Inspection on 26/11/07 for Bramley Court

This inspection was carried out on 26th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Bramley Court 251 School Road Yardley Wood Birmingham West Midlands B14 4ER Lead Inspector Amanda Lyndon Key Unannounced Inspection 26th November 2007 09:20 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.V351164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bramley Court DS0000066491.V351164.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 Debbie Clarke (Home Manager) 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.V351164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 1. 2. That on the ground floor the home can accommodate 37 older people for reasons of nursing care and dementia (DE(E)). That on the first floor the home can accommodate 33 people over 60 for general nursing care and further 6 older people for general social care. As each of these social care beds become available they will transfer to become general nursing beds making a total of 39 general nursing beds. That the home can accommodate two named service users under the age of 65. (Registration Category 1 OP 1 DE) 16th January 2007 3. Date of last inspection Brief Description of the Service: Bramley Court is a 76 bedded purpose built care home providing 24 hour nursing care. The “Dementia House” is located on the ground floor of the Home and can accommodate a maximum of 39 residents with dementia. The first floor is a 37 bed-nursing unit, which also currently has some residential care beds. On both floors the residential care facility will be phased out and no further residential care admissions will be accepted. The Home has level entry access and the first floor can be accessed by a passenger lift. It has wide corridors and handrails to assist residents to maintain their independence. The home has hoists and stand aids that can assist residents with decreased mobility, and pressure relieving equipment is available for residents who require this to prevent skin sores. All bedrooms have en suite toilet facilities, and there are assisted bathing facilities to meet the needs of the residents who require this assistance. The Home has dining room facilities and lounge areas. Kitchen and laundry facilities are located in the basement of the home. Bramley Court is situated in a suburb of Birmingham with public transport and limited amenities close by. There is limited off road parking available at the front of the Home and a small-enclosed garden/patio area to the side of the home for residents use, weather permitting. Contact details for CSCI are displayed throughout the Home and our most recent inspection report was available for anyone interested to read. Notice boards are available throughout the Home displaying forthcoming activities, the Home’s newsletter and other information of interest to residents, visitors and the staff. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 5 Current fee rates are not included in the statement of purpose or service user guide but can be obtained from the Home. Additional charges include hairdressing, toiletries, newspapers/magazines and private chiropody. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of our inspection 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 aspects of service provision that need further development. A random visit was undertaken at the Home on 31st May 2007 in order to monitor the progress made since the previous key visit undertaken in January 2007. During the random visit a number of requirements were made regarding the shortfalls in care planning documentation, the limited social opportunities available for residents who are unable to join in the group activities arranged by the home, and staff pre employment checks such as obtaining suitable previous employment and character references. This information was taken in to consideration when planning for this visit. Other information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving residents and any complaints received about the service provided at the Home. The Project Manager had completed a self- assessment document, giving some information about the Home, including information about residents and staff which was also taken into consideration. Prior to the visit questionnaires had been sent to residents and their relatives. Positive comments received included: “The staff are very good, any problems with my husband they get in touch with me straight away”. “The food at Bramley Court is excellent, plenty of vegetables and a good selection of dishes’’. “I love to see the residents’ faces when dinner is served, there is a good selection of puddings’’. “I am very much a part of the Home and I am a visitor to all thirty eight residents on the ground floor”. “The residents are a happy bunch of people.’’ “They are treated well and they are very relaxed and enjoy life in the Home”. “Bramley Court is a good home’’. “There is a nice atmosphere in the home and the residents are well looked after”. