Inspection on 16/11/09 for Bramley Court

This inspection was carried out on 16th November 2009.

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

Other inspections for this house

Bramley Court 22/02/10

Bramley Court 23/03/09

Bramley Court 26/11/07

Bramley Court 16/01/07

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER Lead Inspector Amanda Lyndon Key Unannounced Inspection 16th November 2009 09:15 DS0000066491.V378424.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Bramley Court DS0000066491.V378424.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 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) www.schealthcare.co.uk Southern Cross Care Management Limited Miss Deborah Clarke Care Home 76 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (39) of places Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within other category (OP) 39 Dementia (DE) 37 The maximum number of service users who can be accommodated is: 76 23rd March 2009 2. Date of last inspection Brief Description of the Service: Bramley Court provides nursing care for up to seventy six older people. This includes a thirty seven bedded unit for general nursing care located on the first floor. A separate unit called the “dementia house” is located on the ground floor. This can accommodate up to thirty nine people with dementia nursing care needs. The home is located in a residential area close to local shops and public transport links. Ample off road parking is provided for vehicles at the front and rear of the home. There is a small enclosed garden/patio area at the side of the home that is suitable for all people to use. A shelter is provided in this area for people who choose to smoke as the home is a non-smoking environment. The home is purpose built and upper floors are accessed via a passenger lift or stairway. All bedrooms offer single accommodation and have en suite bathroom facilities of a toilet and wash basin. In addition assisted baths and showers are available on both floors of the home. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists to meet the assessed needs of people living there. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 5 The home offers communal dining and lounge areas. A separate room is allocated as a hair dressing salon. Kitchen and laundry facilities are based on site. The home employs two activity coordinators so that people should have the opportunity to take part in activities within the home. However, there are limited opportunities for people to take part in activities outside of the home. In the reception area there is information that may be of interest. This includes our last inspection report, the statement of purpose and service user guide. Up to date details of fees charged to live at the home are included in the service user guide, and are available from the home on request. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing and newspapers. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star. This means that people who use this service experience poor quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on areas that need further development. This inspection was undertaken in response to a number of concerns raised by health and social care professionals about the quality of care and living environment provided for people at the home. As a result of this, the Local Authority has suspended it’s contract with the home. They are currently monitoring the quality of service provided. The inspection was carried out over two days with two inspectors on the first day and one on the second. The home did not know we were going to visit on the first day. There were thirty six people receiving general nursing care. There were twenty seven people living in the “dementia house”, and one person was in hospital. Prior to the visit taking place, we looked at all of the information we had received, or asked for. This included complaints received and “notifications” about events that have occurred in the home. The Annual Quality Assurance Assessment (AQAA) was not due to be returned to us at the time of the visit. We sent out random surveys to ten people who live at the home, ten relatives, and eight staff members, in order to obtain their views about the service provided. Prior to our visit, five people who live at the home and three relatives returned surveys to us. Their comments are included in this report. Two surveys completed by people living at the home and three surveys completed by relatives were returned to us following our visit. All contained information of concern about the service and are also included in this report. Four people were case tracked. This involves talking to them and discovering their experiences of living at the home. We focus on the outcomes for these people. We also spent time observing care practices and speaking to twelve staff members about the care they provided to these people. We sampled care, staffing, and health and safety records. We looked around the areas of the home used by people case tracked to make sure it was warm, clean, and comfortable for them. We gave all people living at the home the opportunity to be involved in the inspection. We spoke with five visitors and three health professionals that were visiting the home. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 7 We were assisted by an Expert by Experience (in this report known as “The expert”). This is someone with personal experience of using care services who have been trained to accompany us during our visits. Experts by Experience observe what happens in the home and talk to people to obtain their views about what it is like to live there. The expert talked with four people living at the home and four visitors. She produced a report based on her findings and details of this are included in this report. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing five people who live in the “dementia house” at the home for two hours. We recorded their experiences at regular intervals. This included how they were occupied and how they interacted with staff members and other people living at the home. The outcome of this is included in this report. What the service does well: People have the majority of the information that they need to enable them to decide if they want to live at the home. The expert told us that people said that they are confident that they can choose how they spend their time so that they can make decisions about their daily lives. The expert told us that people said that they are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. People living at the home are offered a variety of healthy meals, that meet any special dietary requirements. There is a robust system for checking that peoples’ money is held at the home in a safe manner. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet health needs. People told us: Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 8 “I am got up by the night staff at 5am and I like that. I like to go to bed at 7pm and I fall straight asleep”. “We have a family party here at Christmas”. A chiropodist who was visiting the home said “They follow our advice. I have always enjoyed coming here”. What has improved since the last inspection? What they could do better: People cannot be confident that they consistently receive the care, support and supervision at the times that they require. People cannot be confident that they receive their medication as prescribed at all times, which may compromise their health. The expert told us that people said that activities on offer do not always meet their needs and expectations. This means that some people are not supported to lead fulfilling and stimulating lives. People cannot always be confident that their concerns have been taken seriously, and that actions have been taken in response to any suggestions they make. People living at the home cannot be confident that they are protected from harm. People should be able to live in a clean and hygienic environment. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.2 Page 9 People cannot be confident that their health and safety is maintained whilst living at the home. People should be able to benefit from the home being well managed. Any shortfalls within the service provided should be identified and rectified for the benefit of the people living there. People told us: “Not all the carers understand my condition and the impact it has on my capacities and behaviour”. A staff member spoken with during the visit confirmed that this was the case. “We cannot go into the garden as it is uncared for”. “There needs to be better standards of hygiene. The family have to ask to have carpets cleaned or request removal of cobwebs”. “I have visited the home on many occasions and had no contact with staff. Is this due to lack of staff or lack of care?” If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 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.V378424.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admission processes are thorough so that people can make informed decisions about whether to live at the home or not. EVIDENCE: Due to the suspension of the contract with the Local Authority, there had not been any new admissions to the home since the beginning of August 2009. There were currently thirteen bed vacancies in the home. A statement of purpose and service user guide had been produced and these were available on display in the home for people to read. We saw that these Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 12 had been produced in a large print format. The manager stated that these could be produced in other formats and languages on request, and information about this was included on the front of the documents. This means that more people can access the information. The documents included information about the services and facilities provided at the home, and the current fees charged to live there. Details about arrangements for people that choose to smoke are not included within these documents. This will prevent people from having this information when deciding whether to live there or not. The manager said that this information would be added. We saw that service user guides had been distributed to people receiving general nursing care and people told us that they had found it to be informative. We saw that comprehensive assessments of peoples’ care needs are undertaken prior to coming to live at the home. We saw that pre admission care plans, outlining peoples’ care and support needs are written from this information. This means that people should be confident that their care needs can be met by the home. We spoke to people about the pre admission process. They told us that they had the opportunity to view the home prior to coming to live there. This is in order to sample what life would be like to live there. People come to live at the home for an initial trial period of six weeks. We saw that following this, a care review is arranged involving the person, people important to them, their social worker and the home staff. This provides all present with the opportunity to discuss whether the persons’ care needs are being met at the home, and whether they wish to stay there. We saw that actions had been taken in response to suggestions made at this time. Intermediate care is not provided. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place do not always meet peoples personal and health care needs, and this places them at risk of harm. EVIDENCE: We saw that assessments of peoples’ care needs are undertaken on admission to the home. Care plans are written from this information. These are individual plans that should include information about what people can do for themselves, and in what areas they require support. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 14 We found that there were inconsistencies in the content of the recording of care plans. A number of care plans did not identify specific instructions for staff, and this may prevent people from receiving care and support in the ways that they prefer. In addition, a number of care plans had not been updated to reflect peoples’ changing care needs. This may result in people not receiving the care they require. The manager told us that she had recently introduced a “handover sheet”, so that the staff could inform her of any changes in peoples’ care needs. She said that this should trigger the staff to update the relevant care plan. However, it was evident that this was not always the case. We found that short term care plans had not been written in a number of instances, for example, when a person had an infection. This may prevent staff from monitoring the progress of the short term care need. We found that care plans had not been written for all health care needs. Care staff met during the visit told us that they had read peoples’ care plans. However, from discussions with people living at the home and the staff team, we identified that there were some gaps in knowledge about the risks associated with a number of medical conditions that people living at the home currently have. This may prevent people from receiving the correct care and support and compromise their health. One person told us “Not all the carers understand my condition and the impact it has on my capacities and behaviour”. A staff member spoken with during the visit stated that she did not have enough knowledge to fully meet this person’s needs. Since our last visit there have been three safeguarding investigations, led by social services regarding the care and treatment provided by the home of people with pressure sores, (sores developed on peoples’ skin). As a result of this, the community tissue viability team (wound care nurses), had undertaken an audit at the home. They identified that the number of people living at the home with pressure sores was high and that there were numerous shortfalls regarding the care and treatment of people in this area. In response to this, we saw that a rolling programme of replacing pressure relieving equipment is now in place and training for all grades of staff is planned. We spoke with two of the community tissue viability nurses that regularly review people living at the home. They stated that there had now been an improvement in the quality of wound care provided. However, they also stated that there continued to be inconsistencies regarding the recording of how often staff assist people to change their positions to prevent further skin damage. We also identified shortfalls regarding this documentation. We saw that care plans had been written for people with behaviours that can be challenging to others. These did not, however, always identify the ways in which people behave and the actual ways that staff can manage these behaviours, in order to improve outcomes for people in this area. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 15 From discussions with people living at the home, staff, and from our observations on the day we identified shortfalls in the care and support being provided in this area. It was of serious concern that from reading daily notes, we identified that there had been a number of incidents of a safeguarding nature regarding a person receiving dementia care at the home. Staff had failed to follow safeguarding procedures as a result of this person’s behaviour, placing people living at the home at risk of harm. It was evident that staff required further training about how to care for people with dementia and we saw that this was planned for the following month. We saw that regular care reviews are undertaken involving people living at the home, people important to them and their key workers. This provides people with the opportunity to put forward any suggestions for improvements to the service provided, and assess whether their care needs were being met. Despite this, however we identified that the care needs of one of the people case tracked were not being met at the home. People told us that they were happy with the level of personal care provided by the home. One person said “I have a shower twice a week. I am happy with that”. One person who completed a survey prior to our visit said “Mom has always been clean and tidy looking, even when in bed”. We saw that the majority of people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture and the time of year. We saw however that one person was wearing stained clothing and another person was not wearing spectacles despite this being an instruction for staff within the care plan. We saw that people can retain their own doctor on admission to the home, if the doctor is in agreement. In addition we saw that advice can be sought as needed from a range of other health and social care professionals. We spoke with the chiropodist who was visiting the home. He said “They follow our advice. I have always enjoyed coming here”. We looked at the system in place for the management of medication. Medication administration charts (MAR charts) were generally well maintained. We audited MAR charts before and after a medication round and found that they had been completed correctly. There was, however improvements required so that people receive their medication as prescribed. Since an incident when one person went without prescribed medication for four days, systems were put in place to ensure that medication was available in the home. However at this visit these arrangements were clearly not working as one person had not received one medicine for three weeks. This places the people using the service at risk of harm. