Inspection on 21/06/06 for Bramwell Care Home

This inspection was carried out on 21st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 08/12/05

Bramwell Care Home 21/07/05

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 Key Unannounced Inspection 21st June 2006 09:30 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 Bramwell Care Home DS0000043196.V301002.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. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramwell Care Home Address Chilwell Lane Bramcote Nottingham NG9 3DU 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) 0115 9677571 0115 9076114 Nottinghamshire County Council Mr Stephen Paul Ward Care Home 59 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (15), Mental disorder, excluding learning of places disability or dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14), Old age, not falling within any other category (30), Physical disability (20) Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Jasmine Wing will have a total number of beds of 14 MD(E) over 65 years to include up to 14 MD 55 years and over. Honeysuckle will have a total of 15 beds for DE(E) over 65 years to include up to 15 DE 55 years and over. Cinnamon will have 15 beds in total for OP aged over 65 years to include up to 5 PD 55 years and over. Lavender will have a total of 15 beds OP over 65 years to include up to 15 PD 55 years and over. No long-term residents to be admitted to Lavender. Total number of residents must not exceed 59 Date of last inspection 8th December 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 ground floor accommodation. The monthly accommodation charges for those residents who are self funding would be £1508 per calendar month. A copy of the most recent inspection report is available in the home. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced visit over one day it took approximately 8 hours. It included the inspection of care and other records, a discussion with the registered manager, one team leader, a member of care staff and the cook. The inspector spoke with seven residents and one visitor to the home. A partial tour of the building was also completed. Prior to complete in this visit the inspector assessed the homes previous inspection reports; the service history and 19 satisfaction questionnaires, which had been completed by the residents at Bramwell Care Home. What the service does well: Staff are ensuring that they can meet the assessed needs of prospective residents prior to their admission to the home. Individual residents care plans a comprehensive and being reviewed on a regular basis, to ensure that staff have up-to-date information of what assistance and support each resident requires. The various staff employed in the intermediate care unit are providing shortterm intensive rehabilitation to enable service users to return home. The residents spoken with during the inspection said that their very satisfied with the services provided by the home. They confirmed that the staff are always friendly and respectful and that they ensure that the residents privacy and dignity is maintained at all times. The observed interaction between residents and staff was of a very good standard. Seven residents stated that they are very happy with their bedrooms and confirmed that they had been encouraged to personalise them with small items of furniture, photographs, ornaments etc. All of the residents spoken with confirmed that they can use their bedrooms at any time. The home is purpose-built; it is comfortably furnished and well decorated. The residents confirmed that it is kept clean at all times. The homes registered manager is well qualified and experienced and ensures that the home is run in the best interests of the residents. Residents and staff confirmed that the manager seeks their views about the way in which the home operates. The staff training records show that a considerable amount of training has been provided since the last inspection. The aspects of health and safety assessed at this visit had all been well maintained and are helping to ensure that the residents live in a safe environment. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 6 The visitors spoken with during the inspection said that they are always made to feel very welcome and that they believe the home has a friendly homely atmosphere. What has improved since the last inspection? 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 DS0000043196.V301002.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 Bramwell Care Home DS0000043196.V301002.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): 1,2,3,6. The literature supplied prospective residents contain sufficient information to enable them to make an informed choice as to whether the home will be able to meet their assessed needs. All residents have been provided with written contracts/terms and conditions of residence. The homes staff ensure that they can meet the assessed needs of prospective residents by obtaining full written assessments prior to their admission to the home. Bramwell Care Home provides appropriate intermediate care facilities. Quality in this outcome area is good. This judgment is be made using available evidence including a visit to the service. EVIDENCE: The literature supplied to prospective residents has been updated and now contains all the required information to enable residents to make an informed choice as to whether the home will meet their assessed needs. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 9 All of the residents’ records viewed as part of this visit showed that Terms and Conditions of Residence documents had been provided and that people were signing to confirm that they had read and agreed with them. (This is good practice). Three residents care plans were assessed during this visit and each contained a preadmission assessment, which had been completed by a social worker or a qualified nurse. The manager was advised that the registered person must confirm in writing to the service user, that having regard to the assessment, the care home is suitable for the purpose of meeting their needs, in respect of health and welfare. The home has a separate unit which provides intermediate care and helps to maximise residents’ independence and return home. One resident in the intermediate care unit said that the staff had worked extremely hard to rehabilitate him, sufficiently to enable him to return home. Bramwell Care Home DS0000043196.V301002.