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 7 “There are lots of improvements. With new management the future looks very promising and a big thank you to Bramley Court”. “Bramley Court has looked after my husband for the last eighteen months and has done a very good job”. “I felt upon entering Bramley Court that it was the right home for my wife to live in”. A number of negative comments were received including: “The evening meals require improvement”. “It could improve by cleaning up the Home”. “I often find food left in the bedroom”. “Regular staff are excellent but they experience shortages all the time, this makes it ver stressfull for carers so many carers have left’’. “Buzzers are frequently ignored, nurses need to take more notice”. “There is not enough experienced staff to cope with so many residents’’. Three Inspectors, including the Pharmacist Inspector, undertook the fieldwork visit referred to in this report over one day. At the time of the visit there were seventy-three residents living at the Home, one of whom was in hospital. The Home was not aware that we were visiting. Information was gathered by speaking with residents, visitors, and the Home Manager, Operations Director, Unit Manager and nursing and care staff. The Inspectors 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 Inspectors during visits to Homes. Experts by Experience observe what happens in the Home and talk to residents to obtain their views of the Home. The Expert talked with eight residents and produced a report based on her findings. Overall, feedback from these residents indicated that they were more than satisfied with the service, care, cleanliness of the Home and choice of food. She concluded that Bramley Court is of a high standard; details of this are included within this report. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 8 An additional method of obtaining information was “case tracking” four residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand their experiences. No immediate requirements were made on the day of the visit What the service does well: Residents know before admission that their care needs could be met whilst living at the Home. A service user guide has been given to all residents so that they have information about the services provided at the Home. Residents come to stay at the Home for a trial period and the staff team supports them during this time. Residents have access to a wide range of health and social care professionals so that their health care needs are met. Staff approach residents in an understanding and sensitive manner so that residents feel calm, confident and relaxed. The Home is conducted in a manner, which respects the privacy and dignity of residents. The medicine management within the home is good. Staff had a good understanding of the medicines they handle to meet the residents needs Residents’ individual religious beliefs and cultural preferences are respected and opportunities for religious worship are provided as requested. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines at the Home and residents can choose where they spend their day and where they are served their meals. Visitors are made to feel welcome at the Home and are encouraged to spend time there. Residents and their families are encouraged to put forward suggestions about how the Home is run and they are informed about what actions have been taken in order to address any issues raised. Residents are served a variety of healthy meals that meet any special dietary requirements for reasons of health, cultural background or taste. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 9 A written record of any complaints received by the Home and the actions taken in response to these is available. The gender mix of care staff reflects the gender mix of residents so that care is provided in an understanding manner. Staff meetings are held regularly ensuring that important information about residents’ care and the services provided are conveyed and discussed amongst the staff team. Staff training is provided so that staff should have the appropriate skills and knowledge to work safely and effectively in order to provide a good standard of care to residents. Residents and their relatives are invited to group meetings in order to put their views forward about the services provided at the Home. 78 of care staff have achieved NVQ Level 2 in Care so that they should have the necessary skills and knowledge to provide a good standard of care. A report based on the findings of quality monitoring at the Home is available for residents to view so that they are aware of any actions to be taken. What has improved since the last inspection? Each resident has a care plan that outlines the care and support that they require so that their preferred routines should be maintained whilst living at the Home. Communications between relatives and the staff team has improved so that all important information should be conveyed between them. Menus are available for residents to refer to and residents are asked what they would like to eat before each meal. A record of food eaten by residents deemed to be at risk of malnutrition is kept in order to monitor what they are eating. “Finger foods” have been introduced during afternoons so that residents deemed to be at risk of weight loss are encouraged to eat more. There is a rolling programme of redecoration and refurbishment in place and since our last visit a number of carpets and curtains have been replaced. New kitchenettes had been created on both floors and good progress had been made regarding the decoration of the communal areas of the dementia care unit. The “In House Trainer” has recently completed a trainers certificate so that she should have the necessary skills to deliver training to the staff team in a competent manner. