Inspection on 02/05/06 for Bramley Court

This inspection was carried out on 2nd May 2006.

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 16/01/07

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 Unannounced Inspection 2nd May 2006 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.V290900.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 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) Southern Cross Care Management Limited Jillian Ball 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.V290900.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That on the ground floor the home can accommodate up to 37 persons on the following basis: 30 older people for reasons of nursing care and dementia (DE(E)) and 7 people for reasons of old age and dementia (DE(E)). That once 2 of the 7 beds for older people with dementia become vacant they transfer to become nursing dementia care beds bringing the total up to 32. That the remaining 5 beds can provide a service to people with nursing dementia care or old age, dementia care. That on the first floor the home can accommodate up to 30 people over 60 for general nursing care and 9 people for general social care. As each of the 9 social care beds becomes vacant they will transfer to become general nursing beds making up to a total of 39 general nursing beds. That the total number of persons that can be accommodated in the home at any one time shall not exceed 76. That two people aged 50 plus can be accommodated for reasons of dementia in interim care beds for a maximum stay at the home of up to eight weeks. 21 December 2005 2. 3. 4. 5. 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 Haven 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 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 and has hoists, pressure relieving mattresses and assisted bathing facilities. 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. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Three inspectors Lisa Evitts, Kath Strong and Jill Brown visited the home in May and completed an unannounced inspection over about 10 hours. During the inspection four residents care files were looked at in detail and four staff files were looked at. Ten residents were spoken with and time was spent in lounges observing the interactions between residents and between staff and residents. Two relatives were spoken with. Medication administration records were checked both in the upstairs and downstairs units. Menus, staff rotas and accident records were looked at. The inspectors also sampled maintenance and inspection files for services such as fire safety and water temperatures. At the time of the inspection, the home had put a voluntary suspension on admissions to the ground floor dementia unit, in order to address concerns raised and to establish management of the unit. Five immediate requirements were made on the day of the inspection. What the service does well: The home collects good information before people are admitted into the home and this means needs can be identified and plans put into place to meet these needs. The home’s administration of medication was good and this good standard had been maintained for over six months. This makes sure residents receive their prescribed medication safely. Residents personal hygiene needs appeared to have been attended to and residents appeared well cared for. The arrangements for activities were good with imaginative activities being available. The staffing had been arranged to have an activities co-ordinator and it was clear from observation that the residents were used to having one to one time with staff. Relatives said that they felt welcome at the home and staff made drinks for them. Residents had choices about what they wished to do and had choices in the food they wished to eat. The menus were varied and detailed snacks that were Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 6 available. Residents said “the food is very good indeed” “staff bring you drinks when you need them” and “lots of drinks”. The home is purpose built and structurally enables residents to have space to walk, and is suitable for disabled people that need equipment for their condition. The home had aids available to assist residents to bathe and to use the toilet safely and this ensures that their personal hygiene is maintained. The home was clean and fresh on the day of the inspection, providing a homely environment for residents to live in. What has improved since the last inspection? What they could do better: Residents’ contracts did not identify the room the resident is to occupy. This could mean changes to rooms could be done without a process of discussion with the resident, their relative and the funding authority. The moving and handling of residents was not always good, the inspectors saw two moves of residents that were poor and two moves following falls that were good. The staff were not always completing turning charts on residents that need turns to prevent them getting pressure sores. These charts are needed to ensure that care is given appropriately. Residents’ lounges were not always staffed and this can cause difficulties for residents that need a high level of care, as they do not have access to support and supervision at all times. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 7 A previous resident’s care record was found not locked away and this does not respect the confidentiality of information about individuals within the home. Whilst the home was resolving complaints and acting on adult protection issues and latterly undertaking these quite well, lack of training for staff, procedures that do not follow the local multi agency guidelines and some complaint issues that are repeated need work to ensure that staff have adequate knowledge to deal with any situations appropriately and that trends in complaints are rectified. The home had a number of small repairs to do and needed to act on making the signage on the ground floor more appropriate for people with dementia, so that they can find their way around the home more easily. A couple of areas of inappropriate storage of foodstuffs and mops showed a lack of attention to important potential contamination issues and this potentially places residents at risk from harm. The levels, recruitment, training and retention of staff needed to be improved. The management of the home has not been consistent for some time and this has meant that management time has had to be spent in dealing with areas of day-to-day concern. This has meant that staff training and supervision have been poor and residents do not get support from a well skilled workforce. Residents and relatives have been concerned about management time being taken up working on the ground floor unit. The Commission is concerned about the lack of consistency and overall management time in the home. This had led to residents meetings not going ahead as planned, and therefore there is no formal mechanism to enable residents to comment on the service they receive. The home has maintenance and inspection records of services as required. There were a number of health and safety issues outstanding. Fire drills had not been undertaken this year and all staff had not had an opportunity to take part in a fire drill and training. This does not mean residents would be safeguarded in the event of a fire. The smoke room did not have a call bell and the loft was storing combustible material. Locks were needed on doors up to the loft and staff must ensure sluice rooms are locked to protect residents. Hot water checks had not been done as often as required and this potentially places a risk that residents may scald themselves. 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. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 8 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.V290900.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home collects good information, which means residents’ needs can be identified and plans put in place to make sure that these needs are met. EVIDENCE: The home has contracts with residents placed by social services. One resident that had no number on their door did not have a contract that described their particular room and this must be done, to ensure that residents are informed of the room they are to occupy and the terms and conditions of residency of stay at the home. Pre admission assessments were thorough and contained good information that needed transferring to the care plan, so that residents will receive care that meets their individual needs. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. 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. Care plans were comprehensive and had improved in detail but needed better organisation and review to make them more useful to staff delivering the care and responsive to residents changing needs. Some practice in meeting needs was inconsistent and this could be improved to ensure the comfort of residents. Medication administration was good and the interaction of staff with residents had improved. EVIDENCE: The home has care plans in place for all residents and these are very comprehensive. However they do not allow information to be retrieved quickly. Good information was available on the care plans such as “prefers a shower”, “two carers to assist with stand aid and wheelchair” but this also resulted in a risk assessment and moving and handling assessment and care plans about Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 11 these which seems excessive. The home had started putting more personalised information in the plans for example “likes face cream” and this is good practice. A pressure sore risk assessment review had not been done since February, a moving and handling, nutrition and a dependency rating since January despite the person scores showing they were a highly dependent. One care plan had excellent detail on cleaning teeth but had yet to be reviewed to show residents likes and dislikes in respect of food. One care plan stated that the resident rolls out of bed family do not want cotsides; a risk assessment should determine whether cotsides are to be used. However a review of the overall care plans of residents showed some good practices such as where cups of tea were agreed to be increased. Moving and handling plans were specific about increasing a resident’s mobility by plans to walk with two specific care staff until confidence is gained. A resident fell during the inspection. This was handled well the resident was kept on the floor and talked to by the staff calmly for ten minutes. The resident was checked over and was assisted to rise from the floor appropriately. Another resident that felt unsteady was assisted to the floor at his request and they allowed him to assist himself to a standing a position. However on two occasions residents were moved inappropriately in the upstairs unit. One resident was not weight bearing and was moved with a stand aid hoist, and on the second a resident was moved with a stand aid hoist without checking that the residents feet were in the right position for this move to be effected safely. A turning chart was in place for a resident that needed turning but not available in their room. The turning chart had not been completed for at least the 8am and 10 am turns. This with the lack of review of tissue viability and nutrition is