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 16 We identified a shortfall regarding the recording of a controlled drug received into the home and this may result in an administration error. Staff were not recording when they had applied cream to a person so that the effectiveness of the treatment could be monitored. Care plans had not always been written for people that had been prescribed “PRN” “as required” pain relief. This means that there were no specific instructions available for staff as to when to administer the medication and the quantity to give. This will prevent the effectiveness of this treatment from being monitored. We saw that the home undertake medication audits. It was however, of concern that recent audits had not identified the shortfalls as discussed in this report. The manager told us that medication training has been booked for staff in the coming month. This should ensure that staff are aware of their responsibilities regarding the management of medication and improve outcomes for people in this area. From our observations on the day, we saw that people are not always supported in a respectful manner. We observed staff changing a person’s soiled blouse in the communal lounge, and saw a lack of supervision during a meal time as identified in the next section of this report. This does not uphold peoples’ dignity or self esteem. We saw that staff greet people by their preferred names. People have the option of having a key for their bedroom doors so that they can keep their personal items private and secure. One person told us that she chooses to do this. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements in place do not always uphold the needs, expectations and dignity of people living at the home. EVIDENCE: We saw that there were activity boards throughout the home displaying photographs of a recent celebration and a copy of the “Bramley Court Newsletter”. This was produced in large print so that it was accessible to more people. It included information of interest to people living at the home, for example the dates of forthcoming relatives meetings, the success of the recent Halloween party and birthday greetings. The home employs two activity staff, however feedback from the expert told us that one of these had been away from the home for a period of time. As a Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 18 result of this, the activity staff member spoken with during the visit told us that she has to split her time between all people living at the home. From speaking with people living at the home, sampling records and our observations on the day it was evident that further work was required to ensure that all people at the home had opportunities to be socially stimulated. People met during the visit told us that the majority of activities involved watching the television or listening to music. Activities for people unable to participate in group events were limited. We observed a group physical exercise class being held within the “dementia house”. We saw that a number of people did not fully benefit from this activity as, with the exception of the activity staff member, staff were not available to provide support at this time. Records were not always reflective of peoples’ participation in activities provided. For example, the records of one person stated that they did not take part in group activities. We did, however see the person participating in the physical exercise class. This may result in people not being offered opportunities to participate in activities. People told us that there are limited opportunities to participate in activities outside of the home. One person who completed a survey said “There are no activities put on for us and we never leave the building on trips anywhere”. We saw that a number of people from the “dementia house” had been on a trip during the summer and children from a local school would be visiting the home at Christmas. This is important so that people can maintain links with the local community. We met with one person as she was on her way out of the home to a local club. She told us that she enjoyed having the opportunity to meet with people outside of the home. The hairdresser visits each week and there is a hair salon so that people can enjoy the experience of having their hair done. Arrangements are in place so that people can follow their religious beliefs if they wish. One person met during the visit said “I spend my time reading my newspaper. A member of staff brings it in for me”. People are encouraged to maintain contact with their family and other people important to them. People told that there is an open visiting policy and that they can meet with their visitors in private if they wish. One person met during the visit said “We have a family party here at Christmas”. In addition, we saw that some people go outside of the home with their friends and family, at any time that they choose. People told us that they could make choices about how they spend their time. One person said “I am got up by the night staff at 5am and I like that. I like to go to bed at 7pm and I fall straight asleep”. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 19 From discussions with people living at the home and from our observations, we saw that people have a choice of where they are served their meals and the time that they are served their breakfast. Menus identified a variety of nutritious meals and special diets are prepared for reasons of health, culture and religion. A choice of meals is always available and in addition people have the option of choosing snacks at other times. The menu choices available on the day of the visit were on display in large print. We saw that both menu choices are presented to each person, so that they can choose which they would like to eat. It was of serious concern that on day one of our visit, with the exception of the registered nurse, staff were not available in the dining room within the “dementia house” to support people at lunch time. As a result of this, one person had been left without cutlery and was eating soft food with their hands. We also saw a person taking food of another person’s plate. This does not uphold the dignity, health and welfare of people living at the home. This also witnessed by the manager who stated that immediate actions would be taken to address this. Prior to our visit, we received a concern that water jugs and glasses were not provided in peoples’ bedrooms, not replaced, or placed out of reach. The expert told us that this was also the case during our visit. One person met during the visit said “That is yesterday’s water”. This means that people would not be able to have a drink when they wish and this may compromise their health. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can not be confident that outcomes will improve as a result of raising concerns. Systems in place do not always protect people from harm. EVIDENCE: The complaints procedure was on display in the home and was included in the service user guide. This should mean that people know how to make a complaint, however the majority of people who completed our surveys stated that they did not know how to do this. It was noted, however that feedback from the expert identified that the majority of people said that they would speak to the manager if they had any concerns to raise. One person met during the visit said “If I wasn’t happy I would talk to the manager”. We saw that a “Visitors comment book” was available in the reception area of the home. This included numerous entries of recent concerns being raised by relatives and other visitors to the home. We saw that a number of the entries written by visitors contained personal information of a sensitive nature about the care being given to named people living at the home. For this reason, the Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 21 purpose of this book should be discussed with visitors in orders to maintain peoples’ privacy and dignity. A number of comments recorded in the book were of a serious nature. However, we found that these had not been recorded as complaints and written details of investigations and actions undertaken were not always available. This means that complaints may not have been investigated and people may not be aware of actions taken in response to these. It was evident that a number of people who had added comments into the book were unhappy with the length of time taken for staff to respond to their entry. It was noted, however, that a relative had recommended that a “relatives meeting” be arranged to discuss common issues. We saw that a meeting had been arranged for the coming week. Since our last visit, we have received six complaints about the service provided at the home. Issues raised included poor cleanliness within the living environment, lack of supervision from staff for people with dementia, and the failure to ensure that a medicine was available to be administered to a person as prescribed. It was of serious concern that despite actions being taken in response to these, and new systems having been put into place, we identified that during our visits, concerns of a similar nature continued. We discussed this with the home’s senior management team. Following our visit we informed other statutory agencies who will decide what they are going to do. Since our last visit we have been made aware of six allegations of a safeguarding nature involving people living at the home. All of these had been upheld. Three of these were made against the home, regarding the care and treatment of people with pressure sores, (as discussed in the health section of this report). We saw that actions had been taken by the Primary Care Trust and the home in response to these. This has improved the quality of care in this area, however systems must continue to be followed within the home, in order to ensure that the improvements are sustained. It was of serious concern that during our visit, we identified two further incidents of a safeguarding nature that the homes’ staff had not referred to social services. We saw that this was despite the importance of safeguarding being discussed during a recent staff meeting. The homes’ failure to report the incidents to social services has placed people at the home at a continued risk of harm. Following the visit, we spoke to social services about these concerns so that actions would be taken to safeguard people living at the home Following the visit, we received a survey completed by the relatives of a person living at the home. They raised a concern that the homes’ staff were not always able to give explanations as to why their relative had sustained bruises. It was of concern that until requested by us, the reasons for this had not been fully explored. This does not safeguard people living at the home. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 22 The staff training matrix identified that a number of staff required fresher safeguarding training. Other staff had not had received training in this area. Not all staff met during the visit could remember if they had received training in this area however one staff member said “I would report anything to the nurse”. This was of concern due to the senior staff’s failure to report two recent safeguarding issues to the appropriate external agencies as previously identified in this section of the report. As discussed in the staffing section of this report, new worker recruitment checks are not always robust, and do not always safeguard people living at the home. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all equipment provided is fit for purpose and people are provided with an unhygienic living environment which may compromise their health, safety and welfare. EVIDENCE: We saw that a number of areas of the home were in need of redecoration and refurbishment, especially within the “dementia house”. There was a stark difference between the quality of the living environment for people receiving Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 24 general nursing care compared to those receiving dementia care. This was discussed with the senior management team for action. There is equipment available to assist staff to deliver personal care to people living at the home in a safe manner. This includes assisted baths and moving and handling equipment, including hoists. During an audit undertaken by the community tissue viability team, it was identified that a number of beds, mattresses, chairs and cushions were in a poor state of repair and not fit for purpose. As a result of this, we saw that the manager is ordering new equipment on a rolling basis, starting with the greatest need. This should improve the quality of peoples’ lives. There is a secure rear garden however people told us that this had not been used recently as it needed to be upgraded. We saw that this area was not being used during the winter months. One person who completed a survey said “We cannot go into the garden as it is uncared for”. People met during the visit stated that they were happy with their rooms. All bedrooms offer single occupancy and an en suite consisting of toilet and wash basin. Communal toilet and bathing facilities are also accessible to people living at the home. We looked at the bedrooms of people case tracked and saw that the majority of these had been personalised to reflect their age, gender, interests and culture. There is a nurse call facility in each bedroom, however a number of people told the expert that they did not know how to use this. In addition, from a discussion with a relative and from her observations on the day, the expert identified that call bells had been placed out of peoples’ reach within the communal lounges on the first floor of the home. This is of concern as staff were not always available in these areas. This prevents people from receiving staff support when they require. From information received prior to our visit, concerns from other statutory agencies and our observations on day one of our visit, it was evident that a number of areas of the home were unclean and unhygienic. One person who completed a survey prior to our visit said “There needs to be better standards of hygiene. The family have to ask to have carpets cleaned or request removal of cobwebs”. The expert identified that a number of bedrooms on the first floor of the home were in need of cleaning. There was food on the floor in two bedrooms We identified an offensive odour in the reception area of the “dementia house” and saw that a number of the ceiling tiles in this area were mouldy. We saw that a number of communal bathrooms were extremely dirty and had not been left in an acceptable state for people to use. Toilets and wash basins were dirty, wall tiles were cracked, a toilet roll holder was broken and lidded bins were not provided. Transfer hoisting equipment was being stored in one of these bathrooms, posing a risk of cross infection. We spoke with a staff member who said “The way the bathrooms were today is pretty standard”. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 25 We saw that the manager arranged for the bathrooms to be cleaned. She told us that plans are in place for an additional cleaner to be on duty during evenings. This should mean that improvements are made regarding the cleanliness of the home. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that staff are available to support them at the times they require. Systems in place for staff recruitment do not always protect people from harm. EVIDENCE: In addition to care staff, administration, cleaning, maintenance, laundry and catering staff are employed so that people living at the home receive some support in these areas. Positive comments were received about the staff team. One person who completed a survey prior to our visit said “I visit the home every day and the staff are very friendly and helpful”. People met during the visit told the expert that recently the high turnover of staff and the use of temporary staff had reduced. They said that they were now getting to know peoples’ names and seeing familiar faces. They said that the waiting time for staff to respond to their call bells had improved. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 27 Prior to our visit, we received a number of concerns about the lack of supervision provided by staff within the communal areas of the home. As previously identified in this report, during our visits, we identified a number of occasions when staff were not adequately supervising people, especially those living in the “dementia house”. Staff met with during the visit stated that, at times, there were not enough staff on duty to supervise people living in the “dementia house”, based on the high dependencies of their care needs. We discussed this with the management team who stated that for the majority of the time, this was due to the supervision of the staff team on duty, rather than the actual number of staff on duty. However, we saw that there were a number of recent occasions when there was just one registered nurse on duty during day time hours within the “dementia house”. This is instead of the two registered nurses as previously identified by the Organisation as being required in order to meet the needs of the people living there. One person who completed a survey said “I have visited the home on many occasions and had no contact with staff. Is this due to lack of staff or lack of care?” We sampled the recruitment files of two staff members who had recently come to work at the home. These included the majority of information required. However we saw that references had not always been obtained from peoples’ most recent or current employer as per the Organisations’ policy. We also saw that just one reference was available for a person who had recently begun working at the home. This means that people cannot always be confident that people employed by the home are suitable to work with them. We saw that new workers undertake a basic induction working alongside a more experienced staff member and then work through a nationally recognised induction programme. A staff member who recently began working at the home expressed their satisfaction about this and said that they felt supported within their new job role. She said “I am just