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 10 The new Home Manager is enthusiastic and has a good knowledge of her job role. Senior Managers and administration staff support her so that she should have the time to support the rest of the staff team. This should improve staff morale and improve the standard of care provided for residents. What they could do better: Care plans pertaining to wound care must identify the current care regimes in order to ensure that residents receive the appropriate care in this area. Behaviour management care plans must include information about any possible trigger factors for challenging behaviour and must identify any management techniques to reduce this behaviour in order to safeguard residents. Systems must be in place to ensure that residents have access to prompt medical attention at the times that they require. Activities to suit individual needs must be arranged. It is recommended that training be provided for suggestions for activities for residents with dementia and residents who are unable to participate in group activities Activities provided do not meet the needs and expectations of residents with dementia and residents who are unable to join in group activities. Staff must be aware of individual residents’ preferred times of going to bed and rising in the morning so that their preferred routines can be maintained whilst living at the Home. Staff must be available to provide care for residents at the times that they require and residents must be aware of how to summons for assistance in order to prevent waiting for assistance for an unacceptable length of time. Systems should be in place to ensure that residents are seated in the chair of their choice during meals in order to ensure their comfort during these times. The garden needs attention so that it is a safe and attractive facility for residents to use. All staff must have two references including one from the most recent employer prior to commencing employment at the home in order to safeguard residents. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 11 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 12 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.V351164.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and prospective residents have enough information in order to decide whether they would like to live at the Home. Residents know before admission and during their stay that the Home can meet their care needs. EVIDENCE: The statements of purpose and service user guides were comprehensive and included interesting information for prospective and existing residents and their representatives. These were available in the Home for anyone interested to refer to. These require updating to reflect the current staff employed at the Home and their qualifications. Plans are in place for these documents to be produced in large print and picture formats for ease of reading. The service user guide is also available on audiocassette for people with poor eye sight. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 14 Comprehensive pre admission assessments had been completed for residents who had recently come to live at Bramley Court. These included all information required in order to assess their social care needs and the physical, mental and emotional health needs in order to determine whether their individual needs could be met at the Home. There is a separate, additional pre admission assessment completed for prospective residents with dementia care needs in order to ensure that their specialist needs could be met at the Home. Prior to admission, a draft care plan is written, outlining the care and support to be provided for this person. Residents come to live at the Home for a four- week trial period and there was evidence that following this time care reviews are undertaken involving residents, their representatives, social workers and the Home’s staff. This provides all present with the opportunity to put forward their views about the care provided and whether the resident would like to continue to live at the Home Intermediate care is not provided at Bramley Court. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 15 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive person centred care and the systems in place for health provision are generally good. However delays in obtaining medical advice on two occasions does not promote the health and well being of residents. Care planning and delivery regarding dementia care require further development in order to ensure the best possible outcomes for residents. The medicine management within the home was good. Robust systems for medicines are in place to ensure that medicines are administered as prescribed. Residents are cared for in a respectful manner and this ensures that their self-esteem and dignity are maintained. EVIDENCE: Comprehensive assessments of residents’ individual care needs are undertaken on admission to the Home and care plans are derived from this information. These are individual plans, written with the involvement of residents or their representatives that outline the specific support required by staff in order to meet their personal and health care needs in the ways that they prefer. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 16 Since our last visit to the home, improvements had been made regarding the content recorded within care plans and the vast majority included good detail of the individual preferences of residents. Most care plans identified the specific support required by staff in order to meet residents’ care needs whilst maintaining their independence and dignity. Short term care plans had not always been written and this may prevent the progress of short term conditions from being monitored. Daily records did not always identify the emotional support provided for residents during that day and how the residents had spent their day. This may prevent an accurate care plan evaluation from being undertaken. Personal risk assessments had been undertaken including the risks of residents’ falling, aggression and nutrition, however not all of these had been dated on completion. Nutrition risk assessments included detail of any food preferences of residents in order to encourage them to eat. Food intake charts had been