Inspection on 21/07/05 for Bramwell Care Home

This inspection was carried out on 21st July 2005.

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 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

Bramwell Care Home 28/06/07

Bramwell Care Home 21/06/06

Bramwell Care Home 08/12/05

Bramwell Care Home 09/02/05

Bramwell Care Home 19/04/04

Bramwell Care Home 25/11/03

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE Bramwell Care Home Chilwell Lane Bramcote Nottingham NG9 3DU Lead Inspector Richard Ramsden Unannounced 21 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. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Bramwell Care Home Address Chilwell Lane Bramcote Nottingham NG9 3DU 0115 9677571 0115 9076114 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) Nottinghamshire County Council Vacant - Mr Paul Ward, Acting Manager Care home 59 Category(ies) of DE(E) Dementia -over 65, x 15 registration, with number MD(E) Mental Disorder - over 65, x 14 of places OP Old age - over 65, x 30 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Jasmin Wing will have a total number of beds of 14 MD(E) over 65 years 2. Honeysuckle will have a total of 15 beds for DE(E) over 65 years 3. Cinnamon will have 15 beds in total for OP aged over 65 years 4. Lavender will have a total of 15 beds OP over 65 years Date of last inspection 9 February 2005 Brief Description of the Service: Bramwell Care Home is owned and managed by Nottinghamshire County Council Social Services, it is a purpose-built care home for 59 older people. The home is divided into four units caring for different service user needs: older people (Cinnamon), older people with dementia (Honeysuckle), older people with mental health problems (Jasmine) and in intermediate care unit offering rehabilitation older people prior to returning home (Lavender). The accommodation is provided over two floors with two passenger lifts to assist independent access. All bedrooms are for single occupancy with ensuite toilet and shower facilities. There are well maintained enclosed gardens which are easily accessible by all service users living in the groundfloor accommodation. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection over a period of approximately 4 hours. It included the inspection of care and other records, a discussion with the manager, as well as speaking with three residents. A partial tour of the building was also completed. What the service does well: What has improved since the last inspection? Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 6 A new policy has been introduced to help staff reduced the likelihood of residence falling within the home and appropriate risk assessments have been completed. Residents are now signing where possible to confirm that they have been involved in planning and reviewing the way in which their care is provided at the home. Since the last inspection all residents have been offered the opportunity to have a Key to their bedroom door unless the risk assessment shows that they are not safe to have Key. The manager is now informing the Commission for Social Care Inspection of any serious accidents or incidents that occur within the home. 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. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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. Prospective residents needs are comprehensively assessed prior to admission. The intermediate care unit is helping people to maximise their independence and where possible return home. EVIDENCE: All three of the residents records checked during this inspection contained Extended Social Work Assessments, which had been obtained prior to their admission to the home. The manager stated that residents are never admitted without the social work assessment. At the last inspection a requirement was made that the assessment documents must, where appropriate, contain details of any history of falls. The assessments viewed during this inspection included all relevant information. Intermediate care is provided in a separate unit within the main building of the home. This unit has specialist facilities, equipment and trained staff to provide intensive rehabilitation to enable residents to return home. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 9 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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 standard(s) 7,8,9,10. Residents health, personal and social care needs are set out in individual care plans which are reviewed at least once a month to ensure that staff are always aware of what assistance and support each resident requires. Residents health care needs are being fully met, they are treated with respect and their right to privacy is upheld. Improvements need to be made to the way in which the homes medication is administered to ensure the safety of the residents. EVIDENCE: All of the care plans viewed during the inspection contained relevant information and were being reviewed and updated on a monthly basis to reflect individual residents changing needs. Risk assessments are included in the care plans where necessary. Where possible residents had signed their care plans to confirm that they had been involved in the implementation and review process. (This is good practice). The care plan of one of the residents in the intermediate care unit was viewed during the inspection. It was comprehensive and had been completed by a Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 11 multidisciplinary team including a physiotherapist, trained nurses and support staff. The care records show that peoples health care needs are being appropriately met. The homes medication systems were checked in two of the four units. The medication is stored safely and the record of receipt of medication had been well maintained. The staff who administer medication have all received appropriate training. (Staff training records were sampled as part of this inspection). The units did not have controlled medication at the time of inspection but appropriate storage facilities and record books were available. One of the residents in the intermediate care unit was administering their own medication and an appropriate risk assessment had been completed. (This is good practice). Although the homes medication system has been generally well maintained there were many occasions when the Administration records had not been signed by staff. The manager was advised that there should be no gaps in the medication administration records, if for any reason, medication is not given to the resident for whom it is prescribed, an explanation must be provided. The use of codes is acceptable for this purpose. It was also noted that the pharmacist had not signed to witness the receipt of the last batch of medication, which was returned to them. Senior staff were informed that the pharmacist must always sign the records of medication returned to them for disposal. There were many occasions when the temperature of the refrigerator in which the medication is stored, had not been recorded. The manager was also informed that staff must record the temperature in the room in which medication is stored to ensure that the temperature does not exceed 25°C. The medication can deteriorate and become less effective if it is stored at a higher temperature. All of the resident spoken with during this inspection said that the staff are always friendly and respectful and that they ensure that their privacy and dignity is maintained at all times. The observed interaction between staff and residents was a very good standard. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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 standard(s) 13,15. People are encouraged to maintain contact with family and friends. The menu provided appears well balanced and varied, however the meals provided by the Meals on Wheels service, on the days of cook does not work, do not appear to meet the needs of all the service users. EVIDENCE: All of the people spoke with during this inspection, said that they can have visitors at any time and that their visitors are always made very welcome. Residents believed that they could invite their visitors to have a meal with them in the home, if they chose to. One of the residents said that the meals provided are of a very good standard that there is always a choice of food at each mealtime and that alternatives will be provided if they do not want the meals suggested on the menu. Another resident said that they sometimes find the food rather bland and that although they never go hungry the lunches are sometimes small with no additional food available. On the day of inspection the cook was off duty and the lunch had been provided by the Meals on Wheels Service. Although the meals appeared Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 13 satisfactory and a choice of food was available the portions were rather small and there were no “seconds” available. The manager stated that they had been trying unsuccessfully, to recruit a relief cook for several months. They had been let down on many occasions by the agency cooks and had decided to use the Meals on Wheels Service as a more reliable alternative. It was recommended that residents be consulted individually to ascertain if they are satisfied with the meals provided. It may also be appropriate to order a few additional meals in case some people require larger portions. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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 standard(s) 16 Each resident is given a copy of a simple, clear and accessible complaints procedure. The residents spoken with believe that any concerns/complaints they may have would be thoroughly investigated and appropriate action taken. EVIDENCE: A copy of the complaints procedure is available in each of resident’s bedroom. The manager stated that the home had not received any formal complaints since the last inspection. He was reminded that the home must keep a record of all complaints formal and informal to provide an overview of the nature and frequency of complaints received and to show that appropriate investigations/remedial action has been taken where necessary. The home had received many letters and cards commending the services provided. All of the residents spoken with during the inspection said that the senior staff are very approachable and that they were confident that any concerns they might have would be dealt with appropriately. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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) 19,24,26. The purpose-built accommodation is maintained to a very good standard. At the time of inspection the home was clean and there were no offensive odours. If the staff do not lock the laundry door when there are no staff in situ, they are putting residents health and safety at risk EVIDENCE: A partial tour of the premises was completed as part of this inspection. The purpose-built accommodation is spacious well decorated, comfortably furnished and maintained to a very good standard. The central courtyard gardens are attractive and accessible to all service users. The people living in the first floor accommodation may need assistance from staff. The residents spoken with all said they are satisfied with their bedrooms, they confirmed that they were encouraged to bring photographs ornaments and small items of furniture to personalise their individual rooms. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 16 The call bell in one of the bedrooms was tested and was answered promptly by staff. The manager stated that all residents have now been offered a Key to their bedroom door unless the risk assessment identifies that they are unsafe have a Key. One resident confirmed that she had been offered the key but that she chooses not to lock her bedroom door. The home has a well-equipped laundry with industrial washing machine and tumble driers. The laundry floor finishes are inpermeable and the wall finishes are readily cleanable. At the time of inspection the laundry was unattended and the door was left unlocked, giving the residents access to the room. This is not acceptable as there may be soiled or infected linen in this room that would present a health and safety risk to residents. There were also cleaning products left in an unlocked cupboard. The homes Infection Control Policy and COSH data sheets were not available in the laundry. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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 The home has sufficient experienced and train staff to meet the assessed needs of the residents. EVIDENCE: The staff rota for the week of this inspection was assessed. The rota showed that a staffing level in excess of previously agreed minimum requirements was being provided. The manager stated that he believes there is sufficient staff to meet the assessed needs of the current residents. There is adequate staff provided at night-time including a qualified nurse on duty each night. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 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) 33,35. The home is run in the best interests of the residents and their financial interests are safeguarded. EVIDENCE: The home operates in Nottinghamshire County Councils Quality Assurance System. Performance and development plans are produced from the information collated as part of the quality assurance system. The records of residence finances were checked at random and found to be well maintained. All of the residents, who were asked, said that they were satisfied with the way in which their finances are managed. Appropriate records and receipts are kept of possessions handed over for safekeeping. Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 19 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 4 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x 3 x x x Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 20 no 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 9 Regulation 13 Requirement It is required that medication records are signed each time medication is given to a resident. If for any reason the medication is not given to the resident for whom it is prescribed an explanation must be provided. The use of codes is acceptable for this purpose. It is required that the temperature in the refrigerator in which medication is stored must be checked and recorded on a daily basis. It is required that the home records, each day, the temperature in the room in which the medication is stored. The room temperature must not exceed 25 C. It is required that the laundry door is kept locked when there are no staff in situ. It is required that hazardous substances are kept securely at all times. Timescale for action Immediate 21/7/05 2. 9 13 Immediate 21/7/05 3. 9 13 Immediate 21/7/05 4. 5. 26 26 13 13 16 31/8/05 Immediate 21/7/05 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 21 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 15 Good Practice Recommendations It is recommended that staff regularly check with individual residents if they are satisfied with the meals on wheels lunches which are being provided on the cooks days off. It may be appropriate to order additional meals in case anyone would like larger portions at lunchtime. It is recommended that the relevant sections of the homes Infection Control Policy and the appropriate COSH data sheets are displayed in the laundry. 2. 26 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Bramwell Care Home C53 C03 S43196 Bramwell V239172 210705 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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