finishing my induction. It has told me what I need to know”. The training matrix identified that a high number of staff required refresher training in mandatory areas, for example, fire safety, food hygiene and infection control. We did however see that training in these areas was planned for the near future. Staff met during the visit told us that they were generally satisfied with the training provided for them, however said that they would like training regarding specific illnesses that people living at the home have. This should ensure that they then have the knowledge to meet peoples’ care needs individually and collectively. Records identified that staff meetings are held regularly. This means that staff have the opportunity to be involved in the running of the home. We saw that the manager discusses areas of concern regarding the service provided at the home, so that the staff team is aware of the improvements to be made. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 28 However, as identified in this report, it was evident that further work is required to ensure that all staff are aware of their responsibilities regarding their job roles. This is in order to improve the service provided to people living there. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that the home is run in the best interests of the people living there, or ensure their safety and well being. EVIDENCE: Evidence at this inspection indicates that managerial arrangements at the home need to improve. We saw evidence that systems had been introduced by the management team to improve the service provided. However it was Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 30 evident that these systems were failing. It was also evident that the management team had failed to identify a number of these failings. It was also evident that the quality of care provided to people varied, depending to whether they were receiving general nursing or dementia nursing care. From analysing our evidence, we identified that people were happier with the care provided to people receiving general nursing care. The home manager has been in post for the past two years and is registered with us. She is a registered general nurse and has completed a nationally recognised management qualification. Due to the size of the home and the complex care needs of the people living there, the need for deputy management support had previously been identified by both the home and other statutory agencies. As a result of this, a deputy manager recently came into post but has since left and the post is now vacant. The senior external manager told us that they were actively trying to recruit a deputy manager once again. In addition to the lack of deputy manager support, we saw that the manager had recently covered a number of nursing shifts, including during night time hours. This means that she has not been given the time to manage the home effectively on a day to day basis. Positive comments were received by the staff team about the support provided to them by the manager. One staff member said “The manager is very supportive”. One relative met during the visit said “The manager is a good leader”. We sent an AQAA to the home in order to obtain their views on what they do well and in what areas they need to improve. This was not due to be returned to us until after our visit so we were not able to determine whether the information included in this was consistent with our findings. A group meeting involving people living at the home had not been arranged for a long period of time. This has prevented people from having the opportunity to put forward their views about the service provided and put any suggestions forward. We did identify, however that a group meeting was planned for the following week however not all people living at the home were aware of this. One person met during the visit said “If I hear about the meetings I go. I didn’t know about it”. A survey had recently been sent out to people living at the home and they were in the process of analysing feedback from these. We saw that a report based on the findings of previous surveys was on display in the home. This means that people are made aware of the results of these and any actions being taken. There is a system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Money is kept in a bank account, Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 31 however people are able to access money at any time they require. Receipts were available and this means that it was possible to establish what peoples’ money had been spent on. From records sampled we identified that regular checks are taken on equipment to ensure that it is safe to use. We saw that a fire drill had been undertaken recently, involving people living at the home so that people were aware of the actions to be taken in the event of a fire. Risk assessments regarding moving and handling had been undertaken. We found, however, that these had not always been updated should a person’s care need change. This may result in the wrong equipment being used and injuries being sustained. In addition, the training matrix identified that a small number of staff had not undertaken training about moving and handling and others required refresher training in this area. During our visit, we saw on two occasions that staff had failed to apply the brakes on wheelchairs during hoist transfers. This could lead to accidents and injuries being sustained by both people living at the home and the staff team. In addition, we saw that one person was walking around the home wearing socks, despite it being identified in his care plan that he would be at risk of falling if not wearing the appropriate foot wear. We saw that accident forms are completed and that the manager regularly audits these. We could not evidence, however that trends had been identified and that actions had always been taken to reduce the risk of further accidents of a similar nature. On the morning of day one