well within their roles, disciplinary action is taken against staff that are not performing appropriately and these actions safeguard the residents. The home undertakes a range of audits including monthly information on the home, medication, training, accidents, care files, staff files, kitchen, recruitment and complaints. A business meeting and financial audit is also completed. These audits should ensure that trends or reoccurrences are highlighted and actions taken to rectify any problem areas. The home must produce an annual report which summarises performance, identifies strengths and weaknesses and identifies how further improvements can be made to include actions and timescales to address the shortfalls. Staff and residents meetings have taken place and the minutes from these were available for review and these meetings enable residents, relatives and staff the opportunity to raise concerns or ideas about the home and how it could improve. The home had also completed a relative’s opinion survey and had produced an action plan in response to the issues raised. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 30 The home keeps a record of any personal monies held on a computer system, monies are kept in individual packets and some receipts are retained. Four resident monies were reviewed and only one had the correct amount of money available. Some residents had received chiropody but this had not been recorded as a deduction and it was not clear where the money had been used, as no invoice was available. The manager stated that she had not been able to access the records when the previous administrator had left employment at the home. It is required that a full audit of resident’s personal monies is undertaken and any discrepancies are rectified. Staff supervision was not fully reviewed on this occasion. A supervision matrix had been devised and there was some evidence that supervisions had taken place and these were kept in a separate folder to staff personnel records. Maintenance record for the home, were comprehensive. Bed rails and profiling beds are inspected on a weekly basis. Monthly checks on the nurse call system, wheelchairs and window restrictors are undertaken and weekly checks of the fire system and emergency lights are maintained and this ensures that all equipment is safe and in working order for both and residents. Maintenance certificates were available for the fire alarm, electrical wiring, portable appliance testing, gas and legionella. There were no certificates available on the day of the inspection for servicing of the hoists, and these must be available for inspectors to review to ensure that equipment is safe to use. Accidents were recorded appropriately and CSCI are informed as per Regulation 37. A monthly accident audit is in place, which assists in identifying any trends, which may be minimised. There was evidence that fire drills had been undertaken, at various times and records were made about the success of or any problems encountered through the drill. It was of concern that a fire drill undertaken on the 4th January, with night staff, had not been very successful and required repeating, but this had not been actioned on the 16th January. This does not ensure that staff are aware of their duty in the case of a fire and does not safeguard residents. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 31 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 2 2 X 2 Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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. 4. Standard OP7 OP7 OP7 OP7 Regulation 15(1)(2) 15(1)(2) 15(1)(2) 13(4)(c) 15 (1) 15(1)(2) 15(1)(2) Requirement Care plans for personal hygiene require more detail regarding personal preferences. Care plans for residents who wake during the early hours must be individualised. Care plans for short term problems must be written. Where visitors are requested not to be allowed into the home, reasons must be documented and risk assessed appropriately. Staff must have appropriate instructions how to position residents comfortably. Care plans for catheter care must be further developed and include instructions for staff to follow. (Previous timescale of 10/11/06. Not assessed on this occasion) Timescale for action 11/04/07 11/04/07 28/02/07 02/03/07 5. 6. OP7 OP7 09/03/07 11/04/07 Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 33 7. OP8 12(1)(a) 8. 9. 10. OP9 OP12 OP15 13 (2) 15(1) 16(2)(n) Sch4 (13) 11. OP15 16(2)(i) 12(5)(b) Residents that require turning must be risk assessed for the time intervals and Monitoring forms for turning must be completed at each turn and is recommended that these be kept in the resident’s room. (Previous timescale of 03/11/06. Not assessed on this occasion) A thermometer must be available for the drug fridge on Maypole unit. Activities to suit individual needs must be arranged and details of activities undertaken recorded. The amount residents eat and of what must be recorded to ensure that adequate nutrition is taken. (Previous timescale of 31/08/06 & 31/10/06 partly met) Menus must be available to inform residents of choices available. Staff must be aware what is on the menu, in order to respond to residents. The manager must ensure that residents receive drinks in order to maintain fluid intake. Complaints regarding staff attitude must be investigated and CSCI must be informed of the outcome. (Previous timescale of 17/11/06 not met) Any incidents must be reported to CSCI without delay. The garden must be made suitable for residents to use. Facilities to enable all residents to use the bath if chosen must be sought. (Previous timescale of 27/10/06 partly met) Equipment must be repaired or replaced in a timely manner. DS0000066491.V326239.R01.S.doc 28/02/07 28/02/07 30/03/07 16/03/07 07/03/07 12. 13. OP15 OP16 16 (2)(i) 12(5)(a) 22 23/02/07 01/03/07 14. 15. 16. OP18 OP19 OP22 13 (6) 37 23(2)(o) 23(2)(j)(n ) 31/01/07 30/04/07 28/02/07 17. OP22 23(2)(c) 28/02/07 Bramley Court Version 5.2 Page 34 18. OP29 13(4)(c) 19. OP29 19 Sch 2 Staff where needed must have a risk assessment to protect both residents and the staff member. (Not inspected on this occasion previous timescale 28/02/06 & 03/11/06) All staff must have two references including one from the most recent employer prior to commencing employment at the home. (Previous timescale of 03/11/06 not met) POVA first checks must be completed prior to commencing employment. Gaps in work history must be explored and documented. Full copies of work permits must be available. All nursing and care staff must have a valid first aid certificate. (Previous timescales of 28/02/06 and 03/11/06 partly met) The qualifications for the in house trainers must be reviewed. An annual quality assurance report must be written. A full audit of resident’s personal monies must be undertaken. Arrangements made with relatives or other service user representatives in respect of service users personal allowance must be recorded. (Previous timescales of 31/03/06 & 03/11/06. Not assessed on this occasion) Staff must have recorded supervision no less than six times a year. (Previous timescale of 31/05/05, 15/02/06 and 03/11/06 partly met). DS0000066491.V326239.R01.S.doc 30/03/07 26/02/07 20. OP30 13(4)(c) 01/05/07 21. 22. 23. 24. OP30 OP33 OP35 OP35 18(1)(a) 24 16(2)(l) 13(6) 16(2)(l) 16/03/07 31/05/07 23/03/07 23/03/07 25. OP36 18(2) 30/04/07 Bramley Court Version 5.2 Page 35 26. 27. OP38 OP38 23(2)(c) 23(4)(e) 28. OP38 13 (4) 23 (2)(p) 23(4)(e) 29. OP38 Certificates for hoist servicing must be available for review. The fire risk assessment must be reviewed, updated and signed and dated. (Previous timescale of 03/11/06. Not assessed on this occasion) The lighting in the loft area requires improving. (Previous timescale of 03/11/06. Not assessed on this occasion) Unsatisfactory fire drills must be repeated in a timely manner. 28/02/07 30/03/07 02/03/07 19/02/07 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. 5. 6. Refer to Standard OP1 OP7 OP7 OP15 OP16 OP22 Good Practice Recommendations It is recommended that previous inspection reports are on display and are readily available. It is recommended that staff use appropriate terminology to respect the dignity of residents when planning care. It is recommended that staff record practice that works for residents who have challenging behaviour. (Previous recommendation. Not assessed on this occasion) It is recommended that the manager monitor how staff assist residents with their meals to ensure it is in a timely manner and promotes dignity. It is recommended that ‘grumbles’ are recorded. It is recommended that ‘stoppers’ fill the gaps in shower chairs. Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Bramley Court DS0000066491.V326239.R01.S.doc Version 5.2 Page 37 - 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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