Inspection on 14/07/05 for Brampton Court

This inspection was carried out on 14th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brampton Court 12/12/07

Brampton Court 15/05/06

Brampton Court 27/01/06

Brampton Court 18/01/05

Brampton Court 27/09/04

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

CARE HOMES FOR OLDER PEOPLE Brampton Court Wharrier Street Walker Newcastle upon Tyne NE6 3BR Lead Inspector Suzanne McKean Unannounced 14 July 2005 10:00 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 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. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Brampton Court Address Wharrier Street Walker Newcastle upon Tyne NE6 3BR 0191 224 3679 0191 224 3684 brampton.court@fshc.co.uk Tamaris Healthcare (England) Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Michael Cave CRH 48 Category(ies) of DE Dementia (1) registration, with number DE(E) Dementia (47) of places Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2005 Brief Description of the Service: Brampton Court is a purpose built care home providing nursing and social care to older people over the age of 65 years with Dementia. The home is on the same site, and it attached to another care home with a shared entrance. The adjacent home is owned by the same company and provides residential and general nursing care. The homes share both the laundry and kitchen. The building is on two floors with passenger lift access to the first floor. Within each floor there is level access to all parts of the home. The parking is to the front of the building. Brampton Court is situated in the Walker area of Newcastle, within easy reach of shops and other amenities, public transport access is good. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over a period of 7 hours on one day by two inspectors. The manager present for the inspection which allowed the examination of all records including those which were being stored securely in line with the homes policy on confidentiality. Eight residents were spoken to during the visit and five relatives and the inspectors also spoke to seven of the staff. The records examined included, five care plans and medication records, the training records, the fire log as well as complaints and accident records. The inspector also viewed three staff files including the process for their recruitment and selection. What the service does well: What has improved since the last inspection? What they could do better: The home must improve the documentation and care planning to show in more detail the way the care is being delivered. The care plans must be up to date and contain more detail and must be reviewed with the residents and/or their relatives. The home must offer residents choice as to what they eat and be Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 6 able to demonstrate that the food being served offers a balanced nutritious diet. Residents at risk of weight loss are must be monitored more closely and a strategy should be documented of how this is being achieved. The home is in a poor decorative state and the carpets now need replacing in both the corridors and some of the bedrooms. There is a need for replacement of some furnishings and fittings and redecoration is to an acceptable standard, including a number of carpets. The home is in need of action to improve the standards of cleanliness and hygiene. 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. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 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 standard(s) 3, 6 The assessment undertaken prior to admission is detailed and the staff are being made aware of the information needed to meet the needs of the residents in the home. The home is not registered for, and therefore does not provide, intermediate care. EVIDENCE: The care plans show that the residents have a care management assessment undertaken by Social Services Department, which is provided, to the home prior to or at the time of the admission and from these documents an individual care plan is produced. The home is not registered for, and therefore does not provide, intermediate care. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 10 The service users are having their needs met by the staff in the home, and the staff are skilled in providing the care in a sensitive and dignified manner. However, it is not possible for this to be demonstrated through the documentation and care plans in place. EVIDENCE: The care plans cover health and social and personal care. A number of assessment tools are in use, however not all were up to date, reviewed monthly, dated or signed by the author. Daily reporting of residents care was generally satisfactory, but the changing health care and mental health care of residents was not reviewed and up dated and did not set out details of care for the complex needs of the residents. There was a lack of detail for the use of bed rails and residents who at risk of falling. There was no evidence from the care plans that professional advice had been sought from wound care specialists or dieticians and progress regarding pressure sore care could not be followed as there was no evaluation of wounds so staff could decide improvement or otherwise. The staff have an excellent knowledge of residents psychological health care needs with evidence of good partnership workings with other professionals. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 10 Throughout the inspection staff were observed to treat residents with respect and dignity. Personal care was given in privacy, staff used residents preferred name at all times. The staff have a good understanding of residents individual needs and were observed to deal with some potential difficult behaviour issues in a professional sensitive manner. Residents said, “The staff are good”, “I couldn’t wish for anymore”, and “I like living here”. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 11 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 standard(s) 15 The residents are not being offered choice as to what they eat and it could be determined if the food being served offers a balanced nutritious diet. Residents at risk of weight loss are not being monitored effectively and there is no strategy documented of how this is being addressed. EVIDENCE: Several of the residents have difficulty eating and have lost weight. There was no record of advice being sought from dieticians, weights were not recorded weekly nor did staff introduce a care plan for those at risk. The four weekly menu is not being followed in the home and none of the staff knew what was for lunch or tea on the day of inspection. Comment from members of staff when questioned about the tea time meal and what the chef was preparing was “he hasn’t decided”. It is acknowledged that the residents would find it difficult to make an informed choice regarding any meal, however their individual likes and dislikes were not taken into account, or are there any records kept. The lunchtime meal consisted of cold meat, mixed salad, a slice of bread and butter and half a baked potato with cheese. Dessert was spotted dick and custard. This was the main meal of the day. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 12 Several of the residents were given “soft diets” which were pre plated on small plates and consisted of pureed meat, potato and vegetables covered with gravy. Residents were given cold drinks at this meal. The residents were not offered any condiments such as salt pepper or salad dressing. One resident said, “It was alright but would have been better with a bit of salt”. Several of the residents had difficulty cutting up the food and only one carer offered to help. In the downstairs dining room two members of staff were standing whilst assisting three residents to eat their meal. This practice compromises the resident’s dignity. However, the staff in the upstairs dining room sat with the residents who needed help with their meal. This assistance was given in an unhurried, sensitive manner. Several of the residents did not eat the meal. One resident said, “I don’t like salad, I am still hungry”. The inspector informed a member of staff and he was given another cheese potato. All of the residents were offered the “cake and custard”. The residents enjoyed the pudding and it was observed that some choice was available; ice cream was given to two or three residents. Staff were unaware of the calorie content of meals, did not understand the need for fortified food and drinks to be available for residents who found it difficult or who were unable to eat and drink due to their physical and mental health conditions. The staff served hot drinks mid morning; residents were not offered biscuits or fruit at this time. Staff said they do not have biscuits as they have just had breakfast. The tea trolleys were old and badly stained with old tea and coffee spillage. The staff confirmed that the residents are offered a cooked breakfast one day and a continental breakfast the next day. This could not be verified and there were no menus or records available. The kitchen was generally clean and organised and there was sufficient food supplies. Since the last inspection the flooring by the back door has been repaired and fly screen have been fitted to windows. There are two new fridges and a dishwasher. The flooring under the dishwasher is stained from overspill from the dishwasher detergent. The hot food lockers are serviceable, however the doors do not fit properly. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 18 The home ensures that the residents and relatives are made aware of the complaints policy. The residents are protected by ensuring that the staff are given Protection of Vulnerable Adults training and the mechanisms for whistle-blowing and reporting concerns to the Manager. EVIDENCE: There is a system for managing and dealing with complaints, which was seen to be available in a variety of places. The records of the complaints made to the home was examined, there have been two complaints recorded since the last inspection. One of the complaints was investigated by the Commission for Social Care Inspection and the records for this were in the records including the response to the complainant and the action taken in response to the issues raised. The outcome stated that the “care was satisfactory”. A second complaint was received in April and was passed to the Regional Manager of the company for investigation. The outcome for this was not available and it therefore could not be examined to determine the level of satisfaction of the complainant. A requirement has been made regarding this issue. The Manager has attended the Local Authority Protection of Vulnerable Adult (POVA) training and has commenced informal training with the staff and has Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 14 included these issues in the staff supervision sessions. However, staff interviewed during the visit were not clear about the principles of POVA and could not identify the initial action they would take if they were concerned about an issue. They were able to describe the ways in which abuse could occur and were clear that they would not ignore or dismiss any concerns and would seek advice from a senior member of staff. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 24, 26 The service users live in a generally safe but shabby environment with good communal areas but poor access to the outdoor areas. There are suitable toilets and baths but not all of these are in use. The bedroom areas are personalised and comfortable but not safe as unfixed wardrobes present a possible risk. The home is in need of action to improve the standards of cleanliness and hygiene. There is a need for replacement of some furnishings and fittings and redecoration is to an acceptable standard, including a number of carpets. EVIDENCE: The location and layout is suitable for the residents who live there. All the corridor carpets were heavily stained. The staff confirmed that they are cleaned on a regular basis however the carpets are now approximately ten years old and are worn. Residents only have access to a secure garden area via a stairwell and two fire doors. This courtyard garden is pleasantly maintained and enjoyed by the Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 16 residents especially in the warmer months. There is another large garden area, which is not used, as there is no secure fencing. There are lounges and dining rooms on each floor. All were pleasantly decorated and furnished. Residents were able to access all areas and there was a range of television and audio equipment available for their use. There are bathrooms, shower facilities and toilets near to all communal areas and residents bedrooms. The flooring in the downstairs shower room is marked and the join between the vinyl and the tiles could cause injury, as it is uneven and raised. The privacy screening has been broken and not replaced. The light cords in all of the facilities were dirty and staff could not clean them on a daily basis. The bathroom/hairdressing room is used as storage for wheelchairs, scales, incontinence pads and chairs. This room was generally untidy and the floor had not been cleaned for some time. The bathroom opposite room 6 was being used as a storage area for incontinence pads. The residents have been encouraged and supported to bring personal items with them resulting in individualised rooms reflecting personal taste and previous lifestyles. One resident spoken with has a key to his room and was keen to show the inspector how it has been decorated for him. Several of the bedrooms have been refurbished, however most of the bedroom furniture is worn and shabby. Many of the bedside tables have the plastic edging missing and the tops are damaged making them difficult to clean. None of the wardrobes are fixed to the walls and there are personal items stored on the top of the wardrobes. Several of the carpets are worn and dirty and some rooms do have an odour problem. The laundry was untidy, disorganised and grimy. The soiled laundry was in piles on the floor, the flooring by the washing machines was split would allow water to seep underneath the vinyl and the room had not been cleaned for some time. A room opposite has been converted into a clean laundry room. This area was generally tidy, however there are no suitable laundry baskets or laundry rails to take clean linen and clothing back to residents rooms and linen cupboards. There are sluices on each floor, which are locked when not in use. Sluice disinfectors are available and in working order. The downstairs sluice was untidy, dirty with an odour problem. Paint is stored and there was bowl of used paint and a brush stored on the shelf. The clinical waste bin was full and the used pads are not double bagged to prevent odours and cross infection. The sluice upstairs was clean, tidy and odour free however, several areas of the home had pockets of odour; generally the staff endeavour to keep it clean and tidy. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The home is staffed with appropriate numbers of staff and there are qualified nurses on duty in sufficient numbers to meet the needs of the residents. The staff are recruited and selected using a system which ensures the safety of the residents. There is a low turnover of staff which is a positive situation. EVIDENCE: Staffing rotas showed that the Manager is ensuring that enough staff are on duty to meet the staffing levels set down prior to the change to the CSCI without reduction. It was noted that when sickness and staff holidays occur these occasions are usually covered by home staff. However, when this is not possible agency staff are being used, late reporting does occasionally result in fewer staff being on duty for short periods. Three staff records were examined and were all complete including two references and a completed application form. The Manager ensures that that all staff are suitable to care for the residents through interviews and trial periods, and have not been identified as posing a risk to their welfare by checking with the Criminal Record Bureau and the Protection of Vulnerable Adults List that they do not have a criminal record or have been identified as being unsuitable. There is evidence of a significant amount of training in both statutory and clinical areas of practice. All staff are receiving training in line with the company policy and statutory requirements. See recommendation regarding POVA training for all staff. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 Although it is acknowledged that the clinical and psychological needs of the residents are being met there are areas of health and safety which have not been addressed and as a result present an increased risk to their welfare. The residents are having their financial interests safeguarded by the systems in place to record and monitor their personal allowance finances. EVIDENCE: The home has in place arrangements to ensure that persons working at the care home receive suitable training in fire prevention and by means of fire drills and training in the procedures to be followed in the case of fire. There is a system in place to review health and safety in the home involving the staff for which records are available. However, here were no detailed risk assessments available for the safe use of bed rails and fire doors were being held open against the fire policy and wardrobes were not fixed to the walls. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 19 The fire exit next to the lounge in the stair well was damaged and must be repaired as planned as a matter of urgency. The shower room floor must be repaired. See environment section for details. The personal records kept in the home of residents who are receiving assistance to manage their personal allowance finances were examined and are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place, and there is a small float available for the staff to access. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 2 3 2 x x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x 3 x x 2 Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 5 (1) (c ) Regulation OP2 Requirement Timescale for action 01.10.05 2. 15 (2) OP7 3. 16 (2) (i) OP15 The service user guide must include a standard form of contract for the provision of services and facilites by the registered provideer. Service users purchasing care privately must be given written details of the trial basis placement. Outstanding Requirement 01.10.05 The service user plan must be:1 up to date, reviewed monthly with additions dated and signed by the authur. 2 detailed regarding the current and changing mental health / wound and nutritional care needs with plans identified to address them. 3 able to demonstrate advice being sought from external advisors. Dietery needs must be assessed, 01.10.05 documented and reviewed. Care plans must be in place for all at risk resdients with monitoring and intervention as necessay. Staff must be given training in understanding the importance of nutrition and in offering assistance to resdients in eating and drinking. Menus being used Version 1.30 Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Page 22 4. 22 OP16 5. 23 (2) OP19 6. 23 (2) (j) OP21 7. 16 (2) OP24 must be submitted to the CSCI and must be available so staff can inform residents. Kitchen equipment must be able to be cleaned and be in good condition. Condiments must be offered in a suitable way. The documentation of the investigations and outcomes of all complaints to be kept in the home. An programme of routine maintenance and renewal of the fabric and decoration must be produced and implemented and this sent to the CSCI. This must include renewal of carpets in the corridors and bedrooms, the flooring and screening to the downstairs shower room. The home must undertake an audit to establish the use of the bathroom areas to ensure that they are available for use and appropriate for the needs of the residents. All bedroom furniture must be checked and replacement/repair undertaken as necessary. 01.10.05 Programme available by 01.10.05 01.10.05 8. 13 (3) & 16 OP26 (2) (j)(k) 9. 13 (4) OP38 The laundry area must be provided with baskets and rails and the flooring repaired. The light cords must be replaced with material which can be cleaned. All staff must be given training in control of infection. Clinical waste bags must not be overfilled and the odour problem be investigated and action taken to reduce it. Risk assessments must be in 01.09.05 place for the use of bedrails. Wardrobes in bedrooms must be fixed and large items removed from on top. The fire exit must be repaired as planned. Version 1.30 Programme available by 01.10.05 01.10.05 Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Page 23 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. Refer to Standard OP18 OP20 OP26 Good Practice Recommendations Formal POVA training to be provided to suppor the ongoing informal training being given during practice and supervision. The home should consider improving the access to the outdoor facilities being mindful of the Disability Discrimination Act. It is recommended that the home seek the advice of the local Health Trust, Control of Infection advisor to undertake an audit within the home. Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington, Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Brampton Court B53-B03 S494 Brampton Court V222238 140705 Stage 4.doc Version 1.30 Page 25 - 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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