concerning. Residents call bells were within reach for residents that were in bed and this ensures that they call for help when needed. The lounges on the ground floor were staffed consistently through the inspection however this was not always the case on the first floor and this needs attention. Residents personal hygiene needs were attended to; residents appeared well cared for. The medication administration viewed on the first floor was good with only two administrative errors. The improvements identified at the last inspection have been sustained. The concerns found on the ground unit about staff interaction with residents had substantially improved from the previous inspection. Staff were able to say who the resident was and the difficulties they had. All interactions witnessed were appropriate and kind. A resident said “it is OK here and the other people Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 12 are fine considering”. A previous resident’s records were found on a bookcase in a residents’ lounge and not securely locked away, and this does not ensure confidentiality is maintained. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides good meals, a range of activities, welcomes visitors and tries to enable residents to make choices and this enhances residents’ lives. EVIDENCE: The home has organised the staff to have an activities co-ordinator available. This member of staff said that the residents like to cook with chocolate rice crispies, craft, music and chair exercises. The music for health was started last week and this went down well. The activities co-ordinator had a good relationship with residents and spent some time in one to one chats with individuals. Upstairs staff said that residents got involved in Bingo, painting, drawing, videos, cooking and external entertainers and churches visited. The home had recently organised a pancake day, mother’s day and Easter raffle events. Music was heard playing in the lounges. A number of the residents were reading and a resident was seen painting and another waiting to get her hair done. The two visitors spoken to said they were made to feel welcome in the home one relative said “they were always made welcome in the home and made a drink”. There appeared to be no undue restrictions in people visiting. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 14 Residents did not appear to be unduly restricted. On the ground floor, because residents need to be protected from dangers, the unit door was locked but within the unit residents were allowed to walk around. However because of a recent incident a fire door has had to have a coded lock to protect the residents further. Residents upstairs appear to be able to rise and go to bed when they wish. Residents did not raise any concerns in this area. The menus provided by the home were good and varied and comprised a fourweek rolling menu. One resident said “the food is very good indeed”. One relative was concerned that the staff member that knew all of the residents’ preferences and been required to work in the downstairs unit. Residents can have a cooked breakfast on a Saturday but they will prepare other options on request. The cook talks directly with residents about food and as a result of this the menus are currently being revised. From suppertime to breakfast time there are additional snacks of cereals, yoghurts or sandwiches these are on the menus to ensure that residents are aware that they are available. Drinks are available residents said “staff bring you drinks when you need them” “lots of drinks are given”. The home record the option that residents choose but the recording on the amount residents have eaten and of what was actually eaten was poor. It is important for residents who require monitoring of intake to ensure that a record of food eaten is maintained. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had received complaints covering the same issues and had not taken action to prevent themes occurring. The homes adult protection procedure is inadequate and poor training of staff did not adequately protect residents. EVIDENCE: There has been a number of complaints. One family made a complaint regarding their relative, which has covered such areas as personal possessions going missing, cleanliness of the resident’s room, finances and contracts. Another complaint was about a residents’ care following a fall but also showed poor cleanliness and care practices overall. Three families and a paramedic have complained and an anonymous complaint has been received. There were some recurring themes and the organisation needs to look at their policy for accompanying residents to hospital. A previous complaint about the access to the building still was causing problems; an officer of the organisation took eight minutes to get into the building on the day of the inspection. The home audits the complaints they receive on a monthly basis and develop action plans for improvement. The home has an adult protection policy and procedure and this needs some revision to be in line with the local multi-agency guidelines in Birmingham and No Secrets Guidance from the Department of Health. The organisation cannot Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 16 alone determine the seriousness of an allegation or incident, all incidents and allegations must be reported to the Commission under regulation 37 processes and Social Care and Health who are the lead authority. The investigation of any allegation will be determined via the strategy meetings. In practice the home has responded well to a difficult allegation appropriately. The home needs to ensure that a larger proportion of staff have received training on adult protection. This may be part of an NVQ2 course and where this has been undertaken evidence should be retained, the home had arranged POVA training in May. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The layout of the building meets the needs of residents. The procedures for good infection control were not always consistently carried out, and this could affect residents’ health. EVIDENCE: The home is purpose built and as such provides a good environment for residents. The home has spacious bedrooms and all of them have an en suite toilet facility. The organisation has a good attitude to upkeep of the building and has acted on all the previous requirements in this area. The home had replaced a carpet in one of the lounges. A number of repairs were noted at this inspection: - a bathroom ceiling was water damaged and an offensive odour from this was noticeable, a shower room had paint that was peeling and one toilet didn’t have a light fitment in place, this does not ensure Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 18 that residents live in a clean, well maintained environment with adequate lighting. All the toilets have toilet frames to assist residents. However toilets did not always have any signage to indicate that it was a toilet and this created problems for a resident on the day of the inspection. The residents’ room doors have now been made to look like house front doors with knockers and numbers. The home stated its intention for biography boards to be placed on the outside of bedrooms on the ground floor to assist residents to find their way to their room. Not all the bedrooms had a number on the door. The mattresses reflected the residents assessed needs for managing the risk of pressure sore development and this was good practice. All bedrooms have door locks fitted and residents or their relatives are offered keys. Cereals were kept in the small kitchen areas and these were not in a airproof container following opening. A fridge in a dining area had fortisips belonging to a deceased person and a box of fortisip was unnamed but open and there was an empty coca cola can. Mops were left in mop buckets and not stored inverted and hooked on to a wall. The home had an inspection from Health Promotion Agency and scored 82 , the home needs to address their weaker areas, to ensure that the environment is clean and the potential for infection is minimised. The home was generally clean and odour free on the day of the inspection but bedding needed checking more thoroughly before being made up. The laundry was clean and tidy and the kitchen clean and well organised. 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 for their condition. The home had aids available to assist residents to bathe and to use the toilet safely and this ensures that their personal hygiene is maintained. There is level entry access and the first floor can be accessed by a passenger lift. A range of hoists and pressure relieving mattresses are available for residents who are assessed as requiring this equipment. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing did not ensure that the manager only acted in this capacity. Staff did not always have the level of training required to perform their roles safely and this does not ensure they have the knowledge and skills to meet the assessed needs of the residents. Information was not available to determine that staff had the appropriate checks before starting work. These failings potentially put residents at risk. EVIDENCE: Staffing levels were not appropriate at the time of the inspection. The manager was acting as one of the required RGNs at time of arrival, as a member of staff had failed to come on their shift and a RGN arrived at 10 am. There was no administrator at the home on arrival but a senior administrator arrived soon after the inspectors. This puts an inordinate amount of pressure on the manager of such a large home. A number of agency workers had been used in the home but not for many shifts and this means that residents have consistency of worker. The schedule of training provided by the home did not have the NVQ 2 recorded on this and this will be a requirement, as the home should be achieving the recommended minimum of 50 staff who have this qualification. The training schedule will assist in the collection of this data. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 20 The employment of staff is generally safe. Staff references are received and checks from the Criminal Records Bureau and POVA are being done but some of these weren’t accessible to inspectors during inspection visits. The training of staff was inconsistent and variable with poor overall attainment of the mandatory training and updates within the specified time limits. This means staff do not always have the skills to meet individual needs. The induction of staff was being undertaken but evidence was not consistent and did not match the skills for care guidance. Worryingly fire training and moving handling was not completed for all new staff and this does not safeguard residents or staff from potential harm. Some staff have received training in challenging behaviour and dementia awareness and this ensures they have the knowledge to deal with residents who have these needs. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The instability of the management arrangements do not ensure a consistent service is received by residents. Poor staff supervision and crisis management put residents at risk. EVIDENCE: The manager had been in post for about 3 months at the point of the inspection. She is a Registered Nurse with a good history of management and training. The manager has had to concentrate a major part of her effort on the ground floor of the home due to serious concerns about that area of the homes performance. This has meant that residents and relatives of residents on the first floor have felt side lined with comments such as “Thought the new Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 22 manager would be good but she is always busy on the ground floor… she does sort things out if you go and see her” “ We are worried that there will be a knock on effect for the residents upstairs with all the problems with down here”. The separation of management of the two areas of the home should be considered to give each group of residents and relatives the time they need. The management of this home has undergone several changes over the last few years and this has caused problems over ensuring consistent good practice. The home undertakes several audits including a monthly information on the home presentation, medication, case file documentation, pressure areas, accidents and so on, and this should ensure that the needs of the residents are being met and documented. Trends or reoccurrences should be highlighted and actions taken to rectify any problem areas. The inspectors noted that that a resident said that the last three residents meeting had been cancelled, which means that the residents do not have an opportunity to voice their views on how the home should be run to meet their needs. The home keeps the record of residents’ personal monies on a computer system. The monies held for residents at the home tallied with that record. The recommendation that the home checks the balance of money against the record on a monthly basis was not inspected as the administrator had recently left and is brought forward. The home has a safe system of invoicing and referring the invoice to the individual resident or representative. A number of residents did not appear to have the full benefit of their personal allowance in the money given to the home. The home do not document who manages resident’s money and why, or what the usual pattern of spending the resident had to ensure that rights to their personal allowance is protected. The supervision of staff remains poor. Evidence of records on staff files showed gaps in the supervision recordings. During four staff interviews it was evident that staff were not receiving supervision, one staff member stated, “she had not received supervision since returning to work” Two other members of staff had not received supervision and one other member of staff had received a formal supervision session in February. The manager sent a copy of the supervision session’s matrix to CSCI for review and this showed that the recommended six sessions a year of supervisions was not being maintained and this does not ensure adequate performance management and development of staff. This and training of staff are the areas that suffer during management changes and this does not protect residents by ensuring they receive care from well-supervised staff. Care notes of residents showed that a number of small injuries to residents had not been reported to the Commission as required and this was outstanding from previous inspections. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 23 The door leading to the boiler room and the attics of the home was unlocked. The attics were full of combustible items that constitute a fire risk. The door also had a hole, which meant it was not acting as a fire door. Sluice rooms were not always locked and this could be a hazard for residents. The residents’ smoke room did not have a call alarm and this prevents residents from getting assistance if needed. The home had pads stored against wiring and this could increase the fire risk and consideration should be given to alternative arrangements. The fire risk assessment had not been signed or dated and there were no records of any fire drills being undertaken this year. Fire drills must have detail on where the alarm was raised, names of staff who attended, length of time it took staff to respond and any issues that need addressing. The fire alarm system was checked monthly along with fire doors and emergency lighting. Maintenance records were generally comprehensive with the exception of water temperature checks, which were not maintained monthly. Where as the home has good accident records and audit tools, the monitoring of unexplained injuries had gaps. The home must advise the commission of unexplained injuries and this is an ongoing requirement. Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 2 1 2 2 Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 25 Yes Are there any outstanding requirements from the last inspection? 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 Standard OP2 OP7 Regulation 5(1)(c) 15(2) Requirement Residents’ contracts must identify the specific bedroom that the resident is to occupy. Care plans must be reviewed on at least a monthly basis especially those areas that identify the level of risk and may result in changes in the plan such as Waterlow, nutrition and so on. Where a risk assessment determines the best way of lessening a risk to a resident is the provision of bedrails these must be used unless the resident themselves refuses. Staff must ensure that residents are moved in a safe manner and with the prescribed Number of staff. (immediate requirement left) All staff moving residents must have had moving and handling training or where appropriate an update in the last year Residents must not be left without staff supervision in the lounges. (This was outstanding since DS0000066491.V290900.R01.S.doc Timescale for action 31/08/06 31/08/06 3 OP7 13(4)(c) 31/07/06 4 OP8 13(5) 03/05/06 5 OP8 13(5) 18(1)(c) (i) 13(4)(c) 