completed for residents identified to be at risk of malnutrition in order to monitor what they are eating. Residents were weighed regularly and the results of this were recorded in an easy to read format in order to detect any weight loss or gain. For residents who were deemed to be at risk of weight loss there was evidence that referrals were made to the community dietician. At the time of our visit there were five residents with pressure sores (sore skin) and three of these sores had developed prior to the residents coming to live at Bramley Court. The Home Manager undertakes an audit of this on a weekly basis in order to monitor the incidences of sores at the Home and ensure that the appropriate care was being afforded to these residents. The Home Manager stated that the appropriate pressure relieving equipment was provided for these residents and other residents who were deemed to be at risk of developing sore skin. An exception to this was one resident who, in conjunction with all agencies involved in her care, had decided to lie on a mattress that did not offer maximum pressure relief. The majority of care plans sampled pertaining to sore skin were recorded in good detail and identified that the appropriate care was being provided in this area. An exception to this was that a care plan had not been updated to reflect a change in care regime following a visit from the tissue viability nurse. This change had, however been recorded within the wound care evaluation notes and there was evidence that the change in care regime had been acted upon at the time that it was made. A number of residents living within the “Dementia House” exhibit unpredictable behaviour and a registered mental health nurse is now employed in this area. This should improve the standard of care plans regarding this type of behaviour. During the visit we sampled a care plan pertaining to a resident Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 17 that exhibited physical aggression towards other people. This included good detail of the support required by staff in order to approach the named resident in a calm manner, however did not include detail of any trigger factors that may result in her becoming agitated and the specific support required by staff during these periods. Daily records for this resident identified that there had been a number of incidents of aggression exhibited by this resident during recent weeks, one of which was of an adult protection nature involving another resident. Records did not indicate what had lead to this behaviour, what support was provided by staff, how the incidents were controlled and what measures have been put in place to prevent further incidents of a similar nature. Staff had received training about supporting residents with challenging behaviour however after discussion with the “In House Trainer”, the content of this course was basic. Residents and their families are invited to regular care reviews. This provides all present with the opportunity to discuss the care that they are receiving and put forward any suggestions for change or improvement. Due to the high turnover of Home Managers at Bramley Court and the number of concerns raised about the care provided at the Home in recent years, representatives from the Primary Care Trust are working alongside the Home’s staff on a temporary basis. This is to provide support and guidance to the nursing staff team. This arrangement was welcomed by the Organisation in order to improve the outcomes for residents. Residents have access to a range of Health and Social Care Professionals, including Social Workers, Dieticians, Community Psychiatric Nurses, Opticians and Chiropodists. Residents have the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement). The Organisation stated that communications between the Home’s staff and the local GP surgery is poor and during the visit it was noted that a concern had been raised by the Practice Manager of the local surgery regarding the Home’s failure to seek prompt medical advice for two individual residents on two separate occasions. This is currently being investigated by the Organisation, however initial enquiries indicate that this was possibly due to a breakdown in communication between the Home’s staff and local GP surgery. The pharmacist inspection lasted two hours. Seven residents medicines were looked at together with their medicine charts and supporting daily records. Three nurses were spoken with during the inspection. The home has a good system to check the prescriptions prior to dispensing and to check the medicines received into the home. Any discrepancies are quickly acted upon. Three nurses spoken with during the inspection had a good understanding of the medicines they handle, which would help them support the residents’ clinical needs. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 18 Audits of medicines and medicine charts indicated that the medicines are administered as prescribed. Controlled Drugs entries in the CD register were accurate and matched entries on the medicine chart. Staff are regularly audited to ensure they adminsiter the medicines as prescribed. The Home has only some protocols written for medicines to be administered occasionally and the remaining were being reviewed. Regular medication reviews take place with the doctor. Residents’ preferred names are recorded within their care plans and on the day of the visit staff were greeting residents by these preferred names. There is a payphone for residents to make telephone calls and a number of residents have chosen to have a private telephone line in their bedrooms. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are provided however these do not meet the needs and expectations of all residents living at the Home. Residents are able to choose how they spend their time and this ensures that their individuality is maintained and their wishes are respected. However residents do not always have a choice about the times that they go to bed and rise in the morning and this may prevent them from receiving support at their preferred times. The choices of wholesome and well-presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. A poor hygiene practice during the serving of residents’ meals does not maintain the health of residents. EVIDENCE: During the visit we had the opportunity to speak with the activities person who had just returned to the Home that day. It was evident that she was very enthusiastic about her job role and had many ideas of activities to introduce for the residents’ enjoyment, including hand crafts, quizzes and bingo. It is recommended that training be provided for suggestions for activities for Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 20 residents with dementia and residents who are unable to participate in-group activities as the activity person acknowledged that she had a gap in knowledge in these areas. The Expert reported that the residents she spoke with were not aware that an activities person was now in post (however it was her first day). Residents confirmed that they had enjoyed the recent trip to Walsall Illuminations and the theatre and that they could choose which activities to participate in. Details of forthcoming events were on display so that residents could choose which activities they wished to participate in. These included Christmas Carol Singers and a Sing a Long. A small number of residents choose to go to a day club and participate in associated activities. The Home Manager has recently produced a Home’s Newsletter and plans are in place for this to be issued monthly. There is an open visiting policy and visitors met during the visit confirmed that they were made to feel welcome at the Home. One relative said “We make our own drinks when we come but the staff always offer as well”. Communications between the Home’s staff and relatives appeared to be improving and relatives confirmed that they were kept informed about individual residents’ progress. There was a lively and friendly atmosphere within the Home and there were numerous visitors on the day of our visit. Residents’ preferences regarding their religion are supported and respected and church services and Holy Communion are held at the Home regularly. Residents of non-Christian faiths can also be supported at the Home. The Expert reported that residents who were independently mobile stated that they were able to go to bed and get up at the times that they chose. However, a number of residents who were unable to stand and walk stated that they were assisted at the times that suited the care staff. Residents confirmed that they had a choice of how they spent their day and where they chose to spend their time and where they are served their meals. Menus identified a variety of nutritious meals with choices provided each day. Hot and cold menu options were available at suppertime and one resident stated that she would prefer cheese on toast on the evening of the visit instead of sandwiches. This was arranged without delay. Residents confirmed that they are offered a snack meal at bedtime so that they would not be hungry during the night. Hot drinks are available for residents during the day and night time and the Expert reported that residents said that they did not have to wait long for these to be served. Special diets are arranged for reasons of health; taste and cultural/religious preferences and the portions of pureed meals are served separately so that residents could experience the taste and textures of each portion. We had the opportunity to speak to the Head Cook and she said that “finger foods”, including pizza slices and pork pie are served to residents Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 21 deemed to be at risk of weight loss during the afternoon. Cream is added to porridge, puddings and soups in order to provide extra calories. She stated that she would like to have more time to spend talking to the residents in order to obtain their suggestions for menu choices and the menus were currently being reviewed. Menus were on display in the dining rooms for residents to refer to and the Home Manager said that plans were in place to increase the print size of these and provide pictures so that they were easier to read. The lunch time meal on the day of the visit was either liver and onion hot pot or sausage and onion with mashed potato and mixed frozen vegetables. It was pleasing that staff asked each resident what they would like to be served and meals were well presented. A number of residents had chosen alternatives to the main menu options, for example, salads and jacket potatoes. Residents were encouraged to serve their own condiments and cold drinks and this promotes their independence. The staff were available to provide assistance as required and this was being provided in a respectful manner. None of the residents in the first floor dining room used adapted cutlery, however this was available if required. It was noted however that out of fifteen residents, twelve were still in their wheelchairs at the dining tables instead of being transferred into a comfortable dining chair, if that was their choice to do so. This concern had also recently been raised by a relative during a care review and was brought to the attention of the Home Manager at the end of the visit. During a recent care review, a relative expressed their concern about poor food hygiene handling techniques and it was disappointing that there was also evidence of this on the day of the visit. This must improve in order to prevent residents’ from becoming unwell as a result of poor practice. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives are now confident that any concerns raised are acted upon for their benefit. There are systems in place that should protect residents from harm. EVIDENCE: A number of compliments had been received about the services provided at the Home. Since our last key visit, communications between us, the Organisation, Primary Care Trust, Social Care and Health have improved so that all are aware of the majority of complaints, concerns or allegations received about the Home. This is in order to monitor the services provided there and improve the standard of care provided. It must also be noted that the number of complaints received about the Home has reduced recently. Residents and relatives met during the visit stated that they were confident that the standard of services provided at the Home would continue to improve now that the new Home Manager was in post. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 23 Since our last key visit a high number of concerns have been raised regarding a range of issues however shortfalls have predominantly been regarding the following: staff shortages and availability, limited activities on offer, lack of continuity regarding the management team, the timing of meals, alleged thefts of residents’ money and perfume on two occasions, poor personal and health care delivery and poor quality food. The majority of issues raised were referred to the Organisation to investigate and there was evidence that meetings were arranged with the people raising the concerns in order to address the issues raised in an open manner. The complaints register identified that in addition to the issues outlined above there had been further complaints made directly to the Home since the last key visit. These included a breach of staff confidentiality, poor staff attitude, poor care delivery, the cleanliness of the Home and missing laundry. Comprehensive investigation notes were maintained. The complaints procedure was on display for residents and visitors to refer to and the Home Manager said that she would re produce this in a larger print format for ease of reading. There have been a number of incidents of an adult protection nature since our last key visit and the Home’s staff had notified the appropriate authorities of these in order to safeguard residents. Staff had received training about the protection of vulnerable adults so that they should have the necessary skills and knowledge to protect residents. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a clean, safe and secure living environment in which they feel relaxed and their privacy and independence are promoted. Aids and adaptations are provided that meet the needs of residents living at the Home. EVIDENCE: The reception area was warm and welcoming. The internal environment was found to be clean and fresh and all residents and visitors met during the visit expressed their satisfaction about this. The Home was decorated to a good standard in a homely style so that residents would feel comfortable in their Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 25 surroundings and there was a rolling programme of redecoration and refurbishment in place. Since our last key visit new kitchenettes had been created on both floors and good progress had been made regarding the decoration of the communal areas of the dementia care unit. Realistic themed areas had been created within the internal environment for example a relaxing garden area, a traditional “wash-up” area and a drinks bar. Plans were in place to recreate a work- shop area for residents who may have an interest in this area. It was evident that on the day of the visit residents in this area of the Home were calm and relaxed having freedom to walk around their living environment. Corridors were wide and handrails were available so that residents had the confidence to walk freely throughout the Home. The Expert reported that one resident had voiced his concern that he had been waiting for a long time to have his bedside light bulb to be replaced by the maintenance man. Residents also requested that additional power points be installed into their bedroom. Both of these issues were brought to the Home Manager’s attention during the visit and she advised that she would address these without delay. The Expert reported that the garden was very small and not especially attractive, however quotes had been obtained and a Landscape gardener has given advice about creating areas in the garden that are suitable for wheelchair users and residents with dementia. Equipment provided at the Home met the needs of residents living at the Home. There were seventeen “profiling beds” available for residents use. These promote the comfort and dignity of residents with high dependency needs, limited mobility and residents who spend prolonged periods of time in bed. The Home was clean and fresh on the day of the visit and a hygienic system was in place for the cleaning of residents’ personal clothing and bed linen. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always receive support from staff at the times that they require and a high turnover of staff does not promote continuity of care for residents. A lapse in procedures regarding staff pre recruitment checks does not safeguard residents. Well-trained staff generally supports residents and this should ensure that care is provided in a competent manner. EVIDENCE: Staff turnover at the Home was high and the Home Manager was in the process of recruiting three new care staff and in addition to these there were further care assistant posts available. Agency staff were being used to cover periods of staff sickness and annual leave however the Expert reported that agency staff were not always available at short notice and this may prevent residents from receiving support at the times they require. The Home Manager advised that there are two registered nurses and six care assistants on duty on each floor during daytime hours and one registered nurse and three care assistants on duty on each floor during night time hours. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 27 In addition, reception, maintenance, kitchen, laundry and domestic staff provide ancillary support. The Expert reported that all residents she spoke with agreed that staff were approachable and kind. One resident stated that the staff were “first class”. The gender mix of staff reflected that of the staff team so that care should be provided in an understanding manner. One relative met during the visit said “Everyone is fabulous with him (resident) here. I think he is very happy here”. Prior to the visit concerns were raised that on some occasions, residents had to wait for an unacceptable length of time for assistance from the staff team. During the visit, the Expert reported that two residents had said that they had been waiting for staff to help them to go to the toilet for over twenty minutes and this is not acceptable. The care assistant advised the resident that she must press the call bell buzzer twice if she requires assistance in an emergency, however the Home Manager stated that the call bell ring tone automatically goes into emergency mode if it is not answered within two minutes. This must be clarified and residents must be aware of how to summons urgent assistance from staff so that they receive support at the times they require. Three staff files were sampled and for one of these people, two valid references had not been obtained prior to or since commencing employment at the Home. Two character references were on file, one of these being from an existing staff member at Bramley Court and this is not considered to be acceptable. This occurred prior to the new Home Manager coming into post. Criminal record checks are undertaken for prospective workers and this should safeguard residents. New workers undertake comprehensive induction training so that they should have the necessary skills and knowledge to work in a safe manner. There is an “In House Trainer” and we had the opportunity to meet with her during the visit. She said that she had recently obtained a formal “Trainers’” qualification however was yet to receive a work based assessment following this in order to assess her ongoing competence regarding the delivery of the training. Moving and handling training is provided to staff via an external source so that they should have the appropriate skills and knowledge to work safely in this area. Staff undertake a rolling programme of training in mandatory areas including food hygiene, infection control, nutrition and fire safety. The majority of staff had received refresher training in these areas recently. In addition, fire drills are undertaken regularly so that staff should have the necessary skills to respond safely in the event of a fire. Other training undertaken by staff recently included tissue viability, care planning, bed rail safety, and first aid and dementia awareness. 78 of staff had completed NVQ Level 2 training so that they should have the skills and knowledge to work in a competent manner. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is generally run in the best interests of the residents living there and further development of the management team will ensure the best outcomes for residents. The systems in place for quality monitoring and resident consultation are good so that residents are involved in the running of the Home. Residents’ health and safety is protected by regular maintenance checks of equipment used at the Home. EVIDENCE: Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 29 Plans were in place for a revised management structure at the Home as there had been a number of Home Managers in post during recent years and this does not promote continuity for residents and staff. This included deputy management support and a Unit Manager for the “Dementia House”. The current Home Manager had recently come into post and was in the process of registering with us. She has worked for the Organisation within managerial roles for a number of years. Positive comments were made by residents, visitors and staff about her management style. One staff member said “ The new manager is very approachable and ready to listen, staff morale has been low but we are starting to get support now”. The new Home Manager had written to all relatives and had met all residents introducing in order to herself. The Expert reported that all residents spoken with had been advised that a new Manager had been appointed and they looked forward to her taking over. A full time Administrator had recently commenced employment at the Home and she stated that she had settled well into this role. In addition a “Project Manager” was providing support to the Home Manager during her induction period at the Home. The Unit Manager for residents receiving general nursing care had been in post for a longer period of time and this ensures continuity of care for these residents. External senior managers undertake quality-monitoring visits at the Home on a regular basis. Service satisfaction questionnaires are distributed to residents, relatives and health care professionals every three months in order to obtain their views about the services