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. Residents individual care plans contain sufficient information to ensure that staff are always aware of what support and assistance each resident requires. The care plans viewed during this visit, had all been reviewed and when necessary updated each month. Residents’ health care needs are generally being met; however there must be a procedure in place for staff to follow if any residents refuse medical intervention. There has been improvements in the way in which the homes medication is managed however it is essential that medication is stored below 25°C, as it can deteriorate and become less effective if stored at a higher temperature. The refrigerator in which insulin is stored must be kept locked at all times when not in use. Residents feel they are treated with respect and their rights to privacy is upheld. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three residents care plans were viewed as part of this inspection, the care plans appeared to address the issues highlighted in the residents’ assessment process. It was noted that all of the care plans viewed had been reviewed and when necessary updated each month to ensure that staff always have up-to-date information about the care and support each resident requires. (This is good practice). The residents spoken with during this inspection said that they believe that their health care needs are being appropriately met. The records viewed as part of this visit generally confirm this. However one resident’s records showed that even though she is a diabetic, she had not seen as chiropodist or a doctor since she was admitted to the home. The manager stated that this residents experiences mental health problems and insists on cutting her own toenails and refuses to see a GP. The inspector stated that a risk assessment must be completed with regard to the resident cutting her own toenails, as this could be very dangerous if it is not completed appropriately. It is also essential that a procedure be put in place for staff to follow if the resident becomes very ill and continues to refuse medical intervention. The homes medication systems are generally very well maintained, however the temperature records in the room in which medication is stored showed that the temperature was more than 25°C for most of June 2006. The manager stated that they are intending to rectify the situation by providing air conditioning in this room, however he was not able to state when this work would be completed. It was also noted that the refrigerator in which some insulin was stored was not locked at the time of this visit. The manager was advised that this refrigerator must be kept locked at all times when not being used by staff. The manager stated that all staff who administer medication have now completed appropriate accredited training, although one person had not received her certificate at the time of this inspection. There was no controlled medication in Honeysuckle unit at the time of this visit. One resident whose records were viewed during the visit was administering his own medication with support from staff. A medication risk assessment had been completed. The manager was reminded that all risk assessments should have the residents name and the date on which the risk assessment commenced. All of the residents spoken with during the inspection said that the staff are always friendly and respectful and ensure that there privacy and dignity is maintained at all times. Bramwell Care Home DS0000043196.V301002.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. The home is now providing a good variety of activities and entertainment however a few residents said that they would like more activities. People are encouraged to maintain contact with family and friends. Where possible residents are encouraged to make decisions about their individual lifestyles. All but one resident spoken with said that they enjoy the food provided by the home. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service EVIDENCE: The home is now providing a good variety of activities and entertainment however a few residents said that they would like more activities. People are encouraged to maintain contact with family and friends. Where possible residents are encouraged to make decisions about their individual lifestyles. All but one resident spoken with said that they enjoy the food provided by the home. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 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 the following standard(s): 16,18. Residents believe that their complaints would be taken seriously and that appropriate action would be taken. The homes complaints records support this view. Informal complaints must be recorded in a central book or file to provide an overview of the nature and frequency of complaints received. The registered person is taking appropriate action to protect residents from abuse. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The home has an appropriate complaints procedure, which is available to residents, staff and visitors. The homes complaints records show that there have been two complaints since the last inspection. One complaint had been appropriately dealt with the other was still being investigated at the time of this inspection. One resident informed the inspector that he had complained about the vegetables at the home being under cooked on a number of occasions. However this had not been recorded as a complaint and the inspector could not locate any evidence that any action had been taken. The home must keep a record of all complaints detailing the investigation and where appropriate any action taken. The complaints records must provide an overview of the nature and frequency of all complaints received by the home. The residents spoken with believe that their complaints would be taken seriously and that appropriate action would be taken. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 14 The inspector was informed that there have been no incidents of abuse in the home in the last 12 months. The home has an appropriate whistle blowing procedure and the member of staff spoken with during the inspection, was clear about her responsibility to report all incidents. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 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 the following standard(s): 19,26. The accommodation is purpose-built and maintained to a very good standard. At the time of inspection the home was clean and there were no offensive odours. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: A partial tour of the premises was completed as part of this visit. The purpose-built accommodation is comfortably furnished and well decorated. All of the seven residents spoken with during this inspection said that they like their bedrooms and confirmed they could use them at any time. They said that they had been encouraged to personalise their rooms with small items of furniture, photographs and ornaments. The residents confirmed that the home is always kept very clean. The laundry is large and well equipped with washable wall and floor coverings. Appropriate COSH data sheets and the relevant sections of the homes infection control policies were displayed, so that staff can have easy access to them. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 16 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. The staff rotas provided, show that adequate staffing levels are being maintained. The homes recruitment policies and practices are supporting and protecting the residents. The manager was able to demonstrate the homes commitment to staff training and development. “Quality and this outcome area is good. This judgment has been made using available evidence including a visit to the service”. EVIDENCE: The staff rotas provided prior to the inspection and those viewed on the day of inspection, showed that sufficient staff are being provided to comply with previously agreed staffing levels. The residents spoken with confirmed that although the staff always appear busy they still find time for social interaction. The personal records of two members of staff were assessed as part of this visit. One set of records contained all the required information. The other records did not have two written references. The manager stated that these references had been received prior to the member of staff commencing employment. However they had been sent to the social services personnel section and the staff had forgotten to take photocopies. He was able to evidence, that he has taken steps, to have copies of all staff references made available within the home. This will need to be checked in detail at the next inspection. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 17 Out of a total number of 41 staff, only 13 had completed NVQ level 2 or above. However 12 people were completing the training at the time of this visit. The manager was able to demonstrate that a considerable amount of staff training is being provided on a regular basis. (This is good practice). Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 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 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. The homes manager is well qualified and experienced. The home is run in the best interests of the residents. Residents’ interests are safeguarded. Where checked the health and safety of residents and staff are promoted and protected. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. EVIDENCE: The manager is well qualified and experienced; he successfully completed a fit person interview with the Commission for Social Care Inspection last year. Residents and staff said that the manager is very approachable and that he seeks their views about the way in which the home is run. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 19 Quality monitoring systems are in place, which show that residents and stakeholders in the community are being encouraged to express their views about the services provided by the home. The manager was able to demonstrate how social services corporate business plan will be used to monitor and improve the individual services within the home. The records of residents’ finances were checked and were well maintained. All of the residents who were asked said that they were happy with the way their finances are managed. The records of items handed in for safekeeping were checked at random and some of the records had been poorly maintained. However all of the items had been appropriately receipted in and out of the home. All aspects of health and safety, assessed as part of this visit, had been satisfactorily maintained. Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 2 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 21 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 OP8 Regulation 13 (4) (d) Requirement It is required that a risk assessment is completed with the resident who has diabetes but insists on cutting her own toenails. The risk assessment should look at how staff will monitor the risk & identify any action that can be taken to reduce the risk. It is required that the registered person produces a procedure for staff to follow if a resident refuses to see a GP when they are ill. It is required that the refrigerator in which insulin is stored is kept locked when not being used by the staff. It is required that the registered person ensures that medication is not stored above 25C. It is required that the registered person keep a record of all complaints, detailing the investigation and where appropriate any action taken. The records must be maintained in a format, which can be viewed confidentially. Timescale for action 21/06/06 2. OP8 12 21/06/06 3. OP9 13(2) 21/06/06 4. 5. OP9 OP16 13(2) Schedule 4 (11) 01/08/06 21/06/06 Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 22 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 OP3 Good Practice Recommendations It is recommended that the registered Person confirm in writing to all prospective residents that, having regard to the assessment the home is suitable to meet their health & welfare needs. It is recommended that the posters informing residents what activities are to be provided are produced in larger print to make them more accessible to people who may have limited vision. It is recommended that staff continuously seek the views of the residents about the types of activities they would like the home to provide. It is recommended that if a resident finds difficulty in eating the food prepared by the home this should be included in their care plan. The plan should state what action is being taken to rectify the problem. 2. OP12 3. 4. OP12 OP15 Bramwell Care Home DS0000043196.V301002.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Nottingham Area Office 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. 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