Inspection on 22/02/10 for Bramley Court

This inspection was carried out on 22nd February 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bramley Court 16/11/09

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 16/05/2010.

Random inspection report Care homes for older people Name: Address: Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Amanda Lyndon Date: 2 2 0 2 2 0 1 0 Information about the care home Name of care home: Address: Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER 01214307707 01214742944 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Care Management Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 76 Number of places (if applicable): Under 65 Over 65 0 39 dementia old age, not falling within any other category Conditions of registration: 37 0 The maximum number of service users who can be accommodated is: 76 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 Date of last inspection Care Homes for Older People Page 2 of 13 Brief description of the care home 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. 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. 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. Care Homes for Older People Page 3 of 13 What we found: The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last key inspection of this service was completed on 16th November 2009. We awarded the service a zero star rating as a result of the findings of the visit. This meant that people living at the home experienced poor quality outcomes. This random visit was undertaken by two inspectors over seven hours. There were fifty five people living there and the home did not know that we would be visiting. Due to the suspension of the contracts with two Local Authorities, there had not been any new admissions to the home since the beginning of August 2009. There were currently twenty one bed vacancies in the home. The reason for this visit was to review the homes progress in meeting a number of the requirements made at the last key inspection. Two 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 five staff members about the care they provided to these people. We sampled care, staffing and complaint 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 spoke with one visitor that was visiting the home. These are our findings: We looked at two peoples care plans. These are individual plans that include information about what people can do for themselves and in what areas they require support. Since our last visit, staff had undertaken training about this and we found that improvements had been made regarding the content of these. We saw that a number of care plans had recently been re written in order to include peoples preferences regarding their daily lives. This means that people should receive care and support in the way they prefer. From discussions with the staff team it was evident that they had some understanding of peoples individual care needs. They said We look at the care plans and fill in a weekly diary. We saw that a quality monitoring system had been introduced, so that shortfalls regarding the content of care plans could be identified. However, this is an ongoing process and we found that a number of care plans required further updating to reflect current care regimes. A number of care plans also required further development to include specific instructions for staff to follow in order to meet peoples needs. For example, regarding how often a person was to be weighed. We did, however, identify that people were being weighed at the times that they required. Care Homes for Older People Page 4 of 13 We found that a number of people who had come to stay at the home with dementia care needs now had additional general nursing care needs. As a result of this, they were now living in the general nursing care unit on the first floor of the home. However, staff met with during the visit working in this area of the home, told us that they would benefit from training about how to care for people with dementia. They said I think that upstairs we could do with training about dementia so we can know more about it. We found that this was the case. An example of this was that one person had not had a bath or shower since returning to the home from hospital seven days previously. Staff told us that the reason for this was because they were not aware of how to manage the persons aggression. In addition, we found that a care plan written for another person who has behaviour that can be challenging to others, identified the types of behaviour displayed, but did not give staff instructions about how to manage this. During the visit we met with a relative of a person who was living at the home. She was concerned as her father was not wearing hosiery as requested by a visiting health professional. This was addressed without delay, however is of concern that prior to the concern being raised, none of the staff team had noticed that the hosiery had not been put on. This may compromise the persons health and well being. 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 saw that people were clean, hair was neatly styled and people were wearing clothing appropriate to their age, gender, culture and the time of year. Exceptions to this were that we saw that one person had dirty fingernails and another person was wearing socks that were boldly labelled with somebody elses name on. This does not promote peoples health or dignity and we brought this to the attention of the manager for actions to be taken. We did, however, see that staff were interacting with people living at the home in a friendly and respectful manner. We saw that improvements had been made regarding the management of medication and that staff had recently undertaken further training in this area. We saw that systems had been introduced to ensure that people received their medication as prescribed thus maintaining their health. An exception to this was that we saw that one person was repeatedly refusing to take their medication. We could not find instructions for staff to follow about this and this may compromise the persons health. Since our last visit a new system had been introduced to ensure that staff are available to provide assistance to people during mealtimes. During our visit we saw that this was working well for the benefit of the people living at the home. Since our last visit we had not received any complaints about the service provided at the home. The manager told us that they had received one complaint since our last visit. However, we looked at the complaints records held at the home and found that they had received two complaints since November 2009. The first complaint was raised by the relative of a person living at the home. This was regarding the management of a recent outbreak of an infection affecting people living at the home and the staff team. The outcome of this was not upheld on the part of the home and the appropriate infection control measures had been put into place. It was evident that the complaint had been investigated in an appropriate and timely manner. The second complaint was also raised Care Homes for Older People Page 5 of 13 by a relative of a person living at the home. This was regarding people being left in wheelchairs for long periods of time. Records identified that the outcome of this complaint was upheld. The manager told us that the Visitors Comment Book that was being used inappropriately at the time of our last visit, had been taken out of use. She told us that plans were in place for a suggestions box and comment cards to be provided at the home. This means that people would have the opportunity to put their views forward about the service provided there. It was of concern however that as identified during our last visit, a group meeting involving relatives was yet to be arranged. This is despite a suggestion being put forward by a relative about this. Information on the staff training matrix identified that since our last visit a number of staff had received refresher training about safeguarding adults. This should mean that staff are aware of how to protect people living at the home and should ensure peoples safety. From discussions with staff during our visit, it was evident that a number of staff were waiting for refresher training in this area, however, had an understanding of safeguarding procedures. One staff member met with during the visit said I would report to the nurse in charge or the home manager. Since our last visit there have been two incidents that have happened at the home that have been raised as safeguarding. This is in order to protect the people