provided at the Home. The results of these were on display in an easy to read format so that anyone interested could view any actions to be taken. Residents and their families are invited to regular group meetings and the minutes of these had been distributed to all residents in a large print format. The most recent group meeting was held on 25/10/07 and this provided all present with the opportunity to meet each other and put forward any suggestions about the services provided at the Home. Topics discussed included the lack of activities provided, ways to improve communications between the Home’s staff and relatives, the time taken to answer call bells, a newsletter to be produced and more puddings and cakes to be offered. It was pleasing that there was evidence that the vast majority of suggestions raised had already been acted upon. Staff meetings are arranged regularly so that staff have the opportunity to put forward their views about working at the Home, suggestions for improvements to residents’ daily lives and to be informed about forthcoming training opportunities. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 30 There had been no changes regarding the management of residents’ money since our last visit. This was a computerised system that identified the money held for each individual resident although all money was held in one “umbrella” bank account. The Senior Manager stated that this system had been approved by us and was used throughout all Homes in the Organisation. Individual residents and their relatives were able to view all transactions in and out of their individual account. An external Senior Manager had recently audited this system. Maintenance checks of equipment were undertaken regularly so that they should be safe to use. Accident records were well maintained and the Home Manager audits these in order to determine any trends or patterns in accidents involving residents. As a result of accident auditing and from Regulation 37 notifications sent, the Home Manager had discovered that a number of residents had sustained minor injuries, possibly as a result of staff using hoisting equipment. She stated that as a consequence of this, all staff had recently undertaken refresher training in this area. Comprehensive individual risk assessments about the use of this and other moving and handling equipment had been undertaken in order to minimise the risk of injuries occurring in the future. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 x x 3 Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(a) 15 Requirement Timescale for action 31/12/07 2 OP7 12(1)(a) 15 3 OP7 15 Care plans pertaining to wound care must identify the current care regimes in order to ensure that residents receive the appropriate care in this area. Care plan for short term 31/12/07 conditions must be written so that staff can monitor and assess the effectiveness of any treatments prescribed. Behaviour management care 31/01/08 plans must include information about any possible trigger factors for challenging behaviour and must identify any management techniques to reduce this behaviour in order to safeguard residents. Time scale of 31/07/07 not met 4 OP8 12(1)(a) 5 OP12 16(2)(m)( n) Systems must be in place to ensure that residents have access to prompt medical attention at the times that they require. Activities provided and opportunities for social stimulation must meet the needs DS0000066491.V351164.R01.S.doc 31/12/07 31/03/08 Bramley Court Version 5.2 Page 33 and expectations of all residents living at the Home. Time scale of 15/08/07 not met 6 OP27 18(1) Staff must be available to 31/12/07 provide care for residents at the times that they require and residents must be aware of how to obtain staff in order to prevent waiting for assistance for an unacceptable length of time. All staff must have two 31/12/07 references including one from the most recent employer prior to commencing employment at the Home. (Previous timescales of 03/11/06 26/02/07 and 30/06/07 not met 7 OP29 19 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should be updated to reflect the current staffing details at the Home so that anyone interested can access this information. Daily records should include detail of how residents have spent their time and any emotional support provided for them in order to evaluate the effectiveness of the care provided. Personal risk assessments should be dated in order to monitor and evaluate the risks identified. It is recommended that training be provided for suggestions for activities for residents with dementia and residents who are unable to participate in group activities. Activity records should include detail about the success of each activity in order to plan for future activities. Staff must be aware of individual residents’ preferred times of going to bed and rising in the morning so that DS0000066491.V351164.R01.S.doc Version 5.2 Page 34 2 OP7 3 4 OP7 OP12 5 OP14 Bramley Court 6 7 8 9 OP15 OP15 OP19 OP30 their preferred routines can be maintained whilst living at the Home. Systems should be in place to ensure that residents are seated in the chair of their choice during meals in order to ensure their comfort during these times. Hygiene practices in place during the serving of residents’ meals should be reviewed to maintain the health of residents. The garden should be made suitable for residents to use. Ongoing assessments of the “In House Trainer’s” competence to deliver training should be undertaken so that she is supported within her job role. Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bramley Court DS0000066491.V351164.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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