Inspection on 18/09/06 for Bramley House

This inspection was carried out on 18th September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bramley House 04/09/07

Bramley House 29/11/05

Bramley House 01/08/05

Bramley House 15/11/04

Bramley House 18/05/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Bramley House Bramley House Bromley Green Road Upper Ruckinge Ashford Kent TN26 2EG Lead Inspector Mrs Sally Gill Unannounced Inspection 09:30a 18 September 2006 th 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 House DS0000023350.V301419.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 House DS0000023350.V301419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramley House Address Bramley House Bromley Green Road Upper Ruckinge Ashford Kent TN26 2EG 01233 732629 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) Rooks (Care Homes) Limited Mrs Caroline Rose Rooks Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Bramley House is registered to provide residential care for up to 18 older people and admits people with low to medium dependency needs. The company Rooks (Care Homes) Ltd owns the business. The Managing Director Mrs Caroline Rooks is also the Registered Manager although currently not in day-to-day control. An acting manager is in place and has day-to-day control. The premise is a detached property, which has in recent years undergone major refurbishment work including an extension with six-ensuite bedrooms. There are 16 single bedrooms and one double situated on the ground and first floor. There is a stair lift to enable access for those with mobility problems. Six bedrooms have ensuite facilities and the others have a wash-hand basin. All rooms have a call bell and television point and a telephone is by arrangement. The residents have the use of three bathrooms. There is a spacious dining room, which includes a seating area in front of patio doors overlooking the front entrance. The residents have the use of two lounges one which has a television. There is a well-maintained garden to the rear with a patio/seating area and a water feature with fishpond. The rear garden also includes an aviary with birds, rabbit, and guinea pig. There is a patio/seating area and parking to the front. The home is situated in a quiet rural area approximately 5 miles from Ashford. An infrequent bus service runs into Ashford from just outside the Home. The current fees range from £288.00 to £472.50 per week. There are additional charges for hairdressing, toiletries, magazines and newspapers and chiropody. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place between 9.30am and 5.45pm. The acting manager assisted throughout the visit. Eighteen people were living at the home although one was currently in hospital. The inspector spoke to eight service users, two members of staff and observed staff working and interactions. The inspector accessed the communal areas, a toilet, the office and two of the ensuite bedrooms. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to service users, families, and doctors and care managers. Surveys were received from nine service users and feedback was generally positive. Nine relatives responded which indicated they are entirely happy with the care provided. Care managers indicated again they were satisfied with the overall care although one felt there is not always a senior member of staff available to speak with. A survey and letter was received from doctors who raised concerns also about a senior member of staff being available and whether management/staff take appropriate decisions when care needs are complex. Various records were viewed during the inspection. What the service does well: What has improved since the last inspection? Residents continue to be weighed monthly and any action taken as a result of significant change is now recorded. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 6 The external sign for the home is now more prominent ensuring that not only visitors but also emergency services can find the home more easily. Attention has been given to the minor health and safety hazards noted at the previous inspection to ensure a safe environment for residents. What they could do better: 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 House DS0000023350.V301419.R01.S.doc Version 5.2 Page 7 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 House DS0000023350.V301419.R01.S.doc Version 5.2 Page 8 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): 2, 3, 5 & 6 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents have terms and conditions that they have agreed with the home. Residents have the opportunity to visit the home prior making a decision to move in. Residents that move into the home have their needs assessed and can be assured on admission that these will be met. Intermediate care is not provided. EVIDENCE: The acting manager advised that all prospective residents receive a copy of the homes statement of purpose and service user guide. To ensure visitors and emergency services can find the home the external sign is now positioned in a prominent place. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 9 Residents spoken to confirmed that they or their families had visited the home prior to admission to have a look round. The homes staff had also visited the prospective resident in their own environment to undertake an assessment of needs. Where residents are funded by social services a copy of their needs assessment has been obtained and is held on file. Residents confirmed that they have a contract in place. These contracts were also seen on file. Intermediate care is not provided. The home does provide respite care bed vacancies allowing. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 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 judgment has been made using available evidence including a visit to this service. Residents current care needs are not all reflected in their care plan or risk assessments, which could put them at risk. Resident’s health care needs are met with support from the community. Minor adjustments are required to the medication systems to fully protect residents. Residents feel they are treated with respect. EVIDENCE: A care plan is in place for each resident, which is generated from, the assessments. The care plans were evidenced as reviewed to appropriate timescales. Although some information regarding care needs had changed the care plan did not evidence the current care practices. Care plans must be kept up to date. Not all residents spoken to were aware of their care plans although the acting manager stated that she has reviewed some care plans with Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 11 residents and intends to do this with all residents. Some care plans contained a description of a typical day for the resident. Bramley House residents’ needs are now more complex than in the past and work must continue to develop the care plans and risk assessments to reflect this. Written risk assessments are required for any risk where the home has taken action in practice to minimise the risk. Manual handling risk assessments should detail the manoeuvres staff are required to use when assisting. The acting manager must ensure staff in practice adopt correct handling techniques. Staff confirmed that they promote and ensure access to health care services. The acting manager has recently gained the services of a dentist who is to visit the home. Staff are very good at ensuring that advice and guidance from health care professionals is followed but this information is not reflected in the care plan (see requirement for care plans). Equipment necessary for tissue viability is accessed. Resident’s psychological health is monitored and professional input obtained where necessary. Feedback from health care professionals was mixed, although satisfied with the overall care provided, there were concerns whether the home has the ability to take appropriate decisions when a residents care needs become complex. Also whether all staff have sufficient knowledge and experience to care for complex needs. Residents continue to be weighed monthly. Any action taken as a result of significant change is now recorded. Medication is supplied in a monitored dosage system. Internal and external medication should be stored separately. Handwritten entries on the MAR charts must duplicate the prescription label. MAR charts reflected that medication is administered correctly with the appropriate use of codes. Where residents are self administering medicines there must be a risk assessment in place and an audit trail on the MAR chart. Five staff are trained to administer medication and another two are currently undertaking this training. Procedures must be in place for the use of over the counter medicines. Residents confirmed that they treated with respect and their right to privacy is upheld. Some rooms have private telephones. Residents are called by their preferred name. Privacy screening is provided in the shared room. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 12 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 judgment has been made using available evidence including a visit to this service. Routines within the home are flexible and residents are able to exercise choices in their day-to-day lives however increased opportunities for activities should be available. Residents maintain contact with their families and friends. Residents benefit from a variety of appetising and balances meals in a pleasant setting. EVIDENCE: There is a relaxed atmosphere in the home. Staff confirmed that residents now benefit from a more flexible approach to routines than in the past. However residents and staff indicated that there are now fewer opportunities for activities than previously. This may have resulted from the period of very hot weather and residents needing more hands on care combined with low staffing levels which means that at present the residents are now less motivated to undertake activities. Residents said that they used to enjoy the cookery sessions and do enjoy the local minister coming in and taking a service. The acting manager acknowledged this decline and is looking to Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 13 develop more individual activities. However this will not be possible without sufficient staffing levels. Resident surveys indicated that activities were sometimes available and one commented that they had to pay for these. The acting manager advised this had been agreed with residents prior to bringing in some outside entertainers. The acting manager is looking at ways of communicating information to residents about what activities are taking place. Residents were involved with reading daily newspapers and magazines, which are delivered, watching television, one was sitting enjoying the sunshine and fresh air outside and another was weeding the front borders during the visit. To try and motivate residents the acting manager had taken a small group to the local pub recently and another on a shopping trip to the local supermarket both of which had been enjoyed. Feedback from relatives was very positive and residents confirmed that families visit frequently. The main meal is at lunchtime and there is a good choice of dishes. All residents said the food is good and they enjoy the meals. Residents are encouraged to the dining room although meals can be taken elsewhere. Independence is promoted with vegetables and drinks available on individual tables so residents can help themselves. The dining room is pleasant; tables are laid with linen tablecloths and napkins. Special diets are catered for. Residents were offered drinks of squash etc through the day. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 14 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 good. This judgment has been made using available evidence including a visit to this service. Generally residents feel their views are listened to and any concerns would be acted upon. There could be improvements to ensure residents are fully protected from abuse. EVIDENCE: The acting manager stated that no complaints have been received by the home since the last inspection. Health care professionals had written to the provider with their concerns as stated earlier in this report and a copy received by the commission. The acting manager said this had been discussed and changes in ways of working had been implemented. A letter of concern was also received by the commission and used to focus on certain areas within this inspection. The provider, prior to the visit, had already addressed most areas highlighted. Other areas are addressed in this report. Most residents confirmed that they would have no problem with complaining to the acting manager and felt sure she would address any issue but there had been nothing to complain about. One survey indicated that usually staff do listen and act although it may depend which staff you ask. All residents spoken to express satisfaction and said there’s nothing really to complain about. A staff member confirmed that they had a good understanding of abuse and how to report any incidents both in the home and outside. Six staff have Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 15 received adult protection training via their NVQ and three places are booked for other staff. However all staff should receive adult protection training. Shortfalls in recruitment procedures, which could leave the residents at risk, are dealt with under staffing. The home does not hold or deal with resident’s own finances. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 16 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, 20, 21, 23, 24, 25 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Resident’s benefit from a clean, attractive and well-maintained homely environment but could be at risk from inadequate fire safety. EVIDENCE: See also the brief description at the front of the report. Resident’s live in a pleasant, well-maintained and homely environment. This has in recent years, has had a large extension (six bedrooms with ensuite) and major refurbishment of other parts of the home, which has been completed, to a high standard. Staff confirmed that any maintenance work required is usually carried out fairly quickly. Visits have been made to the home since the completion of the extension from the Fire Officer and the Environmental Health Officer and one minor recommendation has been implemented. Minor health and safety issues raised at the previous inspection had been addressed. Some bedroom doors were wedged open. This compromises fire safety. Action must Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 17 be taken to ensure safety. A small table was highlighted as needing repair/replacement. Gardens are well maintained and residents enjoy spending time in them. One resident said that the easy seating in the dining area is not comfortable and chooses now not to use this area but spend more time isolated in their bedroom. Toilet and bathing facilities are accessible and equipped to meet the needs of residents. All residents said they are happy with their rooms. Which were bright and airy and reflected interests and hobbies. Problems with the central heating have now been resolved. Not all radiators are fitted with low temperature guards in the bedrooms. These require a risk assessment. Residents confirmed that the home is always clean and tidy and this was certainly true on the day of the visit. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 18 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 adequate. This judgment has been made using available evidence including a visit to this service. The low staffing levels and poor recruitment practices leave residents at risk. Although improved, staff training does not equip all staff members to fulfil the aims of the home or meet the changing needs of residents. EVIDENCE: Two immediate requirements were issued in relation to staffing. The home currently has 18 residents. On the day of the visit in addition to the acting manager, who should be surplus to the care rota, there was only one other member of staff on duty at specific times otherwise this increased to two. There is also cook and domestic support. However there is no domestic three days a week. Care staff are then responsible for cleaning. An immediate requirement was made to review this staffing which is judged as not sufficient. Short staffing also came through resident surveys. The home must have adequate staff on duty at all times. Fifty percent of staff are qualified to NVQ level 2 or above. Staff spoken to on the day were committed, enthusiastic and focused on good outcomes for residents. Some staff that have been recruited have a wealth of experience and knowledge particularly when dealing with complex care needs and it is apparent from discussions that other staff use these as a positive resource. All staff demonstrated a very caring attitude and said they enjoy working here. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 19 Resident’s comments were very positive about individual carers and the staff team as a whole. Two staff files were viewed. On both files the application form had not been completed fully leading to confusion regarding reference information. Consideration should be given to reviewing the application forms so there is space and that full and detailed information can be given. Application forms must now contain the full employment history. Any gaps in completion should be checked out during recruitment and missing information recorded. One file only had one reference, which was not the previous employer, and the other file had two references obtained by the staff member and addressed ‘to whom it may concern’. These references could not be matched to reference information given on the application form. The home must be responsible for obtaining appropriate references. Other appropriate checks had not been carried out. The home must employ staff in line with DOH guidance. Staff confirmed that only one person interviewed them and this was not the manager. Two staff should interview prospective employees one of which should be the manager. The manager must have input to all staff employed within the home. Changes to skills for care induction training need to be implemented by September 2006. Further commitment to staff training is required. The acting manager is addressing reluctance of some staff to undertake training. As the shortfall in training will take time to achieve and in the absence of specialist training (dementia, diabetes etc), it is recommended that an information folder should be set up for staff. Other training is addressed under management and administration. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 20 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, 33, 35 & 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents live in a home where the acting manager is not qualified and although has management experience has limited knowledge and experience of caring for the elderly. Residents feel the home is run in their best interest. The health, safety and welfare of all could be improved. EVIDENCE: Since the last inspection the previous acting manager has left and an existing senior carer has been promoted to acting manager. Both residents and staff felt that the communication about the previous acting manager leaving and the promotion of the new acting manager was poor. The acting manager has Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 21 worked at the home since 2002. This is her only care experience although she does have management experience in another setting. Her enthusiasm and commitment to her role cannot be doubted. Currently she does not have any care qualifications although has undertaken some short training courses whilst at Bramley House. For all her enthusiasm and commitment from discussion there are several areas where she lacks sufficient knowledge and experience to manage the home at present. For example she was not aware of changes in induction specifications or DOH guidance on checks for staff. She needs to find the right balance of hands on care and management in order to take the home forward. Feedback from health and other professionals also highlight a shortfall. Staff felt well supported by the acting manager; feel she is clear in directing and will resolve any issues quickly. Regulation 26 visits have not been undertaken since the beginning of July and must be untaken at least monthly. These should be unannounced. A quality assurance survey was last sent out in June. In the light of Inspecting for Better Lives 2 this will need to be developed further. Quality assurance at present is undertaken informally. However there were comments that consulting with residents had in the past been better. Information supplied prior the visit indicates that several policies and procedures that should be in place are not and this needs to be addressed by the home. The home does not have any involvement with residents own monies. Valid insurance cover was displayed within the home. Checks were made to ensure the building and equipment are in good working order and valid service certificates and records were in place. Further training has been undertaken but more is required to ensure all staff are competent and the home is safe. The acting manager must also ensure that training is followed through into practice. For example on the day of the visit one member of staff was observed to use an unsafe manual handling technique despite having received training. Both cooks must be trained in food hygiene. Concerns had been raised regarding the collective storage of waste, gas cylinders and oil and the acting manager agreed to speak to the Environmental Health Officer. The last accident report was checked and recorded appropriately. Incidents that must be reported under Regulation 37 have not been. The home is required to submit reports under regulation 37. Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 22 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X 3 3 2 3 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X N/A X X 2 Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Develop care plans and risk assessments with residents to contain sufficient detail of health, personal and social care needs Provide a safe medication system for residents (Internal/external storage, exact handwritten entries, risk assessment for self administration and audit trail, written procedures for use of over the counter medicines) Implement adequate fire safety measures to ensure safety (wedged bedroom doors) Staffing levels must be reviewed and sufficient staff must be on duty at all times to meet the needs of residents Staff to be employed in line with DOH guidance and timescales (POVA 1st/CRB) Staff must not be employed before two written references have been obtained (one of which must be from their last employer). The home must be managed by a person with appropriate DS0000023350.V301419.R01.S.doc Timescale for action 18/11/06 2 OP9 13(2) 18/10/06 3 4 OP19 OP27 23(4) 18(1) 18/10/06 18/09/06 5 6 OP29 OP29 18(1)(2) 19 & 17 Schedule 2 9 18/09/06 18/09/06 7 OP31 18/11/06 Bramley House Version 5.2 Page 24 8 9 10 11 OP33 OP38 OP38 OP38 26 18(1) 18(1) 37 qualifications, skills and experience The provider must visit the home unannounced at least monthly in line with regulation 26 Staff that cook/handle food must be trained in basic food hygiene Further staff to undertake training to ensure good practice is adopted and the home is safe The home must inform the commission of appropriate incidents and accidents in line with regulation 37 18/10/06 18/10/06 18/11/06 18/10/06 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 2 3 4 5 6 7 8 9 10 Refer to Standard OP12 OP18 OP7 OP25 OP20 OP27 OP29 OP29 OP30 OP30 OP33 Good Practice Recommendations Residents to have improved opportunities for appropriate activities All staff should receive adult protection training Risk assess residents where their bedrooms radiators are not already fitted with low temperature surfaces Review suitability of comfortable seating in dining area Review provision of domestic staff only four days per week Consideration should be given to reviewing the application forms so there is space and that full and detailed information can be given Two staff to interview prospective employees one of which is the manager Review induction training and implement new Skills for Care training/timescales Staff to receive training in specialist subjects and in the interim an information folder should be set up for staff Review policies and procedures to ensure all subjects are covered as indicated on the pre-inspection questionnaire Bramley House DS0000023350.V301419.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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