living there and minimise the potential for a similar incident to happen again. We are not aware of the outcome of one of these incidents as it is being investigated by the police. The second safeguarding referral was a concern of a repeated nature regarding the home staffs failure to identify that a person had a pressure sore, (skin wound). This was investigated by social services and the primary care trust, and the case has now been closed. Actions taken by the home as a result of this included specialist staff training in this area. The system used for staff to handover information to the next shift team had also been further developed and this should improve communication between the staff team. However, during this visit we identified a further example of poor communication between the staff team. We brought this to the attention of the homes management team for action. During the visit we case tracked a person who had recently developed a pressure sore whilst living at the home. Care records identified that the staff had identified the wound and had made the appropriate referral to the community tissue viability team without delay. We were not, however, able to determine that pressure area relief was provided for this person at the times they required. This was because there were a number of gaps on the care records held at the home. It was also of concern that a care worker who was on duty during our visit told us that she was not aware that this person had a wound. This is despite saying that handover reports are undertaken. We brought this to the attention of the manager for investigation. The day following our visit, we spoke with the community tissue viability nurse who had assessed the persons wound. She agreed that the care record was poorly completed at times, however stated that there were no issues of a safeguarding nature regarding how the homes staff are managing this persons wound. During our last visit to the home, we identified that the communal bathrooms within the dementia house were cluttered and unhygienic. We had found that a cleaning product had been left out placing people at risk of harm. During this visit we looked at all of the communal bathrooms and found that they were safe, clean, tidy and ready for people to use. The manager told us that since our last visit, additional hours had been given for Care Homes for Older People Page 6 of 13 cleaning duties at the home. It was evident that this arrangement had improved the standard of hygiene within the communal bathrooms, for the benefit of the people living there. One staff member met with during the visit said There is an early and late cleaner on now. This makes a big difference. Since our last visit, a rolling programme of redecoration has started within the dementia house. Bathrooms and corridors had been painted. We did, however, see that the walls, ceiling and carpet were stained in one of the communal lounges within the dementia house. The fire exit from this room was blocked and we brought this to the attention of the manager. She said that immediate action would be taken to rectify this. We looked at the bedrooms of people case tracked and saw that they had been personalised to reflect their age, gender, interests and culture. The manager told us that since our last visit, all specialist equipment recommended by the community tissue viability team was now in place. This has promoted the health and comfort of people living at the home. Staff met with during the visit told us that there were now enough staff on duty to meet peoples needs. They said that the use of agency staff has reduced recently. This should promote continuity of care for the people living at the home. Since our last visit, the management structure within the home has changed. The home manager is currently working her notice. Plans are in place for an experienced temporary manager to cover the home, until a new manager is recruited. Since our last visit an acting deputy manager has come into post and a unit manager is now leading the staff team assigned to the dementia house. This means that there is now more time allocated to managerial duties, for the benefit of the people living at the home. In addition, we met with a person employed by the organisation who had spent the last month at the home, supporting the senior staff team within their job roles. This is to ensure that staff provide care and support in a competent manner to people living there. We reviewed two staff files of people who had recently come to work at the home. These included all information required. At least two references had been obtained for each of the new workers and we saw that staff do not start working at the home until satisfactory criminal records checks have been completed. This should mean that people can be confident that people employed by the home are suitable to work with vulnerable people. The staff training martix identified that there is a rolling programme of training in mandatory areas planned throughout 2010. From discussions with staff met during the visit and from records sampled, it was evident that since our last visit staff had undertaken training in a number of mandatory areas. This included moving and handling, infection control, fire safety, pressure area care and health and safety. One staff member met with said I have had food hygiene and infection control training recently. I have taken part in a fire drill and I also did the dignity in care champion training. In addition, we saw that plans are in place for staff to undertake a variety of training provided by the local primary care trust. We saw that since our last visit, a large number of staff meetings had been arranged. This has given all staff working at the home the opportunity to be involved in these. We sampled the minutes of the meetings and saw that feedback had been given to the staff Care Homes for Older People Page 7 of 13 team about the shortfalls identified in the service provided to people living at the home. Ways in which to improve the service provided were discussed. We saw that staff had the opportunity to put forward their suggestions about the service provided. What the care home does well: What they could do better: This is a random inspection and therefore not all the core standards were assessed. There are a number of outstanding requirements and these will be assessed at the next key inspection of the home. People cannot be confident that they consistently receive care and support at the times that they require. Staff must have the knowledge and skills to meet the needs of people who have dementia. Systems must be further developed so that shortfalls within the service provided be identified and rectified for the benefit of the people living there. Care Homes for Older People Page 8 of 13 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 set out on page 2. Care Homes for Older People Page 9 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 (2) Each person must have an 31/01/2010 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 8 12 (1) Care records must be up to date and reflect the actual care provided. This is to ensure that people are receiving care and support at the times that they require. 31/12/2009 3 27 18(1) Systems must be in place so 31/12/2009 that people receive the care and support at the times they require in order to meet their assessed needs. Arrangements must be made 15/02/2010 so that staff providing care to people living at the home have the necessary skills and knowledge to do so in a competent manner. Page 10 of 13 4 30 18 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 5 33 24 Systems must be in place so 31/01/2010 that 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. Care Homes for Older People Page 11 of 13 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 Systems in place for communication between the staff team must be further developed. This is to ensure that people receive care and support in the way and at the times that they require. 31/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 A system should be in place so that actions are taken should a person refuse to take their medication for a period of time. This is in order to maintain their health. Arrangements should be in place so that people are supported to wear their own clothing. This is in order to uphold their dignity and comfort. Arrangements should be made so that the relatives of people living at the home have the opportunity to be involved in regular group meetings. 2 10 3 13 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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