31/08/06 6 OP8 31/07/06 Bramley Court Version 5.1 Page 26 7 OP8 12(1)(a) 8 OP10 12(4)(a) 9 10 OP15 OP16 Sch4(13) 13(1)(b) 11 OP16 22(8) 24(1)(b) 12 13 OP18 OP18 13(6) 13(6) 14 OP19 23(2)(b) (d) 22/12/05) a) Residents that require turning must be risk assessed for the time intervals and b) Monitoring forms for turning must be completed at each turn and is recommended that these be kept in the resident’s room. All care records must be kept in a place where they are not accessible to people other than those who legitimately look at them. (This remains outstanding since28/02/06) The amount residents eat and of what must be recorded to ensure that adequate nutrition is taken. Timely access to the building must be arranged for health professionals and visitors. (This was outstanding from 15/02/06) Audits of complaints must lead to actions to improve – the home must revisit its practice in accompanying residents to hospital and make clear their policy and procedure to residents and their families at the point of admission. (This was outstanding from 28/02/06) The organisation must revise the adult protection procedure to be in line with the local strategies. All staff must receive training on adult abuse and protection at a level commensurate with their position in the home. The home must ensure the following are attended to: a) The water damaged ceiling in a bathroom b) The peeling paint in a DS0000066491.V290900.R01.S.doc 02/05/06 31/07/06 31/08/06 31/07/06 31/08/06 31/08/06 31/08/06 31/08/06 Bramley Court Version 5.1 Page 27 15 OP22 23(2)(n) 16 OP26 16(2)(g) 13(3) shower room. c) The light fitment in an identified toilet. a) All communal toilets must 31/08/06 have some form of signage on the door to indicate they are toilets. b) All bedrooms must have some identifying feature on the door and relate to the contract. All opened dried foods should be 31/07/06 stored in sealed containers once opened and foods should not be stored on the floor. (This remained outstanding since 14/10/05 and 15/02/06) Fridges in the dining area must be checked daily for inappropriate foods stored. Mops must be stored in an appropriate way. The staffing levels in the home must allow the manager to act as a manager and every situation where this is not so must be reported to the Commission. The Registered Person shall ensure that a minimum ratio of 50 of care staff obtain NVQ level 2 or equivalent by 2005. (Previous timescale of 31/05/05and 30/04/06 not met) All staff records must have as a minimum on file documentary evidence of the outcome of CRB and POVA checks and an agreement with the Commission where the full disclosures can be viewed by inspectors. 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) DS0000066491.V290900.R01.S.doc 17 OP27 18(1)(a) 31/08/06 18 OP28 18(1)(a,c) 31/10/06 19 OP29 19 Sch 2 31/08/06 20 OP29 13(4)(c) 31/08/06 Bramley Court Version 5.1 Page 28 21 OP30 23(4)(d) 13(4)(c) 22 23 OP31 OP32 9 24(3) 24 OP35 13(6) 16(2)(l) 25 OP36 18(2) 26 OP37 37 27 OP38 13(4) 28 29 30 OP38 OP38 OP38 23(4)(a) 13(4)(c) 13(4)(c) All staff must have fire training on a six monthly basis and all nursing and care staff must have a valid first aid certificate. (Outstanding since 28/02/06) The manager must complete the Registered Managers Award. The home must ensure residents and relatives views are regularly obtained and their concerns acted upon. Arrangements made with relatives or other service user representatives in respect of service users personal allowance must be recorded. (This requirement remains outstanding since 31/03/06) Staff must have recorded supervision no less than six times a year. (Previous timescale of 31/05/05 an 15/02/06 not met) A copy of the proposed rotas of supervisions must be sent to the Commission by Accident or incident forms are to be completed for all unexplained injuries, and CSCI informed as per regulation 37. (This requirement was outstanding since 13/01/06) The door accessing the loft and the boiler room requires a lock to ensure the safety of residents. This door must be fire resistant and all holes must be filled. (An immediate requirement was left) The attics must be clear of combustible materials. Sluice room doors must be locked. A call alarm must be fitted in the smoke room. (this remained outstanding since 31/03/06 and an immediate requirement was left) DS0000066491.V290900.R01.S.doc 31/08/06 31/12/06 31/08/06 30/09/06 31/08/06 31/07/06 04/05/06 31/08/06 31/07/06 09/05/06 Bramley Court Version 5.1 Page 29 31 32 OP38 OP38 23(4)(e) 23(4)(e) The fire risk assessment must be reviewed, updated and signed and dated. The home must commence fire drills and all staff must have an opportunity to attend. (an immediate requirement was left.) Fire drill records must have appropriate detail of who attended and response time and so on. Regular monthly checks of the temperature of hot water outlets must be maintained. 31/07/06 09/05/06 33 OP38 13(4)(c) 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations It is recommended that the identified corridor is painted in a different colour on the Haven unit as the toilet door blends into it, therefore not making it easy for residents to identify. It is recommended that the home checks residents’ money against the record on at least a monthly basis. (This recommendation was not inspected and was brought forward) It is recommended that the storage of pads next to electrical cables be reconsidered. 2 OP35 3 OP38 Bramley Court DS0000066491.V290900.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 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.V290900.R01.S.doc Version 5.1 Page 31 - 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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