of our visit, we saw that a bottle of cleaning product had been left on the hand wash basin in one of the communal bathrooms within the “dementia house”. This was accessible to the people living in this area of the home and a staff member confirmed that it had been there since the previous day. This is of serious concern and if accessed, could have compromised the health of a person living in this area. We have identified throughout this report continued areas of concern relating to the service provided at the home. We saw that the manager has introduced systems in response to concerns raised by relatives and our partner agencies. This is in an attempt to improve communication between herself and the staff team. Auditing systems need to improve so that shortfalls, for example regarding staff recruitment checks and the management of medication can be identified. Systems should ensure that the appropriate actions are taken in response to accidents, incidents and other events affecting the health and welfare of people living at the home. It was evident however that there had been failings regarding these systems and this had compromised the health and welfare of people living at the home. Ways in which to manage these concerns must be Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 32 implemented in order to improve the outcomes for, and maintain the safety of the people living at the home. Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 33 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 3 2 2 X 2 2 1 STAFFING Standard No Score 27 1 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 3 2 X 3 X X 2 Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2) Requirement Each person must have an up to date care plan outlining the care and support required in order to meet their care needs. This is to ensure that care is provided in the ways they prefer and to ensure that their care needs are being met at the home. 2 OP8 12 (1) Care records must be up to date and reflect the actual care provided. 31/12/09 Timescale for action 31/01/10 3 4 OP9 OP16 13(2) 22 This is to ensure that people are receiving care and support at the times that they require. Systems must be in place so that 31/12/09 people receive their medication as prescribed. A system must be in place for 15/01/10 recording all complaints received by the home. This is to ensure that people can be confident that actions are taken in response to their complaints Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 35 5 6 OP18 OP26 13(6) 13(3) 7 OP27 18(1) 8 OP29 19 Systems must be in place so that people are protected from harm. Arrangements must be in place so that people are provided with a clean and hygienic place to live. Systems must be in place so that people receive the care and support at the times they require in order to meet their assessed needs. Robust recruitment practices must be in place. 31/12/09 31/12/09 31/12/09 31/12/09 9 OP30 18 10 OP33 24 This is so people are safeguarded from harm. Arrangements must be made so 15/02/10 that staff providing care to people living at the home have the necessary skills and knowledge to do so in a competent manner. Systems must be in place so that 31/01/10 shortfalls regarding the service provided at the home are identified. This is so that actions can be taken to address the shortfalls, and improve the service provided to people living there. Arrangements must be made so that staff providing assistance to people regarding moving and handing, do so in a competent and safe manner. Arrangements must be in place so that all areas of the home that people living there have access to are deemed to be safe. This is to maintain the health and safety of people living there. 11 OP38 13(5) 31/12/09 12 OP38 13(4) 31/12/09 Bramley Court DS0000066491.V378424.R01.S.doc Version 5.3 Page 36 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 Refer to Standard OP8 OP9 Good Practice Recommendations Arrangements should be in place so that people are wearing visual aids as prescribed. This is to maintain their health and safety and improve the quality of their lives. Where people are prescribed “when required” (PRN) medication, protocols should be in place that state when, why and how much of the medication is to be given. This is to ensure that staff have clear directions to follow so that people receive their medication as required. Prescription creams prescribed “as directed” should have the dose clarified so that it is applied at the correct times. Arrangements should be in place so that people are wearing clean and appropriate clothing so that their comfort and dignity is maintained. Arrangements should be in place so that people have the opportunity to engage in meaningful and stimulating activities. This is in order to enhance the quality of life for people living in the home. Arrangements should be in place so that people are supported in a sensitive manner during mealtimes. This is on order to uphold their dignity, health and welfare.. Arrangements should be in place so that people can access fresh drinking water at all times. This is in order to maintain their health. A review of the purpose of the “Visitors Comments Book” should be undertaken so that peoples’ confidentiality is maintained, and so that people are confident that any concerns raised have been addressed. Arrangements should be in place so that people are provided with a home that is in a good state of repair and decoration. Arrangements should be in place so that people are able to access the call bell facility in order to get help from staff when they require. Additional management support should be provided so that the service provided at the home improves and so it is run in the best interests of the people living there. DS0000066491.V378424.R01.S.doc Version 5.3 Page 37 3 4 5 OP9 OP10 OP12 6 7 8 OP15 OP15 OP16 9 10 11 OP19 OP22 OP31 Bramley Court Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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